bluuebunny/crossref_metadata_2025 huggingface dataset:
"ROMANIAN ONLINE MEDIA HEADING TOWARDS A FIGHT PARADIGM: A QUALITATIVE ANALYSIS"
Authors:   West University of Timișoara, Bader Simona , Sîrb Corina ,   West University of Timișoara
Published: March 2023

A study we conducted in 2018 revealed that Romanian digital media is migrating towards catastrophism and fight paradigm, as far as its content is concerned. We made a quantitative analysis of almost a half a million headlines published in the first months of 2018 that showed the dominance of fight paradigm and catastrophic headlines versus common, oldschool sensationalistic ones, appealing to excitement. We concluded that this tendency towards fight and catastrophism is a specific kind of sensationalism, that could either reflect the inner conflicts and tensions of the Romanian nowadays society or/and function as clickbait tactics to generate more views. The present paper is a follow-up to the above-mentioned study that has three main purposes: a) to observe and analyze the tendencies in digital media after one year; b) to see which areas of the society are more frequently presented as scandalous and dramatic by the media; and c) to see if there is a connection between this tendency and social and political events.
"LEGAL LANGUAGE AND TECHNOLOGY: ENHANCING THE DELIVERY OF LINGUISTIC MESSAGES? "
Authors:   University of Craiova, Matieș-Verbuncu Isabella-Alice
Published: March 2023

While law requires language, legal experts need to communicate through words which are fundamental devices for delivering linguistic messages. Communication in this area represents the key for a successful outcome of any legal proceeding or particular case. Over the years, we have witnessed as technology has reached one of its greatest potential of development. The phenomenon of humanity evolution arises while technology innovates and legalists make use of science and IT to improve the quality of their work. But when do we know there is enough technology and how to maintain the balance in favour of humans instead of machines?
COMMUNICATING THROUGH PHOTOGRAPHIC IMAGES
Authors:   Politehnica University Timişoara, Suciu Sorin
Published: March 2023

A number of false ideas circulate at the level of common sense in connection with the photographic image. The most frequent ones are those referring to the so-called photographic language, to the hidden grammar of the photographic image, or to the amount of truth contained in a photograph. The fact that the photography does not have a language in the proper sense of the word, does not have a grammar and does not claim to reveal the truth does not diminish in any way its dignity as a medium of expression. My article aims to demystify the photographic expression in order to clarify its specificity
Tinjauan Hukum Islam Terhadap Praktik Upah Kerja Buruh Tani dengan Sistem “Derep”
Authors: Hidayat Roni , Agustine Hendra Karunia , Hasanah Anisa
Published: March 2023

Upah menjadi hal yang sangat penting dalam hal sewa menyewa jasa, karena dengan upah seorang pekerja akan merasa lebih dihargai atas jasa yang telah mereka keluarkan. Ada beberapa macam istilah buruh tani yang digunakan oleh masyarakat di Desa Linggajaya, ada buruh harian, buruh borongan, buruh dengan sistem kontrak, serta buruh derep. Tujuan penelitian ini adalah untuk mengetahui praktik pengupahan buruh tani dengan sistem derep dan untuk mengetahui tinjauan hukum Islam terhadap praktik pengupahan buruh tani dengan sistem derep di Desa Linggajaya Kecamatan Ciwaru kabupaten Kuningan.

Penelitian ini menggunakan metode cara berpikir yang induktif. Penelitian ini menggunakan metode penelitian kualitatif yang bersifat deskriftif analisis, dengan jenis penelitian lapangan. Sumber data yang digunakan dalam penelitian ini adalah sumber data primer dan skunder. Teknik pengumpulan data dengan cara observasi, wawancara, dan dokumentasi. Sedangkan analisis datanya dengan mereduksi data, penyajian data, dan penyimpulan data.

Hasil penelitian yang ditemukan yaitu, Desa Linggajaya merupakan salah satu desa yang berada di Kecamatan Ciwaru, dengan mayoritas penduduk bekerja sebagai pedagang (rantau) dan petani. Dalam praktik pengupahan buruh tani dengan sistem derep di Desa Linggajaya dilakukan secara turun-temurun. Namun sekarang sudah jarang masyarakat yang melakukan sistem derep. Meskipun dalam praktik derep pembayaran upah ditangguhkan, namun hal tersebut telah menjadi kesepakatan antara petani dan buruh tani. Sehingga dalam sistem pembayarannya diperbolehkan dalam Islam karena mengandung unsur saling tolong-menolong dan telah ada kerelaan dari kedua belah pihak. Namun pembayaran upah pada saat terjadi gagal panen, hendaknya untuk tidak membuat penangguhan kembali pembayaran pada saat panen berikutnya, atau diikhlaskan oleh buruh tani, tetapi lebih baik digantikan langsung dengan uang tunai yang nominalnya sama dengan bekerja selama dua hari, untuk menghindari kerugian dan ketidakjelasan akad. 

