bluuebunny/crossref_metadata_2025_split huggingface dataset:
L’autonomia decisionale della persona nelle situazioni di vulnerabilità, di debolezza e di razionalità limitata: iniziali riflessioni a margine della sentenza n. 50 del 15 febbraio 2022 della Corte costituzionale
Authors: Cembriani Fabio , Cingolani Mariano , Fedeli Piergiorgio 
Published: May 2022

SOMMARIO: 1. Introduzione - 2. L’iter procedurale del giudizio di ammissibilità costituzionale dei referendum abrogativi - 3. La sentenza della Corte costituzionale che ha dichiarato non ammissibile il referendum abrogativo sull’art. 579 c.p. (‘Omicidio del consenziente’) - 4. Le buone ragioni della prudente decisione assunta dai Giudici costituzionali - 5. Conclusioni.
Decision-making autonomy of the person in situations of vulnerability, weakness and limited rationality: initial reflections on the sidelines of sentence no. 50 of 15 February 2022 of the Constitutional Court
ABSTRACT: The Authors, starting with the decision of the Italian Constitutional Court which found the referendum to abrogate art. 579 c.p. (Murder of the consenting party), address, in a practical perspective, the question of the decision-making autonomy of the person in situations of vulnerability, weakness and limited rationality. Of the referendum question, they underline its cloudiness and ambivalence before analyzing the strengths of the decision that has finally given prominence to the many situations of fragility and vulnerability of the person not always and only due to the existence of an infirmity of mind. With all the practical consequences that derive from it for the care professionals to whom these people ask not only respect but rigorous guarantees of public protection.
STRESS AMONG HOSPITALIZED PATIENTS AT TEACHING HOSPITAL, CHITWAN
Authors: Lama Sumita , Ghimire Srijana 
Published: May 2022

Background: Stress is defined as the non- specific physiologic response of the body to any demand made upon it. Stress is a state produced by a change in the environment that is perceived as a challenging, threatening or damaging to a person’s dynamic balance or equilibrium. This study tries to find out the stress among the hospitalized patients.
Methods: A descriptive, cross sectional study design was used to find out the stress among the hospitalized patients of Chitwan Medical College Teaching Hospital, Chitwan. Purposive sampling technique was used. Structured questionnaire was used to collect the data through interview method. The data was edited, coded and analyzed using statistical package of social sciences (SPSS) version 16.0. Descriptive and inferential statistics was used to analyze the data.
Results: Out of 84 respondents, 52.4% respondents were female. Findings of the study revealed that more than half of the respondents 57.1% had high stress. So this study showed that the patients had high level of stress during hospitalization. The result also showed that there was statistically significant association between level of stress and sex of the respondents (p=0.002), educational status (p=0.002), place of residence (p=0.01), sufficiency of family income (0.02), previous experience of hospitalization (p=0.03). The major stressors identified in this study were economic stressors, stressors related to family role, disease condition. The minor causing stressors were stressors related to professional behaviors of health personnel and hospital related stressors.
Conclusions: Stress reduction activities such as counseling, warm environment should be provided for the patients to enhance the quality of life by reducing stress.
HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION USING MACINTOSH, MILLER AND MCCOY BLADES
Authors: Deo Gopendra Prasad , Gautam Suresh , Shrestha Indra Narayan , Regmi Bharati Sharma , Shrestha Subin , Yadav Nabin Krishna 
Published: May 2022

