bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons learnt from inappropriate D-dimer testing: Case report
Authors: Pantić Nikola , Sabljić Nikica , Bogdanović Andrija , Jaković Ljubomir , Mitrović Mirjana
Published: July 2024

Introduction: Since the beginning of the COVID-19 pandemic, D-dimer testing has been widely used in not-yet-approved indications. This has led to misdiagnosis, overuse of diagnostic procedures, and unnecessary costs. Case report: Herein, we report the case of a 50-year-old female patient who came to the emergency department with chest pain, shortness of breath, fatigue, and pain in her right leg. Because of an elevated level of D-dimer (4.73 mg/l (N:<0.5)), deep vein thrombosis and pulmonary embolism, as well as COVID-19 were excluded. Therapy with rivaroxaban, 10 mg/day, was initiated. Seven days later, the D-dimer level continued to rise (17.52 mg/l), which was why rivaroxaban was replaced with low molecular weight heparin (LMWH). After another five days, the level of D-dimer continued to rise (27.26 mg/l). A complete blood count revealed significant thrombocytopenia (54 x 10 9 /l). As the 4Ts score for heparin-induced thrombocytopenia was 5, the anti-heparin/PF4 antibody test was performed, and it came back strongly positive (4+). LMWH was replaced with fondaparinux sodium, and the patient was referred to a hematologist. On examination, cutaneous bleeding and gingivorrhagia were present. Laboratory analyses registered pancytopenia (hemoglobin = 101 g/l; white blood cell count = 1.7 x 10 9 /l; platelet count = 29 x 10 9 /l) and consumption coagulopathy (INR = 1.7; aPTT = 27.1 s; fibrinogen = 0.8 g/l; D-dimer = 30.9 mg/l). Bone marrow aspirate was analyzed and the diagnosis of acute monoblastic leukemia, 47, XX, +12 [4] / 46, XX [16], wild type FLT3-ITD and NPM1, was established. Conclusion: D-dimer is a powerful diagnostic tool when used properly. It should never be treated as a single, isolated result and the decision to introduce anticoagulant therapy should never be made based on its value alone.
The use of virtual reality in crime scene investigation
Authors: Dimovski Darko
Published: July 2024

Crime scene investigators are responsible for the identification, collection, packaging and storage of physical evidence discovered at the crime scene, which is the basis for conducting proper investigation. In line with technological development, the crime scene investigation increasingly involves the use of advanced technologies with the aim of creating a virtual reality that should facilitate the investigators' work. In this paper, the author examines the concept of virtual reality (VR) and some types of extended reality (XR, AR, MR). The central part of the paper focuses on different methods of visualization of the crime scene by using VR technology. The last part of the paper focuses on to the use of VR by students for educational purposes.
The computational analysis of COVID-19-induced socio-economic, environmental, and climatic disruptions on the Indian food production system
Authors: Dash Adya Aiswarya , Sharma Sonu
Published: July 2024

COVID-19 dominantly affected all the sectors of the Indian economy, surprisingly the impact is much lower with respect to the agricultural production (−2.7%) in India. The increase in yield of the crops can be attributed to the variables such as environmental, climatic, and socio-demographic factors. The study illustrates the relationship of the increase in crop yield in India during the first wave of COVID-19 along with the increase in the infection count and the land under cultivation attributed to supporting factors during the year 2020. The relation is explained by the method of ordinary least square (OLS) and geographically weighted regression (GWR). The distribution of the increase in crop yield across India is analyzed against COVID-19 infections along with other dominant factors. Useful intuitions against crop yield can be generated by studying the spatial relationships between them. The geographically weighted regression method depicted an increase in R2 value as compared to the global ordinary least regression method. The Akaike information criterion in the geographically weighted regression method is also lower as compared to the ordinary least square therefore explaining GWR as a better model as compared to OLS. The combination of the various variables affecting agricultural yield in India is found to vary geographically as well as with the type of crops.
Article Integrating STEAM education in the school science teaching at Gorkha district
Authors: Koirala Kamal Prasad , Parajuli Krishna Prasad
Published: July 2024

This article explores the integration of STEAM (Science, Technology, Engineering, Arts, and Mathematics) education into the secondary school science curriculum. It provides an in-depth analysis of the current state of STEAM education, challenges, successes, and future directions. The article draws on literature reviews, theoretical frameworks, and interviews with science teachers to offer a holistic view of the benefits of STEAM education integration at school-level science teaching. This study was carried out by selecting three schools in the Gorkha district and three science teachers who are implementing separate types of STEAM-based project approaches in science teaching. This study found that science teachers attempted to implement the project-based technology-friendly STEAM approach in their classrooms. However, they faced several obstacles to the integration of STEAM into the present school science curriculum due to the limited availability of internet facilities. It suggests that policy level and curriculum designers prepare the STEAM-based curricula for transdisciplinary (STEAM-based) school science teaching.
Recent progress in Nanomaterial based biosensors for the detection of cancer biomarkers in human fluids
Authors: Shahazi Razu , Saddam Amirul Islam , Islam Md Rakibul , Rahman Mohammed Muzibur , Paimard Giti , Kumer Ajoy , Alam Md. Mahmud , Mahamud Md. Kawsar
Published: July 2024

