bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARISON BETWEEN RHABDOMYOLYSIS INDUCED AND SEPTIC ACUTE KIDNEY INJURY IN CENTRAL NEPAL
Authors: Sedhain Arun , Bhattarai Gandhi Raj , Shrestha Bidhan , Khan Amir 
Published: May 2022

Background: Acute kidney injury (AKI) is one of the most serious complications of rhabdomyolysis (RM). We studied the clinical manifestations and prognosis of rhabdomyolysis induced AKI and compared it with septic AKI among hospitalized patients.
Methods: A prospective study was conducted at Chitwan Medical College between January 2017 to June 2018 to compare AKI secondary to rhabdomyolysis (RM-AKI) and sepsis (SA-AKI). AKI was diagnosed as per Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Rhabdomyolysis was diagnosed if serum creatinine phosphokinase raised >5 times the upper limit of normal level and sepsis as an increase of two or more points in the Sequential Organ failure Assessment (SOFA) score with the evidence of infection.
Results: A total of 145 patients with AKI (21 with RM and 124 with sepsis) were included in the study. Mean age of the patients was 43.7 years with majority (54%) being males. Wasp bite and bee sting combined together (47.6%) were the most common causes for RM-AKI whereas pneumonia accounted for 46.6% of the septic AKI. Serum creatinine (SCr) at admission and at discharge were 3.8 and 1.4 mg/dL respectively in RM-AKI group; and 2.4 and 1.6 mg/dL in septic AKI group. Duration of stays in the hospital (9.2 versus 6.4 days) and ICU (4.2 versus 3.7 days) were longer in RM than in septic AKI. In hospital mortality was 4.8% in RM and 8.9% in septic AKI.
Conclusions: This study has found that, despite a longer duration of hospital stay, RM-AKI had a lower in-hospital mortality than septic AKI.
TOTAL PROTEIN TO CREATININE RATIO AS AN ALTERNATIVE TO ALBUMIN TO CREATININE RATIO TO PREDICT MICROALBUMINURIA IN TYPE 2 DIABETES MELLITUS
Authors: Pokharel Kabita Khaniya , Pradhan Santosh , Shrestha Sweta 
Published: May 2022

Background: Diabetic nephropathy is the most common complication of diabetes mellitus. Early detection of microalbumin in urine plays an im­portant role in preventing the progression to late stages of chronic kidney disease. For a country like Nepal, the cost of assessment of microalbumin in urine is unaffordable by many patients for regular monitoring. Total pro­tein to creatinine ratio (TPCR) might be a cheaper alternative for this. This study assessed the feasibility of using TPCR as an alternative method for predicting microalbuminuria in diabetic patients.
Methods: Type 2 Diabetic patients with age ranging 30-80 years were in­cluded in the study after ethical clearance. Urinary total protein was deter­mined by pyrogallol red method and urinary creatinine by Jaffe’s method. Urine for microalbumin was determined by nephelometry. Relationships between variables were examined by Pearson correlation or Spearman’s correlation analysis as appropriate. Receiver operating characteristic (ROC) curve analysis was performed to obtain the cutoff value of TPCR for detection of albuminuria
Results: The mean age of the study population was 55.9 ± 11.8 years. There was significant positive correlation between TPCR and urine albu­min (ρ = 0.56; p <0.01) and between TPCR and ACR (ρ = 0.47; p < 0.01). The regression equation for TPCR and ACR was, ACR = 0.82 TPCR = 70.5, r2 = 0.88. ROC curve analysis showed that the urine TPCR had a sensitivity and specificity of 76% and 58% respectively, for the detection of albuminuria with a cutoff value of 95 mg/g(AUC=0.74, p < 0.01).
Conclusions: TPCR might be the cheaper alternative for the prediction of microalbuminuria in patients with type 2 diabetes mellitus.
ASSERTIVENESS AND SELF-ESTEEM AMONG NURSING STUDENTS OF MANIPAL COLLEGE OF MEDICAL SCIENCE OF POKHARA, NEPAL
Authors: Shrestha Sandhya 
Published: May 2022

