bluuebunny/crossref_metadata_2025 huggingface dataset:
การยุติคดีอาญาโดยการไกล่เกลี่ยข้อพิพาทในความผิดเกี่ยวกับทรัพย์
Authors:   , ศรีอ่อน เพชรมณี
Published: July 2024

แม้ว่าบทบัญญัติกฎหมายของไทยจะอนุญาตให้มีการไกล่เกลี่ยคดีอาญาได้ แต่ก็จำกัดไว้เฉพาะคดีบางประเภทเท่านั้น และผลทางกฎหมายยังไม่สอดคล้องกันอย่างเป็นระบบ เอกัตศึกษาฉบับนี้จึงมุ่งศึกษาถึงปัญหาการยุติคดีอาญาโดยการไกล่เกลี่ยข้อพิพาททั้งก่อนและหลังฟ้องคดี โดยศึกษาเฉพาะความผิดเกี่ยวกับทรัพย์ ผ่านหลักการ แนวคิด และทฤษฎีที่เกี่ยวข้องกับกระบวนการยุติธรรมทางอาญา กระบวนการยุติธรรมเชิงสมานฉันท์ และการไกล่เกลี่ยคดีอาญาตามกฎหมายไทยโดยวิเคราะห์เปรียบเทียบกับกฎหมายประเทศฝรั่งเศส นิวซีแลนด์ และแคนาดา (รัฐโนวาสโกเทีย) จากการศึกษาพบว่า การไกล่เกลี่ยคดีอาญาเป็นมาตรการทางเลือกนอกเหนือจากกระบวนการพิพากษาของศาล โดยมีวัตถุประสงค์เพื่อให้คู่กรณีทุกฝ่ายได้แสวงหาแนวทางระงับข้อพิพาทร่วมกัน ชดใช้เยียวยาความเสียหาย และแก้ไขฟื้นฟูผู้กระทำความผิด อย่างไรก็ตาม กฎหมายไทยจำกัดให้ไกล่เกลี่ยเพื่อยุติคดีได้เฉพาะความผิดเกี่ยวกับทรัพย์อันยอมความได้ และความผิดฐานลักทรัพย์ ตามมาตรา 334 เท่านั้น ซึ่งยังไม่ครอบคลุมถึงความผิดเกี่ยวกับทรัพย์อื่น ๆ ที่มีลักษณะไม่ร้ายแรง เอกัตศึกษาฉบับนี้จึงเสนอให้แก้ไขเพิ่มเติมบทบัญญัติกฎหมายเพื่อขยายขอบเขตของความผิดที่สามารถไกล่เกลี่ยได้ โดยเฉพาะความผิดเกี่ยวกับทรัพย์ ตามประมวลกฎหมายอาญา มาตรา 335 มาตรา 336 วรรคหนึ่ง มาตรา 357 วรรคหนึ่ง และมาตรา 365 เนื่องจากความผิดเหล่านี้เป็นความผิดที่มีคุณธรรมทางกฎหมายเป็นเรื่องส่วนบุคคล และความเสียหายที่เกิดขึ้นกระทบต่อประโยชน์ของปัจเจกบุคคลเป็นการส่วนตัวมากกว่ากระทบต่อความสงบเรียบร้อยของสังคมส่วนรวม และเสนอให้กำหนดผลทางกฎหมายเมื่อการไกล่เกลี่ยคดีอาญาเป็นผลสำเร็จด้วย
การกำหนดความผิดอาญากรณีพกพาสารกัดกร่อนในที่สาธารณะ
Authors:   , เบ็ญจาธิกุล วรกมล
Published: July 2024

