bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of waste electronic plastics and waste marble dust as a partial aggregate replacement on concrete
Authors: Marattha Niraj , Amatya Iswar Man , Thapa Kamal Bahadur
Published: May 2022

Concrete is the most abundant material used in construction on present scenario where aggregates comprise of about three-fourth volume of concrete. On 2019, 28 Mt of E-waste generation was recorded in Nepal and its management has created a burden to the landfill sites. Also, marble dust is a waste obtained during processing and installation of marble which can be used as filler or fine aggregate in concrete for strength enhancement. Utilization of crushed E–waste plastics and waste marble dust in concrete will introduce a green and environment friendly method of construction without any compromise in the utility parameter and would represent positive effect to minimize the environmental degradation and replace naturally available aggregates which are continuously been used. The strength effects of waste electronic plastics and waste marble dust as aggregate replacement in concrete was studied in this research. For this study, 12 sets of concrete mixes were prepared with constant water cement ratio of 0.55. Marble dust was used as a sand replacement at 2.5%,5%,7.5% and 10% by volume of sand. Further 2 sets of 4% and 6% replacement of sand by marble dust was prepared to find out the optimum value as 5% replacement showed greater compressive strength. E-wastes plastics were then used as replacement to coarse aggregate at 1%, 2%, 3%, 4% and 5% along with 5% replacement of sand by waste marble dust. The workability test, compressive strength and flexural test of the mixes were determined. Based on the study, result showed that the compressive strength at 5% replacement of sand by marble dust was maximum while E-waste plastics replaced up to 4% had compressive strength greater than that of nominal mix concrete of grade M20. Flexural strength also increased of concrete containing E-plastic than that of normal concrete.
Constructed Masculinity in Jagdish Gimire’s Lilaam
Authors: Bista Asmita
Published: May 2022

This article focuses on gendered construction of masculinity in Jagdish Ghimire’s Lilaam. The main argument of this article is that masculinity is constructed entity; so, male characters of this novel constituted their masculinity through their performances. Moreover, the male characters of this novel confirm the socially accepted universal truths about being a woman or man; consequently, their exhibition of masculinity cause problems not only to them but also to the female characters. To support this argument, Connell’s and Kimmel’s idea of masculinity have been used as major theoretical parameters to analyze the text under scrutiny. They have claimed that conventional masculinity harms both women and men who are caught up in a systematic constructed limitation due to their prescribed gender roles. According to Connell, men are not born, they are made; in fact, men make themselves, actively constructing their masculinities within a social and historical context. Consequently, males undergo repression while exhibiting masculinity. The significance of this article is to analyze the condition of males residing in Manthali village that is situated on the bank of Tamakoshi river. The article concludes that the male characters of Lilaam cannot live happily and peacefully because snatching happiness and peace from their life, patriarchy buries them under the unbearable burden of masculinity.
A Human not a Woman: Radhika in Bhagat's One Indian Girl
Authors: Pokharel Bhawana
Published: May 2022

A girl though born and bred as a female whether remains a woman or challenges the socially assigned stereotypical sexual identity and becomes a human, is the matter of her choice. Chetan Bhagat’s One Indian Girl best illustrates this issue with a suggestive note for the latter. The central character Radhika Mehata, the Indian girl, is his mouthpiece in the novel. This paper analyzes the socio-cultural making of a woman across cultures with critical insights envisioned by Simone De Bauvoir in her seminal book The Second Sex and Sturt Hall’s notion of ‘being’ and ‘becoming’ regarding one’s identity. The researcher argues that Radhika though a born female denies her socially given sexual identity of a woman, the second sex, to enjoy her life by becoming a fully-fledged human being. This article examines how she asserts a self constructed identity for herself as well as exerts independence and freedom that are taken as a male prerogative in patriarchal societies like ours. In doing so, the article imparts voice to the voiceless women who in the course of aspiring to be free and self-sufficient but are undergoing a tougher struggle in their lives at contemporary times. It also discusses how the stereotypically demeaning treatment by male chauvinists can be overcome by the females who want to pioneer their own unfettered being and live a life of their own choice.
Representation of Masculinity in Govinda Raj Bhattarai's Muglan
Authors: Mishra Indira Acharya
Published: May 2022

Patriarchal gender roles provide certain privileges to males. They hold the position of house holder, which provides them access to power and resources, and authority over women and children in the family. Likewise, they get social recognition as the head of the family. But they get these privileges on the condition that they provide and protect their family members as breadwinners. One of the aspects of masculinity is to provide to the needs of the family. Thus, men take risks and accept challenges to earn money so that they can provide for their families. However, while performing the breadwinner role, they are likely to encounter different types of mental and physical threats that may cost them their lives. Govinda Raj Bhattarai's debut novel, Muglan deals with the problems faced by men in patriarchy. Though the protagonist and his companions have emulated the traditional masculinity and hoped to live like men, they fail. Thus, this article aims to analyze the representation of masculinity in the novel to examine the harms of patriarchal gender roles on men. For this, it takes insights from Masculinity Studies, which put forward to inessential approach to gender. This approach suggests that gender is not a natural phenomenon. Rather it is a socially constructed category, and rigid traditional gender roles harm both men and women. The article contributes to understanding the harms of rigid patriarchal gender roles on men.
Eco-spirituality in BhūmiSūkta
Authors: Bhandari Krishna Prasad
Published: May 2022

