bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial profile of Early versus Late onset neonatal sepsis and its antimicrobial susceptibility: A 1-year retrospective study in a tertiary level teaching hospital of Nepal
Authors: Gurung B , Shrestha LP
Published: July 2024

Introduction: Neonatal mortality accounts for 46% of all under-five deaths globally. The Neonatal Mortality Rate in Nepal (21/1,000 live births) still exceeds the global average. Infection remains one of the leading causes. South-Asian studies report different spectrum of pathogens in neonatal sepsis compared to Western literature, with concerns for emerging antimicrobial resistance. Local epidemiological data and periodic surveillance provides guidance to formulate antibiotic policy. This study was conducted to evaluate the organisms of neonatal sepsis and antimicrobial sensitivity pattern in a hospital setting.
Methods: A retrospective study was conducted in Neonatal Intensive Care Unit, Tribhuvan University Teaching Hospital from April, 2016 – April, 2017. All neonates treated as neonatal sepsis were screened. Only the cases with positive blood culture were enrolled.
Results: Out of 172 neonates with Probable sepsis, 36% cases were “Culture-proven sepsis”. Majority ere preterm (56.45%), Low Birth Weight (59.67%) and male (64.5%). Around 30% were outborn babies which probably contributed to high (75.8%) cases of Late-onset Neonatal Sepsis (LoNS). Besides Coagulase-Negative-Staphylococcus, antimicrobial-susceptible, Gram-negative organisms dominates Early-onset Neonatal Sepsis (EoNS). There were 53.19% Multidrug resistant (MDR) organisms in LoNS– Klebsiella followed by Pseudomonas, accounting for 64.7% deaths. Excluding Methicillin Resistant Staphylococcus aureus (MRSA), all LoNS associated MDR isolates were susceptible to Colistin. Majority (90%) Non-MDR isolates in LoNS were susceptible to Amikacin and Piperacillin-Tazobactum or Meropenem combination. All MRSA isolates were susceptible to Vancomycin or Teicoplanin.
Conclusion: Late onset neonatal sepsis remains the major burden. MDR isolates increase the challenge of newborn care with limited antimicrobial options and high mortality.
Surgical management of extrahepatic portal vein obstruction at University Hospital
Authors: Shah S , Ghimire B , Kansakar P B S , Bhandari R S , Lakhey P J , Vaidya P , Singh Y P
Published: July 2024

Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO.
Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed.
Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups.
Conclusions: Surgical management for EHPVO have good perioperative and short term outcome.
Morphometric study of trachea in adult cadavers
Authors: Bhandari R , Ranjit N , Shrestha R , Shrestha A , Adhikari B , Shrestha RN
Published: July 2024

Introduction: Knowledge of tracheal morphometry is essential for carrying out interventional procedures of the airway like endotracheal intubation, tracheostomy and tracheal stenting. It has been described that the length of human trachea ranges from 10 to 11 cm and the internal tracheal diameter in transverse axis is about 12 mm in adults. The main objective of this study is to evaluate the tracheal length and its internal and external diameters from adult Nepalese cadavers.
Methods: A total number of 182 cadavers, 132 male and 50 female, with Nepalese nationality were studied. The study subjects were 18 years or above. Tracheal length, internal and external tracheal diameters in anteroposterior and transverse axes were measured after photographic record of the sample.
Result: The mean tracheal length was 82.87 ± 8.3 mm in male and 77.59 ± 9.3 mm in female. The TEDAP were 18.95 ± 2.0 mm and 15.83 ± 2.2 mm in male and female respectively. The TEDTR were 23.73 ± 3.5 mm and 20.70 ± 3.0 mm in males and females respectively. The TIDAP in males was 9.34 ± 2.2 mm and in females was 6.88 ± 1.7 mm. The TIDTR was 13.24 ± 2.9 mm in males and 10.51 ± 2.9 mm in females.
Conclusion: The tracheal dimensions of our study showed marked dissimilarity with those of the studies conducted in western population.
Right Axillary Mini-thoracotomy approach for surgical correction of Congenital Heart Disease
Authors: Bhattarai A , Khakural P , Pradhan B
Published: July 2024

