bluuebunny/crossref_metadata_2025 huggingface dataset:
Traditional Indonesian Clothing and Modernity. Batik and kebaya
Authors:   Institute of oriental studies, Russian academy of science (MOSCOW), Petrova O.L.
Published: November 2020

Indonesia is the largest island state, each of the provinces has their unique traditional costumes. Indonesian culture has been influenced by many religions, including Christianity, Islam, Confucianism, Buddhism, and Hinduism for centuries. Despite foreign influence, various regions have retained their indigenous cultures. Different ethnic groups still wear their historical outfits and practice ethnic rituals. Styles of traditional dress are still inseparably connected with the prestige and power. Traditional clothing has not remained unchanged in design, but reflects an individual choice in aesthetics and lifestyle, in the face of rapid changes.
Proverbial Rhetoric in Sustenance of Gender Stereotypes: An Ethnological Account of Proverbs from Pakistani Languages
Authors: Akbar Ghilzai Shazia , Sultana Aneela , Zeeshan Mahwish
Published: November 2020

Language is the most effective tool of communication across cultures. Proverbs are one such component of stylistic poetic and rhetoric devices which serves to communicate the worldview of an ethnic group. The paper is an analysis of ways in which gender differences are perceived, symbolized, portrayed, expressed and promoted rhetorically through the use of proverbs amongst various ethnic groups in Pakistan such as Pashto, Saraiki, Urdu and Sindhi consistent with the Whorfian hypothesis of linguistic determinism and relativism. The study employs qualitative data using the descriptive methodology. Discourse analysis of the secondary data and participant observations cast as primary methodological approaches has been gauged to decipher the meanings and intent of the proverbs. The study findings suggest that meanings of proverbs and messages are context-bound and reflect power dynamics rooted in conventional gender roles which serve to construct and deconstruct the notion of 'womanhood' in the ethnicities mentioned above.
Experiences of neurological surgeons with malpractice lawsuits
Authors: Gadjradj Pravesh S. , Ghobrial Julian B. , Harhangi Biswadjiet S.
Published: November 2020

OBJECTIVE

As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits.

METHODS

A survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one’s own practice of medicine.

RESULTS

There were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).

Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53–6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80–5.20) were both independently associated with higher odds of considering leaving the practice of medicine.

CONCLUSIONS

The current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.
Damned if you monitor, damned if you don’t: medical malpractice and intraoperative neuromonitoring for spinal surgery
Authors: Hatef Jeffrey , Katzir Miki , Toop Nathaniel , Islam Monica , Clark Trevor , Roscoe Catherine , Khan Safdar , Mendel Ehud
Published: November 2020

OBJECTIVE

The aim of this study was to identify trends in medical malpractice litigation related to intraoperative neuromonitoring.

METHODS

The Westlaw Edge legal research service was queried for malpractice litigation related to neuromonitoring in spine surgery. Cases were reviewed to determine if the plaintiff’s assertion of negligence was due to either failure to use neuromonitoring or negligent monitoring. Comparative statistics and a detailed qualitative analysis of the resulting cases were performed.

RESULTS

Twenty-six cases related to neuromonitoring were identified. Spinal fusion was the procedure in question in all cases, and defendants were nearly evenly divided between orthopedic surgeons and neurosurgeons. Defense verdicts were most common (54%), followed by settlements (27%) and plaintiff verdicts (19%). Settlements resulted in a mean $7,575,000 damage award, while plaintiff verdicts resulted in a mean $4,180,213 damage award. The basis for litigation was failure to monitor in 54% of the cases and negligent monitoring in 46%. There were no significant differences in case outcomes between the two allegations of negligence.

CONCLUSIONS

The use and interpretation of intraoperative neuromonitoring findings can be the basis for a medical malpractice litigation. Spine surgeons can face malpractice risks by not monitoring when required by the standard of care and by interpreting or reacting to neuromonitoring findings inappropriately.
Overview of medical malpractice in neurosurgery
Authors: Larkin Collin J. , Roumeliotis Anastasios G. , Karras Constantine L. , Murthy Nikhil K. , Karras Maria Fay , Tran Huy Minh , Yerneni Ketan , Potts Matthew B.
Published: November 2020

