bluuebunny/crossref_metadata_2025 huggingface dataset:
Penyuluhan Penggunaan Dan Pemanfaatan Sosial Media Bagi Masyarakat Pulau Lance Batam
Authors: Maldin Siska Amelia , Silitonga Frangky , Sianipar Baktivillo , Kartika Cahayani  , Senop Putra Perwira  , Ayu Dara Tista  , Ardiansyah Saputra
Published: July 2024

This Social Community is carried out to enable lecturers and students together with the community to find the best solutions that can answer the problems experienced by the community, especially in the use of social media as a marketing tool for tourism activities which can be part of the driving force for improving the economy of Lance Island residents. This PKM activity has inspired the Lance community that Lance Island has its own attraction to be marketed using residents' social media in tourism development as part of an opportunity to improve the welfare of the Lance Island community. From this PKM activity, an understanding of the important thing that the tourism area must have networks and upgrade its ability to see tourism opportunities that are of interest will be produced while still prioritizing the cultural wisdom that exists on Lance Island. This activity consists of students and lecturers carrying out their tri dharma
Sosialisasi Ilmu Pengetahuan Hospitality Agar Menjadi Hotelier Profesional Di SMAN 19 Batam
Authors: Lubis Arina Luthfini , Supardi  , Fatimah Zahara , Wibowo Andri
Published: July 2024

Kegiatan PKM ini menggambarkan kegiatan sosialisasi ilmu pengetahuan hospitality yang diadakan di SMAN 19 Batam oleh tim dosen dari Politeknik Pariwisata Batam. Tujuannya adalah untuk memperkenalkan siswa dengan dunia industri perhotelan serta mendorong minat mereka untuk mengejar karir di bidang tersebut. Melalui serangkaian kegiatan seperti penyuluhan, workshop, dan kunjungan lapangan, siswa diberikan kesempatan untuk memperdalam pemahaman mereka tentang aspek-aspek penting dalam industri perhotelan, termasuk etika profesi, keterampilan komunikasi, dan kepemimpinan. Dukungan dari praktisi dan ahli hospitality dalam menyampaikan materi juga menjadi faktor kunci dalam membentuk pemahaman yang komprehensif bagi siswa. Selain memberikan pengetahuan teoritis, kegiatan ini juga memberikan kesempatan praktis bagi siswa untuk merasakan langsung suasana dan tugas-tugas yang terlibat dalam dunia perhotelan melalui simulasi dan kunjungan lapangan. Hal ini bertujuan untuk memberikan pengalaman nyata yang dapat memperkuat pemahaman siswa serta membantu mereka mengembangkan keterampilan yang diperlukan di dunia kerja. Selain itu, kegiatan ekstrakurikuler terkait hospitality juga diperkuat sebagai upaya untuk mendorong partisipasi siswa dalam aktivitas yang dapat memperdalam pemahaman dan keterampilan mereka dalam industri perhotelan. Rekomendasi untuk melanjutkan kegiatan serupa di masa mendatang termasuk perluasan jangkauan ke lebih banyak sekolah, penguatan kolaborasi dengan industri perhotelan lokal, serta evaluasi berkelanjutan terhadap dampak jangka panjang dari kegiatan ini. Dengan demikian, diharapkan kegiatan pengabdian ini dapat terus berkembang dan memberikan manfaat yang signifikan bagi siswa serta industri perhotelan di Batam.
Pelatihan Peningkatan Kualitas Layanan Pelanggan Restoran RM. Sederhana Winsor Batam
Authors: Fatimah Zahara , Lubis Arina Luthfini , Supardi Supardi
Published: July 2024

Laporan pengabdian ini menjelaskan kegiatan Pelatihan Peningkatan Kualitas Layanan Pelanggan Restoran RM Sederhana Winsor Batam yang dilaksanakan oleh tim dosen dari Politeknik Pariwisata Batam. Tujuan utama pelatihan ini adalah memberikan pengetahuan dan keterampilan pelayanan yang tepat kepada para karyawan. Melalui berbagai kegiatan seperti pelatihan, workshop, dan kunjungan lapangan, karyawan diberi kesempatan untuk memahami aspek-aspek penting dalam pelayanan, termasuk keterampilan komunikasi, etika dalam menghadapi pelanggan, dan tanggung jawab pribadi sebagai bagian dari kepemimpinan diri. Dukungan dari praktisi dan ahli hospitality dalam penyampaian materi juga menjadi faktor penting dalam membentuk pemahaman yang komprehensif bagi para karyawan. Selain pengetahuan teoritis, kegiatan ini juga memberikan pengalaman praktis melalui simulasi langsung. Tujuannya adalah untuk memperkuat pemahaman karyawan dan membantu mereka mengembangkan keterampilan yang diperlukan di tempat kerja. Upaya ini mendorong partisipasi aktif karyawan dalam kegiatan yang dapat meningkatkan pemahaman dan keterampilan mereka dalam pelayanan. Rekomendasi yang diusulkan termasuk melanjutkan kegiatan serupa di masa mendatang, memperkuat kolaborasi dengan industri terkait, dan melakukan evaluasi berkelanjutan terhadap dampak jangka panjang dari kegiatan ini. Dengan demikian, diharapkan kegiatan pengabdian ini dapat terus berkembang dan memberikan manfaat yang signifikan bagi karyawan di bidang perhotelan.
Julia: a new language for scientific computing
Authors: Hinsen Konrad
Published: July 2024