Cancer is a global health challenge, and early detection is crucial for effective treatment to improve patient outcomes. In recent years, nanomaterial-based biosensors have emerged as powerful tools for the detection of cancer biomarkers in human fluids. This article highlights the recent progress in biosensor technology for the detection of cancer biomarkers, focusing on advancements in sensitivity, selectivity, multiplexed detection, liquid biopsies, point-of-care testing, wearable biosensors, and integration with artificial intelligence (AI). Recent advancements have significantly improved the sensitivity and selectivity of biosensors, allowing for the detection of low concentrations of cancer biomarkers in complex biological samples. Novel sensing technologies, such as nanomaterial-based sensors and aptamer-based sensors, have played a crucial role in enhancing biosensor performance. Multiplexed biosensors have the ability to simultaneously detect multiple cancer biomarkers, providing comprehensive diagnostic information. This capability is particularly valuable for accurate cancer diagnosis and prognosis. Liquid biopsies, which involve the detection of cancer biomarkers in circulating tumor cells, cell-free DNA, or exosomes present in body fluids, have gained considerable attention. Biosensors have played a pivotal role in the development of liquid biopsy technologies, offering non-invasive and real-time monitoring of cancer progression, treatment response, and the emergence of drug resistance. The integration of biosensors with AI algorithms has shown great potential. AI can analyze and interpret biosensor data, identifying patterns, correlations, and biomarker signatures that may be difficult to detect with traditional methods.
Comparative Analysis of Different Mustard Hybrids: Analyzing Growth and Yield Perspectives
Authors: AHMAD MUNEER , MANISHA MANISHA , ARYA SUSHILA , CHAUHAN TAPOR PAKPU AND ANJANA
Published: July 2024

A field experiment was conducted at Dev Bhoomi Uttarakhand University, aimed to identify the optimal mustard hybrid among six varieties (Pio45S47, Sriram 1666, Proagro5210, Pio46S46, Kesari Gold, Advanta414). Using a randomized block design, Pio46S46 exhibited the highest seed yield (4,355.33 kg/ha), followed closely by Pio45S47. Advanta414 and Proagro5210 had the lowest yields. Pio46S46 also displayed the tallest plants (171.76 cm), while ADV414 was the shortest (152.63 cm). Pio46S46 had the most primary branches per plant (7.66), highest siliqua per plant, highest seeds per siliqua (18.00), and maximum 1000-seed weight (6.95 g). In addition, Pio46S46 had the highest oil content (39.73%), followed by Pio45S47. Consequently, Pio46S46 outperformed other hybrids and is recommended for cultivation in the Doon Valley, Uttarakhand. This hybrid superior performance in growth, yield attributing components, seed yield, and oil content make it a promising choice for farmers in the Doon Valley, Uttarakhand. . KEYWORDS :Brassica juncea, Doon valley, Hybrid variety, Pio46S46, Seed yield
Determination of Antimicrobial Activity of Extracts of Carica papaya Seed
Authors: GANGWAR SUNEET KUMAR SAHNI AND DEVENDRA KUMAR
Published: July 2024

There are a number of antimicrobial agents suggested worldwide. However, many of them exhibit unexpectedly harmful side effects on human beings. The extracts of Carica papaya seeds were prepared through the soxhlet extraction technique, and the antimicrobial activity was analyzed using the agar-well diffusion method, where dimethyl sulfoxide (DMSO) was used as a negative control while antibiotic amoxicillin was used as a positive control. The objective of the study is to evaluate the antimicrobial activity of methanolic, ethanolic, and aqueous extracts of naturally occurring seeds of C. papaya against human pathogens such as Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The results of the study indicated that the methanolic and ethanolic extracts of C. papaya seeds showed very effective antimicrobial behavior against all the test pathogens, while the aqueous seed extracts showed lower antimicrobial behavior. The results revealed a highest zone of inhibition and antimicrobial activity against S. aureus. The present study focuses on the use of C. papaya seeds as an antimicrobial agent in treating bacterial infectious diseases. . KEYWORDS :Agar well-diffusion method, Antimicrobial activity, Carica papaya seeds
Assessment of Xiamen Community Parks to Promote Physical Activity for Older Adults
Authors: Lin Xinyu ,   Faculty of Engineering and Built Environment, The National University of Malaysia, Bangi, Malaysia, Yusoff Wardah Fatimah Mohammad , Sulaiman Mohd Khairul Azhar Mat ,   Faculty of Arts and Crafts, Meizhouwan Vocational Technology College, Putian, China,   Faculty of Engineering and Built Environment, The National University of Malaysia, Bangi, Malaysia,   Faculty of Engineering and Built Environment, The National University of Malaysia, Bangi, Malaysia
Published: July 2024

This study aims to evaluate the impact of community parks in Xiamen on promoting physical activity among older adults. The study employs the Community Park Audit Tool (CPAT) to assess 15 community parks on Xiamen Island. A total of 45 elderly participants were randomly selected to complete the CPAT questionnaire. Data collection focused on four key areas: park information, access and surrounding neighborhoods, park activity areas, and park quality and safety. These findings indicate that well-maintained community parks significantly increase physical activity levels among older adults. Specifically, natural features, diverse activity areas, safety measures, and aesthetic elements promote the health of older adults. The CPAT assessment results revealed that Gaolin Park (No.7) received the highest score, indicating its positive role in promoting physical activity among elderly individuals, whereas Meiren Park (No.9) received the lowest score, suggesting that improvement is needed to better meet the needs of the elderly and enhance their health. The CPAT provides valuable insights for urban planners and decision-makers to optimize the design and management of community parks, thereby better meeting the needs of older adults and promoting their health and well-being.
Social Change in Baduy Society from the Perspective of Auguste Comte's Three Stages of Law
Authors: Al Munawar Faishal Agil
Published: July 2024