Introduction: We describe our initial experience with minimally invasive approach using Peripheral cardiopulmonary bypass (CPBP) and a 4-5 cm long right axillary mini-thoracotomy (RAMT) incision for surgical correction of congenital heart diseases. A right axillary mini-thoracotomy with the aid of peripheral CPBP is a surgical option that has been adopted in our institution in selected patients with congenital heart disease. We present our selection criteria, describe our technique, and analyze our results with this modified technique.
Methods: This is retrospective descriptive study conducted at Green city Hospital, Kathmandu and the procedures were followed in accordance with the institutional guidelines for retrospective record review and protection of patient confidentiality. The preoperative variables, intraoperative data and postoperative outcomes of patients undergoing minimally invasive cardiac surgery were collected and analyzed.
Results: Total 12 patients were included in the study who underwent a minimally invasive approach with the aid of peripheral CPBP for repairing congenital heart disease (CHD) in our institutions. Main diagnosis leading to surgery included: (1) ostium secundum atrial septal defect in 7 patients, (2) ostium secundum atrial septal defect with moderate tricuspid regurgitation in 3 patients, (3) perimembranous ventricular septal defect with patent ductus arteriosus in 1 patient, (4) ostium secundum atrial septal defect with core triatriatum in 1 patient. There were 6 females and 6 males. Median hospital stay was 4 days. There were no residual intracardiac anomalies at discharge two-dimensional echo, and all patients were satisfied with the surgical approach.
Conclusion: The combination of RAMT and peripheral CPBP is safe and effective for treating some congenital heart disease with excellent clinical results.
Psychiatric morbidity pattern in patient after earthquake at Tribhuvan University Teaching Hospital Nepal
Authors: Chapagai M , Tulachan P , Shakya S , Dhungana S , Pant SB
Published: July 2024

Introduction: A trauma is an event that is not within the normal range of the common experience. It is perceived as overwhelming physically and/or emotionally and may involve a perceived threat to the individual or a loved one. The basic aim of this study is to evaluate sociodemographic characteristic and pattern of psychiatric morbidity in patient attending at Tribhuvan University Teaching Hospital after earthquake.
Methods: A cross sectional study was carried out on patients attending psychiatric OPD services of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, a tertiary care hospital, from April 2015 to mid Sep. 2015.
Results: Among 1057 cases who visited the outpatient services at Department of Psychiatry during first four and half months after major earthquake on 25 April 2015, 108 were directly related to earthquake The most commonly diagnosed conditions were F 41.9 Anxiety Disorder Unspecified (15.7%), F43.2 Adjustment disorder (13.9%). F 43.1 Post-traumatic stress disorder (8.3%) and Moderate depressive episode (7.4%). Two cases were referred with incidence of deliberate self harm.
Conclusion: This study has contributed in new knowledge regarding the psychological conditions aftermath of natural disasters in Nepal and also the need of research to determine the prevalence of post-disaster mental health conditions tike posttraumatic stress disorder (PTSD), anxiety and depressive disorders, resilience and factors associated with the impact of event among the survivors Keyword: Earthquake. PTSD, Psychiatric morbidity.
Anticoagulant Dependent Pseudothrombocytopenia: A Case Report
Authors: Aryal B , Adhikari S , Aryal N , Pant V
Published: July 2024

Pseudothrombocytopenia is a laboratory finding caused by in vitro autoaggregation of platelets (an irreversible change) resulting due to the presence of EDTA in containers. In contrast to serious and potential life-threatening causes of thrombocytopenia, EDTA-pseudothrombocytopenia (EDTA- PTCP) is solely an in vitro effect without any clinical relevance.We report a 24 year old patient from MCTVC hospital who presented with common flu. On blood examination there was low platelets count in EDTA anticoagulated sample but he was clinically otherwise normal and there were no symptoms of thrombocytopenia. On smear preparation, in EDTA and Trisodium citrate sample his all blood countparameters were within normal range. This case highlights the importance of slide preparation.
Kidney Diseases Screening for Asymptomatic School Children by Urine Dipstick Method
Authors: Khatri B , Shah DS
Published: July 2024

Background: Screening of urine is a useful tool to identify school children with renal diseases who are asymptomatic. A dipstick urinalysis screening was conducted on World Kidney Day to determine the kidney disease from asymptomatic school going children.
Methods: A cross sectional study was carried out in a secondary school in Kathmandu, Nepal. 579 asymptomatic children were enrolled. Morning mid-stream urine samples were obtained from students and tested by dipstick method.
Results: Seventy (12.08%) children had urinary abnormalities at the screening in the form of proteinuria, none had glycosuria. Urinary abnormalities were more common in females than in males. Children with hypertension were more likely to have proteinuria than normotensive children. Most positive results were detected in the age group 9-12 years. Body mass index had no correlation with proteinuria.
Conclusion: The study found that there is high burden of proteinuria (>12%) indicated asymptomatic urine abnormalities. Hence only early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals with renal disease.
Histologic changes in mice fed with staple food
Authors: Devkota U.N , Steinmann J.P. , Böhm J , Schilcher F. , Veres B. , Helmreich M. , Larsson S.
Published: July 2024

When mice were given staple food of seed quality corn and other cereals by subsistence farmers in Dhading and Bhaktapur areas in Nepal, histopathological changes were frequently found, particularly in the liver. All staple foods from Nepal were severely polluted with mould but only in one sample deoxynivalenol (DON) was found. (The most common liver changes, but to a lesser degree, were also found in the mice given seed quality corn with or without vitamin/mineral mixture.)
Kidney lesions such as tubulonephrosis, suspected parenchymatous degeneration, nonpurulent nephrosis or chronic pyelonephritis were found in mice given Nepalese corn and in the oats group.
In some groups there were histopathological findings like pronounced hyperkeratosis, papillary epithelial surface with hypergranulosis or uneven macropapillary surface observed in the distal part of the oesophagus and in the forestomach.
Because of the similar handling of nutrients for humans and mice, it is suggested that the results of this study be considered when nutritional surveys are made in less developed countries.
Feasibility study of acute thrombolytic therapy for stroke in a tertiary care center in Nepal
Authors: Pradhan S , Shrestha PS , Acharya SP , Prasad PN
Published: July 2024