เอกัตศึกษาฉบับนี้มีวัตถุประสงค์เพื่อศึกษาแนวคิด ทฤษฎีและกฎหมายที่เกี่ยวข้องกับการกำหนดความผิดอาญากรณีพกพาสารกัดกร่อนในที่สาธารณะ เพื่อนำไปสู่การวิเคราะห์ ปัญหาและอุปสรรคในการควบคุมการพกพาสารกัดกร่อนในที่สาธารณะของกฎหมายไทยในปัจจุบัน รวมถึงเปรียบเทียบการกำหนดความผิดอาญาในลักษณะดังกล่าวของกฎหมายต่างประเทศ จากการศึกษาพบว่ากฎหมายประเทศไทยในปัจจุบันยังไม่มีการกำหนดความผิดอาญากรณีพกพาสารกัดกร่อนในที่สาธารณะเป็นการเฉพาะ นอกจากนั้นแนวคำพิพากษาศาลฎีกาตีความว่าน้ำกรดซึ่งเป็นสารกัดกร่อนประเภทหนึ่งไม่ใช่อาวุธโดยสภาพแม้ว่าสารกัดกร่อนดังกล่าวสามารถสร้างความเสียหายร้ายแรงได้หากถูกใช้เป็นอาวุธ ทำให้เกิดปัญหาในการบังคับใช้กฎหมายเนื่องจากโทษอาญาที่ลงไม่ได้สัดส่วนกับความร้ายแรงของความผิด นอกจากนี้ยังส่งผลต่อการปราบปรามอาชญากรรมรุนแรงที่อาจเกิดขึ้นได้หากปล่อยให้มีการพกพาสารกัดกร่อนตามอำเภอใจในที่สาธารณะ อย่างไรก็ตาม จากการเปรียบเทียบกฎหมายของประเทศอังกฤษ ประเทศมาเลเซีย ประเทศสิงคโปร์ และเขตบริหารพิเศษฮ่องกงแห่งสาธารณรัฐประชาชนจีน พบว่ามีการบัญญัติกฎหมายควบคุมสารกัดกร่อนไว้เป็นการเฉพาะ มีการกำหนดนิยามของสารกัดกร่อน และมีการกำหนดโทษที่สูงกว่ากฎหมายของประเทศไทย โดยบางประเทศมีทั้งโทษจำคุกและเฆี่ยน และบางประเทศมีแนวทางสำหรับผู้พิพากษาในการตีความให้สารกัดกร่อนเป็นอาวุธอันตรายอย่างสูง เพื่อลดโอกาสในการก่ออาชญากรรมโดยการใช้สารกัดกร่อนเป็นอาวุธ ดังนั้น ผู้เขียนจึงเสนอแนะให้มีการตราพระราชบัญญัติสารกัดกร่อนขึ้นเป็นการเฉพาะ เพื่อกำหนดคำนิยาม กำหนดความผิดและบทลงโทษที่เหมาะสม เพื่อลดโอกาสในการก่อภยันตรายในที่สาธารณะโดยใช้สารกัดกร่อนเป็นอาวุธในการก่ออาชญากรรม และ กำหนดความผิดฐานพาสารกัดกร่อนติดตัวไปในสาธารณสถาน เว้นแต่เป็นกรณีที่มีเหตุอันควรหรือมีอำนาจตามกฎหมาย หรือมีไว้เพื่อนำไปใช้ในการประกอบอาชีพโดยสุจริต รวมถึงเสนอแนะการวางแนวทางของศาลว่าควรตีความให้สารกัดกร่อนเป็นอาวุธโดยสภาพ
OFFSPRING SEX RATIO IS RELATED WITH LAYING DATE AND HATCHING SEQUENCE IN THE MAGELLANIC PENGUIN SPHENISCUS MAGELLANICUS
Authors: Bertellotti Marcelo , Blanco Guillermo , Tella José Luis , Donázar José Antonio , Forero Manuela
Published: July 2024

We analyzed the variation in the secondary sex ratio of Magellanic Penguin Spheniscus magellanicus breeding in six colonies on the Patagonian coast of Argentina. We tested the effects of laying date and hatching sequence on the probability of producing sons and daughters. The global secondary sex ratio did not differ from equality, and there were no differences among the colonies. However, regardless of the colony, laying date, and hatching sequence, there was a significant effect on the proportion of males and females reared. Pairs that were laid early in the breeding season were more likely to raise a male. In addition, offspring that hatched first were more likely to be male than those that hatched second. Our results are consistent with the adaptive importance of producing males, likely the costliest sex, early in the breeding season or early in the brood when food resources are still abundant.
BIRD COMMUNITIES RESPOND TO THE SEASONAL FRUIT AND FLOWER AVAILABILITY IN A FRAGMENTED TROPICAL ANDEAN LANDSCAPE
Authors: Villegas Mariana , Mayta Cesar , López Cecilia L. , Hansen Isabell , Gallegos Silvia C.
Published: July 2024

Fire is one of the main causes of fragmentation in tropical Andean forests. Fragmentation can influence plant reproductive phenology, which in turn affects bird communities. In the Bolivian Yungas, we investigated how the seasonal availability of fruits and flowers affects bird richness, abundance and bird community composition in forest edges and adjacent bracken (Pteridium ferns) dominated areas. We captured birds with mist nets at eight sites during the dry, transition and wet seasons, and recorded fruit and flower availability through phenological observations and plant collections. We examined variation in species richness and abundance using generalized linear mixed-effects models, and bird species composition in each season using multivariate analyses. Fruit availability was higher in the transition and wet seasons, and lowest in the dry season, while flower availability did not differ among seasons. Bird species richness and abundance were significantly higher in bracken areas, although there was significantly lower fruit availability than at the forest edge, and these were mainly generalist bird species that may be tolerant to disturbance. Total bird abundance increased with higher fruit availability in both habitats, and with flower availability at the forest edge. Bird species composition differed between forest edges and bracken areas in the transition and the wet seasons, being influenced by fruiting and flowering phenology in the dry and transition seasons, and elevation in all seasons. Our results show the varying seasonal influence of plant reproductive phenology on avian communities of disturbed habitats, although other large scale factors associated with fragmentation may also shape bird communities.
Havayolu Çalışanlarının COVID-19 Salgını Sürecindeki Uygulamaların Hizmet Sunumlarına Yansımaları Hakkındaki Görüşleri / Airline Employees' Views on the Reflections of Practices During the COVID-19 Pandemic on Service Provision
Authors: Balci Tuba , Akpınar Ali Talip
Published: July 2024

