bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Firm's Capital Expenditure on Working Capital Management: An Empirical Study across Industries in Pakistan
Authors: Aamir Muhammad , Ali Shah Syed Zulfiqar
Published: September 2017

Various researchers have studied the Impact of capital expenditure on working capital management. This paper aims to analyze the impact of capital expenditure in the light of the fixed effect model on 96 listed companies with respect to working capital management. Data related to the specific time period of 2007-2010 has been focused. The impact of capital expenditure, operating expenditure and finance expenditure on working capital has been analyzed. In this connection, keeping in mind nature of the variables of the study, Net Liquidity Balance (NLB) and Working Capital Requirement (WCR) has been applied as a proxy of working capital management. Then six hypotheses were conducted in two groups. In the first group, we examine the impact of capital expenditure, operating expenditure and financial expenditure on Net Liquidity Balance and in the second group, we investigate the impact of capital expenditures, operating expenditures and financial expenditures on Working Capital Requirement. Capital expenditure has the insignificant relationship with Net Liquidity Balance and Working Capital Requirement. Operating expense has the significant negative relationship with Net Liquidity Balance and significant positive relationship with Working Capital Requirement. Finance expense has the significant negative relationship with Net Liquidity Balance and significant positive relationship with Working Capital Requirement.
Impact of Asymmetric Information on the Investment Sensitivity to Stock Price and the Stock Price Sensitivity to Investment
Authors: Kouser Rehana , Saba Irum , Anjum Farah
Published: September 2017

Purpose: The purpose of the study is to find out the relation between the stock price and investment and to explore the consequence of information asymmetry on the stock price sensitivity to investment and investment sensitivity to the stock prices for the manufacturing firms that are working in Pakistan and listed at KSE.Methodology: Study was conducted by 99 firms listed at KSE and 1386 observations for the period of 2001-2014. Empirical studies were conducted based on two hypotheses by using price non-synchronous, price delay, firms' size and age as a proxy of asymmetric information and change in asset as a measure of investment.Findings: Overall results show that there is an insignificant negative correlation between the sensitivity of investment to stock prices and there is an insignificant positive correlation between the sensitivity of stock prices to the investment. The critical findings of the study are that the management must learn from the market during the decision making.Practical Implications: The research has significant impact on investors, firm management, Government and as well as for the young potential in the field of research.Originality/Value: The paper fills the research gap. It studies the impact of asymmetric information on the investment sensitivity to stock price, and the stock price sensitivity of investment in Karachi stock Exchange (Pakistan) for the first time.
Financial Performance Indicators in Lebanese Hospitals: A Sustainable Improvement Strategy
Authors: Alaaraj Hassan , Aoun Malak
Published: September 2017

Although the quality of healthcare services has been measured extensively using different approaches however; the financial approach is considered one of the most tangible indicators to evaluate the effectiveness of the implied quality improvement strategies at the Lebanese hospitals. It is essential to measure quality of performance especially when hospitals are competing for accreditation and sustainability. Therefore, this paper highlights the significant key performance indicators applied by the Lebanese hospitals and mainly the financial performance indicators to improve the healthcare financing in Lebanon. Such financial metrics are found critical for hospitals to define and evaluate their performanceespecially in terms of insurance and financial coverage. This paper demonstrates conceptually the current strategies for improving thehealthcare financing system in Lebanon yet, future studies are encouraged to provide analytical elaborations for the financial status and relativeperformance indicators of the healthcare system in Lebanon.
HUBUNGAN USIA, PARITAS DAN PERSONAL HYGIENE DENGAN HASIL PEMERIKSAAN INSPEKSI VISUAL ASAM ASETAT (IVA) DI PUSKESMAS BRANGSONG 2 KECAMATAN BRANGSONG KABUPATEN KENDAL
Authors: Cahyaningrum Frida , M Adam T.Ria Marriagewati , Dharminto Dharminto
Published: September 2017

Latar belakang: Kanker serviks adalah keganasan yang terjadi pada leher rahim tetapi terbentuknya sangat perlahan, kanker servik adalah kanker terbanyak kedua pada perempuan di Indonesia setelah kanker payudara. Ada beberapa faktor resiko yang menyebabkan kanker servik salah satunya seperti usia, hubungan seksual sejak usia muda, genetik, merokok, paritas, personal hygiene dan defisiensi zat gizi.  Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan usia, paritas dan personal hygiene dengan hasil pemeriksaan IVA.Jenis : Penelitian ini merupakan penelitian deskriptif korelatif. Sampel terdiri dari 78 orang. Variabel bebas dalam penelitian ini meliputi  usia, paritas dan personal hygiene dan variabel terikatnya hasil pemeriksaan IVA. Data dikumpulkan menggunakan kuesioner dan analisa menggunakan uji Chi Square pada tingkat kesalahan 0,05.Hasil: penelitian menunjukkan ada hubungan yang bermakna antara usia dengan hasil pemeriksaan IVA dengan signifikansi (P) = 0,00; ada hubungan yang bermakna antara paritas dengan hasil pemeriksaan IVA dengan signifikansi (P) = 0,05; tidak ada hubungan antara personal hygiene dengan hasil pemeriksaan IVA dengan signifikansi (P) = 0,73. Simpulan: penelitian menunjukkan ada hubungan yang bermakna antara usia dengan hasil pemeriksaan IVA; ada hubungan yang bermakna antara paritas dengan hasil pemeriksaan IVA; tidak ada hubungan antara personal hygiene dengan hasil pemeriksaan IVA.
MANFAAT STIMULUS OTOT-OTOT PAYUDARA (BREAST MASSAGE) DAN PENGELUARAN OKSITOSIN (PIJAT OKSITOSIN) TERHADAP VOLUME KOLOSTRUM PADA IBU POSTPARTUM
Authors: Parmila Naomi , Yulianingsih Tuti
Published: September 2017