Kata kunci: Hukum Islam, Praktik Upah Kerja, Buruh Tani, Sistem Derep
Levels, trends and differentials of teenage fertility in Nepal: assessing universal coverage of adolescence sexual and reproductive health to achieve Sustainable Development Goal 5 in 2030
Authors: Bhandary Shital
Published: March 2023

Introduction: Adolescence is a transition period from childhood to adulthood and is critically important especially for teenage girls as adolescent birth rate has remained high despite declining fertility in Nepal. Consequently, adolescents are more likely to drop out from the school thus losing the potential earning and leadership opportunities, which in turn, hampers their overall well-being. Thus it was included in the Millennium Development Goals and also in the Sustainable Development Goals (SDGs). Methods: The 1996, 2001, 2006 and 2011 Nepal Demographic Health and Survey (NDHS) datasets were used. Single age birth rates were derived using births histories whereas age-specific fertility rates of 15-19 years women were derived using Poisson regression. Regression-based standard errors and its confidence intervals were used to test the levels and trends statistically. Results: The adolescent birth rate was higher among 18-19 years than 15-17 years old females. Teenage fertility rate was 81 in 2011: second highest in South Asia. Urban adolescent birth rates were significantly different from rural areas and country for all the surveys. Adolescent birth rate was significantly lower than the national estimates for women with some secondary and beyond secondary levels of education. Eastern and Western Development regions had lower teenage fertility compared to other regions of Nepal. Conclusion: Nepal needs to use best practices and approaches from around the globe to systematically reduce its high teenage fertility as aspired by the Target 6, Goal 5 of the Sustainable Development Goals (SDGs) to be implemented between 2016-2030.
Common presentations of patients in general practice clinic at Patan Academy of Health Sciences
Authors: Shakya Abishesh , Maharjan Prativa , Yadav Chadani Salmalee , Shrestha Yasmin , Bhushal Priya , Mahato Rahul , Subedi Rajan
Published: March 2023

Introduction: General practice clinic sees wide variety of patients. To improve the quality of care and for uniformity a protocol based approach should be applied. So, this study is designed to see the common presentations in the patient coming to general practice clinic. Methods: This is a cross sectional study that was carried out from June 2014 to May 2015.Data was evaluated each month to see the common presentation. Results: Total data collected in six month from general practice out patient was 2,120 which is 1.79% of total OPD visit. Out of this 766 (35.9%) were male and 1,362 (64.1%) were female. The most common presenting symptom in the OPD was pain abdomen 19.38% in which acute gastritis was the most common cause. Fever (9.29%) the second most common symptom. Cough (6.79%) was the third common presenting symptom. Fourth most common symptom was amenorrhea (6.13%) , finally the fifth common symptom was headache and the most common cause was tension headache (3.77%). Conclusion: Pain abdomen is the most common cause of patient presenting to emergency out of which gastritis is the most common.
Increasing trend of caesarean section in Patan hospital
Authors: Pradhan Binita , Shrestha Sarda Duwa , RC Laxmi , Sharma Paban , Bhandary Shital
Published: March 2023

Introduction: Caesarean section has been in rising trend every day by day. The study was done to find out the rate of caesarean section and its indications. Methods: This was a retrospective study conducted from January 2010 to December 2014. All cases were reviewed through the records regarding the indications of caesarean section. Results: Out of 44713 deliveries, 18718(41.9%) had caesarean section. The rate of caesarean section was 38.4% in 2010 which increased to 46.9% in 2014. The most common indication for caesarean section was cephalo-pelvic disproportion (19.9%).The next common indication was previous caesarean section (16.5%). Conclusion: The study concluded that there is an increasing trend of caesarean section due to various causes.
Alendronate and its role in post-menopausal osteoporosis
Authors: Sharma Dilip , Yu Deng , Shaobo Zhu
Published: March 2023

Alendronate (alendronic acid) is a nitrogen-containing drug that belongs to the second generation bisphosphonate class of drug. It binds to bone surfaces and inhibits bone resorption by osteoclasts and has been used as a treatment of choice in postmenopausal women with osteoporosis for many years. It is also a suitable drug for treatment of primary osteoporosis in men and for corticosteroid-induced osteoporosis in both men and women.1Oral alendronate (Alendronic acid) 5 or 10 mg/day has shown to produce an sustained increases in bone mineral density (BMD) in postmenopausal women with or without osteoporosis, in men with primary osteoporosis and in both men and women with or without osteoporosis receiving systemic corticosteroid therapy. Alendronic acid, administered at 70 mg once weekly or 35 mg twice weekly dose, has shown to increase the effective at increasing BMD as 10 mg/day and thus helps in the treatment or prevention of osteoporosis.1In this review, I will be focussing mainly on the properties of oral alendronic acid in the treatment of post-menopausal osteoporosis.
Study of prevalence of sexually transmitted infection in patients with symptoms of urinary tract infection
Authors: Sthapit Rekha , Acharya Ramesh Prasad , Prasad Pratap Narayan
Published: March 2023

Introduction: Urinary tract infections are commonly encountered in day to day practice of a general practitioner.The purpose of this study is to determine if there is an association between urinary tract infections (UTI) and sexually transmitted infections (STI), as both may present with similar symptoms.

Methods: This was a hospital based, prospective observational study in 104 women of 18 to 49 years age group, done during a period of six months at Patan hospital. Urinalysis results and genital examination findings were recorded.STI was defined as a vaginal swab positive for Trichomonas vaginalis(TV)/Neisseria gonorrhoeae (NG)/Chlamydia trachomatis(CT).UTI was defined as urinary WBC >=6per high power film. A urine c/s >105 colonies of a single pathogen was considered urine culture positive.

