bluuebunny/crossref_metadata_2025_split huggingface dataset:
Professional Satisfaction among B.Sc. Nursing Graduates of an Institute
Authors: Mehta R S , Yadav R 
Published: September 2018

Introduction: Professional Satisfaction is a measure of valuation judgment of whether the expectations are met from the profession or not. This study was conducted to find out the professional satisfaction among pass-out B.Sc. Nursing graduates from an institute from batches 1996 to 2004.
Methods: Descriptive cross-sectional study design was adopted using convenient and snowball sampling technique. Out of 104 graduates, 50 were included in the study. A pre-tested semistructured questionnaire was used by self administration method to collect the information.
Results: Highest satisfaction was with status 36 (75%) and lowest with working condition 27 (54%). The areas with decreasing value of satisfaction were growth and development 36 (72%), achievement and recognition 35 (70%), autonomy and challenging work 35 (69%). The majority of the respondents 27 (54%) stated that there is job security in the profession and the opportunity 26 (52%) to help others was the reason for their satisfaction but 28% said that there is no updating of knowledge and autonomy 15 (30%) in nursing profession.
Conclusions: There is no difference in professional satisfaction of the respondents living in Nepal and abroad. It is seen that though there are many problems and many areas of dissatisfaction in nursing profession the respondents were satisfied to some extent with it and the reason for brain drain among B.Sc. Nursing graduates were their personal interest.
Keywords: graduate; nursing; professional; satisfaction.
Clinicopathological Evaluationof Thyroglossal Cyst
Authors: Paudel D R 
Published: September 2018

Introduction: Thyroglossal cyst is a common congenital anomaly of the thyroid gland. Though malignant transformation is rare one case was a papillary carcinoma in my series.
Methods: Retrospectively thyroglossal cyst who underwent surgery during the period of January 2004 to March 2009 were evaluated.
Results: Age incidence of the cysts in the present series varied between 4 and 41 years. 12 (63%) patients were male and 7 (37%) patients were female. The sites of the lesion were as:thyrohyoid in 13 (68%),suprasternal in 1 (5%) and suprahyoid in 5 (27%) cases. Twelve patients had painless swelling on the neck and 7 had discharging sinus.Pre-operative cytological evaluation showed non-malignancy in all cases.Postoperative histological result turned out to be papillary carcinoma in 1 female patient of 33 years old and the remaining 18 had non-malignancy. This patient with papillary carcinoma had her thyroid gland in its normal position.
Conclusions: Malignant transformation should be ruled out in all cases of thyroglossal cyst and fistula. Post-operatively specimen should be sent for histological examination.
Keywords: papillary carcinoma;thyroglossal cyst; thyroid.
Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity
Authors: Bista Meera , Mahato Nayan Bahadur , Regmi Deepak 
Published: September 2018

Introduction: Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope.
Methods: This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant.
Results: The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely.
Conclusions: Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.
Predisposing Factors and Outcome of Malpresentations in an Institute
Authors: Maskey Smrity , Dwa Yam 
Published: September 2018

Introduction: This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome.
Methods: This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded.
Results: Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies.
Conclusions: The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.
Leptospirosis in Nepal
Authors: Kandel N , Thakur G D , Andjaparidze A 
Published: September 2018

The study has demonstrated the evidence of leptospirosis infection in the country. It has also highlighted the challenges and the need of further researches on this disease, which seems to be under reported in the country.
Keywords: acute encephalitis syndrome; case definition; endemic; laboratory capacity leptospirosis.
Amniotic Band Sequence - A Debilitating Syndrome
Authors: Uma R , Garg A , Patnaik S K 
Published: September 2018

A male baby was delivered by Caesarean section at term to a 35 years second gravida lady with fibroid uterus. The mother was booked and immunized and not on any medication. Antenatal and natal periods including serial ultrasounds were normal. At birth the neonate was observed to have multiple grooves over ring & middle index finger of left hand and hypoplasia of left little finger. Both great toes were amputated. In view of asymmetrical involvement, presence of amniotic bands, no other organ involvement and sporadic nature, he was diagnosed as a case of amniotic band sequence. Congenital amputations should be distinguished from congenital hypoplasia and/or aplasia. Differentiation is important for genetic counselling and evaluation of the risk of recurrence.
Keywords: Amniotic Bands, Intrauterine Amputation, Intrauterine Constriction Rings.
Pandemic (H1N1) 2009 Cases in Nepal
Authors: Kandel N , Shrestha J M , Upadhyay B , Shrestha A K , Shakya G 
Published: September 2018