New programming languages are probably invented every day, and even those that get developed and published are too numerous to mention. New programming languages developed specifically for science and engineering are very rare, however, and that's why such a rare event deserves some publicity.
Unifying version control and dependency management for reproducible research
Authors: Hinsen Konrad
Published: July 2024

When the Greek philosopher Heraclitus pronounced his famous "πάντα ῥεῖ" (everything flows), he most probably was not thinking about software. But it applies to software as much as to other aspects of life: software is in perpetual change, being modified to remove bugs, add features, and adapt it to changing environments.
Lessons from sixteen years of molecular simulation in Python
Authors: Hinsen Konrad
Published: July 2024

A while ago I was chatting with two users of my Molecular Modelling Toolkit (MMTK), a library for molecular simulations written in Python. One of them asked me what I would do differently if I were to write MMTK today. That's an interesting question, but not the kind of question I can answer in a sentence or two, so I promised to write a blog post about this. Here it is. First, a bit of history.
An analysis of the Puri Brata Resort & Gallery building’s design from an environmental aesthetics and sustainability perspective
Authors: Hermawan Hermawan , Safa’at Amin , Annisa Nabila Arrizqi
Published: July 2024

The research paper delves into the implementation of sustainable architectural design practices at Puri Brata Resort & Gallery in Yogyakarta, Indonesia. The primary objective of the study is to analyze the impact of eco-friendly design principles on both the environment and visitor experience within the resort. Data collection for this research involved conducting a comprehensive survey among visitors to the resort, focusing on aspects such as air quality, temperature control, and overall visitor comfort. Additionally, data was gathered on the utilization of green spaces within the resort and the incorporation of local cultural values and aesthetics in the architectural design. The survey responses were then analyzed to evaluate the perceived impact of sustainable design elements on the guest experience and environmental sustainability. The findings of the research indicate that the integration of eco-friendly practices at Puri Brata Resort & Gallery has positively impacted various aspects, including improved air quality, efficient temperature control, and enhanced visitor comfort. The use of recycled materials, renewable energy sources, and green spaces has contributed to creating a harmonious and sustainable environment that enhances the overall guest experience. The study underscores the importance of incorporating sustainable design principles in architectural practices to create spaces that benefit both the environment and visitors. This research provides valuable insights for industry practitioners and policymakers looking to adopt sustainable design practices in the hospitality and tourism sector.
Plant leaf disease classification using FractalNet
Authors: Alaeddine Hmidi , Jihene Malek
Published: July 2024

In this work, an effort is made to apply the FractalNet model in the field of plant disease classification. The proposed model was trained and tested using a “PlantVillage” plant disease image dataset using a central processing unit (CPU) environment for 300 epochs. It produced an average classification accuracy of 99.9632% on the test dataset. The experimental results demonstrate the efficiency of the proposed model and show that the model achieved the highest values compared to other deep learning models in the PlantVillage datasets.
Exchange of Tax Information in the Aftermath of Brexit: Rethinking the Role of Bilateral and Multilateral Standards As a Result of the United Kingdom’s Departure from the DAC Framework
Authors: Favaloro G.A.C.
Published: July 2024

In this article, the author discusses the extent to which the latest international standards (and the applicable tax treaties) compensate for the United Kingdom’s departure from the DAC directives (and EU law in general) and offer equivalent administrative and enforcement capacities. Further, the article provides specific descriptive and/or comparative tables that synthesize the main features of the various exchange of tax information tools that are available.
PREPARATION OF LIPID-BASED FORMULATIONS USING LOCAL BEESWAX SOURCED FROM HONEYCOMBS
Authors: AGBO CHINAZOM PRECIOUS , NGWU MARIA IFEYINWA , ANYAJI UGOMMA , UBAHAKWE CHINENYE , ASOGWA GODSWILL NNANNA , AKPA PAUL ACHILE , NNAMANI PETRA OBIOMA , OFOKANSI KENNETH CHIBUZOR , ATTAMA ANTHONY AMAECHI
Published: July 2024