Background: Direct Laryngoscopy and endotracheal intubation are essential components of administration of general anaesthesia but trigger major stress response, in the form of in­creased catecholamines leading to tachycardia and hypertension. This study is designed to compare the haemodynamic stress response with the Macintosh, McCoy and Miller blades.
Methods: This prospective comparative study was conducted in 150 ASA grade I and II pa­tients, undergoing laparoscopic cholecystectomy under general anaesthesia from March 2017, were randomly divided into three groups using Macintosh, McCoy and Miller blade for endotracheal intubation respectively.
Results: The groups were also comparable in respect to gender, mean age, ASA grade, Cor­mack and Lehane grade, Laryngoscopic intubation time, baseline heart rate, heart rate before laryngoscopy, baseline mean arterial pressure and Mean Arterial Pressure before laryngos­copy. The mean heart rates at end of 1, 3 and 5 minute were 93.58±13.11, 88.28±11.57 and 83.64±10.94 bpm with Macintosh blade; 93.08±12.09, 94.54±11.87 and 87.50±10.72 bpm with McCoy blades; 108.20±13.94, 95.18±12.75 and 93.22±12.32 bpm with Miller blades. Rise in heart rate as well as mean arterial pressure following intubation was greatest with Miller blade, followed by Macintosh blade and least with McCoy blade and was statistically significant (P< 0.01).
Conclusions: Miller blade produced maximum haemodynamic stress response, followed by Macintosh blade and McCoy blade produced the least haemodynamic response, hence the latter is preferable when less haemodynamic response is desired.
PEAK EXPIRATORY FLOW RATE AMONG SMOKERS AND NON-SMOKERS WORKING IN KATHMANDU MEDICAL COLLEGE
Authors: Gurung Preetu 
Published: May 2022

Background: Cigarette smoking has remained a popular habit since ages. Most people are well aware of the deleterious effects of cigarette smoking yet continue to give a blind eye which dete­riorates overall public health. The purpose of the present study was to assess Peak Expiratory Flow Rate among smoking and nonsmoking staffs who work in Kathmandu Medical College.
Methods: In this comparative cross-sectional study Peak Expiratory Flow Rate was obtained using Mini Wright’s Peak Flow Meter of 108 smokers and 108 nonsmokers in the age group ranging from 25-45 years. Those who never smoked or who have quit smoking for the past 2 years were grouped as nonsmokers and the smokers with history of smoking at least five or more cigarettes per day for at least two years were included in the study for measuring their Peak Expiratory Flow Rate. Data was collected, compiled and analyzed by using Statistical Package of Social Science (SPSS) software version16. Student ‘t’ test was used for group comparison.
Results: The Peak Expiratory Flow Rate value was significantly reduced in the smokers (p value< 0.05). Mean Peak Expiratory Flow Rate was reduced with increasing age of the smokers. However, no significant difference was observed in Peak Expiratory Flow Rate with increase in the number of cigarettes smoked (p value> 0.05).
Conclusions: In the study Peak Expiratory Flow Rate among smokers (367.13 ± 74.182) was lower than nonsmokers (471.39±60.842), which was statistically significant proving that cigarette smok­ing reduced peak expiratory flow rate.
PROXIMITY OF MANDIBULAR THIRD MOLAR ROOTS WITH INFERIOR ALVEOLAR CANAL: A RADIOGRAPHIC STUDY
Authors: Kumar singh Ashutosh , Khanal Nikita , Dhungel Safal 
Published: May 2022

Background: Mandibular third molar’s roots have close proximity to the inferior alveolar canal (IAC) and nerve. Inferior alveolar nerve injuries have been observed to occur more frequently when there is radiographic evidence of close contact of third molar roots to the IAC. Orthopan­tomogram is one of the commonly used diagnostic tools for evaluating the relationship between these two structures. There is lack of data regarding prevalence of these radiographic signs in Nepalese population. It was required to assess the reliability on the radiographic signs of relation­ship between the IAC and the third molar roots, to establish IAC as risk indicators for IAC exposure during extraction.
Methods: A single centre cross-sectional descriptive study was designed where demographic data and radiographic signs of third molar roots proximity to IAC were obtained from imaging software records and descriptive analysis was performed with SPSS version 20.
Results: One or more radiographic signs were observed in 49.6% of mandibular third molars. In­terruption of white line followed by narrowing of canal and darkening of roots was observed in decreasing order of frequency and no statistically significant association between sex, age and side of impacted third molar with presence of radiographic signs.
Conclusions: Presence of one or more radiographic signs of proximity of mandibular third molar roots with IAC in nearly half of the cases. Clinicians should be aware of risk of nerve injury on pres­ence of these signs. Further investigation with cone beam computed tomography to rule out any nerve injury risk should be adopted into practice.
PHYSICAL, CHEMICAL AND MICROBIOLOGICAL ANALYSIS OF BOTTLED WATER IN POKHARA, NEPAL
Authors: Maskey Manisha , Annavarapu Laxminarasimha Sharma , Prasai Tista , Bhatta Dharma Raj 
Published: May 2022