We analyzed the data available in Nepal during this pandemic in order to determine the epidemiological, clinical and virological characteristics of pandemic influenza A in 2009. The test was conducted by real-time Reverse Transcription – Polymerase Chain Reaction on sample from patients with suspected influenza-like illnesses. Out of 538 cases were tested, 32 % were positive for pandemic influenza A 2009 and the infection rate was highest for cases of 11-20 years and lowest in >50 years of age.
Keywords: Influenza A ; pandemic; RT-PCR; surveillance.
Intraoperative stereotactic navigation for reconstruction in zygomatic-orbital trauma
Authors: Nyachhyon P , Kim P C 
Published: September 2018

Reconstruction of the maxillofacial skeleton after traumatic injury is not always straightforward because of its three dimensional complex anatomy and aesthetic signifi cance. In case of zygomaticorbital injury induced by trauma resulting in enophthalmos, the patient is affected on both function and cosmesis. To prevent diplopia or conspicuous asymmetry, exact correction of the orbital symmetry is required. The aim of this case report is to demonstrate the use of an intraoperative image guided navigation system for identifi cation of adequate reconstruction of the orbital fl oor and orbital symmetry in zygomatic-orbital fracture. Navigation-guided open reduction of a zygomatic-orbital complex fractures with orbital fl oor reconstruction can be regarded as a valuable treatment option for this potentially complicated procedure. This case demonstrated the use of the non-ionizing, noncontact, navigation system in intraoperative procedure and clinical monitoring to identify the correct position and symmetry in complex orbital fl oor reconstruction.
Keywords: intraoperative navigations, orbital reconstruction, zygomatico-orbital fracture.
People's Perspective on Access to Health Care Services in a Rural District of Nepal
Authors: Paudel R , Upadhyaya T , Pahari D P 
Published: September 2018

Introduction: Over the past several decades, Nepal has attempted to increase the access of health care services, however progress toward achieving high coverage of health care services in rural communities is still low. Therefore this study attempts to provide a perspective on access to basic healthcare services in government health facility.
Methods: Descriptive cross-sectional study with quantitative and qualitative methods was designed and applied to identify the access to health care services. The study population were people who were sick within three months prior to the study where basic sampling unit was household. Total sample size was 96 through the application of simple random sampling method. Bivariate analysis with 95% confidence interval was used to identify the association of variables with access to health care services.
Results: Among the total population, 28% of households in the study area received health care services at government health facility. The reasons for not accessing health care were insufficient drugs (61%), distance (22%), staff unavailability (19%), sickness (9%), money (7%), and facility hours (4%). Sex, ethnicity and distance were found significantly associated with access to health care services.
Conclusions: Less than one third of households had access to health careservices in government health facility. Addressing the important factors such as drug problems, staff unavailability, long distance to health institutions and inconvenient health facility hours may help to increase access to health care services at government health facility.
Keywords: Access, government health facility, health care services, perspective.
Practice of analgesia in an emergency department of eastern Nepal
Authors: Bhandari Rabin 
Published: September 2018

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.Key Words: Analgesia, Emergency, Nepal
Ketamine gargling and postoperative sore throat
Authors: Shrestha S K , Bhattarai B , Singh J 
Published: September 2018

INTRODUCTION:
Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sorethroat (POST). The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation.
METHODS:
Forty patients scheduled for elective surgery under general anaesthesia were enrolled in this randomized, control trial. Patients were randomly allocated into two groups of 20 patients each: Group C, gargling with drinking water 30 ml; Group K, gargling with ketamine 50 mg in drinking water 30 ml for 30 s, 5 min before induction of anaesthesia. POST was graded at 4, 8, and 24 hours respectively after operation on a four- point scale (0-3).
RESULTS:
POST occurred more frequently in Group C, when compared with Group K at 4, 8, and 24 hours.
CONCLUSIONS:
Ketamine gargle reduces the incidence of POST after endotracheal intubation.
Implementing Self Sustained Quality Control Procedures in a Clinical Laboratory
Authors: Khatri Roshan , KC Sanjay , Shrestha Prabodh , Sinha J N 
Published: September 2018