Solid lipids used in formulation of novel drug delivery systems in most developing countries are sourced from abroad and are quite expensive. Wax from honeycombs is readily available, and is even disposed as waste, but can be utilized as a solid lipid for the formulation of different lipid-based drug delivery systems. This study aims to formulate and compare the features of the solid lipid nanoparticle (SLNs) and nanostructured lipid carrier (NLCs) delivery systems of quinine hydrochloride made with local beeswax (that is beeswax from locally sources honeycomb waste) and other solid lipids sourced from abroad. Local beeswax was first purified by hot bath method. Solidified reverse micellar solutions (SRMS) were prepared by fusion method using Phospholipon®90H and either local beeswax, Softisan®154, foreign beeswax, or stearic acid, separately. SLNs and NLCs of quinine made with SRMS of each of these solid lipids were formulated using hot homogenization method. These SLNs and NLCs were characterized. The average particle size of SLNs and NLCs made with local beeswax was 93.60 ± 4.44 nm and 112.80 ± 3.89 nm, respectively, and was not significantly (p > 0.05) different from the sizes of formulations made from other solid lipids (SLNs: 96.64 to 118.9 ± 4.13 nm and NLCs: 99.68 ± 6.75 to 117.30 ± 4.60 nm). The particles were monodispersed having PDI ranging from 0.281±0.054 to 0.308±0.055. Encapsulation efficiency and loading capacity were generally poor, especially among the SLN formulations. However, SLNs made with local beeswax and stearic acid were able to encapsulate quinine, whereas foreign beeswax and Softisan®154 had zero encapsulation. This study reveals that the features of the SLNs and NLCs made with local beeswax where highly comparable with those formulated with the imported solid lipids. Therefore, local beeswax can serve as a suitable affordable and available alternative to other imported solid lipids for formulating different lipid drug delivery systems.
Evidence for field induced quantum spin liquid behavior in a spin-1/2 honeycomb magnet
Authors: Lin Gaoting , Shu Mingfang , Zhao Qirong , Li Gang , Ma Yinina , Jiao Jinlong , Li Yuting , Duan Guijing , Huang Qing , Sheng Jieming , Kolesnikov Alexander I. , Li Lu , Wu Liusuo , Chen Hongwei , Yu Rong , Wang Xiaoqun , Liu Zhengxin , Zhou Haidong , Ma Jie
Published: July 2024

One of the most important issues in modern condensed matter physics is the realization of fractionalized excitations, such as the Majorana excitations in the Kitaev quantum spin liquid. To this aim, the 3d-based Kitaev material Na2Co2TeO6 is a promising candidate whose magnetic phase diagram of B // a* contains a field-induced intermediate magnetically disordered phase within 7.5 T < |B| < 10 T. The experimental observations, including the restoration of the crystalline point group symmetry in the angle-dependent torque and the coexisting magnon excitations and spinon-continuum in the inelastic neutron scattering spectrum, provide strong evidence that this disordered phase is a field induced quantum spin liquid with partially polarized spins. Our variational Monte Carlo simulation with the effective K-J1-Γ-Γ'-J3 model reproduces the experimental data and further supports this conclusion.
Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal
Authors: Sayami Matina , Baral Suman , Shrestha Rakshya , Karki Dambar B
Published: July 2024

Introduction: Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life.
Methods: This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17.
Results: Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients.
Conclusion: The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients.
Implementation of WHO Surgical Safety Checklist and its Outcome in South Asia
Authors: Kurlberg Göran
Published: July 2024

Introduction: Surgery plays an essential role in any health care system. In 2009, WHO introduced the safe surgery checklist, to improve patient outcome following surgical procedures. The purpose of this trial was to elucidate the effects of the checklist on perioperative complications and checklist implementation at different hospitals in South Asia.
Methods: Online databases were searched to find relevant publications at centres in the South Asian Association for Regional Cooperation (SAARC) area. They were characterised regarding type of study, publication details, study population as well as type of intervention, by the use of the WHO checklist.
Results: Following the search process, seven full text publications were included in the review. They emanated from five medical centres in India and two from Pakistan. All of these reports found a clear improvement in surgical outcomes and the implementation approached 90-96%.
Conclusion: The WHO checklist is a valuable tool to reduce surgical complications, especially in resource-limited settings, where it should be more commonly used.
Factors Predicting Mortality in Perforation Peritonitis at a Tertiary Care Center in Nepal
Authors: Kansakar Prasan , Ghimire Bikal , Mishra Parashuram
Published: July 2024

Introduction: Perforation peritonitis is a common surgical emergency. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, mortality due to this illness still remains high. To analyze various demographic and clinical parameters associated with mortality in patients undergoing surgery for hollow viscus perforation peritonitis.
Methods: A prospective observational study was conducted at the Surgical Gastroenterology Unit, Department of Surgery, Tribhuvan University Teaching Hospital, in patients undergoing surgery for perforation peritonitis over a period of 18 months. Demographic characteristics, physiological variables and laboratory values were obtained. End point of the study was patients’ condition at discharge or in-hospital mortality. Univariate and multivariate analysis of various demographic, clinical and laboratory parameters were performed.
Results: Among 121 patients, mean age was 41.5±18.9 years (range of 16 to 87 years). There was a male preponderance (74.1%). In-hospital mortality was seen in 19 patients (17.0%). Age, female sex, pulse rate, blood pressure, white blood cell count, urea and creatinine were significant parameters associated with mortality. Multivariate logistic regression analysis of the variables found to be of significance from univariate analysis showed that only pulse, systolic blood pressure and creatinine were the independent variables associated with mortality.
Conclusion: Higher mortality was seen in elderly patients. Despite of male preponderance, larger proportion of females succumbed to their disease. Derangement in vital parameters like pulse and blood pressure and renal function test had negative impact in survival.
Vein of Galen Aneurysmal Malformation Presenting with Obstructive Hydrocephalus: A Case Report
Authors: Khanal Nischal , Rajbhandari Binod , Sedain Gopal , Shilpakar Sushil K
Published: July 2024