Introduction: Early thrombolysis is the recommended therapy for acute ischemic stroke (AIS). In a developing country like Nepal, many factors contribute to the delay in performing prompt thrombolysis. This was a feasibility study to assess the determinants of pre-hospital delay for patients diagnosed with AIS.
Methods: From 16th July to 16th September 2017, patients diagnosed with AIS in the emergency department (ED) were identified and a structured interview with the patient or next of kin was performed. Various pre-hospital time intervals and possible factors resulting in delay were assessed.
Results: A total of 58 AIS patients were studied. Only 12% of the total patients underwent thrombolysis. The mean delay (+/-sd) from symptom onset to first contact with a medical personnel was 6.74 (+/- 7.84) hours. The mean (+/-sd) total arrival delay to ED was 15.78 (+/-17.48) hours. The mean (+/-sd) delay in dispatch to delivery time was 9.12 (+/-15.57) hours. Ten patients (17%) arrived to our ED within 3 hours of onset of symptoms, and 14 (24%) arrived within 4.5 hours of onset of symptoms. Fifty percent of those who presented on time for thrombolysis underwent the therapy.
Conclusions: This study shows that there are major obstacles before we are able to provide adequate thrombolysis services for AIS. There remain plenty of areas where the government, the hospital and public health services need immediate addressing.
Neuropsychiatric presentation of Wilson's disease
Authors: Dhungana S , Ojha SP , Chapagain M , Tulachan P , Pant SB
Published: July 2024

Wilson's disease is a rare autosomal inherited disorder with various manifestations. Initial manifestations could be hepatic, neurological or psychiatric and there is invariable delay coming to the correct diagnosis. Exact frequency of children and adolescents presenting with psychiatric complaint as the initial manifestation is not known. It is recommended that detailed medical evaluation be done in any child presenting with psychiatric complaints. We hereby present a case of an eight-year old girl who presented with anxiety and subsequently diagnosed to have Wilson's disease.
Factors affecting stone clearance in Percutaneous Nephrolithotomy
Authors: Poudyal S , Rai BDK , Dhital P , Pradhan M , Chapagain S , Luitel BR , Chalise PR , Sharma UK , Gyawali PR
Published: July 2024

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex renal stones. It is of paramount importance to deliver the maximum clearance with minimal morbidity. There are different anatomical, stone-related and patient-related factors affecting the stone-free rate. This study is conducted to delineate the factors predicting stone clearance in PCNL.
Methods: A prospectively maintained database of 114 cases, who underwent PCNL between January to October 2016 in Tribhuvan University Teaching Hospital, was analysed. Age, gender, body mass index, surgical and medical history, renal anomalies, American Society of Anesthesiologists score, tract size, type of tract dilatation, fluoroscopy time, stone density, stone location and burden, skin to stone distance, presence of hydronephrosis, and duration of surgery were correlated with the stone clearance. Stone clearance was evaluated with either X-ray or ultrasound of the kidneys, ureters and bladder up to three months of PCNL.
Result: Stone clearance rate was 85.96%. Stone burden(p<0.001), stone location(p=0.03), number of calyces involved by stone(p<0.001) and presence of hydronephrosis(p=0.005) were statistically different between stone-free and stone-residue group. Multifactorial analysis showed that stone burden, location and no. of calyces involved by stone were the only factors effecting stone free rate. Area under curve for the stone burden was 0.842 (p<0.001).
Conclusion: Stone burden, location and number of calyces involved by the stone are the principal factors determining the stone clearance in PCNL.
Intestinal parasitic infection among children less than five year of age visiting Children’s Hospital of Kathmandu.
Authors: Shrestha S , Raya S , Shrestha L , Parajuli K , Sherchand JB
Published: July 2024

Introduction: Intestinal parasitosis is a worldwide concern and cause significant morbidity and mortality, particularly in developing countries like Nepal. The current study aims to identify the status of intestinal parasitosis among children less than five years of age visiting Kanti Children Hospital.
Methods: Hospital based cross sectional study was conducted from January 2017 to December 2017 among children less than 5 years of age visiting Kanti Children’s Hospital. Parasites were detected by using standard microbiological procedures.
Results: Among a total of 770 stool specimens collected, intestinal parasites were detected in 7.4% cases. Children of age group 49-60 months were found to be infected more often followed by 37- 48months with higher frequency seen in summer season in the month of May and June. Altogether five species of parasites were detected, among which three were protozoan and two were helminths. The most common parasite identified was  Giardia lamblia (4.3%) followed by Entamoeba histolytica(2.2%) and Hymenolepis nana(0.5%).
Conclusion: The study indicated that there is still burden of parasitic infection in Nepal among children. Hence, there is a need to incorporate effective prevention and control strategies including health education and environmental hygiene.
Efficacy of bronchial cytology in diagnosing lung lesions and its correlation with bronchial biopsy
Authors: Hirachand S , Sthapit RR , Gurung P , Acharya S
Published: July 2024