Tidak memberikan ASI pada bayinya dapat mengganggu pemenuhan kebutuhan nutrisi bayi. Selain itu, juga karena kurangnya pengetahuan ibu tentang cara-cara untuk meningkatkan volume kolostrum dan produksi ASI yang dalam hal ini yaitu mengenai stimulus otot-otot payudara dan pengeluaran oktosin. Diare erat kaitannya dengan perilaku sehat, ketersediaan air bersih, serta sanitas dasar. Pneumonia terkaid eratdengan indioor and outdoorpollution (populasi didalam dan diruangan), ventilasi, kepadatan hunian, jenis bahan bakar yang dipakai, kebiasaan merokok, status gizi, ststus imunisasi dan lam pemberian ASI (Depkes RI, 2011). Populasi dalam penelitian ini ibu pos partum yang terdaapat pada RSUD Hj. Anna Lasmanah Banjarnegara.penelitian ini menggunakan teknik sampel incidental. Berdasarkan data penelitian yang diperoleh di RSUD hj. Anna Lasmanah Banjarnegara menunjukkan bahwa tindakan Stimulasi otot-otot payudara (brast massage) dan pengeluaran oksitosin ( pijat oksitosin (pijat oksitosin) berpengaruh terhadap kolostrum. Stimulus adalah perangsang organ bagian tubuh atau resseptor lain untuk menjadi aktif (Kamus Besar Indonesia, 2005). Breakst massase adalah rangsangan melalui serabut syarF memacu hipofise posterior untuk melepas hormon oksitosin dalam darah. Manfaat dari breast massage adlah melancarkan reflex let down, meningkatkan volume ASI dan encegah payudara bengkak. Berdasarkan hasil penelitian yang diperoleh dalam penelitian ini ddapt disimpulkan bahwa : terdapat manfaat yang bermakna antara stimulasi-stimulasi otot-otot payudara (brast massage) dan pengeluaran oksitosin (pijat okstosin) terhadap volume kolostrum pada ibu post partum.
OPTIMALISASI PERAN KADER DALAM PEMANFAATAN BUKU KIA DI PUSKESMAS TEGALREJO KOTA YOGYAKARTA
Authors: Wijhati Ellyda , Suryantoro Purnomo , Rokhanawati Dewi
Published: September 2017

Buku KIA berisi catatan kesehatan ibu dan anak, serta berbagai informasi kesehatan cara memelihara dan merawat kesehatan ibu dan anak.  Di Indonesia buku KIA kurang dimanfaatkan secara optimal, terbukti dengan rendahnya kesadaran ibu untuk membaca pesan yang terdapat dalam Buku KIA. Tujuan penelitian adalah menganalisis hubungan peran kader dengan pemanfaatan buku KIA oleh ibu. Jenis penelitian adalah survey analitik dengan pendekatan waktu cross sectional. Variabel bebas peran kader,  variabel terikat yaitu pemanfaatan buku KIA. Populasi penelitian yaitu ibu yang memiliki anak bawah usia dua tahun (0-23 bulan), teknik pengambilan sampel Cluster Random Sampling sejumlah 119 responden. Analisis data meliputi analisis univariat, analisis bivariat dengan chi square. Hasil penelitian terdapat hubungan antara peran kader (p= 0,008 RP=1,655 CI 95%= 1,127-2,430) dengan pemanfaatan buku KIA. Kader yang berperan baik meningkatkan kemungkinan pemanfaatan buku KIA sebanyak 1,6 kali lebih besar. Diharapkan kader dapat meningkatkan pemanfaatan buku KIA terutama dalam fungsi media pendidikan kesehatan serta catatan pemantauan tumbuh kembang anak.
EFEKTIVITAS MASSAGE LUMBAL DAN BREAST MASSAGE TERHADAP KONTRAKSI UTERUS PADA IBU BERSALIN KALA I
Authors: Suparti Ipang , Prihadi Ullys Indraria
Published: September 2017

Penyulit dalam persalinan antara lain adanya kelainan presentasi dan posisi, distosia karena kelainan alat kandungan, distosia karena kelainan janin, dan distosia karena kelainan his (Manuaba, 2010). Distosia karena kelainan his dapat terjadi karena sifat his yang berubah-ubah, tidak adanya koordinasi dan sinkronisasi kontraksi dan bagian–bagiannya sehingga kontraksi tidak efisien dalam mengadakan pembukaan. Kelainan his juga dapat terjadi karena his yang tidak adekuat untuk melakukan pembukaan serviks atau mendorong anak keluar. His yang tidak adekuat ini disebut dengan inersia uteri (Leveno K, 2010 dalam Atun Raudotul dkk). Upaya non farmakologis merupakan suatu upaya untuk membantu timbulnya kontraksi tanpa bantuan obat atau bahan sintetik lainnya. Dimana upaya tersebut dengan melakukan pijatan pada bagian tubuh agar merangsang pengeluaran oksitosin secara lebih alami dan aktif sehingga diharapkan tidak menimbulkan efek yang berbahaya bagi ibu maupun janin. Sampel pada penelitian ini yaitu ibu bersalin kala I di BPM Siti Sugiharti pada periode Maret-April 2016. Teknik pengambilan sampel pada penelitian ini menggunakan purposive sampling. Jenis penelitian ini menggunakan metode penelitian kuantitatif dengan desain penelitian quasi experimental yaitu desain yang mempunyai kelompok kontrol, tetapi tidak dapat berfungsi sepenuhnya untuk mengontrol variabel-variabel luar yang mempengaruhi pelaksanaan eksperimen (Sugiyono, 2013). tindakan massage lumbal yang dilakukan pada ibu bersalin kala I terjadi peningkatan kontraksi uterus sebanyak 20 (95,24%) responden. Sedangkan pada tindakan breast massage terjadi peningkatan kontraksi uterus sebanyak 19 (90,48%) responden. Penelitian ini dapat disimpulkan bahwa tindakan massage lumbal yang dilakukan pada ibu bersalin kala I lebih berhasil dibandingkan dengan breast massage. Terdapat perbedaan kontraksi uterus sebelum dan setelah dilakukan Breast Massage terhadap peningkatan kontraksi uterus pada ibu bersalin kala I lama (t = 8,862, p value = 0,000).
HUBUNGAN KARAKTERISTIK DAN DUKUNGAN TENAGA KESEHATAN DENGAN PERILAKU WANITA USIA SUBUR (WUS) TENTANG PEMERIKSAAN PAYUDARA SENDIRI (SADARI) UNTUK DETEKSI DINI KANKER PAYUDARA DI KELURAHAN BULUSTALAN KOTA SEMARANG
Authors: Nining Anggraini Novita
Published: September 2017