Bu araştırmada bir havayolu işletmesinde çalışan personelin Covid-19 salgınına yönelik görüşleri incelenmiştir. Nitel araştırma yöntemlerinden yarı yapılandırılmış ve derinlemesine mülakat teknikleri birlikte kullanılarak katılımcılardan veri elde edilmiş, bu veriler betimsel analiz ile değerlendirmeye alınmıştır. Araştırma neticelerine göre Covid-19 salgınının havayolu işletmelerinde sunulan hizmetleri olumsuz etkilediği görüşü ön plana çıkmaktadır. Salgın sonrası havayolu işletmelerinin hijyen sağlamak ve teması azaltmaya yönelik uygulamaları kalıcı hale getirmesi gibi öngörüler katılımcıların görüşleri arasındadır. Katılımcıların diğer görüşleri arasında, salgın sonrası uçuş esnasında sunulan yiyecek-içecek gibi konfora yönelik hizmetlerin sadeleştirilmesi konularına ağırlık verilmesi gerektiği yer almakta olup, Covid-19 salgının zararlarının yanı sıra, havayolu işletmelerinin bu süreçte hizmet sunumlarında hijyenin arttırılması ve kıt olan kaynakları daha verimli kullanması gerektiği anlayışının benimsenmesi gibi faydalar sağladığı da araştırmadan elde edilen bir başka sonuçtur.
Media Sosial Sebagai Alat Pemasaran Mangrove Pandang Tak Jemu Di Kampung Tua Bakau Serip
Authors: Sianipar Baktivillo , Kartika Cahayani  , Okta Safitri  , Bram Handoko  , Dinda Aisyah Nurul Intan  , M. Khori Kurnia Subagja  , Silitonga Frangky
Published: July 2024

Mangrove Pandang Tak Jemu in Kampung Tua Bakau Serip is a unique and interesting ecotourism destination. Considering the importance of the mangrove tree ecosystem and its potential as a tourist attraction, an effective marketing strategy is needed. One of the most effective and efficient ways to promote this destination is through social media. This article resulting from community service will explain how social media can be used as a very effective tool to market the Mangrove Pandang Tak Jemu in Kampung Tua Bakau Serip. Choosing the right media and the right marketing strategy, social media can increase visibility thereby attracting more visitors, and ultimately support the mangrove forest environment through sustainable tourism. Optimal use of social media can help Mangrove Pandang Tak Jemu in Kampung Tua Bakau Serip become a widely known tourist destination, as well as provide education and increase awareness of the importance of the mangrove ecosystem as a lungs of the world
Managing Communication in Dementia: A Case Study
Authors: Freeman Andrea Georgine
Published: July 2024

This report is part of research concerned with how spousal carers manage communications with their cared-for partners when living with dementia, and how management strategies change as the dementia progresses. Eleven couples were involved in a four-year longitudinal study using semi-structured interviews at home and participant observation within a creative arts programme. This case study focuses upon one interview with one couple, where both partners were present. It is a demonstration of the way that the caring partner negotiated the difficult situation of being interviewed with the disruptive presence of her cared-for partner. It highlights how the caring partner tried to manage the interview in order to participate in the research. The findings showed how the caring partner divided her time between paying attention to the researcher, as researcher and guest in their house, and to her spouse who was joining in the three-way conversationThe conversational strategies and amount of time  speaking differed between all three participants, with the interviewer struggling to ask pertinent questions. The caring partner reacted to her spouse’s comments and questions, but also responded to the interviewer by explaining what she thought was happening when her spouse talked, and answered questions. She adopted multiple roles in order to reassure, give information, and answer questions from her cared-for partner in order to manage communications. On the other hand, the spouse with dementia interrupted, changed topics, asked questions, and confabulated at length.There are also implications for using semi-structured interviews, as the situation affected the dynamics within the spousal relationship, and between the interviewer and the caring partner. 
Teaching parallel computing in Python
Authors: Hinsen Konrad
Published: July 2024