Background: Assertive behaviour and low self-esteem have been found to major problem in the nursing profession. Nursing students today are the backbone of professional nurses of tomorrow. In order to ensure competent and safe practice, it is necessary for them to be individuals with high assertive skills and self-esteem. This study was conducted to identify assertiveness and self-esteem among nursing students.
Methods: A descriptive cross sectional survey was conducted among 202 Proficiency Certificate Level and Bachelor of Science in nursing students of Manipal College of Medical Sciences (nursing programme), Pokhara, Nepal during July/August 2015. Data collection was done by purposive sampling. Tools used were demographic proforma, Begley and Glacken Assertiveness behavior questionnaire and Rosenberg self-esteem scale. Data were analyzed using descriptive and inferential sta­tistics chi-square and correlation coefficient.
Results: The study revealed nursing students had moderate level of as­sertiveness and self-esteem. There is a significant association between assertiveness and level of study and residence. There is a significant as­sociation between level of self-esteem with level of study and residence and There is significant positive correlation (r= 412) among assertive­ness and self-esteem score with p value <0.001.
Conclusion: It is concluded that majority of nursing students have mod­erate assertiveness and self–esteem. Nurse educators should take ini­tiation to improve high assertiveness and self-esteem of nursing stu­dents.
STUDY ON CLINICAL PROFILE OF PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY AND THEIR CLINICO-PATHOLOGICAL CORRELATION
Authors: Shrestha Sabita , Joshi Rakshya , Tamrakar Renuka , Sharma Basant 
Published: May 2022

Background: Hysterectomy is an effective treatment for a wide range of gynaecological diseases, both benign and malignant. There must be a pe­riodic audit for the appropriate indication of the surgery and its complica­tion rate. Histopathological analysis is mandatory for definitive diagnosis and further management. This study aims to review the clinical profile, indications of hysterectomy and to assess the correlation between the clinical diagnosis and histopathological report.
Methods: A retrospective study of all the patients undergoing abdominal hysterectomy was conducted in the Department of Obstetrics and Gyne­cology, Chitwan Medical College Teaching Hospital, Nepal from January to December 2018. Demographic and clinical informations were retrieved from the medical record section. Datas were entered in the pre-designed proforma. Statistical analysis was done in terms of percentages, standard deviation, correlation and mean.
Results: During the study period, 111 patients underwent abdominal hys­terectomy. The mean age of the patients was 46 years. The mean dura­tion of hospital stay was 8.7 days. Abnormal menstrual flow and pain ab­domen were the commonest presenting symptoms. The most common preoperative diagnosis was fibroid followed by ovarian tumor. Leiomyoma was the commonest lesion on histopathological examination. The correla­tion between clinical diagnosis and histopathology was 96.07% for fibroid, 80.95% for ovarian tumor, 66.67% for adenomyosis and 38.46% for DUB.
Conclusions: Fibroid uterus and ovarian mass are the common indications for abdominal hysterectomy. Histopathology is mandatory for confirming the diagnosis, proper counseling and holistic management of the patient.
LOW DOSE HYPERBARIC BUPIVACAINE WITH FENTANYL IN SPINAL ANESTHESIA IN ELECTIVE CESAREAN SECTION
Authors: Regmi Bharati Devi Sharma , Deo Gopendra Prasad , Shrestha Subin , Shrestha Sabita , Mishra Renuka Tamrakar 
Published: May 2022

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section.
Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine.
Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group.
Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.
PREVALENCE OF MICROALBUMINURIA AND ITS ASSOCIATION WITH GLYCEMIC CONTROL IN TYPE 2 DIABETIC PATIENTS: A CROSS SECTIONAL STUDY AT KATHMANDU MEDICAL COLLEGE
Authors: Karki Prabin Kumar , Timalsina Santosh , Chalise Sanat , Yadav Anita , Bhattarai Ashish Kumar 
Published: May 2022