The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it.
Comparative Study on Effectiveness and Safety of Atorvastatin with Rosuvastatin in Hyperlipidemic Patients at a Tertiary Care Hospital in Nepal
Authors: Raut Binod , Paudel Nimesh , Shrestha Deepti , Bhosekar Anant
Published: July 2024

Introduction: Hyperlipidemia is one of the most contributing factors to coronary heart diseases. Statins have become standard medicine in clinical practice to reduce total cholesterol, low density lipoprotein and to increase high density lipoprotein cholesterol. This study is conducted to compare the effectiveness and safety of atorvastatin with rosuvastatin in hyperlipidemic patients.
Methods: This is a prospective observational study involving 150 patients conducted in the Department of Internal Medicine of Kathmandu Medical College and Teaching Hospital from July 2019 to March 2020. Patients newly diagnosed with hyperlipidemia were enrolled. Patients that were prescribed with 10 mg of atorvastatin and 5 mg of rosuvastatin by the treating physician once daily for 6 weeks were divided into two groups. Data was recorded in the customized proforma and the SPSS package version 20 was used for analysis.
Results: Patients that were prescribed with atorvastatin were put in group I and those prescribed with rosuvastatin were included in group II with 75 participants in each group. The mean age of the patients were 50.56± 10.08 years in group I and 52.45±10.20 years in group II with male to female ratio of 3:1. The mean BMI of group I was 25.36±1.74 and that of group II was 26.48±2.21 before therapy. There was a significant main effect of duration (F1,74=401.02, p<0.001) on the TG and TC levels (F1,74=1134.23, p<0.001) as well as (F1,74=614.99, p<0.001) on the LDL and HDL levels (F1,74=146.38, p<0.001).
Conclusion: Rosuvastatin was significantly more effective than atorvastatin in reducing levels of TG, TC and LDL-C. Rosuvastatin also significantly increased the level of HDL.
Normative Measurement of Orbital Structures in Computed Tomography
Authors: Rokka Damodar , Poudel Sharma , Kayastha Prakash , Suwal Sundar , Poudyal Sudil , Chhetry Saroj , Lohani Benu , Shrestha Shantalall , Karn Rakesh
Published: July 2024

Introduction: Normal orbital dimensions are important for diagnosing orbital pathologies. Computed tomography (CT) of the orbit is an important modality offering high accuracy for precise measurements of orbit. The study was disbursed to ascertain criteria for the normative values of the various orbital dimensions using computed tomography in patients visiting Tribhuvan University Teaching Hospital, Kathmandu.
Methods: Orbital volume, ocular diameter, length of the interzygomatic line (IZL), the distance of the posterior extent of the globe from the interzygomatic line, globe position, diameters of extraocular muscles (medial, lateral, superior group, and inferior rectus) and lens density were measured in each eye of 172 patients undergoing CT examination of paranasal sinuses. The correlations with age and sex were also analyzed.
Results: Mean values (mean±SD) of orbital volume, ocular diameter, IZL, globe position and lens density were 24.54±2.57 cm3, 2.44±0.22 cm, 94.3±6.2 mm, 12.3±2.4 mm and 141.43±16.62 HU respectively. Mean diameters of extraocular muscles were 3.67± 0.52 mm, 3.36± 0.50 mm, 3.74±0.42 mm and 3.87±0.38 mm for medial rectus, lateral rectus, inferior rectus and the superior group respectively. There was no significant age and gender difference in most of the measurements. There was significant positive correlation of age with lens density, orbital volume and ocular diameter (p<0.05).
Conclusion: Normative data of different orbital measurements were obtained. The present result may help radiologists and ophthalmologists to accurately assess various orbital parameters, particularly in Nepalese populations.
Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy
Authors: Sigdel Prem R , Subedi Nirajan , Phuyal Suman , Pokharel Ashik , Ghimire Bikal , Singh Yogendra P
Published: July 2024

Introduction: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system.
Methods: A total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone.
Results: Among 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%.
Conclusion: The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4 mm and impacted stone are the preoperative predictors of difficult LC.
Rare Primary Spinal Mesenchymal Chondrosarcoma: A Case Report
Authors: Paudel Sushil , Adhikari Shirish , Adhikari Sharad C , Pokharel Rohit K
Published: July 2024