Annually, 20% of all practicing neurosurgeons in the United States are faced with medical malpractice litigation. The average indemnity paid in a closed neurosurgical civil claim is $439,146, the highest of all medical specialties. The majority of claims result from dissatisfaction following spinal surgery, although claims after cranial surgery tend to be costlier. On a societal scale, the increasing prevalence of medical malpractice claims is a catalyst for the practice of defensive medicine, resulting in record-level healthcare costs. Outside of the obvious financial strains, malpractice claims have also been linked to professional disenchantment and career changes for afflicted physicians. Unfortunately, neurosurgical residents receive minimal practical education regarding these matters and are often unprepared and vulnerable to these setbacks in the earlier stages of their careers. In this article, the authors aim to provide neurosurgical residents and junior attendings with an introductory guide to the fundamentals of medical malpractice lawsuits and the implications for neurosurgeons as an adjunct to more formal residency education.
Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits
Authors: Garg Kanwaljeet , Sharma Ravi , Raheja Amol , Tandon Vivek , Katiyar Varidh , Dash Chinmaya , Bhatnagar Rishi , Khullar Mohan Kumar , Raju Bharath , Nanda Anil , Kale Shashank S.
Published: November 2020

OBJECTIVE

Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.

METHODS

An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.

RESULTS

A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).

CONCLUSIONS

This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.
Medical malpractice in spine surgery: a review
Authors: Medress Zachary A. , Jin Michael C. , Feng Austin , Varshneya Kunal , Veeravagu Anand
Published: November 2020

Medical malpractice is an important but often underappreciated topic within neurosurgery, particularly for surgeons in the early phases of practice. The practice of spinal neurosurgery involves substantial risk for litigation, as both the natural history of the conditions being treated and the operations being performed almost always carry the risk of permanent damage to the spinal cord or nerve roots, a cardiopulmonary event, death, or other dire outcomes. In this review, the authors discuss important topics related to medical malpractice in spine surgery, including tort reform, trends and frequency of litigation claims in spine surgery, wrong-level and wrong-site surgery, catastrophic outcomes including spinal cord injury and death, and ethical considerations.
Informed consent in neurosurgery: a systematic review
Authors: Shlobin Nathan A. , Sheldon Mark , Lam Sandi
Published: November 2020

OBJECTIVE

Informed consent has served as a main principle of medical ethics and laws in the United States. The 1986 American Association of Neurological Surgeons Code of Ethics implied medicolegal liability for the failure to obtain informed consent without providing practical guidance regarding the application of informed consent to individual patient encounters in a medicolegal environment. Here, the authors aimed to identify baseline patient recall after discussions with neurosurgeons and their capacity to provide informed consent, describe the effects of interventions to improve patient comprehension, and elucidate the role of informed consent in malpractice litigation in neurosurgery. Their findings may guide neurosurgeons in discussions to properly inform patients and reduce the risk of litigation.

METHODS

A systematic review was conducted to explore informed consent within neurosurgery and its application to medicolegal liability using the PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.

RESULTS

Of 1428 resultant articles, 21 were included in the review. Baseline patient recall was low, particularly for risks and alternatives of treatments, and even decreased over time. Cognitive impairment was noted as a factor limiting the ability to provide informed consent. Interventions incorporating a combination of modalities in informed consent discussions, a specialized consent form with points for neurosurgeons to check off upon discussion, interactive websites, question prompt lists, and illustrations were found to be effective in improving patient knowledge. Lack of informed consent was a common factor for malpractice litigation. Spine surgery was particularly prone to costly lawsuits. Payments were generally greater for plaintiff verdicts than for settlements.

CONCLUSIONS

The application of informed consent to patient encounters is an important facet of clinical practice. Neurosurgeons have a duty to provide patients with all pertinent information to allow them to make decisions about their care. The authors examined baseline patient comprehension and capacity, interventions to improve informed consent, and malpractice litigation; it appears that determining the proper capacity to provide informed consent and considering informed consent as a process that depends on the setting are important. There is room to improve the informed consent process centered on baseline patient health literacy and understanding as well as clear communication using multiple modalities.
An Incidental Ultrasonographic Diagnosis of Partial Hydatidiform Mole in a Old Primigravida: A Case Report
Authors: Thapa Sudeep , Rana Ramesh , Kumari Sheela
Published: November 2020