Background: Today possibility of rendering water non-potable by various types of contaminants (physical, chemical and biological) is of considerable importance. It is not only the microbial con­taminants but also the physical and chemical contaminants, playing an important role in compro­mising our health in many ways. The aim of this study was to assess the physical, chemical and the microbiological quality of commercially produced bottled water in Pokhara city.
Methods: A study was conducted to assess the quality of bottled drinking water produced in Pokhara city. Total of 21 brands of bottled water was collected, first batch in monsoon season and second batch in pre-monsoon season, from the market. The physical, chemical and microbial as­sessment was carried out as per National Drinking Water Quality Standards, 2062. Coefficient of variation and t-test were applied where applicable.
Results: Better water quality was found in Pre-monsoon season than that of monsoon season, in regard to microbial assessment. None of the samples in first batch tested positive for coliform whereas in second batch 38.2% of samples tested positive for coliform. Coefficient of variation for pH and chloride content was, 8.9% and 6.1%, 35.6% and24.19%, in pre-monsoon and monsoon season respectively. Both were found to be statistically significant. While other tested parameters were within normal limits.
Conclusions: The quality bottled drinking water available for sale do not meet the standards given by National Drinking Water Quality Standards, particularly the microbial quality.
NURSES’ KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING POSTOPERATIVE PAIN MANAGEMENT AT SELECTED HOSPITALS, BHARATPUR, NEPAL
Authors: Thapa Rupa Devi , Gurung Ganga 
Published: May 2022

Background: Acute and severe pain after surgery is the major concern of operated patients and health professionals where the vital responsibilities goes to the nurses for managing pain satisfactorily. Hence, the nurses require to have adequate knowledge, attitude and practice (KAP) to carry out such responsibilities.
Methods: A descriptive cross-sectional study design was used to find out the nurses’ KAP regarding postoperative pain (POP) management. Total 74 nurses of postoperative wards were selected from four hospitals at Bharatpur with non-probability enumerative sampling technique. Data were collected with the structured self-administered questionnaire for knowledge, five-point Likert scale for attitude and observation checklist for practice. Data were analyzed by using descriptive statistics for levels of KAP; Chi-square for association between levels of KAP with selected variables and spearman rank correlation to determine relationship among KAP regarding POP management.
Results: The study showed that 85.1% nurses had low level of knowledge, 55.4% had satisfactory level of attitude and 52.7% had low level of practice. Statistically significant association was found between level of practice and age (p=0.010) of nurses and with professional qualification (p=0.002). There was no statistically significant relationship among KAP scores regarding POP management.
Conclusions: Majority of the nurses had low level of knowledge, more than half had satisfactory level of attitude but low level of practice regarding POP management. The age and the professional qualifications of the nurses found to be associated with the practice of POP management.
EFFECTIVENESS OF NURSES-LED CARDIAC REHABILITATION PROGRAM AMONG CORONARY ARTERY DISEASE PATIENTS ATTENDING A TEACHING HOSPITAL, BHARATPUR
Authors: Shrestha Rosy , Rajbanshi Laxmi , Singh Jaya Prasad , Shrestha Kshitiz , Shrestha Sajeeb 
Published: May 2022

