bluuebunny/crossref_metadata_2025 huggingface dataset:
Kelimpahan Relatif Ektoparasit pada Inang Ayam Buras Lokal
Authors: Putranto Heri Dwi , Meriana Meriana , Brata Bieng , Nurmeiliasari Nurmeiliasari
Published: June 2021

Negara beriklim tropis seperti Indonesia memiliki suhu dan kelembaban lingkungan yang tinggi, dan hal ini menjadi salah satu faktor berkembangnya ektoparasit. Ektoparasit pada unggas peliharaan dapat menjadi masalah yang berpotensi untuk berkontribusi pada kerugian sebuah usaha peternakan seperti penyakit, penurunan produksi dan bahkan mortalitas. Tujuan dari penelitian ini adalah untuk mengeksplorasi serta menganalisa nilai Indeks Kelimpahan Relatif (IKR) ektoparasit yang ditemukan pada 3 jenis inang ayam buras lokal (ayam burgo, ayam ketarras dan ayam kampung) yang dipelihara pada manajemen pemeliharaan intensif. Penelitian eksploratif ini dilakukan dengan menggunakan metode purposive sampling pada 3 jenis ayam buras lokal yang dipelihara secara intensif di Commercial Zone and Animal Laboratory (CZAL) Jurusan Peternakan Fakultas Pertanian Universitas Bengkulu. Ektoparasit dikoleksi langsung dari setiap individu ayam, kemudian data jenis dan populasi ektoparasit dianalisis secara deskriptif kualitatif. Hasil penelitian menunjukkan terdapat 5 jenis ektoparasit yang ditemukan yaitu Echidnophaga gallinacea, Penicillidia dufourii, Lipeurus caponis, Menopon gallinae dan Rhipicephalus sanguineus. Total populasi ektoparasit pada 3 jenis inang ayam buras lokal ditemukan sebanyak 174 ekor. Populasi ektoparasit tertinggi yaitu 68 ekor (M. Gallinae) dan populasi terendah sebanyak 13 ekor (P. dufourii). Spesies M. gallinae dan L. caponis ditemukan lebih melimpah serta memiliki IKR yang tinggi (39,1% dan 24,1%).
Performa Produksi Telur pada Ayam Ketarras Generasi Kedua dengan Bobot Badan yang Berbeda
Authors: Harahap Ahmad Saleh , Kususiyah Kususiyah , Amrullah Amir Husaini Karim
Published: June 2021

Ayam ketarras merupakan ayam persilangan antara ayam arab dan ayam ras petelur dengan persentase darah 75% ayam arab dan 25% ayam ras petelur. Saat ini ayam ketarras keturunannya sudah pada generasi kedua (G2). Penelitian ini bertujuan untuk melihat performa produksi telur pada ayam ketarras dengan bobot badan yang berbeda. Penelitian ini menggunakan 30 ekor ayam betina Ketarras dengan jenis kelamin betina. Penelitian dilaksanakan di Commercial Zone and Animal Laboratory (CZAL) Jurusan Peternakan, Fakultas Pertanian, Universitas Bengkulu. Kandang yang digunakan adalah kandang batteray yang merupakan kandang individu. Pada saat pemeliharan pemberikan pakan dengan komponen konsentrat khusus ayam petelur, dedak dan jagung giling. Paramater yang diambil ketika penelitian adalah produksi telur, berat telur dan  persentase produksi. Rancangan yang digunakan pada penelitian ini adalah Rancangan Acak Lengkap. Data yang diperoleh disajikan berdasarkan rataan dan standar deviasi. Jumlah telur yang dihasilkan dari 30 ekor selama 3 bulan pengamatan sebesar 1.728 butir dengan rataan produksi telur perbulan per ekor adalah 19 butir/ekor/bulan. Secara keseluruhan berat telur yang diperoleh sebesar 48.22 gram. Sementara persentase produksi telur secara keseluruhan yang diperoleh mencapai 63.30 %. Hasil penelitian ini dapat disimpulkan bahwa ayam Ketarras generasi ke-2 umur 11-13 bulan memiliki performa produksi, persentase produksi dan berat telur yang masih bervariasi.
What Happened to MSMEs During the Pandemic?
Authors: Suharsono Andrea Anne
Published: June 2021

