bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Relationship between Road Roughness and Pavement Surface Condition
Authors: Shrestha Satkar , Khadka Rajesh
Published: July 2021

Pavement evaluation is the most significant procedure to minimize the degradation of the pavement both functionally and structurally. Proper evaluation of pavement is hence required to prolong the life year of the pavement, which thus needs to be addressed in the policy level. By this, the development of genuine indices are to be formulated and used for the evaluation. In context of evaluating the pavement indices for measuring the pavement roughness, International Roughness Index (IRI) is used, whereas for calculating the surface distress, indices as such Surface Distress Index (SDI) and Pavement Condition Index (PCI) are used. Past evaluating schemes used by Department of Roads (DOR) were limited to IRI for evaluating the pavement roughness and SDI for measuring the surface distress, which has least variability in categorizing the pavement according to the deformation. Apart from these, PCI which has wide range of categories for evaluating pavement, is not seen in practice in Nepal due to its cumbersome field work and calculations. In this paper the relationship is developed relating PCI with IRI and SDI using regression analysis by using Microsoft excel. In the other words, the pavement roughness index is compared with the surface distress indices. In 2017, 23.6Km of feeder roads in various locations of Kathmandu and Lalitpur districts were taken for this study which comprised of 236 sample data, each segmented to 100m. For this, IRI was sourced as secondary data, obtained from Highway Maintenance and Information System (HMIS) unit, Kathmandu, whereas, PCI and SDI were calculated from the field data obtained from the survey carried out in those sections manually. Then after, among 236 samples, 189 samples were taken for the relationship development which was then validated using 47 remaining samples. Furthermore, in the year, 2019 additional 3 Km of data was taken for validating the obtained relationships. It was done to improve the numerical predictions of data with such variation and thus satisfactory relationships were developed among the indices discussed in this study. The regression relationships between the two indices, IRI-PCI and IRI-SDI were thus significantly obtained. It has been found that the R² value for these relationships developed were statistically significant with 5% level of significance. The R² value for all the relationships showed that these relationships could be used for predicting the indices which would help in evaluating the pavement.
Deterministic and Probabilistic Analysis of Dasdhunga Soil Slope along Narayangarh-Mugling Road Section
Authors: Shrestha Saurav , Acharya Indra Prasad , Dahal Ranjan Kumar
Published: July 2021

Instability of slopes is usually governed by a combination of intrinsic and extrinsic factors. The inherent variability of parameters make the problem probabilistic rather than a deterministic one. This research deals with evaluation of stability of slopes with the calculation of the factor of safety of Dasdhunga soil slope along Narayangarh- Mugling road section under different rainfall conditions through the use of coupled finite element and limit equilibrium method in GeoStudio and the determination of probability of failure by sliding, modeled as infinite slopes by using Monte Carlo simulation in R-Studio. Mean, standard deviation, minimum and maximum values of the parameters like- friction angle, cohesion and unit weight were computed from eight samples of the slope. The pore water pressure developed and its corresponding statistical data for different rainfall conditions were computed from FEM based SEEP/W simulation. The above parameters are assumed to follow truncated normal probability distribution function and the geometric parameters like height and slope angle are regarded as constant parameters. It was observed that the safety factors for theslopeis low in high intensity-low duration rainfalls and the probability of failure is high. The tendency to fail increases as the return period of rainfall increases and viceversa. Sensitivity analysis performed in both deterministic and probabilistic methods showed that friction angle is the most sensitive.
Energy Security Assessment of Nepal for the Period 2005-2030
Authors: Darlamee Shova , Bajracharya Tri Ratna
Published: July 2021

Energy is an important driver of all economic activities and it is necessary for the production of goods and the provision of services. Thus, a secure supply of energy to meet national demand on both the short term and long term is important for any country. As a net importer of petroleum products from only one supplier country of petroleum products (i.e. India), supply and demand gap of energy, frequent price fluctuations of petroleum products and poor diversification of primary energy supply, policies regarding energy security should be developed for Nepal.  This study aims to assess the energy security index of Nepal so as to provide a picture of the historical performance of the country in terms of energy security for the past years 2005-2015 and in the future 2016-2030 under different scenarios. A set of 24 energy security indicators were selected based on literature review and relevant to national energy policies and grouped under 5 dimensions which are availability, affordability, accessibility, efficiency and acceptability. It can be seen that energy security for Nepal has been following a declining trade since 2005/06 to 2015/16, the causes of which could be attributed to the increase in energy consumption, increase in imports of petroleum products, increase in electricity deficit from the year 2008/09, increase in price of petroleum products. However, the value of energy security index is on the higher side (near to 10) which is mainly due to the fact that energy supply of Nepal is mostly dependent on traditional sources which is domestically supplied. There is a need to incorporate energy security in the national energy policy of Nepal with more emphasis on diversification of primary energy sources (other than traditional resources), reduction on import dependency especially on fossil fuel resources, strategic fuel reserves, diversification of energy resources uses in different energy consumption sectors like transport, industries, increase in energy supply from renewable energy sources, etc.
Computational and Experimental Study of the Effect of Solidity and Aspect Ratio of a Helical Turbine for Energy Generation in a Model Gravitational Water Vortex Power Plant
Authors: Joshi Shubhash , Jha Ajay Kumar
Published: July 2021