Latar belakang: Masalah kanker payudara ditandai dengan masih tingginya angka kematian yang disebabkan paling utama oleh karena keterlambatan diagnosa, diikuti keterlambatan pengobatan. Keterlambatan diagnosa lebih disebabkan oleh karena kedatangan pasien di rumah sakit pada stadium lanjut. Beberapa data menunjukkan bahwa lebih dari 50% pasien datang dalam stadium lanjut (Stage III dan IV). Risiko kanker payudara akan semakin meningkat dengan bertambahnya usia. Usia termuda untuk terjadinya kanker payudara adalah usia 10 – 14 tahun dan peningkatan prevalensi kanker payudara terjadi pada kelompok usia kurang dari 45 tahun dan Masa inkubasi masa kanker payudara diperkirakan 8-12 tahun. Tujuan penelitian : mengetahui berhubungan karakteristik dan dukungan tenaga kesehatan dengan perilaku SADARI untuk deteksi dini kanker payudara pada wanita usia 20-40 tahun di Kelurahan Bulustalan Kota Semarang. Jenis penelitian : deskriptif korelasi. penelitian deskriptif kuantitatif dengan pendekatan cross sectional. Variabel bebas adalah karakteristik umur dan pendidikan dan sebagai variabel terikat adalah perilaku wanita terhadap parktik SADARI. Sebanyak 104 wanita usia 20 – 40 tahun yang menjadi sampel penelitian. Pengumpulan data menggunakan angket. Analisis data secara univariat dan bivariat dengan uji statistik chi square. Hasil: tidak ada hubungan yang signifikan dengan perilaku SADARI (p value 0,202 dan hasil uji chi square dengan CI = 95% p value > (0,05 ) tidak ada hubungan yang signifikan terhadap perilaku SADARI dengan p value 0,096 dan hasil uji chi square dengan CI = 95% p value > (0,05), tidak ada hubungan yang signifikan antara dukungan tenaga kesehatan dengan perilaku SADARI, p value 0,113.
HUBUNGAN PENGETAHUAN REMAJA PUTRI TENTANG ANEMIA DENGAN PERILAKU PENCEGAHAN ANEMIA PADA SAAT MENSTRUASI DI SMK NUSA BHAKTI KOTA SEMARANG
Authors: Mularsih Sri
Published: September 2017

Latar Belakang : Remaja putri rentan terkena anemia. Adanya siklus menstruasi setiap bulan merupakan salah satu faktor penyebab remaja putri mudah terkena anemia lebih-lebih didorong oleh pengetahuan mereka yang kurang tentang anemia . Berdasarkan studi pendahuluan dari 10 remaja putri, sebagian besar remaja putri mempunyai pengetahuan yang rendah tentang anemia, selain itu remaja putri juga belum mempunyai perilaku yang baik untuk mencegah anemia seperti konsumsi tablet tambah darah, pengaturan pola makan tinggi zat besi, dan konsumsi minuman yang menghambat penyerapan zat besi. Kondisi ini mendorong penulis melakukan penelitian untuk pengetahuan remaja putri tentang anemia dengan perilaku pencegahan anemia pada saat menstruasi di SMK Nusa Bhakti Semarang.Metode : Penelitian ini adalah penelitian korelasi. Menggunakan rancangan penelitian cross sectional. Populasi penelitian ini adalah remaja putri SMK Nusa Bhakti Semarang sebanyak 155 responden dengan teknik sampling menggunakan purposive sampling dengan sampel sebanyak 61 responden. Cara pengumpulan data yaitu dengan data primer dan data sekunder. Analisis univariat dilakukan dengan cara mendeskripsikan tiap variabel, sedangkan analisis data bivariat dilakukan dengan uji Chi Square dan menggunakan program SPSS for window versi 16.0.Hasil penelitian : pengetahuan remaja yang kurang tentang anemia sebanyak 40 remaja (65,6%), perilaku yang tidak mendukung terhadap pencegahan anemia sebanyak 36 remaja (59%). Hasil penelitian mendapatkan nilai P = 0,000, dengan demikian Ho ditolak dan Ha diterima yang berarti penelitian ini menunjukkan adanya hubungan signifikan antara pengetahuan remaja putri tentang anemia dengan perilaku pencegahan anemia pada saat menstruasi di SMK Nusa Bhakti Semarang.Simpulan : Perlunya peningkatan pengetahuan remaja putri tentang anemia untuk pencegahan anemia pada saat menstruasi. Peran dari tenaga kesehatan, pemerintah setempat, dan institus i kesehatan terkait untuk melakukan peningkatan kesehatan terkait pencegahan anemia pada saat menstruasi pada remaja putri.
HUBUNGAN PERILAKU PEMBERIAN MAKANAN PENDAMPING ASI DENGAN STATUS GIZI BAYI USIA 6-11BULAN DI WILAYAH BEJI SIDOARUM GODEAN SLEMAN
Authors: Hadi Enny Fitria
Published: September 2017