Introduction: Quality control is an essential component in every clinical laboratory which maintains the excellence of laboratory standards, supplementing to proper disease diagnosis, patient care and resulting in overall strengthening of health care system. Numerous quality control schemes are available, with combinations of procedures, most of which are tedious, time consuming and can be “too technical” whereas commercially available quality control materials can be expensive especially for laboratories in developing nations like Nepal. Here, we present a procedure performed at our centre with self prepared control serum and use of simple statistical tools for quality assurance.
Methods: The pooled serum was prepared as per guidelines for preparation of stabilized liquid quality control serum from human sera. Internal Quality Assessment was performed on this sample, on a daily basis which included measurement of 12 routine biochemical parameters. The results were plotted on Levey-Jennings charts and analysed with quality control rules, for a period of one month.
Results: The mean levels of biochemical analytes in self prepared control serum were within normal physiological range. This serum was evaluated every day along with patients’ samples. The results obtained were plotted on control charts and analysed using common quality control rules to identify possible systematic and random errors. Immediate mitigation measures were taken and the dispatch of erroneous reports was avoided.
Conclusions: In this study we try to highlight on a simple internal quality control procedure which can be performed by laboratories, with minimum technology, expenditure, and expertise and improve reliability and validity of the test reports.
Keywords: Levey-Jennings charts; pooled sera; quality control; Westgard Rule.
Age at Menarch: Differentials And Determinants
Authors: Aryal Tika Ram 
Published: September 2018

This paper is an attempt to investigate the differentials and determinants of age at menarche according tothe characteristics of females. Simple average, univariate as well as multivariate analysis were carried out.A multivariate technique has been utilized to study the effect of various socio-economic variables on thetiming of menarche.The data for this study were taken from a sample survey of Palpa and Rupandehi Districts” conductedbetween January and June 2000. A total of 1258 (including 239 daughters and 1019 mothers) femalesprovided information on the age at menarche. For this study only 239 samples of young girls have beenanalysed.Mean age at menarche was found about 15 and 14 years for older generation (mothers) and youngergeneration (their daughters) respectively. A decreased age at menarche was found with the increased levelof socio-economic status group of girls. Age at menarche was found higher for girls belonging to nonschooling(15.7 years) as compared to the schooling girls (14.2 years). It was found that the variables ‘socioeconomicstatus’, and ‘caste/ethnicity’ were the significant determinants for the timing of menarche. Ahigher risk of getting menarche early was found for high socio-economic status and schooling girls ascompared to the low socio-economic and non-schooling, which may be due to nutrition and physical andpsychological stress during the early childhood.Key Words: Fertility, Menarche, Differentials, Determinants, Reproductive, Adolescent, Sub-fecundity, Foetal wastage.
Dementia Assessment and Management Protocol for Doctors in Nepal
Authors: Jha Arun , Sapkota Nidesh 
Published: September 2018

WHO Dementia Report published in 2012 highlighted the exponential rise of dementia in the elderly population worldwide, especially in low-and middle-income countries. There may be over 135,000 people with dementia in Nepal, but there are no formal arrangements for diagnosis and treatment or any care and support for their caregivers.
WHO developed the Mental Health Gap Action Programme (mhGAP) Intervention Guide in 2010, for mental, neurological and substance use, including dementia in non-specialist health settings. This paper reviews the current dementia care provisions in Nepal and proposes a mhGAP-based dementia assessment and management protocol for Nepalese doctors in hospital/clinic settings. The protocol also outlines a post-diagnostic advice for dementia caregivers. The protocol would be discussed at various stakeholders meetings before recommending for routine clinical use.
Keywords: caregiver burden; dementia; MCI; memory clinic; mhGAP-IG; protocol.
Dyke-Davidoff-Masson Syndrome
Authors: Paudel Kalyan , Venugopal Anand 
Published: September 2018

Dyke-Davidoff-Masson syndrome refers to atrophy of one cerebral hemisphere (hemiatrophy) due to an insult to the brain in fetal or early childhood period. This is an uncommon condition. We present a case of a nine month- old female presented with seizure and weakness of the right upper and lower extremities and subsequently computed tomography was performed and showed hemiatrophy of the left fronto-parietal lobe with degenerative changes in the left cerebral peduncle.
Keywords: Dyke-Davidoff-Masson syndrome; hemiatrophy; hemiplegia.
Pyoderma Gangrenosum and High Titer Serum Aanti-CCP2 Antibodies
Authors: Das S K , Banerjee N , Khaskil S , Mukherjee S S 
Published: September 2018