Hydatidiform mole is an abnormal pregnancy common in Asian populations compared to western countries; however, a partial hydatidiform mole is relatively uncommon and very challenging to diagnose on ultrasound. We reported a 24 years old female visited our clinic whose first antenatal visit was regular with normal viable fetus on ultrasonographic scan. However, an uneventful scan at 12 weeks period of gestation revealed a large irregular gestational sac with the disproportionately small embryo corresponding to 6+6 weeks with no cardiac activity. Additionally, there was markedly thickened placenta measuring 30mm in thickness without cystic spaces within the placenta. Further, her beta-human chorionic gonadotrophin level was very high and suction evacuation sample showed hydropic chorionic villi lined by trophoblastic cells with cistern formation and scalloped border. In conclusion, partial hydatidiform mole is an uncommon molar pregnancy rarely diagnose on ultrasonography. Late first-trimester scan and excessively high beta-human chorionic gonadotrophin levels confirm the diagnosis.
Eosinophilic Cholecystitis presenting with Common Bile Duct Sludge and Cholangitis: A Case Report
Authors: Keyal Niraj Kumar , Adhikari Pooja , Baskota Basu Dev , Rai Ujwal , Thakur Aalok
Published: November 2020

Eosinophilic cholecystitis is a rare post-cholecystectomy inflammatory histopathological condition characterized by more than 90% eosinophilic infiltrate in the gallbladder. We present a case of 27-year female presented with abdominal pain, fever, jaundice, altered mental status, shock, leucocytosis, deranged liver function test, and peripheral blood eosinophilia. The patient underwent cholecystectomy and common bile duct exploration. She developed adult respiratory distress syndrome and hospital-acquired pneumonia. From this, we want to emphasize that eosinophilic cholecystitis and cholangiopathy should be a differential diagnosis in patients presenting with allergy, peripheral eosinophilia, obstructive jaundice that are planned to undergo cholecystectomy that will have early critical care intervention.
Triage, Surge Capacity, and Epidemic Emergency Unit: An experience from the 2019 dengue outbreak at a Tertiary Care Centre
Authors: Shrestha Ashis , Bajracharya Sumana , Rose House Darlene
Published: November 2020

In September 2019, a dengue outbreak was observed in many non-endemic areas of Nepal. Theemergency department of Patan Academy of Health Sciences also received febrile patients exceedingusual daily numbers. This surge of the patient was managed by epidemic triage and activation ofsurge capacity. A part of the surge plan was to activate an epidemic emergency unit. An observationward adjacent to the emergency was used for the epidemic emergency unit. The febrile patients whowere triaged yellow and green were treated in this unit. The patients who were triaged as Red weretreated in the emergency department.
Mobile Phone Dependence among Undergraduate Students of a Medical College of Eastern Nepal: A Descriptive Cross-sectional Study
Authors: Thapa Kriti , Lama Sami , Pokharel Rita , Sigdel Rambha , Rimal Surya Prasad
Published: November 2020

Introduction: Mobile phones are becoming increasingly indispensable in daily life of the studentswhich has resulted in mobile phone dependence. The objective of the study was to find the prevalenceof mobile phone dependence among undergraduate students of a medical college of Eastern Nepal.

Methods: A descriptive cross-sectional study was conducted from October 2016 to March 2017on a total of 390 undergraduate students aged between 17 and 25 years using stratified samplingtechnique. Students using mobile phones for more than one year was included in the study. Studentswere requested to complete a pretested self-administered questionnaire which comprised theirsocio-demographic characteristics, pattern of mobile phone usage and mobile phone addiction indexdeveloped by Leung.

Results: The prevalence of mobile phone dependence among the undergraduate students was foundto be 85 (21.8%). Mobile phone dependence was found to be related with time spend on mobile; callsper day, money spend on recharge per month and years of ownership of mobile phone. There wasno difference between males and females with regard to mobile phone dependence.

Conclusions: The present study found that mobile phone dependence was common among theundergraduate medical students. These results suggest the need to develop educational programmeto educate the students to use mobile phone meaningfully.
Histopathological Study of Skin Lesions in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Chalise Sanat , Dhakhwa Ramesh , Pradhan Sailesh Bahadur
Published: November 2020

Introduction: Skin diseases are much common in developing countries. The spectrum varies accordingto geographic distribution, gender, age, and coexisting disorder. We conducted this study to find outthe prevalence of different skin lesions and to evaluate their frequency and site of distribution.

Methods: A descriptive cross-sectional study was done in the pathology department of KathmanduMedical college from June 2019 to November 2019 after ethical clearance. The skin biopsies wereprocessed, sectioned and stained with Haematoxylin and eosin and evaluated. A conveniencesampling method was used. Data was collected and entry was done in Statistical Packages for SocialServices version 20.0, point estimate at 95% Confidence Interval was calculated along with frequencyand proportion for binary data.