Gravitational Water Vortex power plant is a relatively new plant used to generate hydropower from low head rivers and canals. There has been an increase in research in the field of runner design and canal design for GWVPPs throughout the world. As no definite equations are formulated in case of runners used in a GWVPP, they are currently produced by hit and trial method. This research focuses on studying about the use of a pure reaction turbine, Gorlov turbine, to generate power from a GWVPP. ANSYS Fluent was used to perform computational study while the experimental study was done using helical turbine blades fabricated using a 3-D printer. The energy generated is very low compared to the impulse turbines. Both the computational and experimental study shows that when increasing the aspect ratio of the turbine but keeping the solidity same, the efficiency is increased significantly. However, the studies also show that on increasing the solidity, the efficiency seems to decrease. All the turbines used submerged to 3 different depts and all the results show that increasing the submergence increased the efficiency.
Land Use Land Cover (LULC) Change Projection in Kathmandu Valley using the CLUE-S Model
Authors: Lamichhane Suraj , Shakya Narendra Man
Published: July 2021

In the past few decades the urbanization pattern of the Kathmandu valley has rapidly increased and the process was sensed through the increase in the urban facilities, population growth, and changed LULC pattern. The historical LULC change was analyzed using the generated map and the future scenario was found through the CLUE-S LULC change model and processed in GIS environment. Five scenarios and nine driving forces were considered for the sensitivity and future analysis of the model. Based on the evaluation of the historical maps and the conservation matrix, the built-up area is found to be increased nearby by 5% and the agricultural area decreased by 6.5% during 2010 to 2018. It is concluded that the normal LULC conservation scenario provides more reliable information for the future projection. The simulation result highlights that nearly 4 km2 of fertile and open area will be converted to built-up areas due to the rapid urbanization per decade. This increase in urbanization process leads to more challenges in urban environment management in future.
Q-Analogue of Holder’s and Minkowski’s Integral Inequalities on Finite Intervals and Generalization
Authors: Bhatta Suresh , Bhatta Chet Raj
Published: July 2021

In recent years, the topic on Holder’s and Minkowski’s inequalities has been studied by several researchers and variety of new results has been developed on their variants, extensions and generalizations. In this paper we give the extension to the generalized q- Holder’s integral inequality and by using it we also establish the generalization on q- Minkowski’s integral inequality on the finite interval [a, b]
Study on Mechanical Properties of TMT Bars Manufactured in Nepal
Authors: Yadav Umesh , Ale Bhakta Bahadur
Published: July 2021

Three grades of deformed steel bar are presently available in Nepal for concrete reinforcement. The deformed bars are graded according to their specified yield strength. These are Fe415, Fe500 and Fe500D. CTD bars of grade more than Fe415 are scarcely available in market. However, TMT bars of Fe500 grade are easily available in market. This study is undertaken to evaluate the variability of the mechanical properties of reinforcing steel granted with NS Mark and to analyze the degree to which these rolling mills satisfy the minimum requirements established by product national standard NS:191. The data obtained from test results are statistically analyzed to evaluate the variability in the mechanical properties of TMT bars. For the tested mechanical properties, the parameters evaluated for each bar size, and grade at confidence level at 95 % are mean, standard deviation, coefficient of variation, minimum, maximum, skewness. The samples were collected from NBSM reference sample store room of FY 2073-74 and FY 2074-75. These samples were from nineteen industries and twenty-two different brands. Total 745 numbers of TMT bars of grade Fe500 and Fe500D were tested at NBSM mechanical testing laboratory. The mechanical properties determined from the tested samples are: mass per meter run, yield stress, tensile stress, percentage elongation, UTS/YS ratio, total elongation at maximum force, and bond value.The tested data and obtained statistics of different mechanical properties for the separate and combined data takes on an important practical significance and may be used in calibrating local specifications and designs.
Artificial Neural Network Based Approach for Voltage Stability Analysis of for Sustained Operation of Power System
Authors: Adhikari Yuba Raj , Barnawal Rishi Kumar
Published: July 2021