The Covid-19 pandemic causes a huge impact to global economy including people’s income and purchasing power. The contribution of MSMEs is very important to the country so that recovery is very urgently needed. With this pandemic that affects in both microeconomics and macroeconomics, government should take control so that Covid-19 cases can be minimalized and gain public trust for economic recovery.
UMKM DI TENGAH COVID
Authors: Thiopelus Geordye Laurent
Published: June 2021

Kita tahu bahwa saat ini telah terjadi pandemic di berbagai negara yang memberikan dampak cukup besar terhadap perekonomian di berbagai negara. Usaha mikro, kecil dan menengah (UMKM) merupakan pelaku bisnis yang bergerak pada berbagai bidang usaha yang merupakan bagian penting dari masyarakat, Kemunculan sektor Usaha Mikro, Kecil, Menengah (UMKM) membawa pengaruh positif pada perekonomian dan UMKM saat ini dianggap sebagai cara yang efektif dalam membantu mengatasi masalah kemiskinan
KONSEP DASAR ILMU GIZI
Authors: Zakiyyah Wafiq
Published: June 2021

Gizi berasal dari kata bahasa Arab "Ghidza" yang berarti makanan. llmu gizi berkaitan dengan makanan dan berkaitan pula dengan tubuh manusia. Kata gizi selain berkaitan dengan kesehatan juga berkaitan dengan potensi ekonomi seseorang, yaitu berhubungan dengan perkembangan otak, kemampuan belajar dan produktifitas kerja. Dengan memahami gizi maka akan memudahkan kita untuk memahami fungsi masing-masing zat gizi bagi metabolisme tubuh.
KEBIJAKAN KEIMIGRASIAN DI MASA PANDEMI COVID-19
Authors: Lestari Suci
Published: June 2021

Covid Disease 2019 (Covid-19) showed up toward the finish of 2019 in Wuhan, Hubei Province, China. The infection spread to different nations, including Indonesia. To forestall Covid-19 from spreading in Indonesia, the public authority, through the Directorate General of Immigration, given a few approaches while as yet maintaining basic freedoms. This examination will answer two issues. First is the means by which far types of movement strategy identified with Covid-19 from the viewpoint of basic liberties, second what are the deterrents confronted while executing the approach. The examination strategy utilized is subjective and with deductive reasoning rationale. This examination infers that the public authority sets two approaches during Covid-19. They are limitations for outsiders to Indonesian region and identification administrations limitations. On a basic level, the two approaches don't contain components of common liberties infringement. Other than of that, there is no critical obstruction during the time spent carrying out the approach so everything went on while as yet maintaining basic freedoms.
PERAN SYSTEM INFORMASI MANAJEMEN DALAM PENGAMBILAN KEPUTUSAN
Authors: jeriko Fadli
Published: June 2021

Dalam perkembangan zaman sekarang ini ,setiap organisasi atau lembaga sangat diperlikan diperlukan untuk menciptakan suatu sistem informasidan sumber daya manusia agar dalam pengembangan sistem informasi dapat mempengaruhi dari pengambilan suatu keputusan di dalamsuatu lembaga. Pengambilan keputusan diharapkan menjadi suatu proses menuju arah yang lebih baik sehingga denganpegetahuan yang dimiliki tentang sistem informasi manajemen, pertimbangan dan akhirnya diputuskan secara tepat. dikarenakan sebuah sistem informasi merupakan terdiri dari beberapa komponen-komponen yangpenting dari lembaga pendidikan guna untuk menyediakan beberapainformasi yang akan sangat dibutuhkan oleh para pengambil keputusan dalam melakukan kegiatan pendidikan
BoomdiagnoseMethodes voor boombeoordeling kritisch bekeken
Authors: Sterken Peter
Published: June 2021

In 2006 publiceerde Sterken een non-profit visuele methode voor boomdiagnose waarbij het V-model de hypothetische kritische windsnelheid berekent voor bomen. In Groencontact 2007/1 (De Wael) werd aandacht besteed aan deze methode. De SIA-methode (Wessolly en Erb, 1998) berekent de hypothetische veiligheidsfactor van een boom tegenover een bepaalde windsnelheid, waarbij hun SIM-trekproeven de boom statisch belasten om zo het breken en ontwortelen hypothetisch in te schatten. In het zog van deze methodes werden nog andere gelijkaardige methodes ontwikkeld. In de voorbije jaren zijn de belangrijke limieten en tekortkomingen van sommige methodes in onafhankelijk wetenschappelijk onderzoek aangetoond. De meeste van die onderzoeken zijn nog nooit vernoemd in boomverzorgingsliteratuur, reden om die in dit artikel grondig te bespreken.
Quỹ Vaccine phòng chống Covid-19: Một mốc lịch sử kinh tế đương đại
Authors: Ho Manh-Toan , Huyen Nguyen Thanh Thanh
Published: June 2021