Results: Among 133 skin biopsies examined, noninfectious vesicobullous and vesicopustulardisease were found in 42 (46.6%) cases followed by microbial disease in 22 (24.5%) and noninfectiouserythematous papular and squamous disease in 21 (23.4%) cases. Spongiotic dermatitis was themost common vesicobullous disease seen in 26 (28.9%) cases. Leprosy was the commonest microbialdisease found in 7 (7.8%) cases. The commonest noninfectious erythematous papular and squamousdisease was erythema dyschromicum perstans seen in 7 (7.8%) cases. The commonest neoplasticlesion was keratinocytic tumor seen in 12 (32.5%) cases. The commonest tumor of the skin wasintradermal nevus seen in 6 (16.3%) cases. 

Conclusions: Spongiotic dermatitis is a predominating non-neoplastic and overall skin lesion whichwas similar to the other studies done. Histopathological examination is the gold standard for theproper diagnosis as histomorphological features distinguish various skin lesions.
Knowledge on Diet among the Hypertensive Patients in a Tertiary Care Center Nepal: A Descriptive Cross-sectional Study
Authors: Maharjan Nabina , Maharjan Narayani , Li Rui
Published: November 2020

Introduction: Hypertension is one of the leading causes of death and disability in both developed and developing countries. The prevalence of hypertension is increasing rapidly worldwide. The aim of the study was to determine the knowledge of diet and exercise among hypertensive patients.

Methods: This descriptive cross-sectional study was conducted using a structured questionnaire among 169 hypertensive patients at Kathmandu diabetes and thyroid center from May 2017 to July 2017 after taking ethical clearance from Nepal Health Research Council, Nepal. A convenience sampling method was used. Data was collected and entry was done in Statistical Package for the Social Sciences version 16.0 point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

Results: Out of total 169 participants enrolled in this study, only 79 (46.7%) had good knowledge and 90 (53.3%) had poor knowledge regarding diet and exercise. The mean age of participants was 54.68±13.91 years.

Conclusions: This study revealed that the knowledge about diet and exercise among hypertensive patients is poor and this study suggests the need for a proper educational intervention to improve awareness and to control hypertension effectively.
Eruptive Xanthomas as Cutaneous Manifestation of Familial Combined Dyslipidaemia in an Eleven-year-old: A Case Report
Authors: Khadka Anupa , Bhattarai Sabina
Published: November 2020

Xanthomas are subcutaneous lipid deposits containing macrophages loaded with cholesterol and cholesterol esters. Although quite common in adults, xanthomas in pediatric population are infrequent and when present, may represent a cutaneous manifestation of underlying lipoprotein disorders which most often are familial. We report a case of eleven-year-old female child, with multiple eruptive xanthomas of skin since two years of age, a positive family history and deranged lipid profile consistent with possible familial Hypercholesterolemia.
Osteomyelitis of the Knee Following Intra-Articular Injections: A Case Series
Authors: Devnani Anand Sobhraj , Yeak Raymond Dieu Kiat , Fahrudin Che Hamzah
Published: November 2020

Septic arthritis of the knee is rare in adults. This leads to difficulty in making early diagnosis that invariably leads to delayed treatment with consequent destruction of the joint. The delay in diagnosis is largely attributed to absence of clinical signs of flagrant infection. Reported are three adult patients who presented with painful swollen knee and inability to walk few weeks after intra-articular injection for osteoarthritis. This paper discusses the cases in which the difficulties in the early diagnosis of septic arthritis of knee in adults led to the development of osteomyelitis.
Prevalence of Self-medication Practices for Oral Health Problems among Dental Patients in a dental college: A Descriptive Cross-sectional Study
Authors: Bhattarai Rosina , Khanal Sunita , Shrestha Sujita
Published: November 2020

Introduction: Self-medication means the use of medications for the treatment of any disease ontheir own, without consulting any healthcare professional. At times self-medication can be usefulif practiced correctly by saving time and money, whereas disadvantages often occur due to lackof evaluation by trained medical professionals and delay ineffective treatment and can result inunnecessary expenses and drug dependence. This study was conducted to find out the self-medicationbehavior and its associated factors among patients visiting a dental hospital in Kathmandu.

Methods: A hospital-based, cross-sectional study was conducted on 265 patients in Kantipur DentalCollege from December 2019 to January 2020 among the patients attending the dental Out PatientDepartment. Ethical clearance was obtained from the Institutional Review Committee of KantipurDental College. A convenience sampling technique was used. Proformas were prepared in English,translated to Nepali and re-translated to English by the back-translation method. Data entry wasdone in Microsoft Excel and analysis in SPSS 20. Descriptive statistics was done.