For reliable and secure power system, the stability analysis is recognized as an important problem. Voltage stability is the capacity of a power system to maintain steady acceptable voltages at all buses in the system. Voltage stability index (VSI) evaluation for a situation of power system can act as an accurate and fast indicator of the proximity of the system to voltage instability. Recently there has been considerable interest in intelligent methods based on artificial neural network (ANN), fuzzy logic and genetic algorithm to voltage stability assessment problem. ANN, with the ability to provide non-linear input/output mapping, parallel processing, learning and generalization have the potential to make them ideally suited for estimating VSI’s of a power system without solving the governing power system equations. This paper is to purpose an alternative method using ANN for finding the closeness of system operating point to voltage collapse that would be claimed to have better computational speed, accuracy, efficiency and reliability. Voltage Stability Analysis (VSA) using VSI is performed for different alternate loading strategies of power network building ANN models for every different scenario. The outcome found working satisfactorily in analyzing voltage stability problem, basically in ranking the network buses according vulnerability order.
Role of NT-proBNP in Detection of Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Patients with Preserved Ejection Fraction: A Cross-sectional Study
Authors: Pandey Naveen Kumar , Karki Prahlad , Shah Prashant , Lamsal Madhab
Published: July 2021

Background: Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy and is initially subclinical. Early diagnosis enables earlier treatment and stops further progression of the disease. Tissue Doppler Imaging (TDI) is a new diagnostic modality with high sensitivity and specificity to know ventricular diastolic function. N-terminal pro brain natriuretic peptide (NT-proBNP) is a cardiac neurohormone that can be used to identify the changes in ventricular diastolic function. We aimed to estimate the concentration of NT-proBNP and correlate its value with TDI for LVDD in asymptomatic type 2 Diabetes Mellitus.

Methods: In this comparative cross-sectional study, we enrolled 100 asymptomatic type 2 diabetic patients and 100 healthy people aged 30-60 years. In both groups, NT-proBNP levels were measured and the presence of LVDD was determined by TDI. The primary outcome parameter was the level of NT-proBNP in diabetics and healthy people. The secondary outcome parameter was the correlation of NT-proBNP level with various grades of LVDD.

Results: In patients with LVDD, NT-proBNP levels [median (IQR)] were 123 (102,194) pg/ml in diabetics and 72 (67, 77) pg/ml in the control group. In patients without LVDD, NT-proBNP levels [median (IQR)] were 69 (59, 76) pg/ml in diabetics and 57 (49, 63) pg/ml in the control group. The level of NT-proBNP was significantly higher in those with LVDD (p < 0.001). NT-proBNP concentration significantly increased as grades of LVDD increased.

Conclusion: NT-proBNP is a good marker for detection of preclinical LVDD in patients with uncontrolled diabetes prone to develop cardiovascular complications.
Mental Health Status among Adolescents of High Schools: A Cross-sectional Study
Authors: Dass Baishali , Kandangwa Binita , Pokharel Rita
Published: July 2021

Background: Adolescents are prone to develop various psychosocial problems with a long-standing impact. We aimed to investigate the mental health status among adolescents from high schools in Dharan sub-metropolitan city.

Methods: In this descriptive cross-sectional study, we enrolled 150 adolescents from two different schools of Dharan, using a stratified random sampling technique. The Pediatric Symptoms Checklist for Youth was used to assess their mental health status. A score of 30 or more was considered as a mental health problem. Poverty, family dispute, punishment, and personal and family history of a psychiatric condition were considered as potential predictors of mental health problem. The chi-square test was applied to identify the predictors of mental health problem.

Results: The final analysis included 141 samples. More than 60% of the students belonged to the age group 13-15 years, and 52.5% were females. About 59.6% were Janajatis, and 61% were Hindus. The majority (63.8%) were living below the poverty line. The majority (83.7%) had no dispute in the family. All the students had received punishment, and 51.1% had received it at home. One-third of the students had mental health problem. The presence of mental health problem was significantly associated with nuclear family status (p = 0.04), and history of a family dispute (p = 0.04).

Conclusion: Mental health problem was common among adolescents, and it was associated with the nuclear family structure and the presence of family dispute.
Mental Health Problems in Nepalese Migrant Workers and their Families
Authors: Mahat Pashupati , Thorley Kevan , Kunwar Karuna , Ghimire Smriti
Published: July 2021

In this cross-sectional study, we aimed to describe the mental health problems of Nepalese migrant workers and their family members at home in Nepal. Families of migrant workers left behind in Nepal from nine project districts were interviewed to assess the psychosocial problems and offered appropriate psychosocial counselling. We assessed 747 individual members. Ninety-five returned migrant workers received psychosocial counselling, 67% of whom were male. The majority (56%) of the returnees suffered from anxiety, 23% had depression and 11% had serious mental illness. The left-behind family members amounted to 653, 93% of whom were female. The majority (56%) had anxiety, 26% had depression, 7% expressed suicidal ideation or had attempted suicide, 2% had severe mental illness. We concluded that majority of returning workers and left behind family members suffered from anxiety and depression.
Knowledge Regarding Care of Low Birth Weight Babies among Nurses Working in Pediatric Wards of a University Hospital in Eastern Nepal
Authors: Yadav Upendra , Karna Basant Kumar
Published: July 2021

Background: Birth weight is the single most important factor determining a newborn’s survival chance. Recent development in neonatal care demands nurses to have updated knowledge regarding the care of low birth weight (LBW) babies. We aimed to assess the knowledge regarding care of LBW babies among nurses.