Quỹ Vaccine phòng chống Covid-19 của Chính phủ do Thủ tướng Phạm Minh Chính lãnh đạo đã phản ánh rất sát việc thiết kế toàn diện, có tính chiến lược đối với công cuộc xây dựng kinh tế đường dài, dựa trên cấu trúc vi mô có khả năng tương tác hiệu quả cao với các tầng lớp cư dân trong xã hội, đặc biệt là giới doanh nghiệp.
Mindmap Value Proposition Design
Authors: Angellie Natasya Priscilla
Published: June 2021

Value proposition design membantu kita dalam menemukan dan meningkatkan proposisi nilai serta untuk mengelola dan memperbarui value proposition sama seperti untuk menciptakan yang baru. Gunakan value proposition dan business model untuk menciptakan bahasa bersama tentang penciptaan value di organisasi anda. Menggunakannya secara terus menerus akan menciptakan dan meningkatkan value proposition yang memenuhi customer profile yang merupakan usaha yang tidak pernah berakhir
PEMIKIRAN SEJARAH DALAM MENGEMBANGKAN PEMBELAJARAN IPS
Authors: Mukhlis Muhammad
Published: June 2021

Fungsi utama pendidikan adalah pengembangan kesadaran nasional sebagai sumber daya mental dalam proses pembangunan kepribadian nasional tersusun dari karakteristik perwatakan yang tumbuh serta melembaga dalam proses pengalaman sepanjang kehidupan bangsa, Dengan demikian kepribadian nasional serta identitas tertumpu pada pengalaman kolektif bangsa, yang bersifat historis (Sartono Kartodirdjo,1998:1). Sejarah merupakan disiplin ilmu yang menjadi bagian dari Mata Pelajaran IPS di Sekolah. Pembelajaran IPS lebih menekankan pada aspek pendidikan daripada transfer konsep karena dalam pembelajaran IPS peserta didik diharapkan memperoleh sikap, nilai, moral dan ketrampilannya berdasarkan konsep yang telah dimilikinya. Dengan demikian, pembelajaran IPS harus diformulasikan pada aspek kependidikannya.
Mind Map Value Proposition Design
Authors: Martino Agus
Published: June 2021

Mind Map Value Propositon Design
Evolved Mechanisms of Avoidance of Disease and the Implicit Cognition of Apparent Disability
Authors: Federici Stefano , Profidia Vanessa
Published: June 2021

The sight or proximity of a person with an apparent disability generates a series of implicit cognitions that seem to evoke purely negative dimensions, like disease and unpleasantness. This phenomenon would appear to occur because of the presence of an evolved mechanism of avoidance of disease that is (erroneously) activated by unusual physical or behavioral features. A total of 157 university students responded to two Implicit Association Tests and to two explicit self-report questionnaires: the Perceived Vulnerability to Disease and the Sensitivity to Disgust Revised scales. Results showed a strong implicit association between disability and the dimensions of disease and unpleasantness regardless of setting manipulation, suggesting that the implicit association is so strong that it subliminally emerges regardless of whether respondents’ disgust sensitivity is emotionally increased. No correlations were found between implicit and explicit measures, suggesting that implicit and explicit cognitions result in different cognitive mechanisms that do not always and necessarily correspond.
The role of learned societies and grant-funding agencies in fostering a culture of open science
Authors: Brysbaert Marc
Published: June 2021

At first sight, it is a no-brainer to make publicly funded research findings freely available to everyone. Ever increasing pay walls are unsustainable and publishers have been pushing their luck in the last decades. On the other hand, free lunches do not exist either. It is unrealistic for researchers to expect that their manuscripts can be evaluated and published for eternity without someone paying something. Based on my experiences, I think that commercial companies competing against each other are still the best guarantee for good service and innovation (e.g., for manuscript submission and handling). However, these companies must be reined in by people who put the ideals of scientific progress and accessibility first. Otherwise, temptations for easy profit are too large. There is no good alternative to learned societies governed by the researchers themselves. Complementary to the role of learned societies, grant funding agencies have the unique power to nudge researchers toward open science practices and to make sure that the findings of the research they support are copied to secure systems immune to the siren call of profit making.
Sustained rubber hand illusion after the end of visuotactile stimulation with a similar time course for the reduction of subjective ownership and proprioceptive drift
Authors: Abdulkarim Zakaryah , Hayatou Zineb , Ehrsson H. Henrik
Published: June 2021