Every time I teach a class on parallel computing with Python using the multiprocessing module, I wonder if multiprocessing is really mature enough that I should recommend using it. I end up deciding for it, mostly because of the lack of better alternatives. But I am not happy at all with some features of multiprocessing, which are particularly nasty for non-experts in Python. That category typically includes everyone in my classes.
Integrating scientific software and datasets into the citation record
Authors: Hinsen Konrad
Published: July 2024

This morning I read C. Titus Brown's blog post on how science could be so much better if scientitic data and the software used to work with it were openly available for reuse. One problem he mentions, like many others have done before, is the lack of incentive for publishing anything else but standard scientific papers. What matters for a scientist's career and for grant applications is papers, papers, papers.
Harnessing educational psychology to enhance ESL students’ LSRW proficiency through literature: A quantitative study
Authors: Shruthi S. , Aravind B. R.
Published: July 2024

The present study aimed to ascertain the challenges encountered by English language learners in the domains of writing, reading, speaking, and listening. Through the utilization of the pre-test, students have the opportunity to engage in sentence construction, as well as enhance their reading and listening skills by engaging with assigned literary materials. Additionally, they may refine their ability to effectively communicate in English with their classmates. The researcher disseminated the self-generated post-test questions. The investigation employed a quantitative methodology. This survey was done using a sample of 40 undergraduate students who are currently studying English as a second language and are affiliated with the Viscom and Catering programs. The study adopts educational psychology for teaching, testing, and assessing. The results suggest that English speaking is the most challenging among the three skills. Students are demonstrating significant improvement in their writing, reading, and listening skills when comparing their pre-test and post-test results. The speaking proficiency of the ESL students did not show substantial improvement as a result of insufficient opportunities for practice. In addition, instructors are recommended to employ a diverse range of effective teaching practices to enhance students’ proficiency in the four language skill domains.
Inteligencia artificial y confianza a través de una comunicación científica comprensible: un compromiso ético con la ciudadanía
Authors: Terrones Rodríguez Antonio Luis
Published: July 2024

El enorme potencial del desarrollo de la inteligencia artificial (IA) puede observarse en un aumento de su presencia en diversos entornos para ofrecer soporte en actividades que destacan por un alto nivel de complejidad. En ese sentido, instituciones como la Comisión Europea (CE) advierten la necesidad de promover un cultivo de la confianza en la IA para garantizar una gobernanza que sitúe al ser humano en el centro de sus preocupaciones y beneficios. Un cultivo que implica un compromiso con el fortalecimiento de la habilidad comunicativa de los expertos científicos como una estrategia para favorecer la comprensión ciudadana y su participación. Una comunicación científica preocupada por el principio ético de la explicabilidad implica poner en valor la interacción con la ciudadanía para reconocer sus testimonios y experiencias de vida, incorporándolos en los procesos de investigación e innovación.
Debilidades y revisión de los argumentos favorables a la práctica del alquiler de mujeres para gestar hijos para terceras personas
Authors: Cuervo Pollán Ana
Published: July 2024

Los avances científicos han hecho posible que las mujeres puedan gestar criaturas para terceras personas. Esta práctica ha sido objeto de numerosas consideraciones éticas y bioéticas con el fin de esclarecer su legitimidad. Por ello, y dada su plena actualidad política, consideramos necesario revisar la consistencia teórica de las argumentaciones favorables a esta práctica. Con ello, deseamos esclarecer si gozan del sustento ético necesario y suficiente para que pueda reclamarse su legalización y aceptación social o si, por el contrario, la utilización de los argumentos que se convocan en su defensa, relativos a las nociones de derecho, libertad o diversidad, no son oportunos para concluir dicha legitimidad.
Horizontes de tiempo y cuidado. Herencias, continuidades y divergencias entre el Barroco hispano y algunas lecturas contemporáneas
Authors: Gálvez Aguirre Luis Javier
Published: July 2024

Este artículo pretende establecer una comparativa de los conceptos de cuidado en dos tiempos distintos, pero en diálogo: de un lado la funcionalidad del cuidado como elemento constitutivo de la subjetividad barroca en la figura de Baltasar Gracián; del otro lado, la caracterización y el vínculo recíproco entre mundo y ethos, pensado eminentemente a partir de Heidegger y Sloterdijk. Sin desestimar las divergencias epocales, no completamente asimilables ni plenamente traducibles entre sí, se busca examinar las condiciones mínimas y compartidas acerca del cuidado que en los casos presentados posibilitan la constitución del sujeto y del mundo. Con tal lectura pretende indagar en otra vinculación de nuestro presente con la modernidad: en vez de enfocarse en el las posibilidades de emergencia del sujeto autoconstituido y constituyente, se trataría más bien de repensar las condiciones de un ethos instalado en el mundo que se le presenta.
Gilles Deleuze. Elemento formal del Barroco.
Authors: TORRES ORNELAS SONIA
Published: July 2024