Introduction: Neoplastic and non-neoplastic lung lesions have a high rate of morbidity and mortality. Lung cancer is the frequently diagnosed cause for cancer related deaths and tuberculosis is still the leading cause of death in developing countries. Timely detection of disease plays an important role in the management and long term survival of patients. For early diagnosis different diagnostic modalities are available which include bronchoalveolar lavage, bronchial brush, fine needle aspiration cytology and bronchial biopsy. Bronchoalveolar lavage and bronchial brush are very effective in the diagnosis and differential diagnosis of lung cancers. Bronchial brushings often offer excellent specimens and accurate information about the site of the lesion. Better diagnostic yield is often obtained when cytologic techniques are used together with bronchial biopsy. The present study was undertaken to ascertain the role and diagnostic utility of bronchoalveolar lavage, bronchial brush and bronchial biopsy in diagnosing lung lesions.
Method: A prospective study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from January 2016 to December 2017 (2 years). A total of 48 cases were included in the study. Bronchoalveolar lavage, bronchial brush and bronchial biopsy slides were stained with routine cytological and histological staining and examined.
Results: Out of 48 cases, bronchoalveolar lavage smears revealed 24 non-neoplastic, 19 neoplastic and 5 suspicious cases. Bronchial brush smears revealed 24 neoplastic, 22 non-neoplastic and 2 suspicious cases. Bronchoscopic biopsy revealed 31 neoplastic and 17 non-neoplastic lesions. The bronchial brush cytology showed sensitivity of 82.76%, specificity of 89.47% and accuracy of 85.42%.
Conclusion: Combination of bronchial cytology and biopsy can be considered as the best procedures for the diagnosis of lung lesions.
Employment Status of Nurses and Future Scope in Nepal
Authors: Tamrakar J Sayami
Published: July 2024

The nurse is defined by ICN as a person who has completed a program of basic, generalized nursing education providing a broad and sound foundation in the behavioral, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post- basic education for specialty or advanced nursing practice. The program is authorized by the appropriate regulatory authority to practice nursing in his/her country for the promotion of health, prevention of illness, and care of physically and mentally ill and disabled people of all ages and in all hospital and community settings. The nurse is prepared and authorized (1) to engage in the general scope of nursing practice, (2) to carry out health care teaching; (3) to participate fully as a member of the health care team; (4) to supervise and train nursing and health care auxiliaries; and (5) to be
Attitude of the Nursing Students and Practicing Nurses toward Nursing Profession in Nepal
Authors: Khatri P , Sharma MR
Published: July 2024

Introduction: Nursing is considered as a respectful profession giving a sense of value of life through their hard work such as comforting, caring and serving people and saving lives. Attitude can be formed from a person’s past and present. This profession continues to grow and the attitude of the society toward it has been changing gradually. There have been a few studies on the attitude of the nurses toward their own profession in Nepal. The primary objective of this study is to compare the attitude of the nursing students and the practicing nurses toward nursing profession.
Methods: A quantitative, prospective comparative cross sectional study design was adapted for this study. Nursing students studying proficiency certificate level (PCL)in a Nursing campus, and the practicing nurses working at a Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal were selected as study population. Attitude scale for nursing profession (ASNP) developed by Ipek- Coban and Kasikci in 2011 was adapted for the purpose of this study.
Results: A total of 240 participants were selected for the study. One hundred and twenty were nursing students and 120 were practicing nurses. Only 0.8% of nursing students had negative attitude and all practicing nurses had positive attitude toward nursing profession. The t test {t(238)=-2.868, p=0.005} value of the comparative study denoted the attitude of the students and practicing nurses was different statistically.
Conclusion: Contrary to previous beliefs, there is a strong positive attitude on nursing profession among both nursing students and practicing nurses, the attitude of the later reaching 100%. This should be considered by health care planner in formulating national policy to take a major step toward creating more scope for trained nurses which will in turn reduce brain drain.
Comparative Study of CT and Direct Cholangiogram for Evaluation of Obstructive Jaundice
Authors: Gurung GS
Published: July 2024