The rubber hand illusion is a perceptual illusion in which participants experience an inanimate rubber hand as their own when they observe this model hand being stroked in synchrony with strokes applied to the person’s real hand, which is hidden. Earlier studies have focused on the factors that determine the elicitation of this illusion, the relative contribution of vision, touch and other sensory modalities involved and the best ways to quantify this perceptual phenomenon. Questionnaires serve to assess the subjective feeling of ownership, whereas proprioceptive drift is a measure of the recalibration of hand position sense towards the rubber hand when the illusion is induced. Proprioceptive drift has been widely used and thought of as an objective measure of the illusion, although the relationship between this measure and the subjective illusion is not fully understood. Here, we examined how long the illusion is maintained after the synchronous visuotactile stimulation stops with the specific aim of clarifying the temporal relationship in the reduction of both subjective ownership and proprioceptive drift. Our results show that both the feeling of ownership and proprioceptive drift are sustained for tens of seconds after visuotactile stroking has ceased. Furthermore, our results indicate that the reduction of proprioceptive drift and the feeling of ownership follow similar time courses in their reduction, suggesting that the two phenomena are temporally correlated. Collectively, these findings help us better understand the relationships of multisensory stimulation, subjective ownership and proprioceptive drift in the rubber hand illusion.
Playing with words: Do people exploit loaded language to affect others’ decisions for their own benefit?
Authors: Capraro Valerio , Vanzo Andrea , Cabrales Antonio
Published: June 2021

We report on three pre-registered studies testing whether people in the position of describing a decision problem to decision-makers exploit this opportunity for their benefit, by choosing descriptions that may be potentially beneficial for themselves. In Study 1, recipients of an extreme dictator game (where dictators can either take the whole pie for themselves or give it entirely to the receiver) are asked to choose the instructions used to introduce the game to dictators, among six different instructions that are known from previous research to affect dictators’ decisions. The results demonstrate that some dictator game recipients tend to choose instructions that make them more likely to receive a higher payoff. Study 2 shows that people who choose descriptions that make them more likely to receive a higher payoff indeed believe that they will receive a higher payoff. Study 3 shows that receivers are more likely than dictators to choose these descriptions. In sum, our work suggests that some people choose descriptions that are beneficial to themselves; we also found some evidence that deliberative thinking and young age are associated with this tendency.
Correlation between Iron Parameters and Platelet Parameters in Iron Deficiency Anemia
Authors: Chalise Sanat , Acharya Nishant , Pradhan Sailesh B
Published: June 2021

Introduction Iron deficiency anemia is the most common type of anemia and is diagnosed by iron studies. Reactive thrombocytosis is usually seen in iron deficiency anemia. The objectives of the study is to correlate between iron parameters and platelet parameters in patient with iron deficiency anemia.

MethodsThis was a cross-sectional study done in Department of Pathology at Kathmandu Medical College, Sinamangal between December 2018 to May 2019. Blood samples of 81 iron deficiency anemia patients were analysed to determine iron parameters and platelet parameters. SPSS version 20 was used to analyse the data.

ResultsThrombocytosis was seen in 62 (76.5%) patient with iron deficiency anemia. Platelet count was negatively correlated with serum iron, percentage saturation and platelet distribution width (p˂0.001, for all) while positive correlation was obtained between platelet count and plateletcrit (p<0.05). Plateletcrit showed negative correlation with serum iron (p˂0.001) and platelet distribution width (p<0.05) while positive correlation was obtained with mean platelet volume, total iron binding capacity and platelet (p<0.05, for all). There was negative correlation between mean platelet volume and platelet count (p<0.001). Positive correlation was obtained between mean platelet volume and plateletcrit (p<0.05). Correlation was not found between mean platelet volume and iron parameters (p>0.05). Platelet distribution width showed negative correlation with total iron binding capacity, platelet (p˂0.001, for both), plateletcrit (p<0.05).

ConclusionThrombocytosis is more commonly observed as compared to thrombocytopenia in patient with iron deficiency anemia. Serum iron and percentage saturation are the most important parameters affecting the platelet count.
Factors Predicting Mortality in Perforation Peritonitis at a Tertiary Care Center in Nepal
Authors: Kansakar Prasan , Ghimire Bikal , Mishra Parashuram
Published: June 2021

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.