Abstrak : Masalah gizi adalah hal yang sangat penting dan mendasar bagi kehidupan manusia. Kekurangan gizi selain dapat menimbulkan masalah kesehatan (morbiditas, mortalitas dan disabilitas), juga menurunkan kualitas sumber daya manusia (SDM) suatu bangsa. Dalam skala yang lebih luas, kekurangan gizi dapat menjadi ancaman bagi ketahanan dan kelangsungan hidup suatu bangsa (Depkes, 2013). Menurut laporan dinas kesehatan Propinsi DIY tahun 2013, jumlah prevalensi gizi buruk yang ditemukan di kota  Gunung Kidul 4,7%, Yogyakarta 4,3%, Sleman 5,5%, Bantul 2,1%,dan  Kulon Progo 2,4%. Tujuan dari penelitian ini untuk mengetahui hubungan perilaku pemberian makanan pendamping ASI dengan status gizi pada bayi usia 6-11 bulan di Wilayah Beji Sidoarum Godean Sleman. Metode penelitian menggunakan survey analitik yaitu suatu penelitian yang mencoba menggali bagaimana dan mengapa fenomena kesehatan itu terjadi. Pengambilan sampel dilakukan secara menggunakan Simple Random Sampling dilakukan secara acak tanpa memperhatikan strata yang ada. Metode Penelitian : Penelitian ini merupakan penelitian kuantitatif, dengan metode survey analitik yaitu suatu penelitian yang mencoba menggali bagaimana dan mengapa fenomena kesehatan itu terjadi dengan pendekatan cross sectional. Teknik pengambilan sampel dalam penelitian ini adalah teknik sampling jenuh. Sampel berjumlah 57 bayi. Analisis data menggunakan chi square. Hasil Penelitian : Berdasarkan hasil uji Chi Square yaitu p-value yang diambil dari pearson Chi-Square yaitu 0.000. sehingga p-value 0.000 < 0.05 dapat disimpulkan ada hubungan perilaku pemberian makanan pendamping ASI dengan status gizi bayi usia 6-11 bulan di wilayah Beji Sidoarum Godean Tahun 2017. Saran bagi ibu diharapkan lebih aktif lagi dalam menggali informasi yang benar tentang pemberian makanan pendamping ASI sehingga ibu dapat memberikan makanan pendamping ASI dengan tepat waktu.
Knowledge about emergency management of dental trauma among school teachers of Bhaktapur Nepal
Authors: Pradhan Megha , Joshi Ujjwal , Aryal Umesh Raj , Upadhyay Sumita , Shrestha Amrita
Published: September 2017

Background: Injury to a young child’s teeth and face is a traumatic experience for the child and parents. Prompt and effective action on traumatized teeth significantly increases the likelihood of a positive treatment outcome. Adequate knowledge of school teachers in emergency situation arising during school hours can prove to be a boon for the child’soral health.Objectives: To assess the knowledge of school teachers of Bhaktapur about emergency management of dental trauma and also to measure the relationship between socio demographic characteristic of teachers and knowledge about dental emergencies.Methods: The cross sectional study was conducted among 424 schools teachers of Bhaktapur district from September 2014 to March 2015. Simple random sampling was done to select the schools. Questionnaire was distributed among the teachers after taking their informed written consent. Data was collected and sent for statistical evaluation. Frequenciesand percentage were calculated. Chi-square and Fisher’s Exact test were applied.Results: Nearly one third (32.2%) teachers who had information on dental trauma knew the proper management of displaced teeth (p=0.01). Statistically significant difference was found among those who had fi rst aid training and proper management of displaced teeth (p=0.04). Teachers who had experienced dental trauma in their students were only confident of managing displacement of traumatized teeth (p=0.02).Conclusion: Knowledge of the school teachers in Bhaktapur was seen to be inadequate for emergency management of fracture and avulsed tooth.
Opportunity in disguise
Authors: Timalsina Yagya Prasad
Published: September 2017

Not available.
Revisiting the great earthquake of Nepal 2015: Lessons learnt
Authors: Lakhey Shishir
Published: September 2017

No abstract available.
Patterns of psychiatry morbidity in referred patients attending psychiatry out patient department in a tertiary centre
Authors: Malla Deep Prakash , Basnet Rachana Sharma , Pokharel Aakriti Malla
Published: September 2017

Background: Consultation-liaison psychiatry is an important part of psychiatry dealing with cases having co morbid general medical conditions. Psychiatrists need to be involved in evaluation of patients referred from other specialties.Objectives: To assess the patterns of psychiatry morbidity in referred patients attending psychiatry out patient department of Kathmandu Medical College.Methods: A total of 200 patients were referred to the department of psychiatry from different out patient departments during a period of six months. Each of them underwent a detailed psychiatric evaluation.Results: The mean age of the patients evaluated was 36.03 years; most of them were females (66.5%), married (67%), educated up to class seven (28%) and housewives (32.5%) living in a nuclear family (62.5%) coming from a middle income socio-economic status (75%). More than half (52%) referrals were from Medical ward coming with the chief complaint of headache (18.5%) followed by disturbance in sleep pattern (17%) and pain in more than three sites (17%). The most common psychiatric diagnosis was depression (49%) followed by anxiety (35.5%). A majority of the patients (55%) perceived their illness to be neurological and had received alternative treatment from a faith healer (26%) before being referred to the psychiatric out patient department.Conclusion: Psychiatric consultation was sought mostly by medical out patient department that had maximum number of patients. The commonest diagnosis seen in the referred out-patients was depression and anxiety disorder. Patients mostly presented with vague somatic complaints such as headache, disturbance in sleep pattern and pain over morethan three sites of the body.
Analyzing uterine rupture: A study from tertiary care centre of western Nepal
Authors: Shrestha Junu , Shrestha Rami
Published: September 2017