Introduction: The main aim of the study was to compare the findings of CT (computed tomography) and direct cholangiogram for the evaluation of obstructive jaundice.
Methods: A retrospective hospital based study was done among 62 patients with suspected biliary obstruction at Annapurna Neuro Hospital and TUTH from 2013 to 2015. CT scan of the abdomen and DC (PTC) were done in each patient. The level and cause of obstruction were evaluated by these modalitics.
Results:In this study, male to female ratio was 1:1.5 showing female predominance. The mean (+SD) age of the patients was 65.5 +15.6 years and range of from 28-94 years. CT and DC (PTC) identified hilum as the most common level of obstruction in71% and 69.4% of the patients. The most common malignancies were cholangiocarcinoma and gall bladder carcinoma, identified by CT and DC (PTC) respectively, which were present in over one third (35.5%) of the patients. Further, CT and DC (PTC) identify edpostoperative stricture as the most common benign aetiology in 6.4% and 4.8% of the patients respectively. Moreover, sensitivity of CT and DC (PTC) for malignant lesion 75% and 98% while specificity was 96.2% and 54.5% respectively (P value 0.000).
Conclusion: CT and DC (PTC) showed the almost similar accuracy in evaluating the level of obstruction at hilar region. Carcinoma of gall bladder and cholangiocarcinoma are the commonest malignancies whereas postoperative stricture was the commonest benign actiology. Early diagnosis and proper treatment will significantly reduce complication, morbidity and mortality rates.
The role of blood eosinophil level in acute exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Nizam S , Yogi KN , Das SK
Published: July 2024

Introduction: Chronic Obstructive Pulmonary Disease (COPD) has great implications on global health accounting for significant morbidity and mortality. The aim of this study was to assess blood eosinophil level in patients presenting with acute exacerbation of COPD and to check whether pre-treatment blood eosinophil level ≥2% has better improvement with the standard therapy (oxygen, corticosteroids IV/ Oral and inhaled corticosteroids/ inhaled beta 2 agonist/ inhaled muscarinic antagonists along with antibiotics and diuretics) as well as shorten the duration of hospital stay.
Methods: Blood eosinophil level was measured in 106 eligible patients on admission with the diagnosis of AECOPD, under the Department of Pulmonology and Critical Care Medicine, TUTH from December 2016 to August 2017 were included in this observational study. Clinical information was obtained and PFTs were done.
Results: A total 106 patients were enrolled. The mean age of the patients was 67±12 years with smoking history of mean pack year 24± 10.7. Among this population, 46.22% patients had blood eosinophil level ≥2% which had better improvement in general physical examination (edema and cyanosis/ P= 0.05 and 0.01), vital signs (tachycardia P=0.05) including (SPO2 P=0.01) and chest findings (crackles P= 0.01) with standard therapy compared to blood eosinophil level <2%. Similarly, significant shorter duration of hospital stay was observed in patients with blood eosinophil level ≥2% with standard therapy in comparison with blood eosinophil <2% (p=0.01).
Conclusion: Blood eosinophil level represents a potentially important biomarker that could aid treatment decision making as well as gives us a predictive idea regarding the duration of hospital stay upon admission with AECOPD.
Role of Plastic Reconstructive Surgery in the management of earthquake victims of Nepal in Tribhuvan University Teaching Hospital
Authors: Shrestha JM , Rayamajhi S , Lohani I
Published: July 2024

An earthquake of magnitude 7.8 richter on 25 April 2015 and its major aftershock on 12 May 2015 struck Nepal resulted inmassive destruction of Kathmandu valley and rural areas causingmore than 8800 mortalities and left more than 23000 injured. The casualties who were brought to the hospital were treated by various surgical specialties including plastic surgery. This is a cross sectional study in which the authors evaluated soft tissue injuries treated by the plastic surgery team in one month period after the earthquake. Information was gathered regarding pattern of soft tissue injuries and their treatment. There were total of 486 earthquakevictims admitted in the hospital and 532 major operations were performed. Total of 77 patients were admitted under plastic surgery and 115 operative procedures were perfonned for the 104 soft tissue injuries in these patients. Operations for soft tissue injuries accounted for 22% of the total operations performed. The most common operation was split thickness skin grafting (34%). Local and regional flaps were performed on ten cases (9%) and free flap was done in four cases (3.4%) ofinajor soft tissue defects requiring coverage of exposed bones. Complications occurred in 23 patients (29.87%) and included infection, skin necrosis, partial skin graft loss, Acute Kidney injury and sepsis. The authors conclude that the role of plastic surgeons is vital in disasters like earthquake and it helps in the appropriate and timely wound care and debridement and alsohelp to identify patients that would potentially benefit from limb salvage.
New method of defining existing deformities and new operative procedure for correcting the deformities in the congenital clubfeet (Hussain's procedure)- early results in primary surgery.
Authors: Lakhey RB
Published: July 2024

Abstract:
Introduction: A new method of defining the existing/persisting deformities in congenital clubfoot and a new operative procedure for correcting the deformities has been proposed.
Methods: We retrospectively evaluated 43 feet of 30 patients (12 girls, 18 boys) who underwent the new surgical procedure for congenital clubfoot. The patients were evaluated with Cummings' modification of Laaveg and Ponseti score. The mean duration of follow-up was 10.7 months.
Results: 81.3% of the cases of the idiopathic congenital clubfoot had excellent results, 16.2% had good results and 2.3% had fair results, when managed primarily with the new method of clubfoot treatment.
Conclusion: While using the new method, exact existing/persisting deformities can be pointed out and adequate correction of the deformities can be done; thus there is less risk for over-and under-correction. The early results show that this method is effective. Long term results are awaited.
Visualization of Normal Appendix in Multidetector Computed Tomography
Authors: Ansari MA , Kumar M , Subedi K
Published: July 2024

Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Visualization of normal appendix is important to exclude the possibility of appendicitis. With the widespread use of multidetector computed tomography (MDCT) for evaluation of acute abdomen, the normal appearance and rate of visualization of appendix has to be defined.
Methods: This was a prospective cross sectional study involving 250 patients undergoing abdominal CT for various indications in Tribhuvan University Teaching Hospital between October 2012 and September 2013. One hundred twenty seven patients were female and 123 were male. Age ranged from 17 years to 73 years. CT scans of the patients were obtained with a 16 slice CT scanner with IV contrast. In all patients, there was no clinical suspicion of acute appendicitis or history of appendectomy. Appendix was searched in these patients by tracing caecum.
Results: Appendix was visualized in 215 patients, 111 females and 104 males. Appendix was not visualized in 35 patients, 16 females and 19 males. In total appendix was visualized in 86% of patients (87.4% females and 84.6% males).
Conclusion: MDCT is an accurate imaging modality for detection of appendix, whether normal or pathological. Visualization rate of normal appendix by CT scan is higher ranging up to 96% as shown in various studies. Thin collimation, use of contrast and multiplanar reconstruction may be the reason for increased rate of visualization of normal appendix.
Primary Ovarian Pregnancy
Authors: Shrestha R , Singh A , Duwal Shrestha S , Pradhan B , Rokka Chettri L , Shah W
Published: July 2024

Abstract: Ovarian pregnancy is one of the rarest form of ectopic pregnancies. The classic symptoms of ectopic pregnancy may not be present in ovarian pregnancy. Preoperative diagnosis of ovarian pregnancy is still confusing. Delay in diagnosis may lead to increase maternal morbidity and mortality. We present here a case of ovarian pregnancy presenting with acute abdominal pain with no menstrual irregularities. Transabdominal ultrasonography failed to make the diagnosis of ovarian pregnancy. The case was successfully managed by surgery and diagnosis of ovarian pregnancywas confirmed later by histopathological report.
Diagnostic role of fine needle aspiration cytology in the evaluation of salivary gland lesions
Authors: Hirachand S , Kafle N , Thapa R , Gurung P
Published: July 2024

Introduction: Fine needle aspiration cytology (FNAC) is a popular method for diagnostic evaluation of salivary gland lesions due to their superficial nature and easy accessibility for the procedure. The technique is simple and cost effective. The present study was conducted to evaluate the diagnostic accuracy of fine needle aspiration cytology in various salivary gland tumors, which helps in an early diagnosis and appropriate therapeutic management.
Methods: The study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from October 2014 to September 2016 (2 years). A total of 48 fine needle aspirations of salivary gland lesions were done, of which histopathological conformation of diagnosis was available in 34 cases. A standard cytological and histopathological staining were used and examined.
Results: Forty eight cases of salivary gland lesions were included in the study. The age of patients ranged from 6 to 88years, with a mean age of 46years. Male: female ratio was 1.4:1 with common site being the parotid gland. Histopathological conformation of diagnosis was available in 34 cases. Pleomorphic adenoma was found to be the most common benign tumor (50%) and mucoepidermoid carcinoma (14.70%) was the commonest malignant tumor. The overall diagnostic accuracy of FNAC in diagnosing salivary gland lesions was 89.47% with a sensitivity of 77.77 and a specificity of 93.10%.
Conclusion: Fine needle aspiration cytology is an important and useful diagnostic tool for diagnosing salivary gland lesions. Proper sampling of lesions and adequate cellularity of the smears are the pre- requisites for accurate diagnosis. Hence, the appropriate therapeutic management could plan earlier.
Surgical Management of Primary Hyperparathyroidism: An Institutional Study on Surgical Quality Control
Authors: Nepal B , Singh YP , Pokhrel A , Sayami P , Sayami G
Published: July 2024