The Baduy Tribe is a traditional community subgroup of the Sundanese ethnic group located in the Lebak Regency, Banten. One of Indonesia's cultural heritages, the Sunda Wiwitan religion, continues to thrive peacefully amidst dense ancient forests, river sources, and the peaks of Mount Kendeng in South Banten. Sunda Wiwitan is the religion of the Baduy people, which honors the spirits of ancestors (karuhun). It is not widely known that the Baduy Tribe has undergone significant religious changes, particularly towards Islam. This research is a normative study using a descriptive-qualitative approach aimed at analyzing the social changes of the Baduy tribe from the perspective of Auguste Comte's Three Stages of Law. The findings of this research indicate that the pattern of social and religious (intellectual) change in the Baduy Society is evolutionary, as the transformation occurs gradually through a continuous self-change process that takes considerable time, in accordance with Auguste Comte's Evolutionary Theory (Three Stages of Law).
Sero-diagnosis of Japanese encephalitis and Dengue virus infection from clinically suspected patients of Nepal
Authors: Sherchand Jeevan B. , Pandey Basu Dev , Haruki Kosuke , Jimba Masamine
Published: July 2024

Japanese encephalitis (JE) and other viral encephalitis are usually not confirmed in the laboratory in Nepal. However, every year during rainy and post -rainy season in Southern Nepal, from east to west, JE and other viral disease suspected patients become prevalent. The currently available methods for the laboratory diagnosis of JEand dengue virus infections (DVI) (e.g., serology, and virus isolation) are difficult andoften tedious to carry out as well as time consuming. So, there is a need for serodiagnosis of viral infections to identify the type of infection (JE, DVI or other viraldiseases). The use of conventional methods, however, causes confusion due to the cross-reactions between JE and DVI. In our study, the detection of virus-specific IgM has been proved to be useful for early diagnosis of JE and DVI even with the use of a singlespecimen. We applied ELISA to differentiate JE from DVI by detecting IgM specific toJEV antigen and IgM specific to dengue antigen. From the 279 patients, 244 serum and35 cerebrospinal fluid (CSF) samples were collected and examined with ELISA usingtwo different antigens for JE and DVI. The results showed that 28.7% were positive forJE- IgM antibodies and 10.4% positive for DVI-IgM antibodies.In addition, JEV-specific IgM antibody detection by Indirect IgM-ELISA and IgMcapture ELISA was also compared in the study.
Public health action for Injury and violence prevention in Nepal
Authors: Sharma G.K. , Adhikari R.K. , Upadhaya M.P.
Published: July 2024

N/A
Comparative study of lipid profile in smokers, tobacco chewers and diabetic patients
Authors: Yadav B. K , Bade A.R. , Singh J. , Jha B.
Published: July 2024

Background: Smoking, tobacco chewing and Diabetes mellitus have been well recognized risk factors for arteriosclerosis. This study was conducted to find out the effect of these factors on lipid profile in Nepal.Method: Serum lipid profile was Studied In 29 smokers, 13 tobacco chewers,, 22 diabetic patients and 29 controls le. non smokers, non tobacco chewers and non diabetic individuals.Results: The mean serum total cholesterol (4.8±0.9 mmol/ltr) was significantly higher in smokers than in non smokers (p<0.01). Mean low density lipoprotein (LDL) cholesterol (3.2±0.8mmol/itr) andtriglyceride (2.0±0.9mmol/itr) were significantly higher in smokers (p<0.005, p<0.05 respectively) whereas mean high density lipoprotein (HDL) cholesterol (0.77±0.18mmol/Itr) was significantly lower(p<0.05). Tobacco chewing was related to higher total cholesterol (p<0.005), higher LDL cholesterol (p<0.05) and higher triglyceride (p<0.05) levels. There was no significant difference in HDL cholesterol level, The diabetics had higher values of total cholesterol (5.0±0.9mmol/Itr) and triglyceride (2.1±0.8mmol/Itr) levels (p=0.000 and p<0.01 respectively) than controls. However, there were no significant differences in HDL cholesterol and LDL cholesterol levels.Conclusion: A moderate portion of the effect of cigarette smoking, tobacco chewing and Diabetes mellitus on risk of cardiovascular risk may be explained by an adverse effect of these on blood lipids.
Outcome of thyroid surgery in the department of ENT- Head and Neck Surgery: three years experience
Authors: Baskota D. K , Sinha B.K. , Prasad R.
Published: July 2024