Background: Rupture uterus is a serious obstetric complication which if diagnosed and managed early improves foetomaternal outcome.Objectives: To determine the frequency, causes, management aspects and foeto-maternal outcome of uterine rupture.Methods: This is a cross sectional observational study conducted in Department of Obstetrics and Gynaecology of Manipal Teaching Hospital from July 2012 to June 2015. All cases of rupture uterus, both complete as well as incomplete, diagnosed during surgery were included. Patient’s demographic variables, clinical presentation, risk factors for rupture were studied. Factors related to rupture like the type, nature and site of uterine rupture were noted. The operative management, maternal and neonatal outcome of the patients was reviewed. All the information was entered in the Microsoft Excel chart sheet. Data was analyzed using simple frequencies and percentages.Results: There were 22 cases of uterine rupture and 7987 deliveries during that period giving frequency of 2.8 rupture uterus in every 1000 deliveries. Uterine scar following previous cesarean section was the commonest (72.7%) cause for rupture uterus. Repair was the commonest (86.4%) surgical treatment done. There was no maternal mortality. Blood transfusion was needed two-third of the cases. Other complications were bladder injury (9.1%), paralytic ileus (9.1%), acute renal failure (4.5%) and pneumonia (4.5%). The perinatal mortality was 45.5%.Conclusion: Uterine rupture is a grave obstetric event with maternal and perinatal morbidity and commonly follows pregnancies with scarred uterus.
Inferior vena cava anomalies: Incidental finding in two cases during computed tomography scan
Authors: Mubarak Mohd Yusof , Izyan Ismail , Najwa Paiman
Published: September 2017

Inferior vena cava anomaly is usually asymptomatic. It is rare and commonly detected while performing abdominal imaging for other clinical situations. The anomalies can mimic normal anatomical structures. Thus, the identification of the anomalies is important to avoid complication during abdominal procedures. We report two cases of inferior vena cava anomalies found during Computed Tomography scan of our elective cases.
Surgeon’s physical and mental stress while performing laparoscopic cholecystectomy
Authors: Joshi Mukund Raj , Bohara Tanka P , Parajuli Anuj , Rupakheti Shail
Published: September 2017

Background: Laparoscopic cholecystectomy is performed either by four port or three port. Although the overall patient outcome has been studied with comparable results, surgeon’s stress level has not been addressed commonly.Objective: To compare the difference in surgeon’s physical and mental stress between three port and four port laparoscopic cholecystectomy.Methods: This prospective randomized comparative study was carried out from January 2014 to August 2014 in patients undergoing laparoscopic cholecystectomy with American technique. Patients were randomized into four port laparoscopic cholecystectomy group and three port laparoscopic cholecystectomy group. Surgery was performed by experienced laparoscopic surgeons. At the end of procedure, surgeons were given questionnaire to evaluate physical and mental stress faced by them based on Visual Analogue Scale. The results obtained were compared.Results: Total 60 cases were evaluated, 30 in each group. Mean age of patients and American society of Anesthesiologists score were not different. Surgeon’s perception regarding physical and mental stress while performing in two different groups was analyzed. The difference is not statistically significant. Neither any of the three port group needed to add additional port nor any of the patients were converted to open surgery. None of the patient in either group developed clinically significant complication.Conclusion: Both the four and three port laparoscopic cholecystectomy techniques are comparable in regards to patient outcome as well as to the physical and mental stress experienced by the surgeons.
Microbial keratitis: A five years retrospective clinical study in tertiary eye hospital of eastern region of Nepal
Authors: Puri Lila Raj , Shrestha Gauri Shankar
Published: September 2017

Background: Corneal ulcer is a sight threatening disease of significant public health concern. Early diagnosis with microbiological identification of the causative organism and institution of the proper medical therapy are important for successful visual recovery.Objectives: To find out the demographic and predisposing factors associated with corneal ulcers, evaluate management of ulcers on the basis of clinical features and corneal scraping results.Methods: It was a retrospective clinical study conducted among 1897 subjects with microbial keratitis in Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from January 2010 to December 2014. Assessment included detailed eye examination with slit lamp for size, depth and location of ulcer, presenting visual acuity on internally illuminated Snellen’s chart, and corneal scrapings for Gram’s stain and 10% Potassium hydroxide wet mount. A standard treatment was delivered on the basis of clinical features and corneal scraping results. Subjects were evaluated subsequently after 48 hours, one week, two weeks, three weeks and four weeks of initiation of therapy. Non-responding cases were admitted to perform re-scraping and to modify therapy.Results: Majority of subjects (71.2%) belonged to the age group of 26 to 55 years  (71.2%), presented after two weeks (82.3%) and used non-prescription eye drops (71.9%) before visiting to the eye hospital. Ocular trauma (54.5%) was the most commonly reported predisposing factor. The central and paracentral ulcers comprised of 72.8% of ulcers withsize greater than 2mm in 2.7% and moderate ulcer in 71.1%. Microbiological test revealed fungal ulcers in 78.1% subjects. Presenting visual acuity better than 6/18 was reported in 7% only.Conclusion: Corneal ulcer was one of the commonly reported eye disease in Terai region of Nepal. Trauma is the commonest cause of corneal infection. Fungal corneal ulcers werecommonly noted.
Compliance and outcome of implementing World Health Organization surgical safety check list in surgical practice in a teaching hospital
Authors: Shrestha Suman Kumar , Thapa Prabin Bikram , Lama Tseten Yonjan , Maharjan Dhiresh Kumar
Published: September 2017