The prime concern of this article is to unfold the eco-conscience of Vedic people through the Vedic text. It is to trace out their environmental and ecological awareness. The article aims at perceiving their eco-spiritual consciousness. This study becomes significant to analyze the Vedic literature through naturalistic perspective and it assists the contemporary eco-campaigners to address the eco-peril of this planet. In order to achieve this objective, this study uses the qualitative research paradigm mostly on the thematic interpretation. It has amalgamated the essence of some of the disciplines of naturalistic school of thought. The core conclusion of them is incorporated within the frame of eco-spirituality that becomes the eco-tool to analyze the text. The primary text is the Bhūmi Sūkta (the hymn to the Earth) from the Atharvaveda. After making the eco-reading upon the hymn, it is quite evident that the Vedic people were aware of the biophysical and temporal aspects of the Earth, and the earth ethics was their life principle for coexistence. The conclusion of this study is that the Vedic people had cherished spiritual ecology for due existence of living and non-living things on the earth.
Anuradha Bhavan: At the Crossroads of Values and Choices
Authors: Paudyal Mahesh
Published: May 2022

Book Review
First World War in Literature: Reflections across the Genres
Authors: Upadhyay Hriseekesh
Published: May 2022

War is a major theme in literature from ancient times to the contemporary world. Lyrics, ballads, tales, stories, all kinds of poetry and fictions, philosophical reflections and intellectual analyses have been composed and written about war all over the world in all periods of history. War is the result of conflicting human action and desire, too often it results out of atrocities and inhumanities and wrongful action or desire of one person or group of persons against others. War on many occasions in the long history of mankind has been the only option to salvage one’s dignity and enforce right order and values in society and community of nations and organized groups. In this sense war has proved the most important redress for restoring values, justice and dignity among right-minded people. The First World War that began raging in summer a century ago across the frontiers of Europe to cause havoc to much of the world in subsequent four years bears many features of this characterization.
Challenges in Communicating across Cultures
Authors: Adhikari Kumar
Published: May 2022

How often do we encounter situations in which we send one message and our listener receives another? Quite a lot, I guess. It is because pragmatic norms and cultural conventions transfer in cross cultural communication. Transfer of speech act strategies and cultural norms from one culture to another is quite normal when people communicate in second language or in cross-cultural communicative context. This is because people often tend to frame their speech acts according to pragmatic norms of their own language and culture. That is why, understanding of cultural norms and values of other cultures, speech acts of different speech/linguistic communities is vitally important in cross-cultural communication for better understanding between people from different linguistic and cultural backgrounds. Otherwise, utterances of people of certain speech community are likely to be misunderstood or misinterpreted by the addressee resulting pragmatic errors. This paper traces some of the complications of communication in cross-cultural communicative context, and also suggests a number of possible ways to deal with them.
Copyright Legislations and “Public Good”: A Multinational Survey
Authors: Khadka Santosh
Published: May 2022

In this article, I survey the domestic copyright legislations of four countries: the USA, India, Sri Lanka, and Nepal, and examine the stated or implied provisions of “public good” across these nations. My inquiry specifically concerns whether or not their copyright legislations take into account the “public good” aspect at all. The Berne Convention provides some space exclusively for developing and underdeveloped countries to include the clauses related to “public good” in their copyright legislations, while same privilege is denied to developed countries. I am, therefore, interested in exploring whether or not developing/underdeveloped countries, like India, Sri Lanka, and Nepal, have taken advantage of that provision and, therefore, whether their legislations have more “public good” provisions compared to their developed counterparts.
Prevalence of Bacteriuria in Pregnant Women Visiting Provincial Hospital, Janakpurdham, Nepal
Authors: Yadav Nagendra Prasad , Thakur Rudra Narayan , Yadav Rakesh Kumar
Published: May 2022

INTRODUCTION: Considering the importance of urinary tract infection (UTI) in pregnant women which is responsible for several complications, its diagnosis and treatment are essential to maintain the health of mother and baby.The purpose of the present study was to evaluate the isolation and identification of Escherichia coli from the UTI suspected pregnant women visiting at provincial Hospital Janakpur.

MATERIALS AND METHODS: A total of 200 mid-stream urine samples were collected from UTI suspected pregnant women of 18 to 45 years visiting antenetal OPD in Provincial Hospital Janakpur in between February 2021 to April 2021. The collected urine samples were processed in the microbiology department of the Model Multiple College, Janakpur. Standard Microbiological procedures were followed.

RESULTS: The Escherichia coli were predominant identified as 17 (35.41%). Patients aged between 25-30 years were mostly infected 35 (72.9%). The majority of bacteria isolated were more sensitive to Cephalexin and nitrofurantoin.