Introduction: A retrospective, cross-sectional, analytical study, to find out overall outcome of thyroid surgeries and correlation of fine needle aspiration cytology (FNAC) with histopathology of different thyroid lesions was recently carried out at the Department of ENT-Head & Neck Surgery of TU Teaching Hospital, Kathmandu, Nepal. Altogether 114 charts of patients underwent different thyroid surgeries from July15, 2002 to July14, 2005 for different thyroid lesions were analyzed, out of which 11 patients were excluded from the study due to lack of adequate information.
Results: Out of 103 analyzed cases female sex was found to be exclusively predominant 94(91%) and age group of 21-30 years was the most commonly affected group 36(35%). Clinically, solitary thyroid nodule was the commonest diagnosis 57(55.4%) made for these thyroid lesions and right lobe was commonly affected site 50(48.5%). Similarly, hemithyroidectomy was the most commonly performed surgery 63(61.2%) followed by lobectomy 18(17.5%) for the management of these lesions where as hypothyroidism 11(10.7%) and hypocalcaemia 9(8.7%) were the commonest observed postoperative complications respectively. Although 3 cases of malignancy were missed by FNAC, its diagnostic accuracy was still 97.09%.
Conclusion: The results of this study so far indicate that although FNAC is a good diagnostic tool for thyroid lesions, USG guided FNAC would have better option for further accuracy of the diagnosis. Likewise cytologically reported, as solitary thyroid nodule with cystic changes and follicular neoplasm should be taken into consideration as malignancy might be missed particularly in these lesions. Therefore it is better to do hemithyroidectomy in solitary thyroid nodule irrespective of FNAC report.
Aetiology and management of epistaxis at TU Teaching Hospital
Authors: Adhikari P. , Pradhananga R.B. , Thapa N.M. , Sinha B.K.
Published: July 2024

Background: Epistaxis is a common condition, as well as a frequent otolaryngologic emergency. Up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention.
Methods: A retrospective study of records of 93 patients admitted in the department of ENT-Head and Neck Surgery of TU Teaching Hospital for the management of epistaxis in between March 2005 and February 2006.
Results: The incidence of epistaxis was found to be in 6.0% of all the ENT patients admitted in the department in this time period. The most common cause / risk factors were hypertension followed by deviated nasal septum. In 24.7% of cases no cause could be found and was labeled as idiopathic. Regarding treatment, 9.7% treated with Chemical cautery, 34.4% anterior nasal packing, 25.8% posterior nasal packing and 2.2% required arterial ligation to control their epistaxis.
Conclusion: Our study shows that epistaxis is also a common emergency. Etiology could be found nearly 75% of cases only which could be preventable. Anterior Nasal Packing was the most common treatment. We should manage a case of epistaxis in an orderly manner.
Comparison of Ziehl-Neelsen staining microscopy and immunochromatographic tuberculosis test for diagnosis of pulmonary tuberculosis
Authors: Rai D.R , Kshetry N.T , Bhargava D. , Pokharel B.M.
Published: July 2024

Background: Tuberculosis continues to be a great public health problem in Nepal. The evaluation of suitable diagnostic method to diagnose tuberculosis is urged.
Methods: Three consecutive early morning sputum collected from 413 patients were subjected to ZN staining and serum from 224 patients to ICT-TB test.
Results: Overall positive results of Z-N staining and ICT-TB test were 13.1% and 14.3%, respectively. In ICT-TB test, males were found more positive (14.7%) than females (13.9%)(P>0.05) but in microscopy, it was vice-versa (P>0.05). Age group 41-60 was significantly more seropositive compare to younger, however, in combination it wasn’t significant (P>0.05). Alcoholics were significantly high (25.5%)(P<0.05) and smokers were marginally high (17.3%) (P>0.05) AFB positive compared to nonalcoholics (11.5%) and non-smokers (11.6%). Students and service men were remarkably lower AFB positive compare to farmers and workers but interestingly nobody was found positive among business personnel (P>0.05).
Conclusion: Z-N staining microscopy is cheaper and equally sensitive hence it is more useful diagnostic tool than ICT-TB test for pulmonary tuberculosis.
Status of extended spectrum beta lactamase producing Escherichia Coli and Klebsiella species in urinary tract infection
Authors: Manandhar T. , Koirala J. , Pokharel B.M. , Ghimire P.
Published: July 2024

Background: Production of Extended Spectrum Beta Lactamases (ESBLs) is an important mechanism of beta-lactam resistance in Enterobacteriaceae. And the occurrence of ESBL producing isolates has increased worldwide.
Methods: The study was carried out in bacteriology laboratory of TUTH from March 2005 to May 2005 that included 371 midstream urine samples (msu). During these three months period, the MSU samples were investigated by conventional semi-quantitative culture technique, antibiotic susceptibility test and ESBL detection test.
Results: Out of 98 significant positive cases, 60 cases were due to E. coli, 5 were due to Klebsiella oxytoca and 4 were due to Klebsiella pneumoniae. Multidrug resistance (MDR, resistant to two or more than two classes of antibiotics) was observed in 61.7% (37/60) of Escherichia coli, 40% (2/5) of Klebsiella oxytoca and 75% (3/4) of Klebsiella pneumoniae. Out of total 69 cases of E. coli and Klebsiella species that were subjected to preliminary Ceftazidime ESBL screening test, 22 isolates were suspected of ESBL production. Finally 27.5% (19/69) were confirmed for production of ESBL by Double Disc Synergy Test (DDST). Out of 19 ESBL producing strains, 16 were found out to be E. coli, one was K. oxytoca and 2 were K. pneumoniae. All ESBL producing strains were found to be multidrug resistant.
Conclusion: There is a great need to conduct this type of study throughout the year to determine their seasonal variation and also for the study of increasing trends of MDR and ESBL . This type of study should also be conducted in other hospital as well.
Prevalence of anaemia among young girls and pregnant women of Birgunj, Nepal
Authors: Adak M. , Nazri S.
Published: July 2024