Background: Surgical complications represent a signifi cant cause of morbidity and mortality with the rate of major complications after inpatient surgery in industrialized countries. The purpose of this study was to summarize experience with surgical checklist use and efficacy for improving patient safety.Objective: To evaluate the compliance of implementation and outcome of World Health Organization Surgical checklist use in surgical practice at Kathmandu Medical College.Methods: This is a prospectively designed descriptive study including adult patients undergoing surgical procedure in Kathmandu Medical College Hospital from June 2013 till June 2014. Obtained data on compliance of World Health Organization safety checklist use by practitioner and its outcome in patient’s safety were assessed using SPSS version 15.The surgeries that underwent under local anesthesia were excluded from the study.Results: World Health Organization checklist was implemented in all 288 patients undergoing various surgical procedures with acceptable compliance by all 41 practitioners. Although it had no impact on correctable mortality and morbidity, frequent instrument malfunctions were offi cially recorded. Attitudes towards use of checklist was good as 100% of participants wanted use of checklist if they were having operation on themselves. However 22% of the participants complained of extra time needed to fi ll the checklist. Time taken to fi ll up sign in column of checklist was on average from 120 to 150 seconds (mean 135±5secs) and sign out was 80-100 seconds (mean 95±6secs). Only 69% of the participants were available for sign out. Scissor malfunction was detected in 4(1.38%) cases and operation theatre table related problem was found in one case (0.34%).Conclusion: Implementation of World Health Organization Surgical Safety Checklist can be done with acceptable compliance and instrumental malfunction was well documented.
Clinical correlation between Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient
Authors: Thapa Prabin Bikram , Maharjan Dhiresh Kumar , Tamang Tseten Yonjon , Shrestha Suman Kumar
Published: September 2017

Background: Bleeding oesophageal varices are a major complication of portal hypertension following liver cirrhosis. Child Pugh’s score has been used as a prognostic tool while managing a patient with liver cirrhosis.Objective: To clinically correlate Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient.Methods: This is a prospective descriptive study done from January 2014 to January 2015. Cirrhotic patients who were referred for upper gastrointestinal endoscopy with or without history of upper GI bleeding were included. Patients were categorized according to Child Pugh’s score into A, B, C and correlated with their endoscopic finding of grading of varices.Results: A total of 50 cirrhotic patients underwent upper gastrointestinal endoscopy during one year. Out of which 60% were in Child Pugh’s category A, 30 % in category B and 10 % in category C. Among them 62% had grade I varices, 20% had grade II varices and 18 % had grade III varices. Those who presented with history of hematemesis had higher grades of oesophageal varices in comparison to those without hematemesis.Conclusion: Cirrhotic patients with higher Child Pugh’s score had higher grades of oesophageal varices leading presentation with hematemesis. Hence, routine screening of cirrhotic patient is necessary before the development of varices.
Anthropometric study of facial index of medical students
Authors: Pandey Niraj , Gogoi Parmananda , Budathoki Deepesh , KC Gopal
Published: September 2017

Background: The human facial contour has always been an interesting subject for anatomists, anthropologists, plastic surgeons and artists. The purpose of study was to create and evaluate data on face anthropometry.Objectives: To determine total facial index in medical students and to compare these with the data from other population for use in forensic, archaeological studies, anatomy and plastic surgery.Methods: This is a descriptive study. A total of one hundred and forty medical students, presently studying at Kathmandu Medical College, aged between eighteen and twenty four years were selected as the subjects for the present study. Among the one hundred and forty students, forty four were female and ninety six were male. Two measurements:morphological facial length and bizygomatic breadth were taken by using spreading calibre.Results: The mean morphological facial length was 110.7mm with a standard deviation of 5.98mm in males and 102.1mm in females. Bizygomatic breadth was 130.8 mm in males & 123.5mm in females. The facial index (mean) was 86.09 in males and 84.84 in females.The dominant type of face shape in males was mesoproscopic (48.66%) followed by euriprosopic (23%), leptoprosopic (13.33%), hypereuriprosopic (13%) & hyperleptoprosopic (2%). In females the dominant type of face was also mesoprosopic (37%) followed by hypereuriprosopic (22%), euriprosopic (20.33%), leptoprosopic (19%) and hyperleptoprosopic (1.66%).Conclusion: The dominant phenotype in the studied population was mesoprosopic. The data obtained may be useful in anthropological research, forensic, genetic research, as well as in medical clinical practice.
Choice of career by medical students
Authors: Neopane Arpana
Published: September 2017

Not Available.Journal of Kathmandu Medical College, Vol. 5, No. 1, Issue 15, Jan.-Mar., 2016
Use of antibiotics in newborns with maternal history of premature rupture of membrane
Authors: Manandhar Sunil Raja , Manandhar Dharma Sharna
Published: September 2017