Results: The prevalence of self-medication practice was found to be 166 (62.6%). Out of totalparticipants, 99 (59.6%) consumed medicines for few days only and the most common triggeringfactor was found to be toothache in 101 (60.8%) participants. The most common reason for selfmedication was found to be a previous experience of treating similar illnesses.

Conclusions: The prevalence of self-medication was found to be low as compared to the study donein similar settings. Self-medication practice is a sensitive issue that hasn’t been given the requiredconsideration.
Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study
Authors: Shrestha Bishow Kumar , Adhikari Shital , Thakur Binay Kumar , Kadaria Dipen , Tamrakar Kishor Kumar , Devkota Mukti
Published: November 2020

Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion.

Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean (±SD) and frequency (percentage).

Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%).  Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma.  Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively.

Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.
Five Skills Medical Students Should Have
Authors: Guragai Mandeeep , Mandal Deependra
Published: November 2020

NA
Conference of Walter E Dandy Neurosurgical Society: My Life-Time Experience
Authors: Poudel Anita
Published: November 2020

NA
Prevalence of Intestinal Parasitic Infestation among Public School Children of a Community
Authors: Sharma Manisha , Sapkota Jyotshna , Jha Beena , Mishra Bhavesh , Bhatt Chandra Prakash
Published: November 2020

Introduction: Intestinal parasitic infestation is one of the major health problems in developingcountries like Nepal. This study was done to determine the prevalence rate of intestinal parasiticinfestation among school children in Duwakot VDC, Bhaktapur, Nepal.

Methods: A descriptive cross-sectional study was done in 194 public school children of Duwakotvillage development committee from August to October, 2019. Ethical clearance was obtained fromthe Institutional Review Committee (reference no. 1207201915). Simple random sampling was done.One hundred and ninety-four public school children individuals of 6 to 14 years of age were enrolled.Collected stools were examined for the presence of parasites macroscopically and microscopically.Microscopic examination was carried out by direct wet mount using normal saline (0.9%) and Lugol’siodine (0.5%) mount. The data obtained were computed and analyzed using Statistical Package forthe Social Sciences version 16.0.

Results: A total of 194 stool samples were collected from school children and examined. Theprevalence of intestinal parasitosis was 26 (13.40%). The commonest organism was Giardia lambliain 22 (11.34%) cases. Among helminthic infection, 2 (1.03%) cases each were infected by Hymenolepisnana and Hookworm respectively.

Conclusions: The prevalence rate of intestinal parasite infestation in Nepal shows considerabledecline in recent years. However, more effort is required by public health resources to minimize theproblem further.
Study of Medicine: Lessons Learnt from International Medical Students Conference
Authors: Subedi Prarthana
Published: November 2020

N/A
Mouth Self-Examination for Prevention and Control of Oral Cavity Cancer
Authors: Shrestha Gambhir , Maharjan Leison
Published: November 2020

Oral cavity cancer is one of the most common preventable cancers in the world. The burden of thedisease is high in South Asia. Therefore, public health strategies such as creating awareness anddisease screening should be advocated for its prevention and early detection. Mouth self-examinationserves both the purposes. It is easy to perform, non-invasive, and low-cost methods. It not only helpsin the early detection of suspicious oral lesions but also helps people to quit their high-risk behaviorssuch as consumption of tobacco and alcohol.
Prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome in Pregnant Women in a Tertiary Care Hospital
Authors: Sitaula Sarita , Manandhar Tara , Dixit Thapa Baburam , Shrestha Ramesh , Dharel Dinesh
Published: November 2020

Introduction: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome refers to biological syndrome occurring in pre-eclamptic and eclamptic women. There is a higher rate of maternal and perinatal morbidity and mortality due to the syndrome. So, the objective of the study is to find the prevalence and maternal- perinatal outcome in the syndrome.

Methods: A descriptive cross-sectional study was done in a tertiary care hospital from 1st April 2017 to 30th March 2018 after obtaining ethical clearance from the Institutional Review Committee. The inclusion criteria were patients giving consent for participation and those who delivered in our hospital. Patient with the syndrome who delivered outside and referred in the postpartum period was excluded because details of the neonate may not be available. The Statistical Package for Social Sciences version 21 was used for the analysis of the data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results: Out of 11974 deliveries, the prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome was 83 (0.69%) at 95% Confidence Interval (59.06-78.94). Maternal complications were seen in 19 (22.9%) and common complications being acute renal failure 9 (47.37%) followed by postpartum hemorrhage 4 (21.05%). Nearly 27 (33%) of patients required maternal ICU stay and there was one maternal mortality.