Background: The prevalence of anaemia is a major health problem worldwide and is high particularly among young girls and pregnant women. A perusal of the literature on anaemia prevalence in semi urban areas of Nepal is very alarming and its magnitude increases day to day.
Methods: All the patients with illness attending at OPD of NMC Hospital were included in the study. Social demographic profile, morbidity data were recorded on a structured questionnaire. Anthropometric measurements and BMI were recorded on the basis of National Health and Nutritional Examination Survey. Hb was estimated by Sahli’s method and pregnancies were verified with urine specimen using on HCG testing kit.
Results: In the sample of 552 patients, 54-64.2 % were anaemic .Out of which, 26.9 % of pregnant women were moderately anaemic and 3.1 % subject were severe anaemic.
Conclusions: Higher prevalence of anaemia among young in Birgunj was alarming looking due to either lesser consumption of green leafy vegetable or habit of post meal tea/coffee drinking or smaller intake of citrus fruits. These findings suggest that guideline for screening for anaemia may need to further study in relation to the dietary level of iron, iron and ferritin level in blood.
Renal cell carcinoma of a horseshoe kidney mistaken for ovarian malignancy
Authors: Adhikari S. , Rana A. , Gurung G. , Adhikari R. , Vaidya P. , Joshi B.
Published: July 2024

Background: Heterogonous complex mass suspected to be ovarian tumour preoperatively in the vicinity of both low lying kidneys in close approximation to enlarged lymph node by trans abdominal ultrasound was found to be renal cell carcinoma arising from horseshoe kidney.
Case report: A rare presentation, is described herewith in a multiparous (P6), 57 year old post menopausal lady who suffered from pyrexia for 2 months and mass abdomen for 3 years.
Safety profile of herbal drugs: urgent need for monitoring
Authors: Palaian S. , Bista D. , Rajan S. , Shankar P.Ravi , Mishra P
Published: July 2024

Background: In developing countries, herbal medicines are the natural answer to many ailments and are often locally available in affordable cost. Hence, their use remains popular and widespread in many countries. Due to the varying topography and climatic conditions, a variety of herbs and medicinal plants are found in Nepal. The public generally considers natural products as safe. Also, the manufacture, sale, distribution and use of these medicines are not monitored by the regulatory authorities. Doctors also don’t routinely take drug history regarding use of herbal drugs. Several commonly used herbal drugs like gingko biloba, garlic, ginseng, peppermint oil, senna, primrose oil, isapghol, ephedra are reported to cause significant adverse drug reactions which can cause mild gastrointestinal upset to life threatening bleeding disorders. The safety concern regarding allopathic drugs is strengthening and the awareness regarding this issue is increasing rapidly. However, monitoring the safety of herbal drugs is still problematic due to various reasons. Some of reasons are lack of accurate information regarding their safety profile, lack of information on the exact constituents of the conventional herbal formulations, adulteration in the drug formulations, poor manufacturing standards etc.
Conclusion: Team efforts involving doctors, pharmacists, pharmacologists, pharmacovigilance center personnel and drug regulatory authorities will be beneficial in implementing appropriate steps towards safe use of herbal drugs. The participation of patients and the manufacturers is also vital. Worldwide, many initiatives have been taken in the recent past towards herbal drug safety. In Nepal the concept of drug safety issues is still in the infancy stage and the national drug controlling authority has taken the initial steps in monitoring the safe use of allopathic drugs. The need for an herbal drug safety monitoring system is very essential for a country like Nepal.
An unusual case of obstructive jaundice
Authors: Sharma P. , Subedee A. , Khadka H. , Pradhan S. , Lohani B. , Joshi B. R. , Paudel S.
Published: July 2024

A case of hydatid cyst of liver rupturing into biliary tree causing obstructive jaundice is reported.
Calculation of Body Mass Index: Proxy for Prevention of Multiple Disease Syndrome
Authors: Joshi S.
Published: July 2024

Introduction: A mini health survey was conducted to assess the Body Mass Index (BMI) score among 240 respondents who had attended Golden Jubilee Celebration of Maharajgunj Nursing Campus (2006). Materials and Methods: Along with structured interview schedule, health histories, anthropometric measurement (height and weight), and blood pressure were checked among the respondents.
Result: The study findings revealed that majority of the respondents were current nursing students below 40 years of age, among them 56 % of them had normal BMI score (18.5 - 24.9); while 44 % had abnormal BMI score (> 18; and above 25.0). Among the respondents who had BMI score, 29 % were overweight (> 25.0 - 29.9), and 4 % were obese (> 30); while remaining 11 % had less than normal BMI score (<18). Among the overweight respondents who were above 40 years of age, 17 % had hypertension and 4 % had diabetic mellitus. Majority of the respondents who were above 40 years of age had multiple diseases particularly hypertension and diabetes mellitus than those below 40 years of age with normal BMI scores.
Conclusion: This study finding highlights the need of launching awareness raising programmes for the prevention and early detection of multiple diseases among the aged population particularly with high BHI score. It is also recommended to schedule regular health screening programmes incorporating calculation of BMI among the adult population.
Vesicocolic fistula
Authors: Rajbhandari A. , Sharma U. , Gyawali P.R. , Shrestha G.K. , Joshi B.R.
Published: July 2024