MethodsA 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.

ResultsAmong 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.

ConclusionHigher mortality was seen in elderly patients. Despite of male preponderance, larger proportion of females succumbed to their disease. Derrangement in vital parameters like pulse and blood pressure and renal function test had negative impact in survival.
Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis
Authors: Kharel Bijaya , Gurung Urmila , Tripathi Prashant , Rayamajhi Pabina , Silwal Priyansha
Published: June 2021

Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis.

MethodsRetrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

ResultsA total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31).

ConclusionEndoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis.
Case Report on Pseudoaneurysm of Brachial Artery: A Rare Complication of Paediatric Supracondylar Humerus Fracture Pinning
Authors: Bhandari Prawesh S , Bastola Priska , Gurung Dinesh
Published: June 2021

Pseudoaneurysm (PA) of the brachial artery in pediatric supracondylar humerus fracture who have undergone closed reduction and percutaneous pinning is a rare complication. A few cases have been reported in medical literature. This case report sheds some insight into early identification and management outcome of such complication. Rapidly progressive swelling in antecubital fossa in cases of supracondylar fracture who have undergone pinning should arouse suspicion of vascular lesion. It should be timely intervened. Surgical intervention of pseudoaneurysm with reversed saphenous venous graft has shown to have no early vascular complication.
Japan: What to Do with Dead Bodies? A Burning Issue
Authors: Crump Andy
Published: June 2021

Death, the passing of a loved one, friend, colleague or just someone we may have known, is virtually always sad and often traumatic. However, it is a part of life and has to be coped with. Each year around 60 million people worldwide die from a wide and diverse number of causes. The problem of what to do with all those dead bodies is becoming a major conundrum for the families involved as well as for policy makers and governments. Natural and anthropogenic disasters, together with increasing incidence of major pandemics of infectious diseases is making finding a solution ever more difficult. A problem which is made worse by ever-increasing draconian rules about what can and cannot be done when disposing of a body.Currently, there are two basic choices, either bury the body in the ground where such action is permitted or cremate it and dispose of the ashes in a culturally and legally acceptable fashion. Generally, both options are becoming prohibitively expensive. The cost of land and the burgeoning demand for land to be used for industry, agriculture, urbanised centres or leisure activities is making burial no longer an option for most people. Japan has long led the world in incineration technology and it has also led the world for many years in cremating its dead. Virtually all Japanese are now cremated, the funeral process involving a mixture of high technology and unique routines steeped in history. Despite widespread concerns that cremation can cause environmental pollution and may damage public health as a result, it is still deemed less polluting than burial. It is likely that countries around the globe will increasingly adopt a policy of cremating their deceased citizens and would do well to follow the lead in this respect being shown by Japan.
Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal
Authors: Pathak Surya R , Jha Sunil C , Gajurel Ratna M , Poudel Chandra M , Shrestha Hemant , Thapa Sanjeev , Sahi Ravi , Thapa Shovit , Koirala Paras
Published: June 2021

Introduction Coronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital.

MethodsThis is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression.

ResultsTotal 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI where as those with blood group A had increased risk of having unstable angina.

ConclusionThere was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS.
Low Grade Appendiceal Mucinous Neoplasm: A Report of Three Cases
Authors: Sharma Nisha , Karna Alina , Jha Abhimanyu
Published: June 2021

Low-grade appendiceal mucinous neoplasm (LAMN) is an uncommon malignancy with varied clinical features. The most alarming complication of this neoplasm is seeding of mucin into the adjacent peritoneum leading to pseudomyxoma peritonei (PMP). We report three cases of LAMN. Two cases were seen post appendicectomy in 23-year old and 36-year old females. The third case was seen in 53-year-old male post Whipple procedure and hemicolectomy. LAMNs are often diagnosed incidentally, as clinical presentation is barely specific and resembles acute appendicitis. Hence it is imperative to examine all appendicectomy specimens not to miss cases of appendiceal mucinous neoplasm which can have implications on the further management of the patient.
Prevalence of Molecular Subtypes of Breast Cancer in a University Hospital of Nepal
Authors: Hirachan Suzita , Singh Yogendra P
Published: June 2021

Introduction Breast cancer is the second most common malignancy in Nepalese women. It represents a group of heterogenous disease with diverse biologic, clinical and molecular characteristics requiring personalized treatment. Based on Immunohistochemical markers, breast cancer is classified into distinct molecular subtypes. The aim of the study was to analyze the incidence of molecular subtypes of all breast cancer patients treated at University Hospital of Nepal in the period over 3 years.