Introduction: Surgery is key treatment of primary hyperparathyroidism. With the inclusion of serum calcium measurement in routine biochemistry panel, majority of primary hyperparathyroidism can be detected in earlier asymptomatic phase. Preoperative localization by Ultrasonography and Sestamibi scan combined together along with CT or MRI in ectopic adenoma enables for focused minimal invasive surgery. Intraoperative intact PTH (IPTH) measurement is used as a surgical quality control in primary hyperparathyroidism surgery. This study was undertaken to look into current status of surgical management of primary hyperparathyroidism in the tertiary care center in Nepal.
Methods: This was a prospective observational study conducted in Department of Surgery. Tribhuvan University Teaching Hospital Kathmandu, Nepal from November 2014 to October 2016. Demography profile, preoperative symptoms, duration of symptoms, preoperative serum calcium, phosphate, immediate preoperative iPTH level and intraoperative iPTH level, post-operative calcium level and localization techniques were recorded. Final pathology report of each of the patients were recorded.
Results: Thirteen patients were operated for primary hyperthyroidism. Mean age of the patients was 36:15 years. None of the patient had multi-glandular disease on preoperative localization. Mean preoperative Calcium level was 12.8±0.9 mg/dl and mean preoperative iPTH level was 998+805 pg ml. As Intraoperative iPTH measurement was used to ascertain the successful adenoma removal, mean IPTH intraoperative iPTH after the removal of the adenoma was 175±167 pg/ml. Mean difference of iPTH was 823±725 (p 0.024). There was mean decrease of 81% of iPTH after surgery well above 50% decrease confirmatory of successful adenoma removal. None of patients had reported with recurrent symptoms till date.
Conclusion: Hypercalcemia should be subjected for iPTH scanning to identify more asymptomatic patients and Surgery is key treatment and intraoperative iPTH assay is used for confirmation of adenoma removal.
Impact of AI on Education: Innovative Tools and Trends
Authors: Msekelwa Dr Patrick Zingisa
Published: July 2024

Every year, digital technologies appear in every industry. The new, developing technologies offer both advantages and disadvantages. The following are some recent examples of cutting-edge innovations in technology: data science, cybersecurity, block chain technology, artificial intelligence, machine learning, quantum learning, Internet of Things (IoT), 5G and 6G networks, hyper automation, cloud computing, robotics, and natural language processing. AL and ML combined with other cutting-edge, popular technologies have the potential to yield the positive outcomes and contribute to a greener future. Personalized medicine, drug development and predictive diagnostics using large scale data sets are all areas where machine learning might be beneficial to physicians. Students studying mechanical engineering must have a solid understanding of emerging trends such as autonomous vehicles. The potential of AV to create new, improved lifestyle and revolutionize urban planning and transportation has attracted a lot of interest.  A research utilized a quantitative technique to further his research. A questionnaire was used to collect data from different participants, and 120 students from different fields in higher education sector were chosen at random. According to research, students who used popular technologies acquired more sophisticated abilities that will increase their output at work. Technology is always changing because it takes ongoing training to keep up with the latest development. The issue of the digital divide will be resolved by ongoing training.
Struktur Modal dan Nilai Perusahaan Serta Dampak Mediasi Profitabilitas Perusahaan Makanan dan Minuman Indonesia 2020-2022
Authors: Deva Adalia  , Y. Djoko Sukoco
Published: July 2024

This research seeks to examine the influence of capital structure on the valuation of food and beverage companies within the sub-sector that are listed on the Indonesia Stock Exchange during the time frame of 2020-2022, with the inclusion of profitability as a mediating factor. Employing a quantitative approach, the study utilizes a purposive sampling method to select 29 samples from a population of 42 food and beverage companies listed on the Indonesia Stock Exchange. The analysis of hypotheses is conducted through simple linear regression, multiple linear regression, and the sable test. The results of the study indicate that capital structure positively impacts profitability, influences company value in a negative manner, profitability does not directly affect company value, and profitability does not act as a mediator in the relationship between capital structure and company value.
Bodies of Internal Affairs: separate issues of functional appointment
Authors: Ulynets Volodimyr
Published: July 2024

The author points out that among the main priorities of Ukraine’s domestic policy since independence has been the creation of reliable mechanisms for security, political stability, and democracy that would correspond to the relevant mechanisms employed in the European Union. The prospect of EU membership is defined at the constitutional level and is a strategic guideline for Ukrainian aspirations for transformation and a key goal for which reforms are being carried out within the Ukrainian state. The creation and implementation of such mechanisms is the standard that will allow Ukraine to join the EU’s common security system, increase the effectiveness of control over the movement and non-proliferation of weapons of mass destruction, and bring international cooperation in the fight against organized crime, illegal migration, smuggling, terrorism, and drug trafficking to a new level.
It is noted that Ukraine’s intentions to integrate into the European space have necessitated significant changes in national legislation aimed at adapting to a wide range of norms and standards generally accepted in international and European practice. The sphere of public security protection deserves special attention from lawmakers, as human rights protection is an invariable “gold standard” that distinguishes a democratic state. Given the state-forming importance of the national police, its improvement is in the zone of increased attention from both the government and society. It is extremely important today to create an effective organizational model of police bodies capable of reliably protecting the interests of the economy and citizens, implementing such principles of reforming the Ukrainian police that would result not only in excellent work in detecting and stopping offenses but also in creating significant resources for preventing offenses.
The author demonstrates the dependence of the functional orientation of police structures on the functional orientation of the state, in particular on the form of state-legal regime it implements, which directly lays the basic principles of the activities of law enforcement structures in the country and the principles of their reform. Therefore, the logical idea arises that the functional orientation of police structures may depend on the functional orientation of the state, in particular on the form of state-legal regime it implements, which directly lays the basic principles of the activities of law enforcement structures in the country and the principles of their reform.
Principle of humanism and human rights
Authors: Bielova Miroslava , Byelov Oleg
Published: July 2024