Background: Cardiac rehabilitation (CR) is a comprehensive secondary prevention program, de­livered by multidisciplinary team including nurses. This portion in health care sector is found to be lacking and communication between health care providers and cardiac patients is frequently suboptimal. The aim of this study was to identify the effectiveness of nurse-led cardiac rehabilita­tion program among coronary artery disease patients attending a teaching hospital in Bharatpur, Nepal.
Methods: One group pre-test post-test design was used. Total 85 CAD patients were selected for pre and post-test, baseline information was collected using consecutive sampling technique. The educa­tion intervention on CR was developed in Nepali language and distributed to each respondent after pre-test in separate room of OPD of Chitwan medical college and teaching hospital, Bharatpur. After one month of education intervention program, post-test was conducted with same subjects using face to face interview questionnaire using CADE-Q. Data was analyzed using Wilcoxon Rang signed test.
Results: Of all 85 respondents, median difference between pre-test was 17 (IQR=14-22) and post-test was 39 (IQR=32-44) which was statistically significant (p=<0.001). The percentage of respondents with non-acceptable level (<50%) of knowledge sharply declined from 96.4% to 11.7% whereas those with acceptable knowledge (≥50%) significantly increased to 3.53% to 88.2% at p value <0.001.
Conclusion:The nurse-led educational intervention programme considerably improved the knowl­edge on Cardiac Rehabilitation among CAD patients. Hence, it is strongly recommended that nurses should be involved in establishing and organizing cardiac rehabilitation programs at each tertiary level hospital in Nepal.
SOCIO-DEMOGRAPHIC PROFILE OF PATIENTS SUFFERING FROM DEPRESSIVE DISORDER ATTENDING PSYCHIATRY OUT PATIENT DEPARTMENT
Authors: Niroula Riju , Upadhyay Hari Prasad 
Published: May 2022

Background: Depression is one of the most common mental disorders responsible for consider­able morbidity, disability and decreased quality of life. The socio-demographic factors have con­sistently been identified as important factors in explaining the variability in depression prevalence rates. This study was aimed to evaluate the relationship between depression and these socio-demographic factors.
Methods: A descriptive cross-sectional study was conducted among 110 patients above 18years of age of both sexes who met the criteria for diagnosis of Depressive disorder as per ICD-10 DCR in the Psychiatry Outpatient Department of College of Medical Sciences Teaching Hospital, Bharat­pur, Nepal. A self- designed semi- structured proforma was developed to obtain the socio-demo­graphic variables and the data were analyzed.
Results: Mean age of the patients was 35.61±10.83 years and 62.7% of the patients were females. Married people (65.5%) tended to develop depression compared to unmarried people (25.5%). Rural residents (67.3%) were more prone to suffer from depression than urban residents (32.7%). Most of the patients were illiterate (54.5%) and unemployed (29.1%). Majority were of Hindu (71.8%) religion, Brahmins (27.3%) caste and from lower socioeconomic status (58.2%).
Conclusions: This study shows that socio-demographic factors such as age, gender, marital status, residence, level of education, occupation and socioeconomic status were positively associated with depression. This strong association between depression and socio-demographic status which may have long been overlooked may play an important role to understand and treat the disease.
STRESS AND STRESSORS IN FEMALE MEDICAL AND DENTAL STUDENTS AT KATHMANDU MEDICAL COLLEGE
Authors: Kharel Sushil , Raut Binod 
Published: May 2022

Background: Stress is a physical, mental or emotional factor that causes bodily or mental tension. Stress upsets an individual both mentally and physically. Study showed that medical students suf­fer from higher stress than other stream students. Among medical students also female students are more prone to stress due to varied reasons. This study aimed to determine the stress among female medical and dental undergraduates.
Methods: This cross-sectional study was designed to evaluate and assess the levels of perceived stress and common stressors among female medical and dental students at a teaching institute of Kathmandu, Nepal. A cross-sectional study was done to the first- and second-year undergraduate female medical and dental students. Perceived stress was evaluated using universally accepted Cohen’s Perceived Stress Scale (CPSS-10).
Results: A total of 176 female medical and dental students were enrolled in the study. The mean COHEN PSS score was found to be 27.97 (SD 4.32) which showed high stress among study popula­tion. Fifty nine percent (59%) of the female medical and dental students had perceived stress.
Conclusions: Levels of perceived stress were very high in female students. The most common stressors were related to educational and economic concerns. The students were more focused to daily matters and problems related to their academic achievements.
FOOT INDEX: IS IT A TOOL FOR GENDER DETERMINATION AMONG NEPALESE POPULATION?
Authors: Mansur Dil Islam , Karki Raj Kumar , Shrestha Pragya , Mehta Dilip Kumar , Maskey Sunima , Dahal Shreya 
Published: May 2022