MethodsA retrospective observational study was carried out in Breast Unit of Tribhuvan University Teaching Hospital, Kathmandu. Electronic medical records of all breast cancer patients treated between January 2017 to December 2019 were retrieved from the hospital database. Patient’s characteristic, histological features and molecular subtypes were collected and analyzed.

ResultsA total of 156 surgically treated breast carcinoma patients were studied. The median age of study population was 55 years (range 28–82years). Among these, 69 (44%) were of ≤45 years and 87 (56%) were over 45 years. The mean tumor size was 29 mm (range 50-140 mm). The most common histology was invasive ductal carcinoma (93.5%). Luminal type A was positive in 68 (43%) patients while luminal type B was present in 12 (7.6%) patients. Triple negative subtype was observed in 50 (32%) patients while HER2 rich subtype was seen in 25(16%). Incidence of Triple negative subtype was highest in patients less than 45 years (42%). Luminal A subtype was correlated with low tumor grade and less positive lymph nodes metastasis.

ConclusionThe most common molecular subtype of breast cancer in Nepal is Luminal A having favorable features. The incidence of triple negative breast cancer is higher in Nepal, having an aggressive and clinically distinct subtype and is important for personalized treatment plan.
Efficacy of Integrated Intervention Program on Mental Health of Cancer Patients
Authors: Chand Bibin , Sharma Madhavi , Thagunna Narendra S
Published: June 2021

Introduction Copious researchers have made notable findings on the mental health of cancer patients and effect of various discrete therapies, but still there exist a significant paucity on integrated therapeutic interventions over their mental health. The objectives of this study were to find the prevalence of mental health morbidity and the efficacy of an integrated intervention program comprised of Aaron Beck’s Cognitive Behavior Therapy (CBT), Jacobson Progressive Muscle Relaxation Therapy (JPMRT) and self- imagery training on the mental health of cancer patients.

MethodsIn this cross-sectional study, data was collected from 20 patients diagnosed with cancer aged between 40-55 years from an outpatient department of Cancer Institute, India. General Health Questionnaire by Goldberg & Hiller, 1979 (GHQ-28) was administrated to assess the mental health in four domains viz: somatic complaints, anxiety and insomnia, social dysfunction and severe depression. Integrated intervention program was conducted for four days per week for one month. Data was analyzed statistically by using normal probability curve (NPC) and paired t-test.

ResultsAn overall prevalence of negative mental health and significant positive effect by the integrated intervention on the mental health among cancer patients have been statistically corroborated in this pre-post research.

ConclusionIntegrated intervention program is efficacious in improving mental health in cancer patients.
Learning to Live with COVID-19 in Nepal: A Unique Experience
Authors: Singh Yogendra P
Published: June 2021

Corona Virus Disease-2019 (COVID-19) is a global viral respiratory outbreak, known to everyone in society. Nepal is not an exception for this pandemic and we are learning how to live with COVID-19. The pandemic has changed vigorously our daily activities affecting every aspects of the society. In low–middle income countries like ours, we don’t have definite answer to deal with the pandemic, rather we are learning how to live amid COVID-19. We are experiencing something new every day. Despite so many limitations, we need to learn to live with COVID-19.
Outcome of Elastic Stable Intramedullary Nail in Length Unstable Diaphyseal Femur Fractures in Children: A Case Series
Authors: Bhandari Prawesh S , Uprety Suresh
Published: June 2021

Introduction Elastic stable intramedullary nailing (ESIN) has been a common method of treatment of diaphyseal femur fracture in children. Though they are used in length stable fracture with favourable results, their use is debated in case of length unstable variants. The objective of the study was to evaluate outcome of these nails in length unstable diaphyseal femur fracture in children.

MethodsWe retrospectively reviewed seven fractures in seven children treated with ESIN for functional outcome.

ResultsTotal of seven patients with seven unstable femur fractures were studied. There was male predominance with 71.4%. The fracture united at a mean duration of 12 wks. The overall Flynn scoring showed 71.4 % excellent and 28.6 % satisfactory result.