CONCLUSIONS: Escherichia coli is one of the most important pathogen for UTI in pregnant women. The majority of bacteria isolated in the present study were more sensitive to Cephalexin and nitrofurantoin.
Multidisciplinary Approach for Retinoblastoma Management
Authors: Thakur Sristi , Basnet Rakshya , Bajracharya Kabindra
Published: May 2022

We read with keen interest the article by Shah et al "Pathologic Risk Factor in Retinoblastoma: An Institutional Experience Based on Analysis of Enucleated Eyes"(Shah A et al, 2012). They have highlighted high-risk histopathological features in Retinoblastoma with retrolaminar optic nerve invasion being the most common and also showed statistically significant correlation of high risk histological features with tumor size and AJCC stage of tumor. Their aim to assess the frequency and spectrum of high risk histopathological features in enucleated specimens of retinoblastoma was successful which may guide the clinician in timely planning for subsequent neoadjuvant therapy and prevent further ocular morbidity and mortality in children. We would like to congratulate authors for this article and with invoked interest it led us to go in more depth and we wish to discuss several aspects of the study that can potentially influence the results.
Living With Huge Rectal Prolapse and Rectocele: A Sad Story of a Rural Nepalese Woman
Authors: Rana Apariharya , Rana Ashma
Published: May 2022

A postmenopausal multiparous woman with defecation difficulty for over three and half years upon clinical examination was diagnosed as a case of huge rectal prolapse with rectocele during a health camp organized by Perinatal Society of Nepal in Sindhupalchok. She was referred to a tertiary care center so that she could undergo combined corrective surgery in the same sitting: rectal prolapse by Surgeons and rectocele by Gynecologists. Unfortunately, she was returned home with a scheduled elective operative appointment a few months later, which she failed to make owing to the long distance from home to hospital. Her case could not be followed, as the contact number she left was unreachable. This case represents an example for many women who have to live with suffering, their problems overlooked by both families and institutions, a situation in dire need of a solution.
Prevalence and Pregnancy Outcome of Preeclampsia Using International Society for the Study of Hypertension in Pregnancy 2018 Criteria in Comparison to 2001
Authors: Shrestha Junu , Subedi Anjali , Gurung Sangeeta , Gauchan Eva , Shrestha Aashika , Pandey Chandani , Rana Apariharya
Published: May 2022

Introduction: Criteria of preeclampsia (PE) have evolved over years to increase the prediction of adverse pregnancy outcomes. Revised International Society for the Study of Hypertension in Pregnancy (ISSHP) 2018 criteria incorporates organ system dysfunction with or without proteinuria. This study aims to determine changes in prevalence and pregnancy outcome of PE diagnosed by revised criteria compared to traditional ones.
Methods: This was a cross-sectional study conducted in the department of Obstetrics and Gynecology from July to October 2021. Women with hypertensive disorders in pregnancy (HDP) were classified according to ISSHP 2001 and 2018 criteria to study the prevalence and pregnancy outcomes. Data were analyzed using Statistical Package for the Social Sciences version 21.
Results: There was an increase in the prevalence of PE applying ISSHP 2018 criteria (12.6% vs 4.6%). The proportion of cases of PE in HDP increased from 19.4% to 52.7%. Preterm delivery was more in the group diagnosed using old criteria compared to revised criteria (52% vs 33.8%). Maternal morbidity like operative delivery, severe hypertension, eclampsia, abruptio, intrauterine growth restriction, were more in women diagnosed only with proteinuria. Low birth weight, Apgar less than 7 at one and five minutes, perinatal morbidity and mortality, were also more in PE diagnosed using old criteria compared to revised criteria.
Conclusion: The prevalence of PE increased without changes in the pregnancy outcome when revised ISSHP 2018 criteria were applied over the traditional 2001.
Mitral Regurgitation and its Predictors after Acute Myocardial Infarction in the Era of Coronary Intervention
Authors: Kafle Ram Chandra , Jwarchan Bishnu , Sharma Dibya
Published: May 2022

Introduction
Mitral regurgitation is one of the common complications of acute Myocardial infarction but a very limited study was published about its prevalence and associated factors from Nepal.
Methods
A prospective cross-sectional study was conducted in admitted patients of the cardiology unit, Manipal Teaching Hospital from 01-06- 2020 to 15-09-2021. All cases of first time acute myocardial infarction who were presented within 12 hours of symptom onset and undergone revascularization with the coronary intervention were selected for the study
Results                                                              
A total of 219 patients with a mean age of 60.55± 12.5 years were taken for study. Moderate to severe mitral regurgitation was detected in 60 (27.4%) cases. The most common risk factors among responders were overweight followed by low high-density lipoprotein and smoking. Age >65yrs [OR:8.26(95%CI, 1.82-37.52); p=0.006], female gender [OR:2.05(95% CI,1.12-3.76); p=0.019], pre-obesity [OR: 2.43(95% CI, 1.14-5.17); P=0.019], longer ischemic time of >6 hrs [OR: 4.57(95%CI, 2.10-9.91); P= 0.001] and involvement of infero-posterior wall[OR: 3.04(95%CI, 1.61-5.774); P= 0.001] and left circumflex artery involvement [OR: 7.67(95%CI, 3.15-18.63); P= 0.001] were significantly associated with moderate to severe ischemic mitral regurgitation.
Conclusion
Mitral regurgitation is a common complication of acute myocardial ischemia. Elderly age, Female gender, longer ischemic time of more than six hours, involvement of infero-posterior wall and left circumflex artery was significantly associated with moderate to severe mitral regurgitation.
Comparison Between Standard Percutaneous Nephrolithotomy Versus Tubeless Percutaneous Nephrolithotomy
Authors: Thapa Niraj , Acharya Ganesh Bhakta , Poudel Abishek , Neupane Ananda , Mishra Sushil
Published: May 2022