Conclusions: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome is one of the major causes of maternal and perinatal morbidity and mortality. Hence early recognition and prompt management may improve maternal and fetal outcomes.
Combating COVID-19 Pandemic in Nepal: Ethical Challenges in an Outbreak
Authors: Shah Aarati , Aacharya Ramesh Prasad
Published: November 2020

Pandemic outbreak of COVID-19 is the largest of its kind of this century. All countries throughout theglobe are trying their best to contain the disease and eliminate at the earliest. Efforts are continuingto improve the outcome of the infection in terms of minimizing the morbidity and mortality. As apublic health strategy every state has the responsibility of protecting the health of the communityand such measures includes the preventive measures like social distancing or even lockdown ofthe state as a whole restricting the movement of the people, diagnostic measures like testing thesuspects, contact tracing and isolation of the patients. Treatment of the infected requires decisionsin resource constraint situation particularly ICU beds and ventilators. In the meantime, protectingdoctors, nurses, other health workers as well as frontline workers need personal protective equipmentwhich is a scarce commodity. While doing so there might be a compromise in the individualautonomy, privacy, confidentiality, and social justice for the beneficence for the larger community.This is an attempt to explore the ethical quandaries in relation to combating COVID-19 in Nepal byrelating the issues with the principles of biomedical ethics.
Clinical Profile and Endoscopic Findings in Patients with Upper Gastrointestinal Bleed Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Bhattarai Subash
Published: November 2020

Introduction: Upper gastrointestinal bleeding is a common acute medical emergency. Endoscopyis the gold standard diagnostic and therapeutic tool in the management of upper gastrointestinalbleed. This study was undertaken to address the clinical profile, endoscopic profile, and outcomes inpatients with upper gastrointestinal bleed.

Methods: A descriptive cross-sectional study was conducted in a tertiary care teaching hospital inGandaki Province, Nepal from January 2018 to December 2019 after obtaining ethical clearancefrom Institutional Review Committee (MEMG/IRC/291/GA) and informed consent fromthe patient or patient relatives. The sample size was calculated. Six hundred and sixty patientswith upper gastrointestinal bleed were included in the study. Data entry was done in StatisticalPackages for the Social Sciences version 20.

Results: Peptic ulcers and ruptured oesophageal varices are the common aetiologies of uppergastrointestinal bleed. Inpatient mortality was seen in 98 (14.8 %) patients. Upper gastrointestinalbleed of variceal etiology presents with a higher Rockall score and has more chances of rebleedingand has higher mortality than those with non-variceal aetiologies. Bad prognostic factors wererebleeding, variceal etiology, and comorbidities including cirrhotic and Rockall score > 6.

Conclusions: Upper gastrointestinal bleeding is a common acute medical emergency. Early uppergastrointestinal endoscopy preferably within 24 hours is recommended for diagnosis, timelyintervention, and management of the patients with an upper gastrointestinal bleed that helps inreducing morbidity and mortality.
Prevalence of Congenital Malformations among Babies Delivered at a Tertiary Care Hospital
Authors: Shrestha Sabina , Shrestha Anup
Published: November 2020

Introduction: Congenital malformations have emerged as a major cause of stillbirths and neonatalmortality. It is a common cause of morbidity and mortality not only in the newborn but also in childhoodand beyond. The objective of this study was to find the prevalence of congenital malformation at birth.

Methods: The descriptive cross-sectional study was conducted among 2456 live births in KathmanduMedical College and Teaching Hospital from April 2017 to March 2018 after obtaining ethicalapproval from the institutional review committee (Ref no. 08052017). A convenient sampling methodwas applied. All the live-born babies delivered in this hospital during the study period were clinicallyexamined for the presence of congenital anomalies. All malformations were classified accordingto the International Classification of Diseases-10 classification. The mothers of the newborns withcongenital malformations were interviewed in a predesigned proforma. Statistical analysis was doneusing statistical package for the social sciences version 20.

Results: Out of 2456 examined live births, congenital malformations were observed in 66 cases.The prevalence of congenital malformation was 66 (2.6%) at 95% confidence interval (4.19-1.98) oftotal live births. The genitourinary system was the most common system involved with congenitalmalformations being 16 (24.2%), followed by musculoskeletal system 14 (21.2%), and cardiovascularsystem 12 (18.2%).