Background: The premature rupture of membrane is a major risk factor for the early onset sepsis in neonates. It increases the risk of serious neonatal infection to one percent, compared to 0.5% for women with intact membrane. There is a conventional practice of using antibiotics in most of the babies with maternal history of premature rupture of membrane >18 hours. It is noticed that all the babies may not need prophylactic antibiotics in these conditions and there should be judicial use of antibiotics in babies with maternal history of premature rupture of membrane.Objectives: To identify the risk factors for use of antibiotics in newborn babies born at Kathmandu Medical College Teaching Hospital with maternal history of premature rupture of membrane and to observe the outcome of the babies.Method: This is a prospective observational study done at Kathmandu Medical College Teaching Hospital. All newborns with maternal history of premature rupture of membrane for more than 18 hours were screened for neonatal sepsis and managed according to the treatment protocol. Ethical clearance was obtained and data were analyzed in statistical package for social science 16.Results: Among 160 cases included, 99 (62%) mothers received antibiotics for premature rupture of membrane and only 54 (35%) babies’ required antibiotics. Among them 30 babies required oral antibiotics, 20 babies required injectable antibiotics and four babies required both antibiotics(oral and injectable), which is statistically signifi cant (p value 0.03 ).Conclusion: This study has highlighted that every babies may not need antibiotics with maternal history of premature rupture of membrane. The use of antibiotics to mother for PROM before delivery has a signifi cant benefi ciary effect to babies reducing incidence of sepsis.Journal of Kathmandu Medical College, Vol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 3-10
Assessment of rotahaler inhalation technique among patients with chronic obstructive pulmonary disease in a teaching hospital of Nepal
Authors: Sapkota Diksha , Amatya Yogesh Raj
Published: September 2017

Background: Inhalation mode of drug delivery is the mainstay treatment for chronic obstructive pulmonary disease, however; incorrect technique prevents patients from receiving maximal therapeutic benefi ts.Objectives: To assess usage technique of rotahaler among patients with chronic obstructive pulmonary disease and identify factors affecting its performance.Methods: Descriptive cross sectional study was conducted to assess rotahaler (single unit dose dry powder inhaler) inhalation technique among patients with chronic obstructive pulmonary disease in Kathmandu University Teaching Hospital. The study population consisted of 100 respondents using rotahaler for at least one year. Data collection was done by standard checklist, semi structured questionnaire via observation and interview methods respectively.Results: Correct inhalation technique was found in 37% of total respondents. Nearly two out of three respondents (61%) failed to breathe out deeply before inhaling. Majority of the respondents (59%) failed to hold breath for at least 10 second and 25% were unable to breathe in deeply. Age, occupation, source of inhalation instruction and re-demonstration of the technique were found to be signifi cantly associated with the correct inhalation technique (p <0.05).Conclusion: More than half of the respondents had incorrect inhalation technique, so health education program targeting the common identifi ed errors should be carried out. Arrangements should be made for regular involvement of pharmacist in teaching and re-demonstration to ensure good inhaler technique. This would ultimately lead to a greater clinical response and improved patient compliance.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 11-17
Safety of laparoscopic management of ovarian dermoid cyst
Authors: Shrestha Nira Singh , Bajracharya Junu , Saha Rachana
Published: September 2017

Background: In the recent years, with the advancement of laparoscopic surgery, management of ovarian dermoid cysts is possible with laparoscopic approach. Concerns regarding safety of the procedure has been raised.Objective: To analyze the safety of laparoscopic surgery done for ovarian dermoid cyst at Kathmandu Medical College Teaching Hospital.Methods: This is a descriptive study done from July 2012 to June 2015. All the cases with the diagnosis of ovarian dermoid cyst managed laparoscopically during the study period were enrolled in the study. Thorough history, clinical examination fi nding and diagnostic modalities were noted. Three port laparoscopy was done for the management of dermoid cyst. Thorough peritoneal lavage with warm saline was done at the end of the procedure in the cases with spillage.Variables like preoperative diagnosis, postoperative diagnosis, and type of surgery performed, rate of spillage, features of chemical peritonitis if any and duration of hospital stay were noted and analyzed.Results: Total 52 cases with the preoperative diagnosis of dermoid cyst were managed with laparoscopy during the study period. Of these, only 46 cases (88.46%) were dermoid cyst on laparoscopy. In majority of the cases (45.65%) diagnosis was incidental by Ultrasound scan done for other indications. Cystectomy was performed in 42 cases (91.30%) and in 4 cases (8.69%) oophorectomy was done. Spillage occurred in approximately 89% of the cases but there were no cases of chemical peritonitis. Duration of hospital stay ranged between 2 to 5 days.Conclusion: Laparoscopic management of ovarian dermoid cyst is a safe procedure.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 18-22
Knowledge and practices regarding menstrual hygiene among adolescent girls of rural Nepal
Authors: Parajuli Puspa , Paudel Narayani , Shrestha Santoshi
Published: September 2017

Background: Adolescence is a transition period from childhood to adult life during which pubertal development and sexual maturation takes place, thus adolescents have to face physiological development challenges. Adolescent girls often lack knowledge regarding reproductive health including menstrual hygiene which can be due to socio-cultural barriers in which they are grown up.Objective: To assess the knowledge and practices regarding menstrual hygiene among adolescent girls.Methods: A descriptive study was done among one hundred and two adolescent girls of Shree Jansewa Higher Secondary School, Bayarban-8, Morang, where data was collected from the adolescent girls meeting the inclusion criteria.Results: It was found that majority (83.3%) of girls knew that menstruation is a physiological process, 52% knew that it is caused by hormone. More than half of the respondents (53.9%) were taught about menstruation by their mother. Only 33.3% of the respondents used sanitary pad during menstruation. Adolescent girls still have different type of restrictions during menstruation like not being allowed to cook food, not being allowed to visit holy places and sleep in own house during menarche.Conclusion: Socio–cultural restrictions regarding menstruation still persist and knowledge regarding menstrual hygiene among adolescent girls was found to be unsatisfactory. So, the girls should be educated about the process of menstruation, use of proper pads for absorbents and its proper disposal. This can be achieved by giving them proper training and health education by teachers, family members, health educators, and media so that there won’t be any misconception to the adolescent girls regarding menstrual hygiene.Journal of Kathmandu Medical College Vol. 5, No. 1, Issue 15, Jan.-Mar., 2016, page: 23-27
Cerebellopontine angle meningioma extending into internal auditory canal presenting with unilateral facial weakness and sensorineural hearing loss: Case presentation with review of literature
Authors: Kumar Ravinder , Jaiswal Gagan , Bhargava Abhishek , Kundu Jyoti
Published: September 2017