Introduction:
Percutaneous nephrolithotomy (PCNL) is the most commonly done procedure for the treatment of large and complex renal calculi. Tubeless PCNL has been advocated in selected patients as it is thought to reduce the post-operative analgesia requirement and postoperative hospital stay.
Methods:
A retrospective comparative study was carried out in 100 patients who underwent PCNL between January 2019 to July 2020. Patients were divided into two groups; Group A (Tubeless PCNL) and Group B (Standard PCNL) and were compared in terms of stone-free rate, operative time, postoperative analgesic requirement, postoperative hospital stay, postoperative blood transfusion, and postoperative complication. Statistical analysis was done using SPSS software (version24). The Chi-square test and Student’s t-test were applied for the calculation of variables and a p-value of <0.05 was considered significant.
Results:
Stone clearance in Group A was higher than Group B (92% vs 88%, p= 0.51). The overall complication was significantly less in Group A (p=0.03). The mean drop in post-operative hemoglobin in Group A was 0.75 ± 0.26 mg/dl and in Group B was 0.90 ± 0.47g/dl (p=0.44). Post-operative blood transfusion was required in 6 patients in Group A and 14 patients with Group B (p=0.26). The mean operating time in minutes was less in Group A (47.10±5.67, p = 0.048). The requirement of post-operative analgesic (Tramadol) was higher in Group B (172.50 ± 40.75mg. vs 142.31 ± 34.44, (p=0.02). The mean duration of hospital stay for Group A was 3.54 ± 0.91 and Group B was 4.56 ± 0.91 days (p<0.001).
Conclusion:
Tubeless PCNL is a safe, effective, and feasible procedure for renal stones. It decreases the length of hospital stay, the requirement of blood transfusion, and the need for postoperative analgesia.
Role of Ultrasonography in the Evaluation of Thyroid Nodule with Fine Needle Aspiration Cytology ( FNAC) Correlation
Authors: Shrestha Elina , Thapa Narayan Bikram , Rajbhandari Shankar Bahadur Singh
Published: May 2022

Introduction:
Thyroid nodules are commonly encountered pathologies worldwide. High-resolution ultrasonography is the first-line investigation for the evaluation of thyroid nodules as it is a cheap, quick, non-invasive, easily accessible modality without radiation hazards. Our major concern is to select suspicious thyroid nodules and early detection of malignancy. Fine needle aspiration cytology (FNAC) when correlated with ultrasonographic imaging features helps inaccurate assessment of categorizing thyroid nodules. USG guided FNAC is a widely practiced procedure because it is a less time-consuming simple procedure and helps to locate suspicious sites more precisely to get a higher yield.
Methods:
Total   70      patients with thyroid nodules detected by ultrasonography dated from October 2020 till September 2021 were enrolled in the study. The enrolled patients had FNAC in the same settings. The ultrasonographic characteristics of thyroid nodules were assessed and correlated with cytology reports.
Results:
Amongst   70   patients, 84.3% were female and 15.7% were male with a male:female ratio of 1:1.8.  The mean age was 48.6 ± 13.2 years. Out of  70 patients, 49 patients had benign nodules while 21  patients had malignant nodules.   Nodules that have characteristics like ill-defined border, hypoechoic echotexture, having predominantly solid components, microcalcification, increased central vascularity, and absence of halo are good indicators of malignancy. The sensitivity, specificity, positive, negative predictive value, and accuracy of ultrasonography were 72%, 91.8%,78.9%, 88.2%, and 85.7 % respectively.
Conclusion:
Ultrasonography is the most accurate, sensitive, and specific modality in categorizing thyroid nodules. A significant correlation of p< 0.05 was observed between ultrasonography with FNAC resulting in good accuracy. There is less chance of missing malignancy which helps to reduce unnecessary surgeries and promotes surgical intervention.
Functional Outcome Of Reconstruction Of Coracoclavicular And Acromioclavicular Ligaments In Acromioclavicular Joint Dislocation
Authors: Manandhar Rajeev Raj , Manandhar Rajeev Raj , Gautam Saroj , Khanal Krishna Raj , Khanal Himal
Published: May 2022

Introduction: Acromioclavicular joint dislocations account for approximately 12% of injuries to the shoulder girdle. Reconstruction of these dislocations is advised and various authors have described different techniques. The modern approach has emphasized anatomic reconstruction using semitendinosus autograft.
Methods: Adults with chronic acromioclavicular joint dislocation presenting to our hospital underwent reconstruction of the joint. A standard protocol of surgery and post-operative rehabilitation was followed. The functional outcome was assessed using the Constant-Murley shoulder score after six months.
Results: A total of twenty-one patients were evaluated. The functional outcome was assessed at 24 weeks using the Constant-Murley score. Nineteen patients (90.4%) had a very good outcome, one patient had a good outcome whereas one had a fair outcome.
Conclusion: The anatomic reconstruction of the acromioclavicular joint using semitendinosus graft results in very good outcomes with few complications.
Transurethral Resection of Prostate Without Traction: A Retrospective Observational Study
Authors: Acharya Ganesh Bhakta , Thapa Niraj , Mishra Sushil , Poudel Abhishek , Bhusal Sagar
Published: May 2022

Introduction: Application of traction after monopolar transurethral resection of prostate (TURP) is a common practice that causes significant discomfort to the patients. So can we avoid the morbidity of traction in a selected group of the patient where there is no significant hematuria after TURP? Hence we did a retrospective observational study to look for feasibility and safety of traction less TURP.