ConclusionElastic stable intramedullary nailing can be safely used in length unstable variant of femur fracture in children.
Profile and Antibiotic Susceptibility Pattern of Bacterial Isolates from Mobile Phones of Healthcare Workers in a Tertiary Care Centre of Nepal
Authors: Sapkota Jyotshna , Jha Beena , Mishra Bhavesh , Shrestha Deepti , Barakoti Achut , Sharma Manisha
Published: June 2021

Introduction Nosocomial infection is a serious problem worldwide. Healthcare workers mobile phones may act as vehicle for nosocomial infections. Mobile phones are rarely cleaned and healthcare workers frequently use them thorough out their time in hospitals. The objective of this study is to determine the rate of contamination of mobile phones, prevalent microorganisms and their antibiotic sensitivity pattern.

MethodsThe descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2019 to September 2019 after ethical approval. Samples were collected aseptically by rolling sterile swabs over the exposed surfaces of the mobile phones and inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified by standard microbiological procedure and antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018.

ResultsOf the 198 mobile phones sample cultures, 112 (56.6%) samples showed 7 different types of bacteria. Mixed growth was observed in 3 mobile phones and total of 115 bacterial isolates were identified. Staphylococcus species (74.7%) were predominant organism followed by Acinetobacter spp, Klebsiella pneumoniae, E. coli, Citrobacter and Pseudomonas aeruginosa. Total 37.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA).

ConclusionMobile phones may have potential pathogenic microorganisms on their surface and can act as vector in spread of infectious agents in hospital settings. It is recommended to disinfect mobile phones regularly and to implement hand washing practices and regulations around the use of mobile phones in hospital settings.
Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal
Authors: Sharma Manju , Jha Sunil C , Sayami Arun , Gajurel Ratna M , Poudel Chandra M , Khanal Rajaram , Pathak Surya R , Thapa Shovit , Adhikari Suman , Yadav Vijay
Published: June 2021

Introduction Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation.

MethodsThis was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed.

ResultsA total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7).

ConclusionTemporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.
Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal
Authors: Subedi Nirajan , Kandel Bishnu , Ghimire Bikal , Kansakar Prasan BS , Bhandari Ramesh S , Joshi Lakhey Paleswan
Published: June 2021

Introduction Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site.

MethodsThis is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics.

ResultsA total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%.

ConclusionPPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.
Head Injuries at the Emergency Department of a University Hospital
Authors: Henriksson Thérèse , Kjellberg Jacob , Shakya Yogendra , Kurlberg Göran
Published: June 2021

Introduction Traumatic head injuries constitute a major cause of morbidity and mortality worldwide. The developing world is particularly affected due to a high prevalence of risk factors and difficulties in enforcing preventive efforts. This study was carried out at the Emergency Department (ED), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal – where head injuries account for five per cent of all emergency visits. The aim was to describe demographics, cause of trauma, type of injury, and severity according to the Glasgow Coma Scale (GCS), as well as the outcome of emergency attendance in patients seeking medical care for traumatic head injuries. Auxiliary aims were to study correlations between age, cause of trauma and injury severity.

MethodsData from 577 cases of head injuries from June to October 2019 were collected retrospectively.

ResultsTraumatic head injuries accounted for 5.2 % of all emergency visits. The median age was 23 years. Patients were predominantly male. Superficial injuries and concussions were the most common. Most injuries were mild (94.4 %, GCS 13–15) and caused by falls (51.3 %) or road traffic accidents (19.1 %). Fall accidents and mild injuries had the lowest median age. Patients from outside Kathmandu Valley constituted 44.9 % of the cases. Only 12.1 % of the patients were admitted to the hospital.

ConclusionCommonest head injuries are mild and superficial; and are caused by falls and road traffic accidents. Most head injury patients are children.
Admission Profile and Outcome of Patients in a Level III Intensive Care Unit: A Two-Year Comparative Study
Authors: Pathak Sunil , Acharya Subhash P , Acharya Pragya , Bhattarai Binita
Published: June 2021

Introduction An Intensive Care Unit (ICU) is an area where critically ill patients are admitted and the highest level of care is provided with close intensive monitoring and management. Clinical audit is a must to measure indicators of the quality of care in ICU and benchmarking outcome. The main aim of the study was to evaluate the profile of patients admitted to ICU and assess their outcome of two consecutive years.