El presente trabajo está orientado al análisis del elemento formal del Barroco para el cual Deleuze crea el concepto de Pliegue infinito al que trata como un Acontecimiento. Proponemos que el signo de nuestro tiempo es Neobarroco, por lo que indagamos el tránsito del Barroco clásico al Neobarroco; así mismo, formulamos la idea de que el cine de post Guerra también llamado cine moderno, captura en imágenes algunos matices del trastorno en las relaciones de lo real y lo imaginario, lo verdadero y lo falso, la ficción y la fabulación. Lo que persiste en ambos procedimientos barrocos es el concepto de acontecimiento, que no afirma el ser, sino maneras de ser.
Horkheimer lee a Kurosawa. Dos antropologías demasiado humanas
Authors: López-Pérez Sheila
Published: July 2024

El presente trabajo expone la conexión entre dos antropologías que huyen de la abstracción y muestran los aspectos más humanos del ser humano: las antropologías de Horkheimer y Kurosawa. El texto presentará la denuncia de la instrumentalización de la época contemporánea y la falta de individuación de los sujetos por parte de ambos autores. Defenderemos la tesis de que tanto Horkheimer como Kurosawa promovieron un tipo de ética alejada de imperativos categóricos o deberes metafísicos, una ética eudemonista basada en la búsqueda de la felicidad individual. Aunaremos la denuncia de la instrumentalización de la época contemporánea con la defensa de un individuo que lucha contra su reificación. Por último, daremos nuestra opinión personal en el apartado Conclusiones.
TRENDS IN ESG PERFORMANCE REPORTING (ENVIRONMENT SOCIAL AND GOVERNANCE) IN ENTERPRISE
Authors: Capatina Sofia , Busmachiu Eugenia
Published: July 2024

Implementation of ESG principles is essential for the Republic of Moldova to promote sustainable development, environmental protection, social responsibility and effective governance. This not only strengthens the country's position in the international community, but also contributes to sustainable growth and improved quality of life for its citizens. Trends in ESG performance reporting reflect a continuing evolution in companies' approach to sustainability and social responsibility, underlining the importance of integrating ESG issues into their business strategies and reporting transparent and detailed performance in these critical areas. Companies are adopting a more transparent and detailed approach to ESG reporting, including the provision of clear and accessible information on their environmental impact, social issues and corporate governance practices. ESG reports are becoming increasingly complex and comprehensive, reflecting their commitment to sustainability and social responsibility.
Métodos lúdicos entre pares para el aprendizaje de las matemáticas en segundo grado de básica
Authors: Fritas Quispe Dayana Evelyn , Unda Condezo Blanca Luz , Holguin-Alvarez Jhon
Published: July 2024

El aprendizaje de las matemáticas desarrolla el pensamiento lógico, analítico y la capacidad de abstracción, preparando a los estudiantes para los desafíos de un mundo cada vez más tecnológico. La presente investigación tuvo como objetivo evaluar la eficacia de la metodología lúdica entre pares para el aprendizaje de las matemáticas en estudiantes de segundo grado de primaria de una institución educativa en San Martín de Porres, Perú. El diseño pre experimental, aplicado a una muestra de 30 estudiantes de 7 a 9 años, utilizó una técnica de evaluación para medir las dimensiones del aprendizaje del pensamiento numérico, geométrico y algebraico a través de 55 operaciones y problemas. Los resultados muestran un notable incremento en el nivel de aprendizaje en las dimensiones estudiadas. En conclusión, la metodología empleada mejoró la comprensión de las matemáticas y contribuyó al desarrollo de habilidades y competencias matemáticas y de comunicación más sólidas en los estudiantes.
Dinámica familiar en el rendimiento académico en alumnos de Taquile
Authors: Choquehuanca Ccallocondo Jessica , Meneses Cariapaza Luz María , Sardon Ari Zezy Yadeyda , Sardon Ari Danitza Luisa
Published: July 2024

La familia primer entorno social donde se desarrolla el individuo juega un papel en su formación integral. El objetivo del estudio fue evaluar la dinámica familiar en el rendimiento académico de los alumnos de la Institución Educativa Artesanal de Taquile. La investigación se realizó bajo un enfoque cuantitativo descriptivo. Se aplicó un cuestionario a 94 estudiantes. La mayoría de los estudiantes viven en familias nucleares. El 60,6% de los provienen de familias donde ambos padres asumen el rol de jefes de familia. El 29,8% considera la calidad es poco satisfactoria. El 53,2% no cuentan con el apoyo educativo de ninguno de sus padres. Existió asociación entre las variables evaluadas. El análisis de la dinámica familiar incide significativamente en el rendimiento académico de los alumnos. Sus logros de aprendizaje están en proceso, lo que demuestra la importancia de la conexión emocional y el apoyo interpersonal dentro del núcleo familiar.
Analisis Penggunaan Media Wordwall pada Pembelajaran IPAS dalam Menumbuhkan Keaktifan Belajar Siswa Kelas V Sekolah Dasar
Authors: Rahmasari Annisa , Purnamasari Veryliana , Khasanah Siti Khuluqul
Published: July 2024

Salah satu faktor yang memengaruhi keberhasilan dalam proses pembelajaran yaitu keaktifan belajar siswa. Oleh karena itu, penelitian ini bertujuan untuk mendeskripsikan penggunaan media wordwall dalam menumbuhkan keaktifan belajar siswa. Penelitian ini menggunakan deskriptif kualitatif dengan melibatkan tiga subjek kelas VB di SDN Karanganyar Gunung 02 dan teknik pengambilan subjek menggunakan purposive sampling. Teknik pengumpulan data yang digunakan dalam penelitian ini yaitu observasi dan wawancara. Uji keabsahan data yang digunakan yaitu triangulasi data dan sumber. Hasil penelitian ini menunjukkan bahwa penggunaan media wordwall dapat memberikan dampak positif dan dapat menumbuhkan keaktifan belajar siswa. Dalam proses pembelajaran siswa antusias, aktif, dan fokus dalam mengikuti pembelajaran. Saran yang disampaikan adalah diharapkan guru lebih inovatif dan kreatif dalam menggunakan media pembelajaran berbasis digital karena media pembelajaran sangat efektif dalam menumbuhkan keaktifan belajar sehingga siswa lebih antusias dalam mengikuti pembelajaran dan pembelajaran dapat berjalan dengan maksimal.
Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit
Authors: Shrestha Pramesh S , Marhatta Moda N , Acharya Subhash P , Shrestha Ninadini
Published: July 2024

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU.
Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost.
Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001).
Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.
Early Experience of Cardiac Surgery in the Maldives
Authors: Sapkota Ranjan , Shafiu Mohamed , Razzag Dusooma A , Patil Priyanka B , Sadoon Haytham M Y , Abouhabiba Karim M , Vivehananthan Sivaranjani P , Shinde Dipti S , Moosa Mohamed F , Sattar Fathmath A A , Gautam Mani P , Bhadauria Prateek S , Shafeeq Ali
Published: July 2024

Introduction: From stitching a heart wound to the current level of sophistication, cardiac surgery has come a long way as a discipline. Heart surgery in South Asia has advanced tremendously; both, quantitatively and qualitatively. This is a report of the first fifteen surgeries done in the Maldives where cardiac surgery has started as an organized program.
Methods: Data on the first fifteen consecutive cardiac surgeries done in our hospital, over a period of 7 months, was analyzed. We briefly describe our usual perioperative management, and the pretext of the beginning of the cardiac surgery program.
Results: Fifteen patients, 13 males, aged 59.9±13.8 years, with a EuroScore of 0.9±0.4%, were operated. Eleven underwent CABG; and four had a valve replacement. Nine out of 11 had TVD, including 6 who had an LMCA disease. The first surgery was an off-pump CABG. The CABG group had a total of 2-5 grafts. Pump and cross-clamp times were 239.6 (± 56.1) min and 154.2 (± 45) min respectively. Five (33.3%) had at least one non-fatal complication. Two (13.2%) required re-exploration for mediastinal bleeding. The length of hospital stay was 16.5 days (±6.9 days). The chest tubes stayed for an average of 4.8 (±0.7) days. There was no in-hospital, 30-day and 90-day mortality recorded.
Conclusion: Cardiac surgery has begun in the Maldives. It is safe and feasible to sustain cardiac surgery program in the country, provided continued national support and international collaboration is ensured.
Lumbar Diastomatomyelia with Syringomyelia: A Case Report
Authors: Gyawali Deepika , Lama Dharana , Pradhananga Amit B , Sharma Mohan R.
Published: July 2024

Diastomatomyelia with syringomyelia is a rare clinical condition where there is a duplication of spinal cord. We recently came across a child who had this anomaly. The case was successfully managed with an uneventful recovery. We describe this patient in detail in addition to reviewing the pertinent literature.
Risk Factors for Gall Stone Diseases in Patients Presenting to General Practice Out Patient Department in a Tertiary Care Center in Nepal
Authors: Neupane Ram P , Shrestha Tirtha M , Raut Shankar , Aacharya Ramesh P
Published: July 2024