Methods: In this descriptive cross-sectional study, we enrolled 54 nurses working in pediatric wards of BPKIHS. To assess their knowledge regarding the care of LBW babies, a pre-tested self- response questionnaire was administered with focus on six domains: knowledge about care of LBW babies, the kangaroo mother care, adequacy of breast feeding, vaccination, bathing of LBW babies, and prevention of infection. The chi-square test was used to examine the association between different categorical variables and their knowledge.

Results: The majority (83%) had a Proficiency Certificate in nursing education, 11% had a Bachelor of Science in nursing education and only 6% had completed Bachelor in general nursing. More than half (55.6%) of the nurses had a job experience of 1-5 years. The overall knowledge score (mean ± SD) among the nurses on care of LBW babies was 86.5 ± 2.3. Nurses with Bachelor level of education had better knowledge score (85.5 ± 15.4) compared to those with proficiency level of education (75.1 ± 15.9) (p = 0.003).

Conclusion: The knowledge regarding the care of LBW babies among the nurses working in pediatric wards of BPKIHS seemed excellent. Knowledge was better in nurses with higher educational level.
Cerebral White Matter Hyperintensities in T2 Weighted Magnetic Resonance Images of Elderly Patients- Correlation with their Mental Status
Authors: Regmi Niraj , Mohiuddin Abu Saleh , Taher Abu , Ferdousi Mahfuz Ara
Published: July 2021

Background: White matter hyperintensities (WMH), focal and/or diffuse areas of hyperintense signals on T2 weighted magnetic resonance imaging (MRI), are the most common incidental finding in elderly patients. However, their clinical significance is usually overlooked. We aimed to find out the correlation between the degree of cerebral WMH in MRI with the mental status of elderly patients, assessed by Mini-Mental Status Examination (MMSE) score.

Methods: This cross-sectional study was conducted for two years on eighty eligible elderly patients (> 60 years) referred to the Department of Radiology and Imaging for MRI of the brain. Demographic variables like age and sex, MMSE score, and MRI variables like location and number of WMHs were studied. The Pearson’s correlation coefficient was used to calculate the correlation between the extent of periventricular WMHs and MMSE score.

Results: A significant negative correlation (r = -0.78; p < 0.001) was found between decreased MMSE and the extent of periventricular WMH. A significant negative correlation was also found when periventricular hyperintensities were evaluated individually for frontal caps (r = -0.68; p < 0.0001), band opacities (r = -0.55; p<0.0001) and occipital cap (r = -0.59; p < 0.0001). However, subcortical WMH was not significantly corelated with MMSE score (r = +0.018, p = 0.0897).

Conclusion: A significant negative correlation exists between the extent of periventricular WMH seen at brain MRI with cognitive decline in elderly subjects. However, no such correlation exists between subcortical WMH and mental status.
Fasting or Starving our Patients to an Inhumane Extent? A Plea for Some Common Sense
Authors: Pokharel Krishna
Published: July 2021

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Challenges in Care of Individuals with Autism Spectrum Disorder during the Covid-19 Pandemic: A Perspective from UK, India and Nepal
Authors: Sharma Pawan , Srivastava Paakhi , Gnanavel Sundar , Saini Lokesh , Madaan Priyanka
Published: July 2021

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Awareness Regarding Health Insurance Policy Scheme of Government of Nepal among Local Residents of Dharan Sub-Metropolitan City
Authors: Thapa Roshni , Lamsal Shyam , Badhu Angur , Shrestha Sharmila
Published: July 2021

Background: An expensive care discourages people from using health services. The health insurance policy scheme of the government of Nepal aims to provide quality health care services without a financial burden to its citizens. We aimed to assess its awareness among local people of Dharan and also find its acceptance and association with various demographic variables.

Methods: This cross-sectional study was conducted among 249 households in 5 wards of Dharan sub-metropolitan city. Using a semi-structured questionnaire, a face-to-face interview was taken either from the financial decision maker/ financial supporter of the family. The socio-demographic characteristics, awareness and perception towards the health insurance policy scheme and its acceptance were assessed. The chi-square test was used to find the association of their awareness with different demographic variables.

Results: The majority (70.7%) of the families were aware of the health insurance policy scheme. The most frequent source of knowledge was their friends/ family members (43.7%) followed by insurance service providers (32.4%). Only 36.6% of the families were enrolled in the health insurance policy scheme while 34.1% were not enrolled despite their knowledge about the scheme. Elderly (> 60 years), dependent, those without formal education, or those living below the poverty line were less aware regarding the health insurance policy (p < 0.05).