 Methods: It is a retrospective observational study conducted in the Department of Urology, Manipal Teaching Hospital from August 2018 to August 2020 in patients who underwent traction less TURP.  There was a total of 64 patients who fulfilled the inclusion criteria. All the demographic profiles, preoperative investigations, and perioperative parameters were noted. Postoperatively requirement of reapplication of traction, bladder washes, and application of tranexamic acid for hematuria, clot retention, and blood transfusion were noted. Statistical analysis was done by SPSS version 25.

 Result: Mean age and prostate size were 71 yrs. and 52 g. Sixteen(25%) patients were on antiplatelet therapy, fourteen(21%) patients had a catheter in situ and 34(53%) patients were on anti-BPH (Benign Prostatic Hyperplasia) medication. There were no patients who require re- traction, bladder washes, or application of intravenous tranexamic acid. There was one (1.56%) patient who had clot retention requiring evacuation and blood transfusion. VAS score after 8 hrs. and 12hrs. was 3.22 and 1.73. Mean hemoglobin fall was 0.81 g%.

 Conclusion: Traction after monopolar TURP can be safely omitted in carefully operated patients but traction should be reserved for those patients with continuous hematuria.
Study to Evaluate Coronary Artery Disease Prevalence and Risk Factors in Heart Failure Patients with Reduced Ejection Fraction
Authors: Paudel Navaraj , Thapa Namrata
Published: May 2022

Introduction: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. The aim of this study was to assess the prevalence and risk factors of coronary artery disease (CAD) in HF with reduced ejection fraction (HFrEF) using invasive coronary angiography (CAG).

 Methods: This was a prospective, cross-sectional, descriptive observational study conducted from July 2020 to September 2021. All consecutive patients with HFrEF who met the inclusion criteria underwent CAG at Manipal Teaching Hospital were evaluated and analyzed using various statistical tools.

 Results: Total 108 patients with a male to female ratio of 2.02:1 were assessed. The mean age of patients was 63+6.08 years. The prevalence of CAD was 72% of which 42% were having significant CAD (stenosis >50%) with 45%, 32% and 23% having triple (TVD), double (DVD) and single vessel disease (SVD) respectively Smoking was the commonest risk factor (61%) followed by hypertension (52%), dyslipidemia (27%) and diabetes (22%).  The prevalence of CAD increased with increase in the number of risk factors. There was significant association of smoking (OR: 11.5, P: 0.005), hypertension (OR: 8.5, P: 0.002) and diabetes (OR: 10, P: 0.001) for occurrence of significant CAD.

 Conclusion: In our study, otherwise unexplained HFrEF showed overall 72% of CAD with 42% having significant CAD (stenosis >50%). Conventional risk factors like smoking, hypertension and diabetes were significantly associated with development of CAD.
Musculoskeletal pain syndrome in postpartum women
Authors: S Chungade Niharika , Mahishale Arati , Dalal Anita , Angolkar Mubashir
Published: May 2022

Aim: To estimate the occurrence of musculoskeletal pain syndrome in postpartum women.
Method and Measures: A cross sectional study was conducted from August 2018 to February 2020 among 115 postpartum women attending at a tertiary care hospital in north Karnataka. Standardized and pre validated questionnaires “Brief Pain Inventory” and “Visual Analogue Scale” were used for subjective rating of pain. Result expressed in frequency and percentage.
Results: Musculoskeletal pain syndrome was present among 99% women and most common complaint was low back pain (74%). General activity, walking ability and mood were much interfered by pain.
Conclusions: The results showed there is high occurrence of musculoskeletal pain syndrome in postpartum women at a tertiary care hospital; most common is low back pain.
Keywords: Brief Pain Inventory, musculoskeletal syndrome, postpartum women, Visual Analogue Scale.
Hysteroscopy in Abnormal Uterine Bleeding
Authors: Pradhan Binita , Pun Isha , Lama Sushma
Published: May 2022

Aims: To evaluate the role of hysteroscopy in abnormal uterine bleeding in women of reproductive age group and to correlate the hysteroscopic findings with histopathology.
Methods: The study was carried out in the Department of Obstetrics and Gynecology at Patan Academy of Health Sciences, Kathmandu. Thirty patients of age group 20-61years with abnormal uterine bleeding were included. Demonstrable pelvic pathology like cancer of cervix, vagina or endometrium and active pelvic inflammatory disease (PID) were excluded. All patients were assessed using hysteroscopy and findings were correlated with histopathology.
Results: On hysteroscopy, endometrium was normal in 30%, hyperplastic in 30%, polyps found in 20% and atrophic in 10%. Endometrial polyp and submucous fibroid was seen in 6.7% cases and 3.3% cases each. On confirmation by histopathology the findings were: normal endometrium in 40% cases, hyperplastic in 40%, polyp in 16.7% and atrophic in 3.3%. Submucous fibroid and suspicious endometrium came to be endometrial hyperplasia on histopathology.
Conclusions: Hysteroscopy has more than 90% diagnostic accuracy to diagnose endometrial morphology and diagnostic agreement of endometrial finding is 63.33%.
Keywords: abnormal uterine bleeding, hysteroscopy, predictive value
Maternal and fetal outcome of severe pre-eclampsia and eclampsia in cesarean section and normal delivery
Authors: K Lokeshwari , B Sreenivasa
Published: May 2022

Aims: To evaluate the maternal and fetal outcomes in severe preeclampsia and eclampsia in Cesarean Section  and normal delivery .
Methods: An observational descriptive study of severe pre-eclampsia-eclampsia conducted in the Department of Obstetrics and Gynaecology, Basaveshwara Medical College Hospital. Gestational age 32-42 weeks were included and imminent deliveries were excluded from the study. Primary outcome variables were mode of delivery, maternal morbidity-mortality, and perinatal morbidity-mortality.
 Results: 63.2% in severe pre-eclampsia, 50% in eclampsia group delivered vaginally; 15.1%  in severe preeclampsia and 25% in eclampsia group underwent elective LSCS; 21.7% in severe preeclampsia and 25% in eclampsia group underwent  emergency LSCS. Incidence of cesarean deliveries in severe pre-eclampsia was 36.8% and in eclampsia it was 50%. No maternal death was observed in elective LSCS. Maternal death in vaginal delivery cases was 0.94% in severe preeclampsia and 4.76% in eclampsia. In emergency LSCS cases maternal mortality was 1.4% in severe preeclampsia and 4.76% in eclampsia group. No perinatal mortality was observed in elective LSCS group; 4.7% perinatal mortality occurred in normal delivery, 20.5% in emergency LSCS in severe preeclampsia and 7.1% in eclampsia who were delivered  vaginally.
Conclusion: In eclampsia, feto-maternal outcome is better in the cesarean deliveries than in the vaginal deliveries
Diagnostic laparoscopy findings in pelvic pain among the women attending Gynecology OPD at Dhulikhel Hospital
Authors: Yadav Arun , Tamrakar Suman Raj
Published: May 2022

Aims: To evaluate the laparoscopic findings in women with pelvic pain.
Methods: A prospective study conducted in Department of Obstetrics and Gynecology at Dhulikhel Hospital from March 2017 to December 2018. All women with pelvic pain, ultrasound evaluation and laparoscopic procedure at the hospital were taken. Data entered in SPSS 23 and analyzed using descriptive parameters.
Results: Maximum number of cases of pelvic pain belonged to 21-30 years, most of them were parous with mean duration of pain of 16.48±4 months. The mean age and parity of the patients was 34±5 years and 1.74 respectively. The most common complaint was dysmenorrhea (33.3%) followed by abnormal vaginal discharge (31.7%). On clinical examination, pelvic tenderness was observed in majority (21.7%) of cases.
On laparoscopic examination, normal finding were seen in 41.7% cases followed by pelvic inflammatory disease (19.2%), endometriosis (17.5%), pelvic adhesion (12.5%), retroverted uterus (2.5%). PCOS, pelvic congestion and fimbrial cyst were seen in 1.7% each. Pyosalphinx and twisted ovary were seen in 0.8% each.
Conclusions: Laparoscopy serves as diagnostic as well as a therapeutic modality of management in chronic pelvic pain.
Juvenile nulliparous uterine prolapse in an unmarried 17-year-old adolescent
Authors: Rana Apariharya , Rana Ashma
Published: May 2022

In a peripheral health camp, a 17-year-old juvenile nullipara who presented with the history of something coming out per vagina was clinically diagnosed as third-degree pelvic organ prolapse (POP) Stage III, acknowledged as a rarity concerning patient wellbeing and reproductive future.
Correlation of Amount of Cigarette Smoking with Thickness and Elasticity of Distal Femoral Cartilages using Sono-Elastography Techniques of Ultrasound, a Cross-Sectional Study.
Authors: Bista Neha , Ghimire Pradesh , Collao Mahgn Rances
Published: May 2022