Abstract: Vesicoenteric fistulae, also known as enterovesical or intestinovesical fistulae occur between the bowel and the bladder. We report a case of vesicocolic fistula after undergoing TURBT. After confirmation following radiological investigations and cystoscopy the patient underwent repair of the fistula.
Choriocarcinoma of uterine cervix with cerebral and lung metastasis
Authors: Ansari M.A. , Pokhrel L.R. , Thapa R. , Shrestha D.M. , Pradhan S.
Published: July 2024

Abstract: Uterine cervical choriocarcinoma was diagnosed in a 22-years-old woman, admitted to the hospital with irregular vaginal bleeding, hemoptysis and intermittent fever for three months. She had undergone dilatation and curettage for incomplete abortion in the past and had a full term normal vaginal delivery. Pelvic examination revealed a tumor mass occupying the uterine cervix. Ultrasound of the abdomen and pelvis showed an ill defined heterogeneous predominantly isoechoic mass lesion arising from the cervical part of the uterus with invasion to the posterior wall of urinary bladder with bilateral ovarian cysts. Chest radiograph revealed multiple nodular soft tissue density radiopaque shadows of various sizes in lower zones of both lung fields. CT scan of the abdomen revealed heterogeneous soft tissue density mass lesion with central areas of hypodensities, arising from the cervical part of uterus. Fat plane with inferior wall of the bladder and rectum were lost. The mass shows heterogeneous enhancement after administration of contrast material. CT scan of head revealed multiple hemorrhagic lesions in the supratentorial compartment with perilesional edema. Urine pregnancy test was positive. Urine hCG in high dilution was also positive (upto I: 1024) and Serum B-hCG was 181.3(7) mUL/ml. Histopathological findings led to the diagnosis of choriocarcinoma of the cervix.
Maternal mortality in hilly districts of Nepal
Authors: Shrestha B.
Published: July 2024

Background: Maternal mortality is a vital indicator and exhibits great disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study are to describe the socio-cultural and health service factors associated with maternal deaths in rural hill districts of Nepal. Methods: We reviewed 33 maternal deaths of women who tried to reach or reached health care services in three remote districts of Nepal, namely Baglung, Dolakha and Ramechhap. A verbal autopsy technique was applied for 33 of the cases. Individuals who had witnessed any stage during the process leading to death were interviewed. Health care staffs who participated in the provision of care to the deceased were also interviewed. All interviews were tape recorded and analyzed using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results: The socioeconomic background of the cases including caste, ethnicity, geography, direct cause of death, place of death and care givers during delivery were included to analyze each cases. The following items evolved as important: underestimation of the severity of the complication, lack of family support, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt, lack of money for transportation and health service, delay in reaching an appropriate medical facility, and lack of appropriate care after reaching the hospital. Conclusion: Women in rural hill area faces variety of problems to access to care for obstetric emergencies, hence maternal mortality is prevalent among poor women. Lack of awareness and family support on safe birth preparedness, danger signs of pregnancy, delivery and post natal period, disorganized health care with lack of referral and support for transport and health service networking prompt response to emergencies with quality care are major factors contributing to a continued high mortality rate.
An obstacle for alcohol abstinence
Authors: Shakya D.R.
Published: July 2024

We report a case of ‘alcohol dependence’ with anxiety to highlight importance of addressing co morbid psychiatric problem for effective management of alcohol dependence. A 53-year-old lady presented with anxiety for five years, more in the initial days of attempts at abstinence. She had been drinking for thirty years, regularly for ten years and more for the last six years. After developing Hypertension five years back, she had been trying to stop drinking. Upon such attempts, she suffered from restlessness, profuse sweating, tremors and sleeplessness and would feel better only after taking alcohol. Since 2-3 months, after having GI bleed, she was compelled to stop drinking and was struggling in spite of anxiety. Finally, she drank herself to intoxication and her children brought her to psychiatric OPD. With the diagnosis of ‘alcohol dependence syndrome with anxiety disorder’, after investigations, she was put on fluoxetine, clonazepam and thiamine-vitamin B supplementation along with psychological interventions to enhance motivation and prevent relapses. She responded well and remained abstinent and asymptomatic at 3-year-follow ups. Blood pressure was also under control
Benign broncho-esophageal fistula in an adult
Authors: Singh K.N , Pradhan S. , Thapa B. , Shrestha U.K. , Sayami P.
Published: July 2024

Tracheoesophageal and bronchoesophageal fistulas are usually diagnosed early in life after an infant presents with difficulty in feeding or recurrent pneumonia. These conditions rarely present in adulthood. We report the case of a 65-year-old man who presented with chest discomfort and cough particularly after meals for three months. Workup including a barium esophagogram revealed bronchoesophegeal fistula. Dissection of the fistula and pedicled intercostal muscle flap repair was done.
An aid to houseman interns by Prof. C. L. Bhattachan
Authors: Khakurel Mahesh
Published: July 2024

N/A
Health and Sanitation Status of Bote Community
Authors: Rosyara K.P.
Published: July 2024