Background: Diabetes mellitus has become one of the biggest health problems of this era. The resultant microvascular and macrovascular complications add to significant amount of morbidity and mortality. Urine microalbumin is considered as an early marker for microvascular compli­cations among diabetic patients. The aim of this study was to find out the prevalence of microalbuminuria among type 2 diabetic patients attending Kathmandu Medical College and its relation with glycemic control, age, sex, duration of diabetes.
Methods: A total of 208 previously diagnosed type 2 diabetic patients at­tending medical outpatient department of Kathmandu Medical College, Sinamangal were included in the study over a period of 1 year (October 2017 - September 2018). Fasting and 2-hour postprandial venous blood for blood glucose and HbA1c measurement and early morning urine sam­ple (after overnight fast) was collected for detection of microalbuminuria. Statistical analysis was done using SPSS version 23.
Results: The prevalence of microalbuminuria among the study population (mean age: 54.22 ± 11.76 years, mean HbA1c: 7.62 ± 1.53 %) was 42.8%. Microalbuminuria had significant correlation with HbA1c and duration of diabetes (p<0.001), but not with age, sex and type of medication. There was positive correlation between urine microalbumin and fasting and post-prandial blood glucose.
Conclusions: Our present study found high prevalence of microalbumin­uria among diabetic patients with poor glycemic control. It is suggested that tighter glycemic control with regular urine microalbumin testing should be integral part of diabetic management plan to prevent long term complications such as diabetic nephropathy
PERIPARTUM HYSTERECTOMY AND ITS RISK FACTORS
Authors: Tamrakar Renuka , Pandit Upendra , Shrestha Sabita , Sharma Basant , Joshi Rakshya 
Published: May 2022

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy.
Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts.
Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded.
Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.
MEDICAL STUDENTS’ PERCEPTION REGARDING OBJECTIVE STRUCTURED CLINICAL EXAMINATION IN MEDICAL COLLEGE, CHITWAN
Authors: Jaiswal Pratima , Mehta Raj Kumar 
Published: May 2022

Background: Objective Structured Clinical Examination (OSCE) has been globally recognized as gold standard of performance based assessment that aids in evaluating the clinical competency of medical undergraduate students. Hence, it increases the confidence of students in their learning ability by helping them to identify areas of weakness and gaps in their competencies. This study was conducted to identify perception towards OSCE among medical students.
Methods: A descriptive cross-sectional study design was adopted and a total 173 respondents were selected from MBBS 4th and 5th year of Chit­wan Medical College by using probability stratified proportionate random sampling technique. Self-administered questionnaire with 5-point likert scale were used to collect the data. Descriptive and inferential statistics was used to analyze data.
Results: About half of the Bachelor of Medicine and Bachelor of Surgery (MBBS) students had positive perception toward OSCE. There is signifi­cant association between the level of perception towards OSCE and year of study (p=0.002), choice of study MBBS (p=0.045) and evidenced based learning (p=0.041).
Conclusions: Thus, optimum emphasis should be given on formulat­ing OSCE guideline and orienting student about it and also organization should create environment to facilitate actual objective structured clinical examination in order to increase positive perception in our context.
HANDLING OF COVID-19 IN PERIPHERAL HEALTHCARE INSTITUTIONS IN NEPAL
Authors: Shrestha Dhan Bahadur , Budhakhoki Pravash , Khadka Sitaram , Amgain Kapil , Giri Santoshi , Bidari Sahadev 
Published: May 2022

Background: With the increase in COVID-19 cases globally as a pandemic, the concern should be there for the management of such disease from a different level of healthcare set up. The aim of this review was focused on the assessment of COVID-19 cases from the healthcare setups in the periphery.
Methods: The English-language databases of Google Scholar, PubMed, were searched using the following keywords: ‘COVID-19’, ‘handling of COVID-19, ‘primary healthcare center’, and ‘Nepal’. All the related articles published in journals as well as newspapers were considered for this nar­rative review
Results: There are 7177 cases in Nepal with 20 mortalities, 1167 recovered cases, and 5990 cases under treatment as of June 17, 2020.
Conclusion: As there is no proven treatment for COVID-19, countries with low economic income like Nepal are facing great challenges by the disease due to poor quarantine facilities and limited testing capacities. The peripheral healthcare institutions in Nepal are doing their level best for management of COVID-19 cases though lack of adequate resources is still there. Cases in Nepal are rapidly increasing and it is necessary to allocate proper resources based on the areas of most need to control the outbreak.
KNOWLEDGE OF INTRAMUSCULAR INJECTION AMONG THE NURSES OF A TEACHING HOSPITAL
Authors: Sah Soni Rani , Maskey Sreeja 
Published: May 2022