Conclusion: About 29% of families had no idea about health insurance policy scheme and 34.1% were not enrolled in it despite being aware of the scheme. Friends/ family members and insurance service providers were common sources of information.
A Unique Case of Hoarseness of Voice following Left Sided Supraclavicular Block: A Case Report
Authors: Lakhe Gajal , Poudel Hari , Pradhan Suresh , Dhakal Santosh
Published: July 2021

Supraclavicular brachial plexus block is popular for surgeries distal to the level of mid-arm. Though rare, recurrent laryngeal nerve palsy can occur in 1.3% of cases. It has been reported mostly in cases of right-sided block and only one case has been reported on the left side. We present a case of 50-year-old-female patient, who developed hoarseness of voice following a left-sided classical supraclavicular block.
Sistrunk’s operation: Ten years’ experience in a teaching hospital
Authors: Koirala Krishna Prasad
Published: July 2021

Introduction: Thyroglossal duct cyst (TGDC) is a congenital condition that results from persistence of thyroglossal duct. It commonly presents in the midline neck as a painless nodule. On physical examination, it moves with protrusion of tongue and on swallowing. Meticulous clinical history and physical examination are sufficient to make a correct preoperative diagnosis. Ultrasonography of the neck and fine needle aspiration cytology are other useful tools in the diagnosis. Although a congenital anomaly, it usually presents in the first and second decades of life. The standard treatment of choice for thyroglossal duct cyst is Sistrunk’s operation. The aims of this study are to identify the age of presentation of patients with thyroglossal cyst, its site of occurrence in relation to hyoid bone and to look for the patterns of recurrence after Sistrunk’s operation.

Methods: This is a retrospective study with 34 patients over a period of ten years operated by a single surgeon. Patients treated by Sistrunk’s operation and confirmed as the thyroglossal duct after histopathology report were included in the study. Their demographic data, age at presentation, surgical treatment and recurrence rate were noted and analysis were made.

Results: There was slight male predominance, majority of the thyroglossal cysts were found in the pediatric population and below the hyoid bone, and there were acceptable recurrences.

Conclusions: Thyroglossal duct cyst is a disease of children. Sistrunk’s operation is the standard surgical procedure with minimal recurrence.
Anxiety and Depression among Patients with Chronic Obstructive Pulmonary Disease
Authors: Acharya Chandra Prakash , Poudel Kalpana , Thapaliya Rekha
Published: July 2021

Introduction: The prevalence of anxiety and depression among patients with COPD is significantly higher than the general population; there are serious barriers to the recognition and treatment of these co-morbid conditions. The study aimed to identify the anxiety and depression among patients with COPD.

Methods: A cross sectional study design was adopted and consecutive sampling technique was used to collect 131 samples. A structured interview schedule of Beck Depression Inventory and Beck Anxiety Inventory was used.

Results: Low level of anxiety was found among 83(63.4%) of COPD patients whereas 16(12.3%) had potentially concerning levels of anxiety. It also reveals that 31(23.7%) of the COPD patients were suffering from moderate depression, 14(10.7%) had severe depression whereas 7(5.3%) had extreme depression. A total of 28(21.4%) of them were free from depression. There was association between alcohol consumption and depression (p=0.00). Likewise, there was association between age (p=0.03), educational status (p=0.04), types of family (p=0.00), smoking habit (p=0.01), duration of disease diagnosed (p=0.01) and duration of treatment (p=0.00) with anxiety.

Conclusions: It is concluded that one fourth of the COPD patients had moderate level of anxiety as well as depression. Additionally, some of the COPD patients also suffered from extreme depression.
Outcome of fixation of acromioclavicular joint dislocation type-iii with clavicular hook plate
Authors: Thapa Pabin , Sapkota Krishna , Ranjeet Niraj , Onta Pratyenta Raj , Wahegaonkar Krishna , Thapa Upendra Jung
Published: July 2021

Introduction: Acromioclavicular (AC) joint dislocation is one of the most common shoulder injuries accounting for approximately 9-12% of all shoulder girdle injuries. Rockwood classification of AC joint dislocation is the most widely accepted classification system which classifies the injury into six types. Surgical management with open reduction and fixation with clavicular hook plate without the repair of coracoclavicular ligament has proved to be one of the best treatment options for Type III AC joint dislocations.

Methods: Twenty-three patients with Rockwood Type III AC joint dislocation were included in the study. Open reduction was done and the fixation was done with the clavicular hook plate. The functional outcomes were assessed before and two months after the implant was removed using the Constant- Murley Score.

Results: A total of 23 patients were included in the study with the mean age of 30.74 years. The plates were removed on an average of 6.43 months and mean follow up was 8.83 months. The functional outcome was assessed using the Constant- Murley Shoulder score. The pain scores were significantly better after the implant removal was done (p= 0.007). The final mean constant score was 74.6 ± 4.11 before removal and 93.91 ± 2.71 after implant removal and all the 23 patient had excellent result (>90 points).