Introduction: This is a study of the health and sanitary status of Bote community, an indigenous caste of Nepal. Their Major source of income of fishing and boating and traditionally, they are less dependent on farming. Most of them stay along the riverside. There are two types of Bote; paani Bote and Pakhe Bote. Paani Botes are those who solely depend on fishing, boating, collecting motes of gold from river banks. Pakhe Bote depend more on agriculture, animal husbandry and porter for their survival. Health status and sanitation are a major problem in this community.
Methods: This is a non experimental descriptive exploratory study carried out during the period of October-November; 2009. The study population constituted 100 inhabitants of Bote community of Pragatinagar VDC of Nawalparasi district. Data was collected by on their opinion on issues such as level of health awareness, personal cleanliness, sanitation status, willingness to participate in various awareness programmes and skill development trainings.
Results: Only 15 percentages of respondents are aware of hygiene and most of them believe that ghosts spread of diseases. Most of the respondents known about family planning and immunization but there was minimal use of family planning tools and immunization (8%).
Conclusion: Health and sanitation in this community was found to be very poor when compared to other communities of Nepal. Emphasis on health education programme should be given to improve the status of health and sanitation in this community
Wound – biological basis of surgical treatment
Authors: Bishwas NC
Published: July 2024

Introduction: After having a through study along with available methods and medicines to treat external wounds, I came to conclusion that existing antiseptic solutions or antibiotic ointment to treat wounds is not sufficient and also costly. Biological basis of healing should be most crucial for wound healing. Central mechanism that control normal wounds healing is very important. Local wound’s environment like moistures, temperature, and tension is also very important. So it was very important to get such a ointment which meets all these demands and should be easily available and can work without sterilization or without antibiotic.
Method: A long and difficult work was started. At last a ointment was created which was cheap and met the conditions which was put in research work. This ointment contains coconut oil, water, bhangra sindoor, ghee, carbolic acid, Aloe Vera, Placentrex, coral, Evion, Xantinol Nioctinate ( Complamina). Complamina and trental was given orally also as it is a new combination of medicine, so any reference.
Results: Two groups were studied with different type of treatment. The first group containing 60 patients received routine treatment of wound with sterility maintained as well as antibiotic used. The other group consisting 150 patents wastreated with the new ointment. To treat with the new ointment sterilized material was not needed as well as without giving any antibiotic.
Conclusion:Ointment givesthe patientsthe feeling of calmness and removesstress, can work without antibiotic and sterilization. The whole treatment is cheaper with this ointment. This ointment will be useful for the people of the whole world.
Spinal synovial cyst presenting with radiculopathy
Authors: Shrestha P , Malla H , Pant B.
Published: July 2024

Synovial cyst (SC) is one of the relatively rarer spinal pathology which can lead to radicular feature. The most common differential diagnosis is herniation of intervertebral disc (HID).
A 34 year-old male patient presented to orthopedic surgeon with the history of right thigh pain on and off. The case was then referred to us. On examination, he had mild hypoesthesia over fronto lateral aspect of right thigh and knee jerk wasslightly diminished. Repeat magnetic resonance imaging (MRI) of lumbosacral spine was done as previous image quality was poor.
New MRI suggested cystic lesion at L2-3 on right side suggesting most likely synovial cyst.
With midline incision, right hemilaminotomy was done and thecal sac and nerve root was exposed. When thecal sac and nerve root was retracted, cystic lesion was very clearly seen arising from facet joint. Complete excision was done and sent for histological evaluation which showed features of synovial cyst.
Post operatively, thigh pain disappeared and patient went have to normal work after 1 month of surgery.
The main purpose of this article is to emphasize that synovial cyst is one of the possible, though rare, etiology of radiculopathy. Though it occurs in older age group it can be found in younger people also as in our case. Surgical exploration and radical resection is the way to cure it.
Multifocal Tubercular Osteomyelitis Involving Bilateral Symmetrical Second Metacarpals
Authors: Pokharel R.
Published: July 2024

Abstract: Skeletal tuberculosis involving small bones of the hand is less common. We report a case, 6 year old boy, of bilateral symmetrical tubercular osteomyelitis of second metacarpals. He presented with gradually increasing swellings over bilateral hands over duration of one month. There was no other significant history relating to tuberculosis. Hand X-rays showed expansive lesions of bilateral second metacarpals. Thick pus and necrotic tissue was removed from both the swelling and from the bone. Presence of typical tubercular granuloma in the histopathological examination confirmed the diagnosis. The boy was treated with antitubercular drugs and improved after completion of anti-tubercular treatment. Tuberculosis can present in different ways, and should be kept as one of the possible diagnosis of several bony pathologies including metacarpals and phalanges, especially in this part of the world where tuberculosis endemic.
Emergency surgical workload in a teaching hospital
Authors: Bhattarai P.
Published: July 2024

Introduction: Emergency operations are life saving and it may account for over 50% of surgical admissions depending upon the place. Its impact on the skill development in a teaching hospital is very important. However the impact on service provision and implications for training are difficult to quantify. We analyzed ten months data of emergency operations done at Kohalpur Teaching Hospital.
Methods: Data on emergency surgical operations over twelve months was collected including patient demographics, diagnosis, and operation and analyzed according to the operation performed and age-groups.
Results: There were 535 emergency surgical operations over ten months; 20.7% were under 14 years of age, 48.7% were between 15-39 years of age and 30.4% patients were more than 39 years age. The commonest operations performed were from gastrointestinal cases (38.6%), orthopedic (21.4%), and wounds (20.5%).
Conclusions: Children constituted one fourth of the total operations indicating peripheral hospital should have provision of a paediatric surgical team to have the optimum service. Resource planning should be based on more comprehensive, prospective data such as these.
Childhood chronic pancreatitis
Authors: Basnet S , Sharma A.K.
Published: July 2024