MethodsA single-institutional, descriptive cross-sectional study was conducted on all adult patients admitted to the ICU of Tribhuvan University Teaching Hospital, Kathmandu, between April 2018 and April 2020 (Baisakh 2075 to Chaitra 2076).

ResultsWith an average of 1.98 admissions per day, a total of 1447 patients were admitted to TUTH ICU over the period of two years. A male preponderance was noted with a male to female ratio of 1.19:1. Most of the patients admitted were neurosurgical cases 429 (29.6%). A total of 884 (61%) were shifted out of ICU in stable condition while the overall mortality was 458 (31.6%).

ConclusionThis study shows that there is a higher severity of illness at admission as well as a comparatively high mortality rate. More number of patients were male, of age group of 15-65 years, with medical and neurosurgical conditions. This study of profile and outcome of patients admitted in ICU can serve as a quality indicator as well as evidence on which planning and policymaking can be based upon in the future.
Correlation of Body Mass Index with Handgrip Strength and Endurance of Dominant Hand in Medical Students
Authors: Shrestha Lava , Gurung Sanyukta , Bhat Neeti , Mahotra Narayan B , Bajimaya Mahesh M , Kandel Sabita , Malla Neha , Shakya Aman , Aryal Vibina , Gyawali Bigyan R , Rayamajhi Nirmala , Pradhan Sait
Published: June 2021

Introduction Hand grip strength is used in evaluation of muscle strength and is also increasingly being used as an indicator for nutritional status. The maximum force applied voluntarily by the subject is called maximum handgrip strength, which is measured in kilograms. Muscular endurance is the ability of a muscle or muscle group to perform against a load for an extended period of time, measured in seconds. This study aims to correlate body mass index with handgrip strength and handgrip endurance in medical students.

MethodsThis is a cross sectional, observational study which included 74 undergraduate students of Maharajgunj Medical Campus by convenient sampling method. Body mass index was calculated by Quetelet’s formula. Camry digital hand dynamometer was used to measure handgrip strength in the dominant hand in kilograms. Participants were instructed to hold dynamometer with maintained pressure of 30% of maximum handgrip strength for as long as possible to determine the handgrip endurance. Statistical analyses were performed with SPSS Statistics software.

ResultsThe handgrip strength was more in males than females with a mean of 43.09±3.72 kg, while handgrip endurance was more in females with a mean of 123.60±50.65 sec. Positive correlation was seen between body mass index and handgrip strength (r=0.23 and p=0.045). Body mass index and handgrip endurance also showed positive correlation (r=0.34 and p=0.003).

ConclusionSignificant correlation of body mass index with handgrip strength and handgrip endurance was seen in medical students.
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: June 2021

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.

MethodsA 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.

ResultsAmong 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%.

ConclusionThe 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.
Relation of Neck Circumference to Central Obesity and Overweight in Patients with Type 2 Diabetes Mellitus Presenting to a Tertiary Center
Authors: Sharma Ishwor , Gupta Sanjay K , Niraula Kiran
Published: June 2021

Introduction Overweight and obesity with their surrogate anthropometric markers like body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) have been shown to be strongly associated with Type 2 diabetes mellitus. Neck circumference (NC) though less used can be an equally effective alternative to diagnose overweight and obesity in patients with Type 2 diabetes mellitus in a resource limited setting.

MethodsPatients who had Type 2 Diabetes Mellitus for 5 years or more and above 35 years underwent simple random sampling. Weight, height, WC and NC were measured. BMI was calculated and patients were graded into overweight and obesity based on the Asian cutoffs for BMI and abdominal obesity.

ResultsAmong 100 patients enrolled in this study, 45% were men and the mean age was 53.05. Mean neck circumference was 36.55 ± 1.28 cm and 35.27 ± 1.78 cm for male and female respectively. NC was positively correlated with WC and BMI in both men and women (p ˂ 0.001). In the ROC curves, NC presented the largest area under the curve (AUC) for overweight in males (p ˂ 0.001), while NC presented a large AUC for central obesity in both genders. Furthermore, the cut off value of neck circumference for overweight was 35.6 cm in males vs 35.2 cm in females and for central obesity was 36.75 cm in males vs 34.75 cm in females.

ConclusionNeck circumference was positively associated with overweight and central obesity in patients with type 2 diabetes mellitus.
Rare Primary Spinal Mesenchymal Chondrosarcoma: A Case Report
Authors: Paudel Sushil , Adhikari Shirish , Adhikari Sharad C , Pokharel Rohit K
Published: June 2021

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.