Results: Mean age of patients was 28.38 years. The most prevalent organism was TV (6/104, 5.8%), followed by NG(4/104,3.8%) and CT(2/104, 1.2%). 11.5% of women had STI , while 57.7% were urine culture positive. Out of those with urine culture positive, 83.3% had urinary WBC<30/hpf , and 16.7% had urinary WBC> 30/hpf. The relation between pyuria and urine c/s positivity was significant ( p value 0.005). The prevalence of STI in urine c/s positive group was 13.3%, and in urine c/s negative group was 9.1% ( p value 0.553).

Conclusion: There was no statistically significant difference in the prevalence of STI between urine culture positive and negative groups.
Socio-demographic factors affecting family planning decisions among the married women in rural district of Nepal
Authors: Shrestha Tirtha Man , Gauchan Shrijana , Acharya Ramesh Prasad
Published: March 2023

Introduction: Various socio-demographic factors are known to play decisive role in the acceptance of family planning methods. Commonly known factors include age of the women, age at marriage, age at first pregnancy, education and occupation.

Methods: This is a hospital based cross sectional, observational study conducted at Okhaldhunga Community Hospital among married women of reproductive age (15-49 years) attending either general OPD clinic or family planning clinic. Data were collected through an interview using a predesigned questionnaire.

Results: Age of women had statistical significance as the acceptance increased with the age. More than two-third of women using methods of family planning were married before the age of 20 years. About 43% of women had first pregnancy before the age of 20 years. There was no statistical significance between the current use of family planning methods and the education (p- value 0.6) and the various occupations (p-value 0.1).

Conclusion: There is a need for particular emphasis on contraceptive needs of adolescents and to improve accessibility and availability of all family planning services.
Parotid Tumor: A review of seven yearsâ€™ experience
Authors: Shah Surendra , Shah Jay Nath , Gongal Rajesh Nath , Shrestha Sameer , Poudyal Sanjay
Published: March 2023

Introduction: Parotid tumors represent about 80% of all salivary gland tumors. Our study was conducted to assess the clinical features, diagnostic accuracy of fine needle aspiration cytology (FNAC), surgical outcome and histological pattern of all patients underwent parotid surgery for parotid tumor at Patan Hospital.

Methods: All data of patients who underwent parotid surgery from 2060 to 2067 BC at Patan Hospital were collected retrospectively from medical files and analyzed.

Results: Among 18, all were presented with lump in the parotid region. Mean age of the patients was 45 years. Malignancy was common among older age group (mean age 51 vs 44 for benign). The overall accuracy in detecting malignant tumors was 88.89% with positive predictive and negative predictive values 100% and 83.24% respectively. Out of 18 histological reports, 15(83.33%) were benign lesions, pleomorphic adenoma was being most common 9(60%) among benign lesions, and 3(16.67%) were malignant lesions.

Conclusion: Painless lump is most common presentation of the parotid tumor. Benign pathology is common and majority of them are pleomorphic adenoma. Malignancy is prevalent in older age group.
Discrepancy in the early childhood mortality rates obtained from the two recent surveys of Nepal
Authors: Bhandary Shital
Published: March 2023

Introduction: In Nepal, early childhood mortality rates are derived from the Demographic and Health Surveys, which are prone to sampling and non-sampling errors being the probabilistic in nature. Thus, it is required to compare these mortality rates with other similar national survey to validate the findings.

Methods: Early childhood mortality rates were calculated using one of survival analysis methods or Kaplan-Meier Life Table technique on birth histories of the 2011 Nepal Demographic Health Survey and 2011 Nepal Living Standard Survey. Life table standard errors were used to calculate confidence interval in order tostatistically compare the early childhood mortality rates within and between these surveys.

Results: Life table estimates of early childhood mortalities on the 2011 Nepal Demographic Health Survey birth histories were similar to the published rates. Both surveys revealed declining trend of these mortality rates. However, estimates from 2011 Nepal Living Standard Survey were found to be significantly lower than the 2011 Nepal Demographic and Health Survey. Further, neonatal mortality was found to be stagnant during 1996-2000 and 2001-2005 periods using Living Standard Survey rather than 2001-2005 and 2006-2010 periods using Demographic and Health Survey.

Conclusion: Two nationally representative surveys of Nepal carried out at same calendar year using similar survey design and identical analysis technique, gave a drastically different early childhood mortality rates.
Comparison of intubating conditions during rapid tracheal intubation between Rocuronium and combination of Rocuronium with Vecuronium
Authors: Piya Roshan
Published: March 2023

Introduction: Rapid sequence induction (RSI) is usually indicated during emergency surgical procedure in the presence of full stomach and other conditions with an increased risk of aspiration. The use of succinylcholine has been the gold standard for RSI because of its rapid onset and short duration of action in spite of its adverse effects and contraindications in many conditions. Because of these side effects of succinylcholine many techniques have been attempted and published to replace succinylcholine when it is contraindicated. Aim of the study was to compare the quality of intubation conditions during tracheal intubation in 60 seconds after administration of thrice ED95 dose (0.9mg/kg) of rocuronium and combination of one & half times ED95 dose (0.45mg/kg) of rocuronium and one & half times ED95 dose (0.075mg/kg) of vecuronium.

Methods: Sixty patients scheduled for elective surgery requiring tracheal intubation, age ranges from 1865 years were chosen after informed consent. Prospective, Randomized, double blind study was conducted in the Department of Anaesthesiology, Tribhuvan University Teaching Hospital.