Introduction: Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital.
Methods: A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultrasonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method.
Results: The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female whereas in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion. Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases (p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Non-vegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease.
Conclusion: High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases.
Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report
Authors: Shrestha Uma
Published: July 2024

Introduction: Parity more than five is grand multiparity and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and perinatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among young primigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grand multiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome.
Early Post-Operative Outcome and Complication of Arteriovenous Fistula Creation under Regional Anesthesia
Authors: Shrestha Kajan R
Published: July 2024

Introduction: Arteriovenous fistula (AVF) is the commonest vascular access for patients with end stage renal disease (ESRD) undergoing hemodialysis, however there is no consensus regarding mode of anaesthesia for creation of AVF. Mode of anaesthesia may have effect on outcome and complication of AVF.
Methods: This is a retrospective descriptive study conducted on the basis of data collected from patients undergoing AVF under brachial plexus block (BPB) from January 2018 to December 2018 at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications have been analyzed.
Results: A total of 79 patients (male: female=45:34) underwent AVF under BPB during one year period at University teaching hospital with a mean age group of 56.76±11.65 years (24-86 years). In three patients, the brachial plexus block failed and was substituted with general anaesthesia while 21 patients needed some adjuncts with block to create fistula. In 38 patients (48.10%) brachiocephalic fistula was created and in 48 patients (60.76%), plan to make fistula at proximal site was changed after application of block to more distal level. All fistulas were patent at 24 hours (100%, 79 patients) and the rate was 93.67% (74 patients) at 6weeks. The complications seen post procedure were limb oedema in five patients (6.33%), thrombosis and infection in one patient each, hematoma in two patients and bleeding in three patients.
Conclusion: Brachial plexus block is effective modality of anaesthesia to create AVF for hemodialysis as it increases chances of creating distal fistula and also increases the effectiveness of it.
Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis
Authors: Kharel Bijaya , Gurung Urmila , Tripathi Prashant , Rayamajhi Pabina , Silwal Priyansha
Published: July 2024

Introduction: Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis.
Methods: Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results: A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31).
Conclusion: Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis.
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: July 2024

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.
Methods: This 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 immunoglobulin findings, mode of management, complications of surgery were evaluated.
Results: Majority 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.
Conclusion: Majority of cases occured in liver. Most cases were managed conservatively. Laparoscopic management of hydatid cyst is effective.
Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy
Authors: Malla Bala R , Simkhada Suyog
Published: July 2024

Introduction: Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults.
Methods: One hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings.
Results: A total of 129 (77 male and 52 female) patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%).
Conclusion: Colonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population.
Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal
Authors: Phuyal Suman , Rajbhandari Binod , Pradhanang Amit B , Sedain Gopal , Shilpakar Sushil K , Sharma Mohan R
Published: July 2024

Introduction: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center.
Methods: A single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications.
Results: Out of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%.
Conclusion: The shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.
Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review
Authors: Gyawali Bigyan R , Sharma Guragain Rajendra P , Neupane Yogesh , Dutta Heempali , Shrestha Lava , Pradhananga Rabindra B
Published: July 2024

Introduction: Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion.
Methods: This was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up.
Results: Our final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications.
Conclusion: Button battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve.
Granular Cell Tumor of Breast: Rare Tumor Masquerading as Malignancy
Authors: Hirachan Suzita , Singh Yogendra P , Jha Anamika , Manandhar Usha
Published: July 2024

Granular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann cells of peripheral nerves. It was first postulated by Abrikossoff in 1926 as Myoblastoma. About 5-15% of these tumors occur in the breast and less than 1% has the potential to be malignant. Here we present a case of 41 years old premenopausal woman with Benign GCT of the right breast, having clinically malignant features. The clinical and radiological features of GCT are similar to malignant lump. However, histology showing presence of sheets of polygonal cells with abundant granular eosinophilic cytoplasm with round nuclei and granules with Periodic acid–Schiff (PAS) positive, diastase resistant and S-100 antigen positive are confirmatory. Treatment of Granular cell tumor is wide local excision. There is apparently no role of chemotherapy and radiotherapy. The presence of GCT in the breast is quite rare and clinically as well as radiologically it may mimic malignancy, however with histopathology and appropriate immunohistochemistry, proper diagnosis can be made.
Comparison of Nepalese and Swedish Patients with Colorectal Cancer Regarding Tumor Suppressor Methylation in Tumor and Mucosa Samples
Authors: Ghimire Bikal , Kurlberg Goran , Singh Yogendra P , Wettergren Yvonne
Published: July 2024