Introduction: Cigarette smoking is a well-known etiology for chronic musculoskeletal system disorders, like osteoarthritis, affecting the distal femoral cartilages. However, recent studies show protective effects of smoking against osteoarthritis. Ultrasound is an easily accessible and reliable imaging tool for the evaluation of the cartilages, measurement of their thickness, and tissue stiffness. This study seeks to objectively show the effects of smoking by affecting their knee joints’ cartilage and clarify whether it has a chondroprotective effect, or support the usual evidence that smoking is harmful at any cost.
Methods: This prospective cross-sectional study compares the thickness and elasticity of distal femoral cartilage in heavy, ordinary smokers and non-smokers using B-mode scanning and real-time strain elastographic technique of ultrasound respectively.
 Results: Among 377 individuals with a mean age of 27.66 years, male predominance (70 %) and mean Body Mass Index (BMI) of 24.55, a higher proportion (50 %) of volunteers were ordinary smokers (pack years <20). Elasticity strain ratios were found to be significantly lower in heavy smokers in both sides’ distal femoral cartilages except in right lateral cartilage (p = <0.001) using Fisher’s exact test. Significantly lower thickness was noted in both cartilages of the right side (p <0.001) and left lateral cartilage (p = 0.001) among heavy smokers. After adjusting for the effects of age, sex, BMI, and occupation using one-way ANOVA, similar results were obtained.
 Conclusions: Heavy cigarette smoking causes degradation of distal femoral cartilages by decreasing their thickness and elasticity.
Radiographic Measurements of Normal Knee Joint Space in Adults
Authors: Kayastha Prakash , Khatun Nagma , Regmi Pradeep Raj , Poudel Sharma , Dhakal Prajwal , Adhikari Govinda , Upadhyaya Rudra Prasad , Maharjan Santosh
Published: May 2022

Introduction: The knee joint is the space between the femoral and tibial condyles. The tibiofemoral articulations are separated by articular cartilages and menisci; with little contributions from cruciate ligaments. These are collectively seen on a radiograph as a radiolucent area between the bony tibial and femoral condyles. This study was conducted to measure the normal knee joint space in patients referred for X-Ray to the Department of Radiology of a tertiary care hospital.

Methods: This descriptive cross-sectional study was performed from 1st January to 1st April 2021 in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH). A total of 157 patients were involved. The radiographic joint space width in the knee joint was measured in both medial and lateral compartments of bilateral knees in correlation with age and gender.

Results: The mean right medial, left medial, right lateral, and left lateral spaces for females were 0.25±0.08 cm, 0.23±0.09 cm, 0.49±0.10 cm, and 0.49±0.29 cm respectively. Similarly, the mean right medial left medial, right lateral, and left lateral spaces for males were 0.26±0.07 cm, 0.10±0.09 cm, 0.18±0.09 cm, and 0.17±0.08 cm respectively. There was a strong positive correlation between both right and left joint spaces about age.

Conclusion: The radiographic reference values for the joint space width were obtained, showing a positive correlation with age and no significant gender variations in bilateral knees.
Sensitivity and Specificity of High-Resolution Computer Tomography in the Diagnosis of COVID-19 Infections
Authors: Lalchan Subita , Kushwaha Niraj
Published: May 2022

Introduction: The goal of this study is to find the sensitivity and specificity of High resolution computed tomography (HRCT) of the chest in diagnosing COVID-19 infection using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as a gold standard.

Methods: All patients clinically suspected of having COVID 19 infection who had undergone both RT PCR test and HRCT chest were included in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of HRCT chest in diagnosing COVID 19 infection were calculated considering RT-PCR as the gold standard test.

Results: A total of 100 patients were included in the study. The mean age was 55.68 years. HRCT chest showed 92.85 % sensitivity, 68.75 % specificity, 93.97 % PPV, 64.7 % NPV and 89 % diagnostic accuracy in the detection of COVID-19 infection.

Conclusion: HRCT scan of the chest shows high sensitivity and specificity for the diagnosis of COVID-19 pneumonia. It is a fast diagnostic test and also helps in grading the severity of pneumonia thus in further management.
Effect of different planting time and varieties on Growth and Yield of African Marigold (Tagetes erecta) in the Kavre district, Nepal
Authors: Dhakal Mira , Pun Amar Bahadur , Bhattarai Shandesh
Published: May 2022

A field experiment was conducted to study the effect of different planting time on growth and flowering attributes of different varieties of African marigold at Kavre district of Nepal during the year of 2014 to 2017. The experiment consisted of four replications and was laid out in a two factorial RCB design. Six treatment combinations consisting of two open pollinated varieties of marigold viz. Calcattia Orange and Calcattia Yellow and three planting time viz. 1st January 2015, 15th February 2015 and 30th March 2015 were evaluated. The pooled analysis of two years’ data showed a significant influence of varieties and planting dates on vegetative growth and flower yield and yield attributing characters Flowering duration differed significantly with variety and its interaction with date of planting. Longer duration of flowering was observed by Calcattia Orange (57.58 days) followed by Calcattia Yellow (53.50 days). 1st January planting of Calcattia Orange exhibited significantly the longest flowering duration (62.00 Days). The flower yield per plant was the highest in Calcattia Orange (894.3 gm/plant) than Calcattia Yellow (815.3 gm/plant). Similarly, 1st January planting had the highest flower yield/plant (1033.1 g/plant) followed by 15th February planting (854.9 gm/plant) and 30th March planting (676.4 g/plant). Although not significant, Calcattia Orange planted on 1st January showed better results in terms of Flower yield /plant (1081 g), Number of flowers per plant and flower size as compared to other treatment combinations and significantly the highest duration of flowering (62.00 days) along with attractive orange color under Kavre condition.
Nutritional value and antioxidant properties of Diospyros malabarica (Desr.) Kostel., fruit from midhills of western Nepal
Authors: Shrestha Rachana , Dawadi Prabin , Bhusal Santoshi , Bhatt Lok Ranjan
Published: May 2022