Results: The intubating conditions obtained with the combination groups were comparable with that of rocuronium alone. Most of the patients had excellent intubating condition and few had good intubating condition. The combination of one & half ED95 dose of rocuronium & one & half ED95 dose of vecuronium produced either excellent or good intubating condition during RSI.

Conclusion: Thus the combination of this drug with above dose can be an alternative to succinylcholine and rocuronium for RSI.
Data quality of reported age-sex structure from a community diagnosis program of a hilly region of Nepal
Authors: Bhandary S , Shakya SR , Sinha NP
Published: March 2023

Introduction: Indicators of health are extensively based on the age-sex data and thus warrants a detailed assessment of data. The main purpose of this study is to assess and then adjust the various types of bias and error that can occur during any census or survey.

Method: This study is based on a cross-sectional de jure census of Ugrachandi Nala VDC, Kavre, Nepal, which was conducted during August 30 â€“ September 5, 2005. Digit and gender preference is analysed using Whipple Index Myers Index and, Age-Sex Accuracy Indices. The data is adjusted using Beerâ€™s Method and Hill Technique. Microsoft Excel 2003 and SPSS 11.5 programs were used for data entry and analysis respectively.

Result: The Whipple Indices revealed that the single year data as rough and Myers Index confirmed that 0 and 5 are the most preferred digits. Age-Sex Accuracy Indices disclosed the quniquennial age data as highly inaccurate. Single-year age data adjusted using Beerâ€™s Method and quinquennial age data adjusted using Hills Technique are found to be an ideal age-sex structure.

Conclusion: Although the reported age shows serious problems of digit preference and age displacement in Ugrachandi Nala VDC, its data quality is better than the Nepal and Kavre district. This study shows that bias and errors related to the reported age and gender in a census and survey can be identified and adjusted using various demographic tools. Thus, it is suggested to use adjusted age-sex structure for calculating demographic, epidemiological and other health indicators.
Organophosphate compound poisoning
Authors: Shrestha SR
Published: March 2023

Acute organophosphorus (OP) pesticide poisoning is a major clinical problem in the developing world. 1, 2, 3 The World Health Organization (WHO) estimates the number of acute pesticide poisoning at 3 million cases per year and mortality of 3, 00,000deaths per year.4. Most of these pesticide poisoning and subsequent death occur in developing countries following a deliberate self ingestion of the poison. Metacid (Methyl Parathion) and Nuvan (Dichlorovos) is popular Organophosphorus compound used for deliberate self harm in NepalThe Organophosphorus inhibites cholinesterase activity leads to accumulation of acetylcholine at synapses, causing overstimulation and disruption of neurotransmission in both central and peripheral nervous systems. Exaggerated manifestations of nicotinic and muscarinic receptors appear as a result of these actions.Diagnosis of poisoning is done with history of exposure to pesticides, characteristic signs of toxicity and improvement of condition with Atropine. Supportive management of poisoning follows rapid initial management of airways, breathing and circulationGastic lavage and administration of charcoal is done routinely with decontaminating procedure. Cholinesterase reactivates e is an important part of management, but benefit is not well confirmed in clinical trails
Prevalence of anemia among non-pregnant and pregnant women of reproductive age in Nepal
Authors: Bhandary S , Shrestha A
Published: March 2023

Introduction: The prevalence of anaemia among pregnant women in developing countries is high. Iron deficiency is one of the major causes of nutritional anemia worldwide. In order to address the problem of anemia in Nepal, government of Nepal introduced the Iron Supplementation and Intensification Programs. The 2006 Nepal Demographic and Health Survey evaluated these programs and revealed the reduction in the prevalence of anemia among women of reproductive age. However, reduction on prevalence of anemia among the non-pregnant and pregnant women has not been studied separately so far. Thus, this study aims to explore the 2006 Nepal Demographic and Health Survey (NDHS) data to study the change in the prevalence of anemia among non-pregnant and pregnant women of reproductive age.

Methods: The data is taken from the 2006 Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey of 10647 women of reproductive age or 15-49 years. Out of them 604 were pregnant at the time of the survey. Hemoglobin level is adjusted for the altitude and daily cigarettes smoking is used in this study. Using the adjusted hemoglobin level, anemia is classified into four categories i.e. severe, moderate, mild and any anemia.

Results: The prevalence of anemia among the non-pregnant reproductive age women is found to be 35.8%. The highest prevalence is observed for Far-Western terai (67.1%) followed by Mid-Western terai (59.4%), Central terai (55.5%) and Western terai (47.15%). Mean hemoglobin (Hb) level is found to be less than 12 g/dl at these regions. The prevalence of severe anemia among non-pregnant women of reproductive age at national and eco-development regions is less than 2%, moderate anemia is 5.6% and mild anemia is 29.8%. The overall prevalence of anemia among the pregnant reproductive age women is found to be 42.7%. The highest prevalence is again observed for Far-Western terai (69.2%) followed by Central terai (55.2%) and Western terai (52.1%). The mean h level is less than 11 g/dl at Central, Western, Mid-Western and Far-Western terai regions. Prevalence of severe anemia among pregnant women of Western terai and Mid-western terai is found to be more than 2%. Furthermore, Mid-western hill and Central terai also has equal or more than 1.5% prevalence of severe anemia among pregnant women of reproductive age.

Conclusion: There are some eco-development regions where anemia prevalence was found to be less in the pregnant women than the non-pregnant women and vice-versa. This warrants an immediate intervention policies and programs from the governmental and non-governmental agencies. Even though Nepal has reduced the prevalence of anemia among non-pregnant and pregnant women of reproductive age, it is required needs to further decrease the anemia prevalence in order to reduce the maternal mortality in the country and meet the target 5a of MDG Goal 5 on maternal health.
Comparison of Holmium Laser and Pneumatic Lithotripsy in treatment of ureteral stones
Authors: Bhandari BB , Basnet RB
Published: March 2023

Introduction: To compare the effectiveness and complications of treatment of ureteric stones by holmium laser lithotripsy and pneumatic lithotripsy.

Methods: Comparison of 100 patients with ureteric stones, 50 of whom were treated with pneumatic lithotripsy and 50 with holmium laser lithotripsy was done and effectiveness and complications of the two were analysed.

Results: Both the groups were similar in respect to sex, age, stone size and location of the stones. Successful stone fragmentation occurred in 94 % on pneumatic group and in 92 % on laser group. On following the patients for a month, stone free rate was 98 % in both the groups. None of the patients had any complications relating to the procedures.

Conclusion: Although pneumatic lithotripsy has more retrograde migration of ureteric stones, the results are comparable to holmium laser. Other complications are very rare.
Post laparoscopic cholecystectomy gastro intestinal bleed
Authors: Rajbhandari A , Bhomi KK , Pradhan GB , Shrestha S , Bhattachan CL
Published: March 2023

Post laparoscopic gastro intestinal bleed accounts for less than 1 % of laparoscopic complications. Here we present a 26 year female who presented with gastro intestinal bleed after 2 weeks of undergoing laparoscopic cholecystectomy. CT scan of abdomen revealed pseudo aneurysm of anterior branch of right hepatic artery. She underwent embolization which revealed pseudo aneurysm of cystic artery and GI bleeding stopped thereafter. She presented 1 month later and had to undergo Laparotomy with the findings of a subphrenic and pelvic collection.
Analysis of pediatric patient admitted through emergency at Patan Hospital, Nepal
Authors: Acharya S , Shrestha A
Published: March 2023

Introduction: It is very important to know the important causes of emergency visit of children and mortality. Identifying diseases which are common and severe enables planners to design proper priority setting and intervention planning.

Methods: This is a descriptive retrospective study done at Patan Hospital reviewing files of Pediatric patients admitted from Poush 2065 to Mangshir 2066 (December 2008 to December 2009).

Results: Out of 612 records selected, top five causes of hospital admission observed were Pneumonia 25.8%, Acute gastroenteritis 12.7%, Neonatal sepsis 12.3%, Febrile Seizure 12.1% and Enteric Fever 4.7%. The mean hospital stay observed was 4.93 days with SD 4.73 days. In this study mortality rate was 2.1% with major causes being Severe Sepsis 38.4% and Severe Pneumonia 30.7%.

Conclusions: In this study Pneumonia is found to be the common cause of pediatric admission and also contributes significantly in mortality.
Using a bedside ultrasound (US), an emerging technology, to confirm endotracheal tube (ETT) location in adults in emergency department
Authors: Bom Rabin , Maharjan Ramesh Kumar , Neupane Ram Prasad
Published: March 2023

Introduction: Airway management is the most important aspect of patient treatment in emergency medicine. Prompt confirmation of Endotracheal Tube (ETT) in larynx is imperative for avoiding complications in sick patient. With quick learning graph, Point of Care Ultrasound (POCUS) has high sensitivity and specificity for detection of ETT in place.

 

Method: A prospective observational study was conducted at adult Emergency Department of Tribhuvan University Teaching Hospital among patients undergoing intubation for various reasons. Transtracheal POCUS was used to confirm the tube placement. Time to confirm tube by POCUS in trachea and by bilateral chest auscultation was noted.

 

Result: Of the 71 intubations, 68 were correctly identified to be in trachea and 3 in esophagus, resulting in sensitivity and specificity of 100% each. Transtracheal POCUS was the fastest method to determine endotracheal intubation (8.08 ± 1.69 seconds) compared to bilateral chest auscultation (22.37 ± 3.45 seconds).

 

Conclusion: With high sensitivity and NPV for confirmation of correct endotracheal tube intubation and early detection, transtracheal POCUS in emergency could be a useful tool for prompt localization of ETT and instant action needed before final confirmation by other means.
Loperamide in adult acute diarrhea
Authors: Shrestha A , Acharya S
Published: March 2023

Introduction: Decrease in duration of diarrhea significantly reduces morbidity, loss of working days, hospital bed occupancy and use of hospital resources. Loperamide is an established treatment of acute diarrhea to decrease the duration and frequency of unformed stool with only rare adverse reactions.

Methods: This is a descriptive, cross sectional, parallel group, single centre study done in odd and even days of the month for treatment and control group. The study was conducted from 1st to 30th September 2010 in Patan Hospital Emergency Department.

Results: Out of 104 patients, 43 patients were included in Loperamide group and 63 patients were taken in supportive treatment group. Mean duration of diarrhea was 16.3 and 41.9 hours in supportive plus Loperamide group and supportive treatment only group respectively. Mean difference in duration of diarrhea was 25.6 hours 95% CI (23.9 to 27.3) (P<0.05). Similarly mean working day loss was 1.19 in group treated with Loperamide and 2.84 days in group not treated with Loperamide. Mean difference was 1.65 days CI 95% (1.45 to1.85) (P<0.05). Absolute risk of complication in Loperamide group was 6.6%

Conclusion: Loperamide significantly reduces duration of diarrhea and working days lost with low rate of complications in Adult with acute non infective diarrhea.
A study on effect of different inter-pregnancy intervals on perinatal outcomes
Authors: Bajracharya S
Published: March 2023

Introduction: Both short and long inter-pregnancy intervals have been found to increase various adverse perinatal outcomes such as low birth weight, preterm delivery, and small for gestational age, still birth and neonatal death. This proposed study was endeavor to find out impact of different inter-pregnancy interval on perinatal outcome like preterm birth, low birth weight, perinatal death in second gravida women of age group 18 â€“ 35 years

Methods: This is a cross-sectional study conducted in Patan Hospital, Lalitpur in 2064 B.S. from 1st of Magh to 31st Falgun. Total 84 Patients included in the study were the women of second gravida of age group 18 â€“ 35 years. The study population was divided into three inter-pregnancy interval < 18, 18 â€“ 59 & >59 months. All the women of second gravida who fitted in the study were interviewed with the questionnaire after taking an informed consent.

Results: Among the total 84 women who were included in the study, maximum number (57.1%) of women were of IPI >59 months. In women with IPI <18 months & IPI>59 months, 33.4% & 16.7% of women had preterm delivery respectively. All women with IPI 18-59 months had termed delivery. (P value=0.007). Among women with IPI <18 months & >59 months, 50.05% & 25% woman had delivered low birth weight babies respectively. And in a group of IPI 18- 59, only 16.7% of women delivered low birth weight babies. (p value=0.272). There was only one perinatal death in the group of IPI > 59 months. In comparison of APGAR score at 5 minutes of delivery with IPI, all babies were found to have APGAR score 7 - 10.

Conclusion: There is an increased risk of preterm & low birth weight babies in women with IPI < 18 months and > 59 months compared to women with IPI 18 â€“ 59 months
correlation between arterial and venous sodium and potassium values in critically ill patients by arterial blood gas and electrolyte analyzer attending tertiary hospital of Nepal
Authors: Bhusal Pramila , Nepal Suresh Prasad
Published: March 2023

Introduction: Electrolytes are elements and compounds that occur naturally in the body and control important physiological function. Electrolyte disorder occurs when the levels of electrolytes in the body are either too high or too low. The causes, severity, treatment, and outcomes can vastly differ depending on the implicated electrolyte imbalances. The objective of this study is to comprehend the correlation between sodium and potassium levels measured in critically ill patients attending a tertiary care hospital of Nepal.

 

Method:  This study was a hospital based prospective observational comparative study conducted in the Department of General Practice and Emergency Medicine, Bir hospital, Kathmandu, from June 2019 to December 2019. After fulfilling inclusion and exclusion criteria a total of 95 patients were included in the study. Data were entered and analyzed in SPSS 20. The findings were presented in figures and tables. Statistical analysis was done using appropriate formula. Mean, standard deviation and correlation coefficient were calculated.

 

Result: The mean value of arterial sodium was 134.67mmol/L and venous sodium was 135.93mmol/L. The mean value of arterial potassium was 4.0mmol/L and venous potassium was 4.19mmol/L. The correlation coefficient obtained for sodium was 0.703 and for potassium was 0.436. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters.

 

Conclusion: Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.
Prospective study of intubation after physiological optimization in the emergency department
Authors: Das Sunil Kumar , Chhantel Narma , Shah Ashok Kumar , Tiwari Umakant , Maharjan Kripa
Published: March 2023

Emergency departments witness all sorts of unprecedented types of patients with respiratory compromise. Airway management must be done expeditiously in dire situations. It’s a well-known fact that patients are not well optimized for intubation as soon as they land up in an emergency. There might have a myriad of comorbidities to be addressed. Amongst various, we have discussed intubation in patients with increased intracranial pressure, patients with shock, patients with acidosis, and patients with respiratory failure.  To have a better understanding of the physiological status of patients, reviewed 18 articles, and retrieved a synopsis from the abstract and conclusion. Here we have discussed the physiological optimization of patients based on current recommendation.
Experience of a junior doctor during the COVID-19 pandemic when it all began
Authors: Sharma Rajiv
Published: March 2023

Challenges faced by a young doctor recently passed out from medical school and then into a seemingly never-ending wave of the virus that left us breathless.
Assessment of shock in emergency: Narrative Review
Authors: Silwal Shruti , Devkota Prerit , Sinha Puja , Raut Randip , Shrestha Ashis
Published: March 2023

Shock is an important clinical condition presenting to the emergency department. Pathophysiology of septic, cardiogenic, hemorrhagic, obstructive, and anaphylactic shock are different however clinical assessment tools are the same and limited. It is important to identify shock in its early phase or the patient at risk of shock in the emergency department. There is no accurate clinical tool to identify the early stage of shock. Moreover, it is also important to assess fluid responsiveness to shock, available clinical and biochemical parameters respond differently to fluid resuscitation and none of the tools had 100% sensitivity and specificity. Therefore, this article reviews the available clinical and biochemical parameters to assess and monitoring fluid responsiveness in shock.
Stroke Review- Nepal
Authors: Joshi Dipesh Mangal , Maharjan Rony
Published: March 2023

The prevalence of stroke in the Nepalese population over the years has shifted from a higher age group, over 60 years to below 45 years of age, most common being ischemic stroke with the cardioembolic origin and predominantly in the male population. Smoking, diabetes, hypertension, dyslipidemia are the main predisposing factors. A very small percentage of patients (5-20%) presenting in the emergency department is thrombolysis eligible due to late arrival to which lockdown also has some effect. Endovascular recanalization has also shown good outcomes. Complications of stroke included aspiration pneumonia. Mortality was more in patients with low GCS at presentation and was not affected by the presence of AF. NIHSS score is reliable and can be used to predict outcomes.
Outcome of bipolar transurethral resection in benign enlargement of prostate: A retrospective analysis.
Authors: Shrestha Samir , Maskey Pukar , Shah Jay N
Published: March 2023

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate (BEP) is one of the common urological problem in men.  Bipolar transurethral resection of prostate (B-TURP) is a standard surgical intervention for BEP. In this study we aim to analyze the perioperative outcome and complications of B-TURP for BEP.

Method: This retrospective study analyzed the perioperative outcome & complications of B-TURP in patients with BEP from August 2017 to July 2020at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Data was collected from the operating room register and from inpatients files from the record section. SPSS version 16 was used to analyze the data. Study variables included age, ASA grade with known concomitant co-morbidities, prostate volume, total prostate specific antigen (TPSA), operative time, decreased hemoglobin level, postoperative bladder irrigation duration, hospital stay, transurethral resection syndrome (TURS), hyponatremia, blood transfusion, postoperative hematuria requiring intervention, postoperative acute urinary retention, urinary tract infection (UTI) and urine incontinence.

Result: A total of 72 patients underwent B-TURP. Data was analyzed on 46 patients. Those with incomplete data and those files which were unable to retrieve were not analyzed. Perioperative outcomes were: median operative time was 81.73 minutes, median hospital stay was 3.4 days, median decreased hemoglobin was 3.0 g/dl and median postoperative bladder irrigation duration was 22.50 hours. Perioperative complications were: hyponatremia in 1 (2.1%), postoperative urinary retention in 2 (4.3%), blood transfusion in 4 (8.6%), postoperative hematuria requiring intervention in 3(6.5%), urinary incontinence in 8(17.3%) & urethral stricture in 6 (13.0%). There were no TURS & mortalities.

Conclusion: Our study shows B-TURP is safe procedure with minimal morbidity for the treatment of benign enlargement of prostate.

Keywords: Benign enlargement of prostate (BEP), bipolar transurethral resection of prostate (B-TURP), lower urinary tract symptoms (LUTS)
Audit of Cesarean section by non-obstetricians in the remote part of Nepal using the Robson classification system.
Authors: Ghimire Rajan , Rai Tupesh Thulung , Dhamala Manoj , Adhikari Sugat
Published: March 2023

Introduction: Cesarean delivery is increasing throughout the globe. It is increasing here in Nepal too. There are inequalities in cesarean deliveries in urban and rural/remote areas. Through this study, we tried to see the Cesarean delivery rate in one of the remote districts of Nepal and audited the Cesarean deliveries as per the Robson classification system.

Method: A retrospective cross-sectional study based on secondary data collection of sixteen months (Aug 2019 to Dec 2020) was designed for this purpose. We collected data from the health management and information system (HMIS) maternity registry and record files of inpatients located in District Hospital, Terhathum. We used the Robson classification system and Robson reporting table for the analysis purpose.

Result: We included 495 participants. The overall Cesarean rate was 12.9%. Robson group 1 i.e. nulliparous, single, cephalic, >37 weeks of gestation contributed most (40.63%) in cesarean delivery followed by group 5 (17.19%) i.e. multiparous, single, cephalic, >37 weeks of gestation with previous Cesarean section (CS).

Conclusion:  In our study, the main contributor to CS was Robson group 1 i.e. nulliparous, single, cephalic >37 weeks of gestation followed by group 5 i.e. multiparous, single, cephalic >37 weeks of gestation with previous CS. Though the CS rate is within the WHO recommendation, we need to intervene to decrease CS in low-risk groups and strengthen hospital facilities for vaginal birth after Cesarean (VBAC).
Unilateral Angioedema of Tongue following Ginseng containing Multivitamin intake in patient with SLE: A case report.
Authors: Pant Manish Nath , Thapa Ashish
Published: March 2023

Unilateral angioedema of tongue is a rare presentation of allergic reaction. If not identified and treated immediately, may lead to compromise of the airway and warrant tracheostomy or sometimes may also lead to death. In lupus patients, angioedema may be due to an acquired type of C1 inhibitor deficiency. Acquired angioedema can also be drug induced mostly seen with the use of non-steroidal anti-inflammatory drugs, contrast media, proton pump inhibitors and serotonin reuptake inhibitors. There are rare cases reported of angioedema related to Ginseng intake.
Assessment of knowledge towards emergency contraceptives among college students in Ramechhap district of Nepal
Authors: Pokharel Yagya Raj , Pokharel Shaluja , Shrestha Bharat Kumar
Published: March 2023

Introduction: A high rate of unintended pregnancy exists among college students as they belong to the sexually active age group. So, it is significant to know the knowledge of college students regarding emergency contraceptives.

 

Objectives: To assess the knowledge of students towards Emergency Contraceptives and to identify the association between male and female students towards knowledge of emergency contraceptives.

 

Method: An online survey in Ramechhap district among college students studying in bachelor’s and master’s level was conducted from March 15, 2022 to April 10, 2022 where total of 169 students participated.  Non parametric test was used to find the result of the objectives.

 

Result: The study showed that 83.4% students had the knowledge of Emergency Contraceptive pills and 59.2% of students first heard about such pills in the last 5 Years. Among them 79.9% of students knew where to get Emergency Contraceptive pills, 24.2% of students know the Emergency Contraceptive pills works if there is menstrual delay. Only 56.9% of students know the time to take Emergency Contraceptives pills after unprotected sexual intercourse and 46.7% of students know that the Emergency Contraceptive pill is not used for regular contraception. Only 49.1% of students know the right number of tablets that needs to be consumed after unprotected intercourse.

 

Conclusion: Majority of the students are aware of the Emergency Contraceptive pills however they have limited understanding about it. In comparison to female students, male had better understanding about Emergency Contraceptives.
Management of strangulated inguinal hernia with Resection and Anastomosis in a primary health care setting during COVID -19 crisis
Authors: Sapkota Sanju
Published: March 2023

Introduction: Longstanding reducible hernia should be intervened timely so as to prevent the risk of strangulated hernia and resection and anastomosis of gut. Strangulated hernia is a surgical emergency and only timely surgical intervention can prevent from further deterioration of patientâ€™s health condition.

Case Report

There was a case of 75 years male from rural area of Eastern Nepal at Charikot Hospital emergency department, with the complaint of severe pain and swelling over right inguinal region, associated with abdominal distension, vomiting, not passing stool for 3 days. He had history of swelling of right inguinoscrotal region for last 5 years. Intraoperative finding showed that there was indirect hernia and the content was jejunum and omentum which was gangrenous, resection and anastomosis along with bassini's repair was done.

Conclusion: Hernia should be managed as soon as the diagnosis is confirmed before emergency visit due to serious risk of obstruction and strangulation. So, we should repair any inguinal hernia on an elective basis in any age group.
Trend of utilization of Safe Motherhood Services in rural Nepal
Authors: Dangal Binod , Kalaunee Shankar Prasad , Upreti Arun , Khadka Shyam , Khati Karuna , Lamichhane Reena , Khadka Himshail , Thapa Roshan Kumar
Published: March 2023

Introduction: The government of Nepal has implemented Safe Motherhood programs throughout the country to decrease the perinatal morbidity and mortality. Safe motherhood service includes normal vaginal delivery, Caesarian Section (CS) and perinatal management.  CS rates are a major public concern.  Currently 18.6% of all births occur by CS, ranging from 6 to 27.2% in different parts of the world.

Methods:  Retrospectively collected data from Electronic Health Record (EHR) of deliveries from May 1,2016 to October 31,2020 were used. We have analyzed demographic profiles like age, geographical location. Similarly, gestational age, caste, gravida, parity, various indications of CS, maternal, fetal and neonatal outcomes were also recorded.

Results: A total of 4168 deliveries were conducted over four and half years with 3694 (88.6%) vaginal deliveries and 474 (11.4%) CS. There was constant maintenance of CS rate from 5-15% over four and half years, 11% in 2016 to 12% in 2019.  Fetal distress was the commonest indication of overall CS followed by Non-progress of labor. The women from Bhimeshwor municipality were 156 (32.9%). The most CS was done in the age group of 20-24 years, which was 192 (40.5%). Neonatal Death was 3/1000 births. There was one maternal mortality due to PPH and late presenation.

Conclusion: Different from the other evidences, we found that our CS rate was within the limit of WHOâ€™s recommendation for lower resource setting. Following strict guidelines and with dedicated care, itâ€™s possible to maintain recommended CS rate with less neonatal and maternal morbidities even in lower resource setting where there are no NICU, ICU facilities and Electronic Fetal Monitoring (EFM).
Study of endometrium in abnormal uterine bleeding at Patan Academy of Health Sciences, Patan Hospital Nepal
Authors: R.C. Laxmi
Published: March 2023

Introduction:Abnormal uterine bleeding (AUB) is considered as one of the most common and challenging problem presenting to the gynecologist. Establishing a cause of AUB is important, as medical therapy is effective in managing abnormal bleeding in most cases and should be attempted prior to surgical management. Endometrial biopsy is a safe and effective diagnostic step in evaluation of endometrium after ruling out any medical causes. The objective of this study is to evaluate the different histopathological patterns of the endometrial biopsy specimens in women presenting with AUBat Patan Hospital.

Method: A two year retrospective study of AUB covering the year 2068 to 2069 . Patients charts were retrieved from the medical record section and reviewed.

Result: The most common age group presenting with AUB was 41â€“50 years 58(49.1%).Among these patients,normal physiological patterns 62 (52.5%) with secretory endometrium(24.6%), proliferative endometrium 29 (22.9%) and menstrual phase 6 (5.1%) were observed. The commonest  pathology irrespective of the age group was disordered proliferative pattern 23 (19.5%). Othercauses identified were endocervical polyp 8 (6.8%), hormonal effect 5 (4.2%), atrophic endometrium 5 (4.2%),endometrial carcinomas 5 (4.2%), complications of pregnancy  3 (2.5%), endometrial hyperplasias  3 (2.5%), endometritis 3 (2.5%) and endometrial polyp 1 (0.8%).

Conclusion:Histopathological variations of the endometrium can detect the cause of the disorders taking into account the age and phase of a menstrual cycle. Timely evaluation of AUB by histopathology can be life saving diagnostic tool for early management.