Primary extradural mesenchymal chondrosarcoma (MCS) is a very rare intraspinal tumor. Proper clinical evaluation with magnetic resonance imaging (MRI) followed by biopsy of the mass can confirm the diagnosis. Since MCS has a high tendency of recurrence and metastasis, the prognosis is guarded. We report a 52 years old male with primary extradural MCS in the lumbosacral region (L5-S3). Subtotal excision and biopsy were performed which confirmed the diagnosis. The patient received post excisional radiotherapy but expired after four months. Though rare, this tumor should be kept in differentials which helps in early diagnosis and thus can be treated with radical excision of the mass along with postoperative radiotherapy.
Outcome of Carotid Endarterectomy in a Tertiary Center of Nepal: A Retrospective Study
Authors: Kadel Prashiddha B , Shrestha Uttam K , Shrestha Kajan R , Gurung Dinesh
Published: July 2024

Introduction: Carotid endarterectomy for carotid artery disease is one of the surgeries performed by vascular surgeons for carotid artery disease. The objective of this study is to describe the early and late outcome of the patient undergoing carotid endarterectomy and the association between the complication and comorbidities present previously in the patient.
Methods: All patients undergoing carotid endarterectomy at Manmohan Cardiothoracic Vascular and Transplant Centre between April 2010 to April 2020 were included. The follow-up data for upto a year from medical and clinical records, telephone interview regarding the immediate and late postoperative complications in patients with and without comorbidities were investigated and compared.
Results: The total study population was 42 patients. Two patients (4.7%) developed stroke, one immediately in postoperative period and the other during follow up. There were two deaths (4.7%) postoperatively due to cardiac events and three (7.14%) recurrences of carotid stenosis among whom one (2.5%) developed late stroke. Twenty six patients (61.90%) were symptomatic prior to the procedure of which 20 patients (47.61%) had brain infarct. Overall one year survival was 95.2% post procedure and overall complication rate was 7.14%. The consequence in the form of death and stroke occurred more in the patients with comorbidities (3vs1) p=0.42.
Conclusion: The immediate and late postoperative complications following carotid endarterectomy were death (4.7%), stroke (4.7%), cranial nerve injury (9.5%). The most frequent cause of death was postoperative cardiac event. Though major complications occurred more frequently in patients having comorbidities, it was statistically insignificant.
A Tale of β-Lactamases and Multidrug Resistance in Pseudomonas aeruginosa Isolated from Inpatients in a University Hospital
Authors: Yadav Santosh K , Sharma Sangita , Mishra Shyam K , Sherchand Jeevan B
Published: July 2024

Introduction: In this era of modern medicine, antimicrobial resistance can be regarded as a major health calamity. The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains poses therapeutic challenges and lead to treatment failure in hospitalized patients. This study was conducted to determine various types of β-lactamases among MDR P. aeruginosa isolates recovered from hospitalized patients.
Methods: This study was conducted at Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. The clinical samples collected from inpatients were processed for detection of P. aeruginosa isolates and antibiotic susceptibility profile was determined. The MDR strains were identified and ceftazidime-resistant isolates were subjected for detection of extended-spectrum-β-lactamase (ESBL), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC).
Results: A total of 161 P. aeruginosa isolates were recovered during the study period encompassing 73.3% (n=118) MDR isolates. The MDR isolates included 50.0% (n=59) from lower respiratory tract infections; and 39.8% (n=47) were from the intensive care unit patients. The MDR isolates showed a high resistance profile towards piperacillin, cephalosporins, and fluoroquinolones (>85%). Resistance to carbapenems and aminoglycosides were up to 80% and 60% respectively. Extended spectrum-β-lactamase, MBL, and KPC mediated resistance were seen in 34.7%, 43.6%, and 14.4% MDR isolates, respectively.
Conclusion: Multidrug resistance as well as resistance mediated by β-lactamases production were high among P. aeruginosa isolates. Therefore, early detection of antimicrobial resistance and rational use of antibiotics play a critical role to fight against this MDR pathogen.
Survival in Critical Care Patients with COVID-19 Pneumonia: A Single Center Based Observational Study
Authors: Bam Niraj , Kuikel Sandip , Sapkota Dharmendra , Poudel Sagar , Pant Pankaj , Das Santa K
Published: July 2024

Introduction: The severity of COVID-19 pneumonia ranges from asymptomatic to requiring mechanical support for survival. This observational study describes the demographic, management, vaccination status and outcome in Nepalese patients with COVID-19 who were admitted to critical care settings .
Methods: Single center based cross sectional study was conducted. All the patients admitted to critical care of Tribhuvan University Teaching Hospital (TUTH) were eligible subjects for this study. Demographic, clinical details and vaccination status of respective patients was obtained from interview and chart review. Data was collected in Microsoft Excel 2016 and statistical analysis was performed using statistical software SPSS 21.
Results: A total of 342 patients with mean age 53.95±15.6 years were included in the study. The mean duration of stay in critical care was 6.74±4.43 days. Fever and shortness of breath was the predominant symptom present in the studied patients with all patients having shortness of breath. Out of the 342 patients, 20.2% (n=69) were intubated at least once during their critical care stay, 57.89%(n=198) received only non-invasive ventilation and 21.9% (n=75) received oxygen via other means. The overall survival rate of patients admitted to critical care of TUTH was 60.53% with very low survival rate in intubated patients. Only 8.8% of the included patients had received at least one dose of vaccine.
Conclusion: Our study suggest that the prognosis of critical care COVID-19 patients is poor with highest mortality in patients receiving mechanical ventilation. Delay in intubation may contribute to this worse outcome in intubated COVID-19 patients.
Elective Lower Segment Cesarean Section in Patients with Severe Mitral Stenosis under Sole Epidural Anesthesia: Initial Experiences Case Report
Authors: Shrestha Amit , Oli Samana , Baral Dilip , Parajuli Bashu Dev
Published: July 2024