Human and civil rights have emerged as a crucial legal institution, evolving through constitutional law, legal theory, and various legislative sectors. This institution gained prominence in the latter half of the 20th century, both nationally and internationally. It represents one of the most significant achievements in society’s legal development, tracing back to ancient times and culminating in its current status as an essential feature of democratic, rule-of-law states.
However, the contemporary approach to democracy’s principles is considered somewhat outdated. There’s a global need to reassess established concepts and develop fresh perspectives on equality, justice, and protection.
The enduring stability of human and civil rights protection is rooted in scientifically and practically tested principles. This concept’s viability and progressive nature stem from a blend of legal, moral, traditional, and other social regulatory norms. Such an approach helps prevent legal negativity from dominating the legal system and curbs legal nihilism and indifference.
Legal principles serve as indicators of law’s development and starting points for legal regulation. They should reflect fundamental values, embodying the essence of “ideal” law. These principles aim to ensure ideological consistency in lawmaking, law enforcement, and overall legal order, guiding the legal system towards universal ideals like democracy, justice, equality, humanism, and individual freedom.
Humanism, as a legal concept, views humans as supreme, self-sufficient, and self-aware beings. It manifests in at least two ways: as a moral requirement for human behavior and as a recognition of human beings as the highest social value within the state.
Los docentes digitales en Educación Superior
Authors: Parraga Menchaca Diego
Published: July 2024

Las instituciones de educación superior, docentes y estudiantes ante la pandemia COVID-19, tuvieron que realizar cambios para poder dar continuidad a las actividades académicas, ocasionando bastantes impactos a todos los actores en el proceso enseñanza-aprendizaje. Con las medidas de bioseguridad y distanciamiento social, obligaron a migrar de clases presenciales a clases virtuales, provocando procesos de adaptabilidad, reinvención y flexibilidad en plataformas tecnológicas, donde los docentes y estudiantes cumplen las actividades académicas necesarias para continuar con la formación de nuevos profesionales.
Role of Innovative Pedagogies in Achieving Excellence in Teaching of Science at Primary School Level
Authors: Iqbal Muhammad Nadeem , Batool Sidra , Qadir Snobia
Published: July 2024

The main purpose of the current study was to investigate the role of innovative pedagogies in achieving excellence in teaching of science at primary school level. To achieve the objectives of this study researcher used descriptive survey design. All the primary school teachers from districts of Multan Division constituted the population for this study. As the population of teachers was heterogeneous, therefore, the researcher used stratified proportionate random sampling technique to select the sample. Finally, 880 (477 male and 403 female) primary school teachers were selected as sample of the study. Nine hundred questionnaires were distributed among the participants and 880 finally were returned. Researcher used the statistical techniques to analyze the collected data of 880 participants by using SPSS. From the findings of data analysis, it is concluded that in general, role of innovative pedagogies in achieving in excellence in teaching of science at primary school’s level behavior more positive than negative. Furthermore, from the comparisons made on the basis of teachers’ demographics i.e. gender, area, age, years of teaching experience, academic qualification and professional qualification, it is concluded that there is significant difference in the views of teachers.
Reflection of Immigrants’ Identity Crises in Kamila Shamsie Home Fire vs. Mohsin Hamid Exit West: A Gender-Based Thematic Exploration
Authors: Rehman Ali , Hussain Muhammad Sabboor , Mukhtar Shehroz , Aqeel Muhammad
Published: July 2024

Kamila Shamsie's "Home Fire" and Mohsin Hamid's "Exit West" both discover the displacement and acknowledgement in a world that is becoming a global village. "Home Fire" throws light on the crucial integration of a loyal family member as a Muslim in a post-9/11 Western society scenario. It finds out the social and political identities that can cause conflicts. Migrants from the Western world, in contrast to "Exit West", have suffered emotional and physical suffering in the journey of refugees. It shares the love and barriers through the borders of countries. Both have different approaches to narration, and both the novels share belonging and feelings of human burdens they face during migration to the Western world. This research aims to identify and analyze themes of Kamila Shamsie's "Home Fire" and Mohsin Hamid's "Exit West". Along with this, it sheds light on the writing styles used to construct the plots of the works that share a lot of similar elements. This is qualitative research, and for analyzing themes, this study takes the help of 'Critical Theory', which was propounded in the early 20th century by the Frankfurt School. The primary source for this research is the text of the novels, through which the researchers identified major themes, and the secondary source to support the arguments is already published works by different scholars to analyze and deepen understanding of the issue/s. This research concludes that migration, identity, and political conflict are the major themes in both novels, and these themes serve a significant role in constructing the plots/stories of the novels. As an implication, this study would help readers understand the texts from several new perspectives.