Tumour types other than schwannomas are uncommonly encountered in the cerebellopontine angle, and unusual lesions extending into the internal auditory canal are even rarer. We herein present a case of a 50-year-old woman with a right cerebellopontine angle meningioma (measuring 34mm x 35mm x 36mm), arising from the posterior surface of the petrous bone or the petrotentorial junction, secondarily involving the internal auditory canal. Contrast enhanced MRI showed typical appearance of a meningioma, with calcifi ed fl at surface against the petrous bone, a hemispheric or ice-cream-cone shape sign, adjacent hyperostosis, and ‘dural tail’ extending from the tumour. Initial clinical evaluation revealed continued presence of a stable neurological defi cit such as unilateral headache, hearing loss, reduced taste sensation, positive corneal and conjunctival refl ex along with right facial weakness (House-Brackmann grade III) signalling towards the involvement of V, VII and VIII cranial nerve. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumour has to be kept in mind, and preservation of these vital neural structures should be the goal in every case. Tumour resection was performed through a suboccipital-retrosigmoidal approach with a good outcome. Ours is an unusual case report analysing the diagnostic and therapeutic issues, surgical management strategies and treatment outcomes related to this rare disease entity.Journal of Kathmandu Medical College Vol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 34-40
Infrared Spectra of the Ices at ≈4 K and the Interpretation of the vOD(D2O) Bands of Ices II and IX
Authors: Bates F. E. , Jacobs S. M. , Bertie J. E.
Published: September 2017

We have studied the infrared absorption by the OD stretching, vOD(D2O), and D2O rotational, vR(D2O), vibrations of fully deuterated ice II and ice IX at lo K, and the absorption by OD stretching vibrations, vOD (HDO), of HDO molecules isolated in ices Ih, II, and IX at 10 K. Calculations of the frequencies and relative intensities of the zero-wave-vector normal vOD(D2O) vibrations of ices II and IX have allowed the vOD(D2O) absorption to be assigned. Each component of the band is broad, even at 10 K, most probably because of Fermi resonance between the fundamental OD stretching vibrational states and the isoenergetic continuum of high-order overtone and combination states of the lattice modes. This work has yielded the most complete interpretation yet achieved of an infrared band due to the OH or OD stretching vibrations of a phase of ice.

The far-infrared absorption by the translational vibrations of H2O and D2O ices Ih and Ic at 4.3 K has been measured, and has revealed differences between the spectra of ices III and Ic for the first time.

Papers describing this work in full have been published in Journal of Chemical Physics, Vol. 67, No. 4, 1977, p. 1311-18, and Vol. 67, No. 6, 1977, p. 2445-48.
Lichen Growth on Supraglacial Debris and its Implications for Lichenometric Studies
Authors: Griffey Nigel J.
Published: September 2017

Lichens were found growing on some of the supraglacial debris of six small, active, retreating valley glaciers in southern Norway. The circumstances permitting their growth are discussed, as is the possibility of their surviving pro-glacial deposition under current and past conditions. Their occurrence does not appear to present a problem to careful lichenometric surveys of Holocene glacial and fluvio-glacial deposits.
The Col-Gully and Glacial Deposits at Court Hill, Clevedon, Near Bristol, England
Authors: Gilbertson D. D. , Hawkins A. B.
Published: September 2017

An outline is given of the Quaternary geology and geomorphology of Court Hill Col in Failand Ridge near Clevedon, Avon County, from observations made during the construction of the M5 Motorway.

A glacial col-gully about 100 m wide and approximately 25 m deep is described. The col-gully, eroded through the Carboniferous Limestone, opens and deepens northward. Associated with the Col and the col-gully is a complex sequence of Quaternary deposits. Uppermost in the sequence is a layer of red sandy silt (cover sand) approximately 0.5 m thick, of periglacial origin, probably of Devensian (Weichselian) age. Largely confined to the col-gully are unstratified tills, stratified ice-contact deposits and glacio-lacustrine deltaic deposits. The glaciogenic deposits are up to 25 m thick. Boulders of about 8 Mg in weight have been observed.

The geomorphology of the col-gully, and the stratification and composition of the glaciogenic deposits, demonstrate that an ice sheet at least 85 m thick had impinged against the south flank of Failand Ridge and was discharging immense quantities of water and sediment down an ice-contact slope through the Col into a small ice-marginal lake north of the col-gully. The ice sheet is regarded as being Wolstonian, or Anglian, in age.

The precise origins of the col-gully and the interpretation of the glacial sequence are not yet completely clear. However, it is believed that the balance of evidence indicates that both the col-gully itself and the glaciogenic deposits represent a complex sub-, en- and pro-glacial sequence associated with the downwasting and division of an ice mass into two parts by the "emergence" of Failand Ridge. The possible extent and geomorphological implications of ice-sheet penetration into the Bristol area are briefly discussed.