Background: Intramuscular injection (IM) is one of the most frequently use practices in nurs­ing. Lack of knowledge can make the procedure ineffective resulting in lot of complications. The objective of the study was to find out the knowledge of IM injection among the nurses of Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur, Chitwan.
Methods: A descriptive, cross-sectional study design was used among 220 nurses of CMCTH who were selected by using non- probability purposive sampling technique. Self-adminis­tered questionnaires were used to collect the data. The data was analyzed using IBM SPSS version 20.0 and descriptive, inferential test was applied.
Results: The age study findings revealed that 60% of respondents belonged to group 21 to 25 years and the mean age was 22.20±2.57 years, 72.3% respondents had completed Proficiency Certificate Level (PCL) Nursing, 90% of respondents were working as staff nurse, 57.3% of respondents were working in general wards, 48.2% of the respondents had hos­pital experience less than 12 months. Majority of the respondents (71.8%) had inadequate knowledge regarding IM injection. There was statistical significant association between re­spondents’ knowledge regarding IM injection and their age (p <0.001), professional designa­tion (p <0.001), hospital experience (p=0.023), current ward experience (p= 0.026), positive reinforcement (p=0.031), standard protocol (p=0.045), and in-service education (p<0.001) .
Conclusions: It is concluded that standard protocol and frequent in-service education should be provided to increase the level of knowledge regarding IM injection among nurses which will result in better practice and hence better patient satisfaction with no complications.
HIGH RESOLUTION COMPUTED TOMOGRAPHY AND CHEST RADIOGRAPHY FINDINGS AMONG INTERSTITIAL LUNG DISEASE PATIENTS
Authors: Pal Anusmriti , Yadav Manoj Kumar , Pant Chiranjibi , Shrestha Bishow Kumar 
Published: May 2022

Background: Interstitial lung disease (ILD) is a heterogeneous group of diffuse parenchymal lung diseases, characterized by restrictive physiology, impaired gas exchange, pulmonary inflammation and fibrosis. Chest radiograph (CXR) may appear normal during initial course of the disease and may show few abnormalities. High resolution computed tomography (HRCT) chest is a most ac­curate non-invasive, high spatial resolution descriptive imaging modality for evaluation of lung parenchyma. It assesses presence, location, type and characterization of ILD in appropriate clinical setting. Our aim was to study radiological patterns and its distribution in CXR and HRCT chest of ILD patients.
Methods: This was an observational, single centered, cross-sectional study conducted at author’s place over the period of 6 months starting from January 2018 using convenient sampling method. Data analysis was done using students t-test for comparison of means and chi-square test for proportions.
Results: A total of 30 suspected or diagnosed patients of ILD were enrolled in our study and pat­terns found on CXR were correlated with that on HRCT chest. The number of findings in HRCT chest for a patient was significantly higher than CXR (Median number: 4 verses 2, P<0.001), commonest reticular opacity 50% in CXR and 56.6% HRCT. One subject had normal CXR.
Conclusion: HRCT was superior to CXR in detection of all basic patterns and their distribution as­sociated with ILD as higher numbers of findings were detected by HRCT chest as compared to CXR. HRCT chest could characterize the abnormality and specify its location much more accurately.
Bridging the Gulf: A Critique Rajiv Khandelwals,’ Conch Shells And Cowries Reference: Love Poem, ‘Word’
Authors: Diwakar Shobha 
Published: May 2022

As an unconventional and innovative poet in contemporary modern Indian Writings in English, Khandelwal’s Conch Shells and Cowries, his first Anthology, holds him apart from other present-day writers. In appending such a title to his anthology of love poems, Khandelwal has rationally developed a unique style of his own. His poem ‘Word’, and others in the anthology are not only cloaked in numerous symbols and other figures of speech but are also innovative in their unique structure, form and content. In this manner, he has paved the path for a new concept of writing in expressing his ‘love thoughts,’ pertinently in singular pounding words that nail him as an innovative poet of the 21st century. Khandelwal has thus, effectively established the trend for post-modernist, futuristic poetry in the realm of Indian Writings in English for which he deserves recognition as an eminent poet.
CONTRABANDO Y FALSIFICACIