bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal
Authors: Pradhan Bishwas , Bastola Priska , Basnet Madindra B , Shrestha Bibhush , Sigdel Shailendra , Gurung Arjun 
Published: June 2021

Introduction European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients.
MethodsA retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve.
ResultsObserved mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power.
ConclusionMortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory.
Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal
Authors: Khanal Babita , Kafle Prakash , Singh Sandip K , Yadav Sunil K , Neupane Bishomber , Shakya Ipsa , Yadav Dipak K 
Published: June 2021

Introduction Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal.
MethodsThis is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS).
ResultsThe study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome.
ConclusionThis study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome.
Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study
Authors: Sharma Lamsal Kamal , Neupane Keshab R , Acharya Niranjan , Lamsal Dinesh K , Karmacharya Niraj , Paudel Deepak , Paudel Rajan , Sharma Rabi P 
Published: June 2021

Introduction Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. <40 years in a tertiary care hospital, Nepal.
MethodsThis is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of <40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver­age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0.
ResultsAmong 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level.
ConclusionA high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients <40 years of age.
Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal
Authors: Maharjan Narendra , Joshi Lakhey Paleswan , Ghimire Bikal , Kansakar Prasan BS , Bhandari Ramesh S 
Published: June 2021

Introduction Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate.
MethodsThis is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019.
ResultsThere were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality.
ConclusionThe management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.
Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study
Authors: Gyawali Bigyan R , Pradhanaga Rabindra B , Rayamjhi Pabina , Dongol Kripa , Gupta Mudit , Shrestha Lava , Acharya Kunjan 
Published: June 2021

Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population.
MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics.
ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin.
ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.
Multilevel Spinal Injury: Incidence, Distribution and Neurological Patterns
Authors: Khadka Yagya , Lakhey Rajesh B , Kafle Dinesh 
Published: June 2021

Introduction Fractures and dislocation of spine are serious injuries that most commonly occur in young people. Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient.
MethodsThis was a prospective observational study carried out in Department of Orthopedics, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal from February 2012 to September 2013. Sixty cases of age group between 18 to 63 years of traumatic spinal injury were enrolled. Patients were examined clinically and radiographically.
ResultsOut of 60 patients, multilevel spinal injury occurred in 26 (43.3%) patients; 10 (16.67%) had contiguous spinal injury and 16 (26.67%) had non-contiguous spinal injury. There were 5 type A pattern spinal injury. Contiguous spinal injury most commonly occurred at level L1/L2 (n=4, 40%) and most had Frankel grade E neurology (n=6, 60%) followed by Frankel grade D (n=2, 20%). Non-contiguous lesions most commonly occurred at thoracic spine and had Frankel grade E neurology in most cases (n=10, 16.67%) followed by grade B and C (n= 2, 2.33% each).
ConclusionMultiple spinal injury was a common pattern of injury, which occurred in 26 (43.3%) patients out of 60 patients enrolled in our study. Multilevel spinal injury is common. We should be aware about its occurrence. We should evaluate for multilevel spinal injuries, so as not to miss them, especialy non-contiguous injuries, in the patients presenting with spinal injury.
Thyroid Disorders and Prolactin Hormone and Their Association with Obesity in Infertile Women in a Tertiary Hospital of Nepal
Authors: Maskey Suvana , Rijal Hima 
Published: June 2021

Introduction Thyroid dysfunction has profound effects on menstrual function and female fertility. Hypothyroidism is often associated with increased prolactin level which again worsens the problem. This study was done to evaluate the prevalence of thyroid disorders in infertile women attending infertility outpatient department (OPD) in Tribhuvan University Teaching Hospital (TUTH) and to determine the association of hypothyroidism and hyperprolactenemia with obesity which is not well studied in our population.
MethodsA hospital-based cross-sectional study was conducted in infertility OPD of TUTH reviewing women’s records who underwent infertility workup and relevant history, clinical finding and results of investigations including thyroid function test (TFT) and serum prolactin (PRL) level were documented. Descriptive and inferential statistical analyses were used to identify the prevalence and associations of predictors and outcome variables.
ResultsOut of 213 participants, the majority of the participants were obese (90; 42.3%) with mean (±SD) body mass index (BMI) being 24.8 ± 4.5 kg/m2. The prevalence of thyroid disorder was 18.4% including hypothyroidism 13.6% and hyperthyroidism 4.8%. There was no significant association of BMI and hyperprolactinemia with thyroid disorder as well as of BMI with hyperprolactinemia however the thyroid stimulating hormone (TSH) had significant positive correlation with prolactin (r=0.23, p<0.001).
ConclusionThyroid disorders and hyperprolactinemia are commonly observed in infertile women, so they should be routinely screened during initial evaluation of infertility. As majority of the study population were obese, despite no significant association of BMI with thyroid disorder and hyperprolactinemia, the effect of weight gain on infertility cannot be overlooked.
Clinical Profile of Patients Presenting with Low Back Pain to Out Patient Department of a Tertiary Level Hospital
Authors: Thapa Pradeep , Lakhey Rajesh B , Shrestha Binay L 
Published: June 2021

Introduction Low back pain is experienced by most of the people at some point of life. In our setting, there are very limited data on low back pain. This study aims to elaborate demographic and clinical profile of patients presenting to outpatient department of Orthopedics, in Tribhuvan University Teaching Hospital with complaints of low back pain.
MethodsA descriptive cross-sectional observational study was carried out in 150 patients who presented with complaints of lower back pain in outpatient department of Orthopedics of TU Teaching Hospital from May to November 2019. The demographics including age, gender, occupation, and clinical data- duration of symptoms, body mass index, VAS score and radiculopathy along with Body Mass Index of each patient were recorded in a proforma separately.
ResultsOut of total 150 patients, male: female ratio was 1:1.9. The average age of patients was 42.1 years The average height, weight and body mass index of patients were 157 cm, 61.81kg and 24.83kg/m2 respectively. The mean visual analogue score of patients was 5.41. Occupationally, predominant number of patients were housewives (41.3%). Seventy nine patients (52.7%) had low back pain alone. Seventy one patients (47.3%) had low back pain associated with radicular symptoms, out of which 74.6% had unilateral radiculopathy.
ConclusionLow back pain is most commonly seen in fourth decade of life. More females as compared to males are affected with low back pain. The radiculopathy associated with low backache is mostly unilateral.
Plasma Fibrinogen Level in Chronic Obstructive Pulmonary Disease and Its Correlation with GOLD Severity Staging
Authors: Gyawali Achyut , Bam Niraj , Pant Pankaj , Das Santa K 
Published: June 2021

Introduction Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction.
MethodsThis observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done.
ResultA total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p<0.001). There was significant negative correlation between plasma fibrinogen level and forced expiratory volume in one second (FEV1%) predicted (r=-0.71, p=0.01).
ConclusionHigh plasma fibrinogen level on discharge was found in COPD patients with severe airflow obstruction, frequent exacerbations and severe level of dyspnoea during AECOPD.
RELAÇÃO ENTRE CONDUTIVIDADE ELÉTRICA E DESEMPENHO FISIOLÓGIO DE SEMENTES DE ARROZ
Authors: Ascoli Carla Aparecida , Silva Andréa Carvalho da 
Published: June 2021

Estudando genótipos de arroz (Oryza sativa L.), ANa 8001, 9005 CL e 9027, determinou-se o potencial fisiológico das sementes, sendo o mesmo correlacionado com índices de condutividade elétrica. O experimento foi conduzido nas safras 2017/18 em Sinop-MT, na determinação dos índices de condutividade elétrica foram avaliados dois fatores de luminosidade e 9 períodos de embebição. Adotou-se o delineamento inteiramente casualizado com comparação de médias pelo Teste de Tukey (5%), quando necessário, os dados foram transformados por raiz quadrada. Os resultados destacaram a cultivar ANa 9027 com o pior desempenho fisiológico, vigor de 69%, e para as demais cultivares ANa 8001 (79,54%) e ANa 9005 CL (84,41%). O teor de água absorvido pelas sementes do início do processo de hidratação até o final, é afetada pela qualidade fisiológica, sementes menos vigorosas apresentam menor velocidade de hidratação e umidade final. Constatou-se também, que o teste de condutividade elétrica é eficiente para determinar a viabilidade de sementes de arroz e a melhor resposta foi obtida na ausência de luz, além disso é possível a redução do período de imersão para 8 h com o intuito de diferenciar o potencial fisiológico das sementes de arroz acima de 80% de vigor, daquelas abaixo desse padrão.
Palavras-chave: qualidade fisiológica; Oryza sativa; vigor de sementes; germinação.

Relationship between electrical conductivity and physiological performance of rice seeds

ABSTRACT: Studying genotypes of rice (Oryza sativa L.), ANa 8001, 9005 CL and 9027, the physiological potential of the seeds was determined, being the same correlated with electrical conductivity indices. The experiment was conducted in the 2017/18 harvests in Sinop-MT, in determining the electrical conductivity indices, two luminosity factors and 9 imbibition periods were evaluated. It was adopted a completely randomized design with comparison of means by the Tukey test (5%), when necessary, the data were transformed by square root. The results highlighted the cultivar ANa 9027 with the worst physiological performance, 69% vigor, and for the other cultivars ANa 8001 (79.54%) and ANa 9005 CL (84.41%). The water content absorbed by the seeds from the beginning of the hydration process to the end, is affected by the physiological quality, less vigorous seeds have a lower rate of hydration and final moisture. It was also found that the electrical conductivity test is efficient to determine the viability of rice seeds and the best response was obtained in the absence of light, in addition it is possible to reduce the immersion period to 8 h in order to differentiate the physiological potential of rice seeds above 80% vigor, those below this standard.
Keywords: physiological quality; Oryza sativa; seed vigor; germination.
Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series
Authors: Akamatsu Yosuke , Kashimura Hiroshi , Fujiwara Shunrou , Kubo Yoshitaka , Ogasawara Kuniaki 
Published: June 2021

BACKGROUND
When performing clip ligation of superior projecting aneurysms of the proximal (M1) segment of the middle cerebral artery (MCA), meticulous sylvian fissure dissection alone may be inadequate for safe clip application, especially in cases in which the aneurysm is buried in the limen recess, since the limen insulae may be positioned lateral to the aneurysm. In the present patient series, the authors present their surgical technique for clip ligation of aneurysms located in the limen recess, with partial resection of the limen insulae.

OBSERVATIONS
A retrospective analysis of patients who had undergone clip ligation of MCA aneurysms located at the limen recess at a single institute was performed. Patients with angiographic and clinical follow-up data were considered eligible. A total of 11 aneurysms (4 ruptured and 7 unruptured aneurysms) in 11 patients were evaluated. Postoperative ischemic lesions were observed on images obtained within 1 week after surgery in 5 (45.5%) patients who had undergone partial resection of the limen insulae, although none of them presented with neurological deterioration.

LESSONS
Partial resection of limen insulae may be feasible to avoid severe ischemic complications following clip ligation of M1 aneurysms embedded in the limen recess.
Management of giant prolactinoma causing craniocervical instability: illustrative case
Authors: Chugh Arunit J. S. , Patel Mohit , Chua Lorayne , Arafah Baha , Bambakidis Nicholas C. , Ray Abhishek 
Published: June 2021

BACKGROUND
Giant prolactinomas (>4 cm) are a rare entity, constituting less than 1% of all pituitary tumors. Diagnosis can usually be achieved through endocrinological analysis, but biopsy may be considered when trying to differentiate between invasive nonfunctioning pituitary adenomas and primary clival tumors such as chordomas.

OBSERVATIONS
The authors presented a rare case of a giant prolactinoma causing significant clival and occipital condyle erosion, which led to craniocervical instability. They provided a review of the multimodal management. Management involved medical therapy with dopamine agonists, and surgery was reserved for acute neural compression or dopamine agonist resistance, with the caveat that surgery was extremely unlikely to lead to normalization of serum prolactin in dopamine agonist–resistant tumors.

LESSONS
Adjunctive surgical therapy may be necessary in cases of skull base erosion, particularly when erosion or pathological fractures involve the occipital condyles. Modern posterior occipital-cervical fusion techniques have high rates of arthrodesis and can lead to symptomatic improvement. This procedure should be considered early in the multimodal approach to giant prolactinomas because of the often dramatic response to medical therapy and potential for further craniocervical instability.