Pyoderma gangrenosum is an uncommon ulcerative cutaneous neutrophilic dermatosis. In about 50 percent of cases, it is associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythromatosus, hematological diseases and various malignancies. There is no specific laboratory finding or histological features pathognomonic of pyoderma gangrenosum and it is often a diagnosis of exclusion. Here, we report an elderly female without history of any systemic disorders, presenting to us with extensive, bilaterally symmetrical, deep leg ulcers along with multiple superficial ulcers involving the right groin which was diagnosed as pyoderma gangrenosum. The only positive rheumatologic marker was serum anti-cyclic cittrulinated peptide2 antibody, which was found to be strongly positive. Dramatic response to systemic corticosteroid followed by successful split skin grafting was observed in our patient.
Keywords: Anti cyclic cittrulinated peptide2, pyoderma gangrenosum, symmetric leg ulcer.
Effective control of hypertension in adults with chronic kidney disease
Authors: Adhikary L , Koirala A , Gautam B , Gurung A 
Published: September 2018

INTRODUCTION:
Adequate control of hypertension in Chronic Kidney Disease patients is difficult to achieve. This study was designed to analyze the adequacy of Hypertension control in adults with CKD using different classes of antihypertensive drugs.
METHODS:
A cross-sectional observational study was done that included 85 patients with CKD admitted to our Medicine Department over a period of two years (2006-2008 A.D.). Presence of CKD was defined as glomerular filtration rate <60 ml/min per 1.73 m2 for more than three months or presence of albuminuria (albumin:creatinine ratio >30ug/mg). Adequate blood pressure control was defined as systolic blood pressure less than or equals to 130 and diastolic blood pressure less than or equals to 80 mm Hg. Data and Statistical analysis was done using SPSS Version 12 for Windows.
RESULTS:
Of all the CKD patients, 51.4% required three Anti-Hypertensive drugs combination for the effective control of Hypertension, while only 21% of CKD patients with hypertension was controlled on two drugs.
CONCLUSION:
Adequate control of blood pressure in CKD patient was shown to be most effective on combination of three antihypertensive drugs. A poor control was seen on patients taking less than three antihypertensive drugs.
Keywords: antihypertensive drug; chronic kidney disease; glomerular filtration rate; hypertension.
Accidental Chemical Burns of Oral Mucosa by Herbicide
Authors: Deo S P , Shetty P 
Published: September 2018

Glyphosate (GlySH) is a broad spectrum, nonselective herbicide, widely used in agriculture. This case report describes a 25-year-old man presenting with extensive chemical burns and ulceration of the oral cavity as a result of accidental exposure to GlySH. This paper aims to illustrate the typical appearance of GlySH related chemical mucosal burn and to demonstrate the severity of the corrosive effect of GlySH which need team approach to prevent unfavorable sequelae such as microstomia.
Keywords: Chemical burns, corrosive injury, glyphosate poisoning, herbicide, microstomia, oral mucosal burn.
Pralidoxime in organophosphorus poisoning
Authors: Simkhada N R , Kafle KK , Prasad PN 
Published: September 2018

INTRODUCTION:
Pralidoxime are enzyme reactivator that are known to reactivate the phosphorylated acetylcholinesterase by binding to the organophosphorus molecule. The use of oximes in acute organophosphorus poisoning has been a controversial subjects for over two decades. This study was conducted with the objective to find out the estimation of serum cholinesterase and use of pralidoxime in organophosphorus poisoning.
METHODS:
A prospective analysis of all organophosphorus poisoning cases presented at the Emergency Department, Tribhuvan University Teaching Hospital for seven months was done.
RESULTS:
Out of 26 cases about 60% of poisoning cases were monitored for pseudocholinesterase level. About 50% of them had pseudocholinesterase level within normal limit and 20% had less than 10% of normal value. Only 33% cases with pseudocholinesterase level less than 10% were treated with pralidoxime.
CONCLUSIONS:
The initial dose of Pralidoxime used was 1 gm followed by maintenance dose of 500mg 6 hourly, the doses prescribed were less than WHO recommended doses.
Keywords: cholinesterase, emergency, organophosphorus,poisoning, Pralidoxime.
Enteric fever with severe pancytopenia in a four year girl
Authors: Pathak R , Sharma A , Khanal A 
Published: September 2018

Typhoid fever and paratyphoid fever (also known as enteric fever) are severe systemic illnesses caused by salmonella typhi and S. paratyphi respectively. Enteric fever is prevalent in developing countries including Nepal, where it still remains as a major health problem. There have been reports of pancytopenia with enteric fever which has been attributed to mechanisms like bone marrow suppression, infection associated hemophagocytic syndrome and disseminated intravascular coagulation. We report here a case of severe pancytopenia in enteric fever as a result of bone marrow suppression due to systemic infection.
Keywords: enteric fever, pancytopenia, bone marrow suppression