Conclusions: Congenital malformation plays a major role in the mortality and morbidity of neonatesas well as children. The genitourinary system was the most common system involved.
Current Imaging Trends in COVID-19 Pneumonia
Authors: Jha Anamika , Lohani Benu , Ghimire Ram Kumar
Published: November 2020

COVID-19 has rapidly emerged as a pandemic threatening lives and healthcare systems worldwide.With the emergence of the disease in Nepal, all faculties of medicine need to be well prepared toface the challenge. Fortunately, now plenty of research is available to facilitate our preparednessin the war against COVID-19. The reverse transcriptase-polymerase chain reaction is the currentgold standard diagnostic test and chest Computed Tomography scan for screening the disease isconsidered inappropriate by most society recommendations. The Nepal Radiologists’ Associationhas proposed its guidelines which have been endorsed by the Nepal Medical Council. This articleaims to summarize the role of imaging focusing on chest X-ray and Computed Tomography scanincluding the indications, specific findings, and important differentials. Imaging needs to be donetaking necessary precautions, to minimize disease transmission, protect health care personnel, andpreserve health care system functioning.
Anterior Tooth Width Measurements among Patients in a Tertiary Hospital of Nepal: A Descriptive Cross-sectional Study
Authors: Shrestha Prabhat , Paudel Sabina , Neupane Madhu , Lamba Suman
Published: November 2020

Introduction: The knowledge of anterior tooth width and their relationships with each other isessential for any esthetic and prosthodontic rehabilitation. The objective of this study is to measurethe width of the anterior teeth of patients coming to a teritary hospital of Nepal.

Methods: This descriptive cross-sectional study was conducted at a tertiary care hospital from 30thSeptember 2019 to 30th October 2019 after receiving ethical clearance from the institutional reviewcommittee (reference number: 2076/77/20). Convenient sampling was done. Point estimate at 99%Confidence Interval was calculated along with frequency and proportion for binary data. Dataanalysis was done in Statistical Package for the Social Sciences version 21.

Results: Out of the 40 participants, the mean width of right and left side of anterior teeth of themaxillary central incisors were 8.62±0.62 mm and 8.65±0.55 mm; maxillary lateral incisors were6.97±0.74 mm and 7.11±0.78 mm; maxillary canine were 7.81±0.69 mm and 8.15±0.72 mm; mandibularcentral incisors were 5.37±0.4 mm and 5.43±0.37 mm; mandibular lateral incisors were 5.88±.52mm and 6.06±0.53 mm; mandibular canine were 6.69±0.55 mm and 6.93±0.7 mm respectively. Thedifference between the teeth was compared with the central incisors of each side.

Conclusions: Our findings of the average values of the anterior teeth and their difference from thecentral incisors on each side showed an agreement with the optimal relationships of anterior teeth,with the exception of the maxillary lateral incisors, which were 0.5mm larger than the values of theoptimal relationship.
Knowledge of Health Care Professionals and Medical Students Regarding Covid-19 in a Tertiary Care Hospital in Nepal
Authors: Neupane Harish Chandra , Shrestha Niki , Adhikari Shital , Angadi Siddeshwar , Shrestha Bishow Kumar , Gauli Basanta
Published: November 2020

Introduction: The lack of knowledge among health care professionals leads to diagnostic delays,further spread of disease, and poor infection control practices. Health care professionals must beupdated knowledge regarding COVID-19. This study aims to assess the knowledge of health careprofessionals regarding COVID -19 in a medical college in Chitwan.

Methods: A Knowledge, Attitude and Practice Study was carried out in a tertiary care hospitalin Chitwan, Nepal from April 22, 2020, to April 28, 2020. The institutional review committee ofChitwan Medical College provided ethical approval for the research. Data were collected with anonline questionnaire using Google forms. The questionnaire was sent out to 724 potential responderswho included health care professionals from medical, dental, nursing, and allied health sciences inChitwan Medical College. A convenient sampling method was used for data collection. Data wereanalyzed using Statistical Package of Social Sciences.

Results: A total of 181 respondents completed the web survey. Overall, a total of 35 (19.3%)respondents were found to have “Good” knowledge; 105 (58%) respondents had “Fair” knowledgeand 41 (22.7%) respondents had “Poor” knowledge regarding various aspects of COVID-19. Therewas no significant difference among the various health professional groups in their knowledgescores under the four knowledge domains.

Conclusions: The study of knowledge of health care professionals could act as a reference for theprevention and better management of COVID-19. This study shows that there is a need to implementperiodic educational interventions and training programs on infection control practices for COVID-19across all healthcare professions.
Knuckle Pigmentation as an Early Cutaneous Sign of Vitamin B12 Deficiency: A Case Report
Authors: Srivastava Ankita , Choudhary Sanjiv
Published: November 2020

Vitamin B12 deficiency can present with variable hematological, neuropsychiatric, and mucocutaneous changes. Hyperpigmentation, specifically involving the knuckles has been described in vitamin B12 deficiency, but usually,these patients are symptomatic with systemic manifestations like megaloblastic anemia, pancytopenia, or neurological deficits. Here, we are reporting a case of nutritional vitamin B12 deficiency, who presented with isolated knuckle pigmentation and was successfully treated with oral therapy. This case also highlights the importance of recognizing this cutaneous sign as an early marker of vitamin B12 deficiency; thereby enabling the clinician to treat the disease before it leads to irreversible neurological complications.
Overt Hyperthyroidism in Third Trimester of Pregnancy: A Case Report
Authors: Khadka Madan , Thakur Achala , Das Dipti , Mishra Akshat
Published: November 2020

Hyperthyroidism is a state of excessive thyroid function. The most common cause of hyperthyroidism is Graves’ disease. Overt hyperthyroidism if not treated can have serious outcome on the mother and the fetus. We present a pregnant women at 31 weeks of gestation presented with shortness of breath and palpitation with previous history of caesarean section and was treated with propyl thiouracil, beta blockers, antihypertensive drug, and during her course of treatment had Preterm Prelabor Rupture of Membrane with subsequent onset of labor and had normal vaginal delivery of 1.7 kg healthy baby. This report emphasize on the timely management of overt symptoms before the onset of labor.
Prevalence of Psychological Effect of COVID-19 on Medical Professionals in a Tertiary Care Center
Authors: Shrestha Surendra Lal
Published: November 2020

Introduction: COVID-19 is a pandemic disease first detected in Wuhan, China on last December 2019. Many doctors and nurses, were infected and lost their life by COVID-19 around the world. Therefore COVID-19 brought unbearable psychological pressure on doctors, and nurses. The objective of this study is to find the prevalence of anxiety among medical doctors and nurses.

Methods: This is a descriptive cross-sectional study of 101 doctors and nurses carried out in a tertiary care center. Convenience sampling was done with the study period from April to May 2020. Ethical approval was taken from the institutional review board of NAMS (IRB reference no. 1076). The collected data stored and analyzed with statistical software (SPSS version 26.0). Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results: Out of 101 participants prevalence of anxiety was found to be 74 (73.3%) (64.68-81.33 at 95% Confidence Interval). Among them, 9 (8.9%) of participants experienced sever types of generalized anxiety disorder, 23 (22.8%) moderate, and 42 (41.6%) mild type. Similarly, 18 (17.8%) and 10 (9.9%) of participants felt very difficult and extreme difficulty at the workplace and home respectively.

Conclusions: The mental health of medical doctors and nurses is significantly affected during the COVID-19 pandemic. Hospital administration should conduct psychological preparedness training to the medical profession before posting on duty to provide quality health services to the patients.
Effectiveness of Clinical Postings for Third-year Medical Students
Authors: Jha Pinky
Published: November 2020

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Information about COVID-19 among Selected Population of Eastern Nepal: A Descriptive Cross-sectional Study
Authors: Chapagain Kumud , Rauniyar Gajendra Prasad , Pokharel Rais , Bhattarai Abhisekh
Published: November 2020

Introduction: Rapid spread of COVID-19 has become a major concern worldwide. Strong adherence to preventive measures can help to break the chain of the spread of coronavirus. We conducted this study to find out the extent of information general people of Eastern Nepal have regarding COVID-19 and their attitude and practice towards preventing its spread.

Methods: A descriptive cross-sectional online study was done among the people of Eastern Nepal on knowledge, attitude, and practice related to COVID-19 from May 1st to May 15th after obtaining ethical clearance from the ethical review board (ERB) (ref no. 319/2020 P). A 20 item survey instrument was adapted using WHO course materials on an emerging COVID-19. A convenience sample method was used. Data were collected and entered in Statistical Packages for Social Services version 11.5. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results: Among 1069 respondents, the correct answer on the COVID-19 related knowledge questionnaire was 958 (89.61%), 487 (93.11%) were health professionals, and 471 (86.26%) non-health professionals. Preventive measures were strictly followed by 1044 (97.66%) participants. A wrong perception about the disease was present in 390 (36.48%). Health ministry website 356 (33.30%) followed by news media 309 (29%) was the major source of information among the people.

Conclusions: Knowledge regarding COVID-19 among people the selected population of eastern is satisfactory which was similar to other studies done. However, people still have misperceptions regarding the disease and do not strictly follow the preventive measures.
A Lesson to Learn from the History of American Physicians
Authors: Khadka Manoj
Published: November 2020

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