Management of a pregnant females with rheumatic heart disease is always challenging due to pregnancy related hemodynamic changes, which is further complicated by the pre-existing heart disease. We, here, report unique successful management of two pregnant women with multi-valvular heart disease, amongst severe mitral stenosis, who underwent elective lower segment cesarean section, under sole epidural anesthesia on contrary to general or spinal anesthesia. In woman with severe stenotic valvular heart disease especially aortic and mitral stenosis, it is always challenging to carry out the pregnancy to term, hence planned cesarean delivery at 36-37 weeks of gestation is always preferred mode of delivery for better maternal and fetal outcomes.
Validation of Nepali Version of Depression, Anxiety and Stress Scales (N-DASS21) among Higher Secondary School Students
Authors: Choulagai Bishnu P , Sharma Poojan , Sharma Chandrakala , Neupane Subas , Rana Mita
Published: July 2024

Introduction: Depression and anxiety are recognized as serious public health problems and are globally leading causes of disability in terms of total years lost due to disability. Depressive disorders often start at a young age; they reduce people’s functioning and are frequently recurring. The aim of this study was to examine the reliability and validity of Nepali version of Depression, Anxiety and Stress Scales (N-DASS21).
Methods: The study was conducted during February – May 2017 among higher secondary school students from nine public schools in Kathmandu. The sample size achieved for this study was 1007, with a response rate of 94.8%. The Nepali version of the questionnaire was used for data collection. Data were analyzed for validity using confirmatory factor analysis.
Results: The internal consistency of the three subscales for the constructs was assessed using Cronbach’s alpha with values obtained between 0.76 and 0.81 indicating a reliable scale. The receiver operating characteristic curves showed the area under the curve for depression and anxiety scales as 0.80 and 0.91, respectively. This indicates that the scales are accurate.
Conclusion: The Nepali version of DASS21 (N-DASS21) is psychometrically sound with good reliability and validity. It can be utilized as an instrument for measuring depression and anxiety in Nepali population.
Burden of Care among Mothers Having Children with Thalassemia
Authors: Bhujel Bishnu , Mishra Tulashi Adhikari
Published: July 2024

Introduction: Thalassemia, an inherited disorder is characterized by reduction in the ability of the body to synthesize hemoglobin. Though care giving is a normal parental duty, providing lifelong care to thalassemic children may increase burden among parents. The objective of this study was to find out the burden of care among mothers having thalassemic children.
Methods: This descriptive cross-sectional study was carried out among 100 mothers attending a Thalassemia day care center in Kathmandu, Nepal. Non-probability purposive sampling technique was used to collect data through interview using Zarit Burden Interview scale.
Results: Findings revealed that out of 100 mothers, 19% had little or no burden, 43% had mild level of burden of care, 34% had moderate burden of care and 4% had severe burden of care. It was found that 43% of the mothers frequently felt that child is depended upon her, 20% of the mothers, frequently felt stressed from caring their children. 35% of the mothers frequently felt that money is insufficient to care for their child. Statistically significant association was found between level of burden with economic status (p=0.002) and place of residence (p=0.03).
Conclusion: The study concludes that mothers face burden of caring the child having thalassemia. Burden of care among mothers tends to be influenced by the family economic status and residence. This burden should be minimized by health personnel through proper counseling and support to mothers of thalassemic children
Liver and Spleen Stiffness as Predictors of Esophageal Varices in Patients with Liver Cirrhosis
Authors: Jaishi Shila , Pathak Rahul , Bhandari Brindeswari Kafle , Jha Anurag , Hamal Rabin , Koirala Dinesh , Gyawali Susmita
Published: July 2024