Chronic pancreatitis is one of the rare cause of abdominal pain in children. We report a seven year old boy with recurrent episodes of epigastric pain for one year which was ultimately diagnosed as chronic idiopathic pancreatitis, we discuss the evaluation and treatment of chronic pancreatitis
Use of five different tests for Helicobacter pylori infection in Nepal
Authors: Sharma RP , Yamaoka Y , Shrestha PK , Khadga P , Sharma S , Shrestha KB
Published: July 2024

Introduction: The prevalence of Helicobacter pylori (H.pylori) has declined rapidly in Asia. This has been shown in both sero-prevalence-based and endoscopy-based studies. The present study was conducted to determine the current prevalence of H.pylori infection in Nepali population referred for upper gastrointestinal endoscopy and its relation with gastro-duodenal diseases.
Method: Total of 146 patients (71 males and 75 females with the mean age of 42, 43 yrs, range 16-90yrs) underwent endoscopy at endoscopy services in Tribhuvan University Teaching Hospital (TUTH), Nepal. The diagnosis of H.pylori infection was determined non-invasively by serology and invasively by rapid urease test, culture, histology and immunohistochemistry.
Results: The overall prevalence of H.pylori infection was 48.6%. The sero-prevalence was 43.8%. Gastritis was the predominant finding (76.7%), followed by duodenal ucler (4.1%), gastric ulcer (4.8%), gastric adenocarcinoma (3.4%) and normal mucosa (10.9%).
Conclusion: The present study revealed the prevalence of H. pylori infection measured by serology was higher than that with other studies conducted in Nepal, the present study of the first study to use several tests at the same time to determine H. pylori prevalence.
Maternal Mortality in Pregnancy with Heart Disease
Authors: Dali B , Baral J
Published: July 2024

Introduction: The incidence of heart disease complicating pregnancy is approximately 1–3% of pregnancies and is responsible for 10 to 15% of maternal mortality. While rheumatic heart disease is on real decline in western world, it is adamantly remaining unchanged here in Nepal and persistently contributing to maternal mortality in cardiac complication in pregnancy.
Methods: From the ongoing maternal mortality study since BS 2050 (13th April 1993), data from last 15 years (April 1998 - 2013) were extracted. The data were tabulated and analyzed.
Results: There were 14 12.5% deaths accountable to heart disease in a total 112 maternal mortality during the period of 15 years and they were mostly from rheumatic heart disease. Most of them were multivalvular heart disease except for a solitary case of aortic stenosis. MTP (2) Caesarian (3) breech vaginal delivery (1) were performed and spontaneous expulsion was managed along with supportive care delivered in mothers who died shortly after admission.
Conclusion: Poor health seeking behavior and careless attitude is a part of blame game played often played whereas mortality from rheumatic heart disease which is obsolete in global scenario is of utmost concern as cardiac conditions pertaining to this etiology can be minimized certainly and the mortality attributed thus can be reduced. Termination of pregnancy should only be allowed for reason more than valvular lesion like coarctation of aorta.
Severe Winter Diarrhea associated with Rotavirus Disease in children
Authors: JB Sherchand
Published: July 2024

Rotavirus is the leading cause of severe diarrhea in children under 5 years of age and is responsible more than 600,000 deaths in children annually with millions of hospitalizations. Due to limited access to proper health care, 95 percent of rotavirus related deaths occur among children in the developing countries including Nepal1. In Asia, rotaviruses take the lives of 188,000 children, accounting for more than 40% of global rotavirus deaths2. WHO (2014) publication showed that 35% of Asian children hospitalized with acute diarrheal illness are infected with rotavirus3. Although rotavirus infection occurs throughout the year the prevalence was higher during winter season (60 to 70%) 4. In Nepal, study conducted between 2007 and 2013; rotavirus infection was 30 to 50% and more than 60% strain circulated in winter and the most prevalent strain was G12P[6] followed by G2P[4] and G1P[8] 5,6,7,8,9. Rotavirus infection is highly contagious and spreads easily from person to person through contaminated hands and objects. Rotavirus disease is difficult to treat with antibiotics or other drugs.
Mild rotavirus gastroenteritis can be treated effectively in the same manner as other forms of diarrhea, by oral rehydration therapy. However, children with severe rotavirus diarrhea lead to severe dehydration and often need intravenous fluids to prevent mortality. In developing countries including Nepal, this type of emergency health care is often inaccessible or unavailable, making rotavirus prevention through vaccination very important for preventing child mortality.
Vaccination is the best way to prevent severe rotavirus disease and the deadly, dehydrating diarrhea that it can cause. Improvements in water quality, hygiene, and sanitation stop bacteria and parasites that cause other forms of diarrhea but do not adequately prevent the spread of rotavirus infection. Lifesaving rotavirus vaccines should be introduced as part of a comprehensive approach in control diarrheal disease, along with other interventions including oral rehydration therapy, exclusive breastfeeding, zinc supplementation and improvements in water and sanitation.
The surveillance data of Nepal on rotavirus 4, 7,8,10 provides good baseline information for policy makers in regards to rotavirus vaccine introduction. In addition, rotavirus vaccination if kept under national immunization program will not only save the lives of Nepalese children but also reduces rotavirus disease burden and economic thereby contributing to poverty reduction.