Conclusions: The pre-contoured clavicular hook plate has proved to be a good implant option in the fixation of Rockwood Type III AC joint dislocation without the need of any ligamentous repair
The Role of Magnetic Resonance Imaging in Traumatic Knee Injury
Authors: Thapa Madan , Thapa Subash , Chhetri Pramod Kumar
Published: July 2021

Introduction: Magnetic Resonance Imaging (MRI) as a non-invasive modality plays a vital role in assessment of a wide spectrum of internal knee derangements. This study focuses on the commonest anatomical derangement and reveals the importance of MRI to characterize the pattern of derangement in the assessment of the patient with knee injury.

Methods: This is the hospital based prospective study conducted among 65 patients referred to department of radiology with first presentation of knee injury during two years period from August, 2013 to August, 2015. Patient fulfilling the inclusion criteria underwent Magnetic Resonance Imaging knee in SIEMENS MAGNETOM C 0.35 Tesla MRI machine, after taking written informed consent. Descriptive analysis of data was analyzed using SPSS 20.0 program

Result: Of the total 65 patients with knee injury, Sport injuries were the most common mode of knee injury. 63 cases with trauma had findings on MRI. Most of the cases presented with joint effusion (59 cases). Anterior Cruciate Ligament (ACL) tear is the commonest injury (37 cases) during knee trauma followed by Medial Collateral Ligament (MCL), Medial Meniscus, Posterior Cruciate Ligament (PCL), Lateral Meniscus and Lateral Collateral Ligament(LCL) injuries.

Conclusion: MRI as a high-contrast soft-tissue imaging technique can be used as a noninvasive modality to assess a wide spectrum of internal knee derangements in a patient with knee injury. Specific pattern of bone bruise can guide us to narrow our diagnosis.
Pattern of computerized tomography findings of the brain in cerebrovascular accidents
Authors: Shrestha Elina , Thapa Narayan Bikram , Rajbhandari SBS
Published: July 2021

Introduction: Semi-industrialized countries  like Nepal have  high  mortality and disability rates due to cerebrovascular accident, representing  for more than 80% of all stroke deaths globally. Stroke is the most common neurological disorder requiring prolonged hospital stay. Aims of our study was to evaluate the role of computerized tomography in evaluation of cerebrovascular accident by differentiating ischemia from hemorrhage and proper identification of negative cases.

Methods: A descriptive cross sectional  study of total 155  patients, clinically diagnosed as stroke,  referred to our department of radiology  for computerised tomography evaluation during six month period, were enrolled  into study. The clinical information, proper history, computerised tomography  findings  were properly documented and analysed in  SPSS version 20 software.

Results: Out of total 155 patients, 85 cases (55 %)  were males and  70 cases (45 %) were  females with male: female  ratio of 1.2:1. The mean age of the patients was 63±15 years. There was significant  correlation between clinical with neuroradiological findings as evidenced  by p value of 0.000.  Sensitivity, specificity, positive predictive value, negative predictive value of clinical findings when correlated  to CT in diagnosing ischemic infarction were 84.3%, 67.3%, 82.6%, 70%. Similarly, sensitivity, specificity, positive predictive value, negative predictive value in diagnosing hemorrhagic infarction were 67.3%, 84.3%, 70%, 82.6% respectively.

Conclusions: Computerised tomography is the first line reliable imaging modality for diagnosis, management of cerebrovascular accident and exclusion of stroke mimicker lesions. Education regarding prevention and control of  modifiable risk factors can minimize the incidence of  stroke.
Analysis of Acute Postoperative Pain in Patients undergoing Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia in Manipal Teaching Hospital
Authors: Shrestha Binod Bade , Shrestha Sujan
Published: July 2021

Background: Laparoscopic inguinal hernia repair in adults require the use of prosthetic material. We aimed to investigate the acute postoperative pain in patients who underwent transabdominal preperitoneal inguinal hernia repair using heavy or light weight polypropylene mesh.

Methods: This observational, analytical study was conducted in172 adult patients, aged 18-80 years, who underwent transabdominal preperitoneal inguinal hernia repair from January 2017 - October 2019. The patients were divided into two groups as HWM group (heavyweight polypropylene mesh), n=81 and LWM group (light weight polypropylene mesh) n=91. The patients in both the groups were compared in terms of acute postoperative pain at 24 and 48 hours using visual analogue scale (VAS) score.

Results: The visual analogue scale (VAS) score of HWM group and LWM group at 24 hours was 5.42 ± 1.25 and 4.46 ± 1.61 respectively (p=0.00). The VAS score at 48 hours was 3.44 ± 1.07 and 2.74 ± 1.27 for HWM and LWM group respectively (p=0.00).

 Conclusions: The post-operative pain at 24 and 48 hours following transabdominal preperitoneal inguinal hernia repair using light weight polypropylene mesh was less as compared to the patients whose hernia were repaired using heavy weight polypropylene mesh.
SERVQUAL Questionnaire based Health Service Quality Assessment in a Private Hospital of Western Nepal.
Authors: Ghimire Pradeep , Ghimire Prajwal , Acharya Madhu
Published: July 2021

Introduction: Questionnaire based assessment is a simple, scientific tool to collect responses from individuals and standardised questionnaires can be used to assess health care quality of a health care institution. The aim of this study was to assess health service quality of a private hospital on the basis of questionnaire-based data collected from the patients admitted in the hospital using service quality (SERVQUAL) questionnaire method.