Introduction: Colorectal cancer (CRC) is common with wide variation in incidence. However, the incidence in younger adults is showing an increasing trend with rectal preponderance. Such cases appear to present in advanced stage with poorly differentiated histopathology and the trend is stronger in developing countries. The aim of the study was to compare the MLH1 and in matched mucosa and tumor samples obtained from the large gut of Nepalese and Swedish patients with CRC.
Methods: Patients diagnosed and operated for CRC at Tribhuvan University Teaching Hospital, Nepal (n=39) matched for age with those operated at Sahlgrenska University Hospital, Sweden (n=39) were included in the study. Demographics and clinicopathological data were compared. The tissue methylation status was compared in the Nepalese and Swedish populations and correlated to clinicopathological data.
Results: There were 56% men and 44% women in the study. Their mean age was 53 years with a range of 20 to 78 years. Colon cancer amounted to 70% and 60% in the Nepalese and Swedish patients respectively and the majority of lesions were on the right colon. The colorectal cancer was commonly of stage III (52% and 38%) in the Nepalese and Swedish group respectively. Most of the tumors were well differentiated (41%) in the Nepalese population where as in Swedish patients it the differentiation was medium to low (52% and 11%). Methylation of MLH gene, in different CpG sites, when analyzed independently, showed that in about 18-20% of the cases, the degree of methylation is significantly higher in tumor tissue as compared to sites at least 10 cm away from the lesion.
Conclusion: Colon cancer is more common in men in Nepal with predominantly more on the right colon. Most of them present in advanced stage with higher MLH1 methylation.
Clinicopathological Review of Resectable Gastric Cancer at a Tertiary Level Teaching Hospital of Nepal
Authors: Kansakar Prasan , Vaidya Pradeep
Published: July 2024

Introduction: According to available data, gastric carcinoma is the most common malignancy arising from the gastrointestinal tract in Nepal. Our objective was to analyze the pathological features of gastric carcinoma in patients undergoing curative resection.
Methods: Retrospective analysis of histopathological reports of patients who underwent curative surgery for gastric cancer was performed at Department of Surgery, Tribhuvan University Teaching Hospital for a period of two years. Demographic characteristics, symptoms, site of tumor, type of surgery performed, macroscopic and microscopic characteristics including number of harvested lymph nodes, number of positive lymph nodes and tumor stage were analyzed.
Results: A total of 36 patients underwent curative resection. Mean age of the patients was 61.6 years with range of 21-82 years. Male:female ratio was 7:4. Pain abdomen was the predominant presenting symptom. Vomiting, hematemesis and malena were the other frequent symptoms. Endoscopy Borrmann type II tumor was seen in 27 (75%) of patients. Most patients underwent subtotal gastrectomy. In 25 patients, tumor was located in antrum. Lymphovascular and perineural invasion was seen in 21 and 20 patients respectively. Sixteen patients had poorly differentiated tumors. All but two patients had microscopic negative distal margin whereas proximal margin was negative in all patients. A mean of 15 lymph nodes were harvested. Twenty three patients had node positive disease. Pathological staging revealed Stage IA in 3 patients, Stage IB in in 5 patients , stage IIA in 4 patients stage IIB in 6 patients, stage IIIA in 6 patients, stage IIIB in 8 patients and IIIC in 4 patients.
Conclusion: Gastric carcinoma was common in seventh and eighth decade of life with male preponderance. Most of the patients presented with locally advanced gastric cancer. Tumors located in antrum requiring subtotal gastrectomy was the predominant finding.
Efficacy of Integrated Intervention Program on Mental Health of Cancer Patients
Authors: Chand Bibin , Sharma Madhavi , Thagunna Narendra S
Published: July 2024

Introduction: Copious researchers have made notable findings on the mental health of cancer patients and effect of various discrete therapies, but still there exist a significant paucity on integrated therapeutic interventions over their mental health. The objectives of this study were to find the prevalence of mental health morbidity and the efficacy of an integrated intervention program comprised of Aaron Beck’s Cognitive Behavior Therapy (CBT), Jacobson Progressive Muscle Relaxation Therapy (JPMRT) and self- imagery training on the mental health of cancer patients.
Methods: In this cross-sectional study, data was collected from 20 patients diagnosed with cancer aged between 40-55 years from an outpatient department of Cancer Institute, India. General Health Questionnaire by Goldberg & Hiller, 1979 (GHQ-28) was administrated to assess the mental health in four domains viz: somatic complaints, anxiety and insomnia, social dysfunction and severe depression. Integrated intervention program was conducted for four days per week for one month. Data was analyzed statistically by using normal probability curve (NPC) and paired t-test.
Results: An overall prevalence of negative mental health and significant positive effect by the integrated intervention on the mental health among cancer patients have been statistically corroborated in this pre-post research.
Conclusion: Integrated intervention program is efficacious in improving mental health in cancer patients.