Introduction: The risk for the occurrence of esophageal varices in a cirrhotic patient is assessed by two gold standard invasive tests: hepatic venous pressure gradient measurement and esophagogastroduodenoscopy. We aim to find the association between spleen and liver stiffness with the occurrence of esophageal varices in our settings.
Methods: This was a prospective cross-sectional study. In the study duration of one year, 94 cirrhotic patients who met the inclusion and exclusion criteria were included. All patients were subjected to transient elastography for measuring liver and spleen stiffness and endoscopy.
Results: Of 94 patients, only 77 (81.9%) had esophageal varices. The mean liver stiffness in patients with and without varices was 19.46±4.9SD kPa and 12.92±1.52 SD kPa respectively. The difference was statistically significant, p<0.001. The mean spleen stiffness in patients with and without varices was 22.26±4.6 SD kPa and 14.08±1.20 SD kPa respectively. The difference was statistically significant, p<0.001. The optimal cut-off value of liver and spleen to detect patients with any grade of esophageal varices was 14 and 16.15 kPa respectively.
Conclusion: The stiffness of liver and spleen using transient elastography can be considered an equivalent method for screening cirrhotic patients for esophageal varices in clinical settings.
Road Traffic Regulation Awareness, Attitude and Practice among Public Health Students: An Observational Study
Authors: Shah Shirshak , Singh Sarswoti , Sharma Bimala , Shakya Sujata
Published: July 2024

Introduction: Road traffic accidents (RTAs) are the leading causes of premature deaths in Low and Middle Income Countries (LMICs). Public health students are the special cadre of human resources for addressing public health issues in the community including RTAs. This study aimed to assess the awareness, attitude, and practice of public health students of Kathmandu Valley regarding road traffic regulations.
Methods: This was a cross-sectional study conducted among 395 undergraduate public health students of Kathmandu Valley using structured self-administered questionnaire via google forms. The study participants were selected through student networking and invitation through emails and phone calls. Descriptive statistics and inferential statistics: Mann-Whitney U test, Kruskall-Wallis H test, and spearman’s rank correlation were computed at 5% level of significance.
Results: Majority of the participants had knowledge on causes of RTAs, rule for seat belt and not using mobile phone while driving. However, few knew about the maximum penalty for driving without a license and correct side for pedestrians to walk. The median knowledge score on road traffic regulations was 11 out of 14, attitude score 7 out of 7, practice score for pedestrians 10 out of 12 and for drivers/riders 16 of 18. No significant association was found between knowledge and any socio-demographic variables. Knowledge was weakly correlated with attitude.
Conclusion: Majority of the participants had knowledge scores above average, while the attitude and practice percentages were higher. We found weak correlation of knowledge with attitude, and no correlation with practice. This indicates that there is still gap between knowledge and practice, which needs to be explored further.
Assessment of Volume Status Using Body Composition Monitor for Blood Pressure Control in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Trial
Authors: Dhakal Niraj , Sapkota Nisha K , Sigdel Mahesh R
Published: July 2024

Introduction: Optimal fluid balance and blood pressure control have been shown to improve outcomes in hemodialysis population. We investigated the effectiveness of body composition monitor (BCM) to target dry weight in maintenance hemodialysis (MHD) patients for blood pressure (BP) control and intradialytic adverse events.
Methods: A total of 61 consenting adults under MHD were randomly allocated into either BCM group or Clinical Method group. Target dry weight was set every 4-weekly based on BCM report or clinical assessment; dry weight was adjusted with 200-500 ml/session reduction or increment of ultrafiltration in addition to interdialytic weight gain. Outcomes were analyzed in terms of BP control, anti-hypertensive medicine score, and intradialytic adverse events.
Results: During 12 weeks of study period, systolic blood pressure (p<0.001), diastolic blood pressure (p=0.01) and mean arterial pressure (p<0.001) significantly decreased from baseline in BCM group but there were no significant changes in Clinical Method group. Lower blood pressure was achieved in BCM group as compared to Clinical Method group. There was a significant decrease from baseline in anti-hypertensive medicine score in the BCM group (p<0.001) but not in the clinical method group (p=0.34). There were significantly fewer events of cramps in the BCM group as compared to the Clinical Method group (p=0.04).
Conclusion: BCM guided volume management in MHD patients was more effective than volume management based on clinical judgment only in controlling blood pressure and decreasing anti-hypertensive medicine burden and intradialytic cramps.
Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors
Authors: Kafle Prakash , Rufus Phelix , Paudyal Nabin , Joshi Narendra P , Khanal Babita , Jonathan Edmond , Bhandari Binod R , Sharma Mohan R
Published: July 2024

Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes.
Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed.
Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes.
Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery.
Case Report of Foveolitis with Optic Neuritis: A Barely encountered Ophthalmic Manifestation of Dengue
Authors: Bista Bipin , Kharel Sitaula Ranju , Lama Dichen M , Sitaula Sanjeeta
Published: July 2024

Dengue fever is a tropical disease which is endemic in tropical/subtropical nations like Nepal. Bilateral optic neuritis with unilateral foveolitis is an unusual dengue-related ophthalmic complication. We here present to you a case of bilateral optic neuritis with right eye foveolitis who initially presented with complaints of sudden diminution of vision in one eye following dengue fever. This report deals with prolonged treatment of rare ocular presentation of dengue infection. Patient had persistent myodesopsia and scotoma in the right eye even after 5 months of treatment with oral steroids. Dengue-related ophthalmic findings although rare, can have significant and long-lasting visual impairment if not treated timely and appropriately.
User fees and the cost of irrational prescribing
Authors: Holloway K. A , Gautam B. R.
Published: July 2024

Lack of funds, insufficient drug availability and irrational prescribing undermine primary health care in Nepal. This study measured the cost of irrational prescribing and the impact of different kinds of user fee on the cost of irrational prescribing. The study took place within cost-sharing drug re-supply schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged. A before-after non-randomized controlled trial was conducted. The cost per prescription, the cost of irrational prescribing (wastage) per prescription and % drug cost recovery were measured. It was found that more than one-third the value of all drugs dispensed to patients had been irrationally prescribed and that item fees were associated with 20% financial savings due to reduced irrational prescribing as compared to flat fees. If all irrational prescribing were eliminated it maybe that an amount of drugs equivalent to value of the annual HMG drug indent would last the year round in many health facilities.
Psychological and behavioural problems in school students of Morang district
Authors: Sharma VD
Published: July 2024

Results of structured and semi-structured interviews of 37 school teachers from 9 different schools of Morang has been presented in relation to existence of psychological/behavioural problems in their students. Data on 3911 students have been analyzed. The study shows that 1442 (36.89%) of students had some kind of problem. The list of conditions in decreasing order of incidence are: very slow to learn, irregular school attendance, suddenly degrading school performance, not able to concentrate and running away from school. The female/male ratio of students was 1:1.47.
EFECTO DEL TIPO DE ENTRENAMIENTO SOBRE EL AJUSTE CONDUCTUAL DE ESCUCHAR
Authors: Rocha Hernández Edgar ,   Facultad de Estudios Superiores de Iztacala, UNAM, Luevano León Daniela Stephanie , Alavéz Sánchez Estefani Jovanna , Silva Victoria Héctor Octavio
Published: July 2024

El presente manuscrito reporta los resultados de dos estudios dirigidos a analizar el ajuste conductual de escuchar. El primero de ellos tuvo por objetivo evaluar el efecto del cambio de modalidad de presentación de la tarea sobre el desempeño efectivo, para lo cual se formaron dos grupos experimentales, uno al que se le aplicó una tarea de ajuste lector y otro al que se le aplicó una prueba de Escucha. Esta última prueba supone el mismo contenido de la prueba de ajuste lector, pero en una modalidad de presentación auditiva. Los resultados muestran un desempeño efectivo mayor en el grupo de Ajuste lector. El segundo estudio tuvo por objetivo evaluar el efecto de distintos tipos de entrenamiento sobre el desempeño efectivo en pruebas de Escucha, para tales fines se definieron cinco grupos experimentales (uno por criterio de ajuste en el entrenamiento) y un grupo control. El diseño experimental fue A-B-A y el análisis de resultados con base en el porcentaje de respuestas correctas. Los resultados muestran una mejora en el desempeño efectivo en los grupos con entrenamiento en criterios de pertinencia y congruencia. Se discute la necesidad de identificar formas cualitativamente diferentes de escuchar, y someterlas a estricto estudio experimental de sus causas y las variables que inciden en su configuración como ajuste psicológico.
Effect of different agro-techniques on yield of Bt cotton
Authors: V.B. GOHIL  , D.M. PATEL  , M.M. CHAUDHARY
Published: July 2024

A field experiment was conducted during the 2 consecutive kharif seasons of 2019 and 2020 at Agronomy Instructional Farm, Chimanbhai Patel College of Agriculture, Sardarkrushinagar Dantiwada Agricultural University, Sardarkrushinagar, to study the yield maximization of Bt cotton through agro-techniques in loamy sand. The experiment consisted of four factors viz; spacing, detopping, intercropping and sowing time with two levels in each treatment. The results of pooled data of 2 years indicated that Bt cotton sown at spacing of 60 cm × 45 cm recorded significantly higher plant height, crop growth rate as well as seed cotton (3077 kg/ha) and stalk yields (5930 kg/ha), seed cotton equivalent yield (3512 kg/ha) and oil yield (335 kg/ha). However, wider spacing of 120 cm × 60 cm produced remarkably higher number of sympodial branches per plant, relative growth rate, number of open bolls per plant, weight of seed cotton per boll and seed cotton yield per plant. Topping carried out at 75 DAS remarkably improved growth and yield attributes, seed cotton and stalk yields, seed cotton equivalent yield, oil yield. All growth and yield attributes as well as seed cotton yield were recorded significantly higher without intercrop in Bt cotton. Though intercropping of greengram (additive series) in Bt cotton produced significantly higher seed cotton equivalent yield than no intercropping in pooled mean. Advance sowing of Bt cotton in last week of May produced significantly higher seed cotton yield and seed cotton equivalent S1 T2I2 D1 [Advance sowing (Last week of May)] at plant spacing of 60 cm × 45 cm along with detopping at 75 DAS and intercropping with greengram] gave significantly higher seed cotton equivalent yield as well as net returns and B: C ratio of Bt cotton.