Background: The human foot shows variations in its dimensions and shape in different age group of both male and female. It can be used as gender predictor of an individual in forensic science investigations which may have a great value for identification of unknown deceased body. This study was aimed to measure the various dimensions of foot and derive a tool to predict gender of an individual.
Methods: This study was the cross-sectional type which consisted of 556 individuals (268 males and 288 females). Foot dimensions (foot length and foot breadth) were measured in centimeter and the foot index was derived for both sexes separately. The data was analyzed using descriptive statistics with SPSS vesion 20.0.
Results: It was concluded that there were gender differences in foot length and breadth. The foot length and foot breadth were found to be higher among males than females. The bilateral differences of foot dimensions were not recorded in both male and female. There were gender differences in foot index.
Conclusions: The male is found having longer and broader foot than female foot. The foot index is not used as an appropriate tool to determine gender.
PREVALENCE OF CORACOCLAVICULAR JOINT IN PATIENTS VISITING RADIO-DIAGNOSIS DEPARTMENT AT COLLEGE OF MEDICAL SCIENCES, CHITWAN
Authors: Pandit Ruku , Shrestha Sunara , Sharma Nitasha 
Published: May 2022

Background: Coracoclavicular joint (CCJ) is a true synovial joint between superior surface of coracoid process of scapula and conoid tubercle of clavicle. The radiological prevalence of CCJ in various population ranges 0.55% to 21%. The CCJ are mostly discovered incidentally and is rarely associated with any symptom. Sometimes it may present with shoulder pain, limitation of shoulder movement, upper limb paresthesia and osteoarthritis of itself or adjacent acromioclavicular joint. Hence, this study is aiming to determine the prevalence of anomalous CCJ in patient visiting department of Radio-diagnosis in College of Medical Sciences, Bharatpur, Chitwan, Nepal and to observe association of CCJ with laterality, sides and gender.
Methods: A total of 1936 digital chest x-rays films were observed for the presence of CCJ, out of which 1097 images were of male and 839 of females. Age of study population ranged from 3 to 90 years. The data obtained were analyzed using Stastical Package for Social Science version (SPSS) 16.0. The prevalence of CCJ was calculated. The cases with CCJ were further analyzed to evaluate the association of CCJ with laterality, sidedness and gender using Chi-square for one-dimensional "goodness of fit" test. Chi-square of Independence was employed to compare the various parameters (laterality and side) with genders.
Results: The prevalence of CCJ was 4.6%. CCJ was more frequently observed in male (67.42%) than female (32.57%). Unilateral occurrence of CCJ (55.06%) was slightly more than bilateral (44.94%). Gender difference was not significantly associated with laterality and sidedness of joint (p<0.05). The incidence of CCJ was more in group C (between 20 to 29 years of age) in both male and female.
Conclusions: CCJ is not rare, hence, knowledge of presence of CCJ as an etiology of shoulder pain is essential for rational therapy and will prevent misdiagnosis.
REFLECTIONS OF MEDICAL INTERNS ON INTERNSHIP IN INTERNAL MEDICINE
Authors: Piryani Rano Mal , Piryani Suneel , Deo Gopendra Prasad 
Published: May 2022

Background:Reflection and reflective practices are considered as one of the important components of medical education and imperative for self-directed lifelong learning. The objective of this study was to take reflections of interns what they learnt during posting in internal medicine and challenges they faced and what was gratifying moments.
Methods:MBBS course in Nepal is of five and half years including one-year mandatory rotational internship of which 2 months posting in internal medicine. The Internship of first MBBS batch at Chitwan Medical College started in May 2015. At the end of last round of posting of first group within department of internal medicine, written reflections of all interns were taken. The data were streamlined manually and presented.
Results: Interns updated and enhanced clinical, report interpretation, correlating clinical condition with lab reports, decision making, management, documentation, counselling and communication skills for a limited time posted in medical wards, OPD, ICU, CCU and hemodialysis unit. Some of the challenges were dealing patients with different attitude, to become responsible trustworthy doctor, responding to expectations of patient and family and to keep patient informed. When patient believes and trusts on us and happily returns home were among the gratifying moments mentioned by interns. In fact, students were not taught about reflection during 4 and half years of study
Conclusions: Though interns reflected but approach was not systemic as they didn’t learn about reflection during course of study. Incorporate reflection as a teaching learning and assessment methods in curriculum, implement it and make reflective practice as core professional skill.