Methods: A descriptive cross sectional study was conducted in 203 adult patients in Fishtail Hospital and Research Centre, Pokhara, Nepal from January 2015 to January 2016. The response of the patients towards various aspects of service provided by the hospital was collected using SERVQUAL questionnaire. The data was graded in Likert scale and SPSS software 24 was utilized to analyse the data.

Results: A total of 181(89.12%) patients were satisfied with the health service quality provided by the hospital that was assessed on the basis of parameters of SERVQUAL questionnaire and 156 (76.74%) patients graded various hospital factors as being good.

Conclusions: Based on SERVQUAL questionnaire we found that 89.12% of patients were satisfied with the service provided by our hospital and 76.74% of patients graded various hospital factors such as doctors, nurses, reception staff and food provided in canteen as being good. We recommend such surveys should be regularly performed in health care institutions to scrutinise and enhance the level of health care service quality.
Blunt abdominal trauma leading to acute abdominal wall hernia: a case report
Authors: Sharma D , Shrestha Santosh , Ghimire R
Published: July 2021

Acute traumatic abdominal wall hernia is a rare but serious diagnosis resulting from blunt abdominal trauma. The challenge of managing acute traumatic abdominal hernia is approach and timing of repair. We describe a 32 years male patient’s acute traumatic abdominal wall hernia and its management.
Online Medical Education during COVID-19 Pandemic
Authors: Sharma Prakash
Published: July 2021

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The Impact of Dialysis Modality on Left Ventricular Function in Patient with End Stage Kidney Disease
Authors: Maskey Abhishek , Paudel Navaraj , Sapkota Subash , Jha Pooja
Published: July 2021

Introduction: Cardiovascular disease is frequent in end-stage kidney disease patients, and is a major cause of morbidity and mortality. This study was carried out to assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis on left ventricular function.Methods: A prospective observational study was carried out in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis at least for 6 months. The duration of the study was from June 2019 to May 2020. CAPD consists of 3 to 4 exchanges/day and haemodialysis 2-3 times/week for 4 hours. Baseline characteristics age, gender, dialysis duration, hypertension, diabetes and hyperlipidaemia were collected. The same cardiologist performed all echocardiography at the end of hemodialysis session in hemodialysis patients and after the drain of dialysate in peritoneal dialysis patients.Results: Sixty patients (40 hemodialyses, 20 peritoneal dialyses) were enrolled. The mean age of the patient was 53.71±13.00 years (range 25-76). There was a slightly higher number of male in the hemodialysis group (p= 0.065). Systolic and diastolic blood pressure were significantly higher in hemodialysis groups (p<0.001). Regarding left ventricular parameters, hemodialysis patients had a higher prevalence of left ventricular diastolic dysfunction, left ventricular hypertrophy, left ventricular mass compared to peritoneal dialysis patients. Pericardial effusion and thickening were present higher in hemodialysis patients and was statistically significant (p<0.05).Conclusion: The modality of dialysis influence left ventricular function. Left ventricle dysfunction is prevalent among hemodialysis patients compared to peritoneal dialysis. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.
Pre-existing Corneal Astigmatism in patients undergoing Cataract Surgery in Western Nepal; A hospital-based Unicentered, Comprehensive, Prospective Observational Study
Authors: Shrestha Shristi , Kaini Khemraj
Published: July 2021

Introduction: Cataract surgery is one of the most commonly performed surgical procedures worldwide. The final postoperative visual acuity is dependent on the pre-existing corneal astigmatism, accurate biometry and surgically induced astigmatism. Because of the increase in the patient’s demand for better postoperative visual acuity, it becomes important to evaluate the distribution of pre-existing corneal astigmatism in different populations. The objective of the study was to analyze the magnitude and pattern of pre-existing corneal astigmatism in cataract surgery patients in Western Nepal.Methods: A hospital-based cross-sectional descriptive study was carried out in the Department of Ophthalmology, Manipal Teaching Hospital, Pokhara. Three hundred and two patients undergoing routine cataract surgery between February 2016 and January 2018 were recruited in the study. Keratometric data from these patients were collected and were analyzed using the statistical software SPSS version 21.Results: The mean age of the subjects was 70.25 ± 10.97 years (range 35 to 94 years). There was a preponderance of females (62%) over males (38%). The mean corneal astigmatism was 0.78 ± 0.59 D (range 0.00 to 5.00 D). The pre-existing corneal cylinder ≥ 1.00 D was seen in 40.06% of patients. The corneal astigmatism was mainly against the rule (65.56%). The amount of corneal astigmatism and corneal steepness increased with age.Conclusion: Corneal astigmatism of 1.00 D or more was seen in 40.06% of the patients undergoing cataract surgery which should be corrected to meet the patient’s expectation for good, unaided visual acuity after cataract surgery.
Correlation between Expulsion of Distal Ureteric Calculus with CRP Level, WBC Count and Neutrophil Percentage among the Patients attending on Manipal Teaching Hospital, Pokhara (Retrospective Study)
Authors: Timilsina Bishow Deep , Karki Om , Subedi Babita
Published: July 2021

Introduction: Urolithiasis is a common medical diagnosis that doctor encounters in the outpatients and emergency departments. The prevalence of renal stone disease has increased steadily over the past decades. There are different modalities of treatment of ureteric calculus. However, most of the distal ureteric calculus passes spontaneously thus the application of invasive procedure at the early stage can be considered overtreatment.Methods: The 68 patients of the surgical department, Manipal teaching hospital, Pokhara, with distal ureteric calculus of ≤ 8mm, who were under the treatment Tamsulosin Hydrochloride 0.4mg once daily for 2 weeks or till the expulsion of stone from 1st October 2017 to 30th September 2018 (one year period) were retrospectively evaluated for the spontaneous stone expulsion rate and its association with serum CRP level, WBC count and Neutrophil percentage. The patients were divided into 2 groups i.e. spontaneously ureteric stone expelled group and non expelled group. Furthermore, for statistical analysis, each group were subdivided according to normal and elevated serum CRP level, white blood cell count and neutrophil percentage. The associations between these factors and ureteral stone passage were then examined.Results: Most of the cases were in the age group of 21-40 years with the mean age of 40.09 ± 16.11, where 57.4% of patients were male. Among all mean duration of symptoms was 6 days. The ratio of left to right stone was 1.26:1. Out of 68 patients, 80.9% of the patient’s distal ureteric stone was passed out spontaneously with medical expulsion therapy. There were statistically significant (p<0.001) association between normal serum CRP level, White cell counts and neutrophil percentage with the expulsion of distal ureteric calculus with size ≤ 8mm.Conclusion: There is a higher expulsion rate of distal ureteric calculus of size ≤ 8mm with the patient of the normal level of serum CRP level, White cell counts and neutrophil percentage than that of abnormal level.
Retrospective Evaluation of Patients Leaving Against Medical Advice from Intensive Care Unit (ICU) in Tertiary Care Teaching Hospital
Authors: Adhikari Kiran , Devkota Kriti , Yadav Rajesh Kumar , Sah Rakesh
Published: July 2021

Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treating physician whether to continue the treatment or to de-escalate from the treatment. It can deteriorate the primary disease of the patient, leading to an increase rate of re-admission to the hospital, increased morbidity and mortality. This is a worldwide phenomenon and the prevalence of LAMA varies between various countries and between different region, religion, and the socioeconomic status of the patient in the same country.Methods: The hospital records from 1st December 2018 to 30th November 2019 of a tertiary care teaching hospital were studied. Patient demography, disease characteristics and length of ICU stay and the factors leading to LAMA were noted and statistically analysed.Results: During the study period, 14.5% of patients asked for LAMA. The mean age was 51.22 ± 22.39 years (range 8 months to 97 years) with Male predominance (n= 288, 62.60%) over Female (n= 172, 37.39%). Patients residing in rural areas were 56.08% (n=258) and 63.91% were financially dependent on others for their living. The mean length of stay in hospital was 3.02 ± 3.50 days while 30.86% of patients required mechanical ventilation. About 51.73% of patients taking LAMA were admitted from the Internal medicine department. Around 79.56% were Hindus, with 54.34% opting for LAMA due to financial restrain followed by poor prognosis (22.60 %).Conclusion: The large number of patients admitted in ICU opts out for LAMA. This necessitates formulation and implementation of strategies to reduce the prevalence of LAMA discharge so that patient gets the optimum level of care and the burden in the health care system is reduced
ATE Scale to Assess Attitudes towards Euthanasia among Health Professionals in Pokhara, Nepal
Authors: Parajuli Sudhir Raman , Gautam Rabin , Timsinha Sidarth , Subedi Anil , Pokhrel Suman
Published: July 2021

Introduction: Most people want to live up to old age with no pain and sufferings. This study is meant to know the opinion of doctors and nursing professionals regarding euthanasia which is an important component for practising euthanasia in Nepal, which is a debated topic in the whole world and Nepal is no exception.Methods: A descriptive study design was used to conduct this study. ATE scale was used which includes ten questionnaires.Results: The ATE scale used in this study showed to have internal consistency, with Cronbach alpha at 0.736. Men were found to be more supportive of Euthanasia.Conclusion: Overall, this study suggests that health professionals from Pokhara have a positive attitude towards Euthanasia with patients request taken as more important.
Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study
Authors: Mahato Vibha , Shrestha Pravin , Bhattarai Pradeep
Published: July 2021

Introduction: Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.Methods: A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and >24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.Results: Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.Conclusion: Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.