Fruit consumption has long been recognized for its beneficial impact on human health. Persimmon fruit (Diospyros malabarica (Desr.) Kostel.) is a popular wild edible fruit distributed in mid-hill regions of Western Nepal and is used in treatment of various ailments by local people. Although, persimmon is a popular fruit, its significant nutritive values and bioactive compounds are still unexplored in Nepal. This research on nutritional and phytochemical analysis of persimmon fruit pulp was carried out using standardized analytical methods (Association of Official Analytical Chemists, AOAC) and microplate spectrophotometry with ultraviolet (UV) detection. The results revealed that the fruit is rich in sugar (66.52±2.17 mg /g), fiber (103.95 mg/g), ash (107.44 mg/g) and total phenolic content (112±2.89 mg GAEs/g) and the mild supplier of antioxidants.
Comparative Studies on Antioxidant Activity of Ten Medicinal Plants Collected From the Ilam District of Nepal
Authors: Kalauni Surya Kant , Niraula Muna , Thapa Prakash , Pathak Ishwor
Published: May 2022

Methanol extracts of ten medicinal plants collected from Ilam district were prepared and a preliminary phytochemical screening was performed. Phytochemical test revealed that selected plant samples contain alkaloids, flavonoids, terpenoids, glycosides, quinones, reducing sugars, coumarin, polyphenols, and saponins. The antioxidant properties of ten samples were evaluated by using DPPH free radical scavenging assay and their inhibitory concentration for 50% inhibition (IC50 values) for antioxidant properties were calculated. Among all ten studied samples, IC50 values of extracts of barks of Atrocarpus lakoocha (41.42±3.1 µg/mL) and flowers of Woodfordia fructicosa (41.89±2.5 µg/ mL) were very close to that of standard ascorbic acid (38.74±2.5 µg/mL). Similarly, flowers of Rhododendron arboreum (45.55±2.2 µg/mL), roots of Vetiveria zizanoids (46.22±2.0 µg/mL) and rhizomes of Mirabilis jalapa (48.99±3.0 µg/mL) also showed strong activity against DPPH free radicals. These results showed that these plants could be the potential sources of natural antioxidants in the food and/or pharmaceutical industry
Inclusive Policy in Tribhuvan University: A Case of Its Pre and Post Implementation
Authors: Limbu Prem Prasad
Published: May 2022

Tribhuvan University (TU), a leading institution of higher education in Nepal covers 83 percent educational enrolment for higher-level education. It has been implementing inclusive policy since 2009 in order to mitigate inequality in composition of higher education governance. The main assumption of the policy action of inclusion is to increase the participation of excluded groups to maintain proportional equilibrium to privileged groups. Is the policy practice working as its assumption? This study has explored the answer of this question. The result shows that the increasing participation status of women, Indigenous Nationalities and Dalit. It has justified the relevancy of continuity of inclusive policy practice. However, the participation of two privileged groups i) Bahun and Chhetri and ii) Newar is not found remarkable decreased. To present the concluding result the article has contained about higher education governance and TU’s inclusive policy legal provision in introduction. After that, it has included the result, discussion and conclusion interpreting comparative data presentation of policy parget groups’ pre and post policy practice participation status.
Front Pages
Authors: Khatiwada Som Prasad
Published: May 2022

Front Pages
A Lived Experience of a University Retired English Teacher: A Narrative Inquiry
Authors: Timsina Jib Nath
Published: May 2022

Teaching is a challenging job. It requires mentoring and helping students to grasp the meaning and understand the message the subject delivers. A teacher is one who inspires guides, enlightens and motivates the learner. It is lifelong process. This article is based on narrative inquiry research on the lived experience of a recently retired English teacher from Tribhuvan University who contributed a lot in English education. It explores how a master degree holder in English education joined at university and constructed and reconstructed his identity in his teaching profession unless he retired. Data were collected from face to face in depth interviews and telephone conversation then analyzed through narrative case analysis. The findings show that a university English teacher develops and modifies his identity through engaging himself in different professional development activities, interacting with different socializing factors and experiencing various emotions in university activities. He also works as curriculum developer, examiner, and invigilator, external and internal examiner in practical examinations.  He has to labour hard in his whole professional period and has to balance his emotional behaviours, that is, happy moments as well as frustrated moments. The paper concludes with some implications for language teachers in context of education campuses under faculty of education in T.U.
Challenges of Teaching English as a Foreign Language in Nepal
Authors: Timsina Lok Nath
Published: May 2022

This article has presented the difficulties and challenges faced by teachers in teaching English as a foreign language in Nepal. The main objective of the article is to describe the challenges in teaching English in the countries where it is not spoken as a mother tongue. The primary data were collected from three English teachers who have been teaching English in basic level at community schools located in Madhyapur Thimi Municipality, Bhaktapur. Field observation and in-depth interviews were the major tools for data collection. From the interviews and the available literature, some challenges of teaching English as a foreign language in our context have been drawn. The result shows that the teachers encounter the challenges inside the classroom with the knowledge of teacher and students, outside of it with parents and unfavorable environment, some challenges are related to languages and others are related to the curriculum, textbooks and the policy of the government.  The findings of the study is beneficial to the teachers, researchers, school administrators, policy makers, curriculum developers and textbook writers to obtain the fruitful results in teaching English in Nepal.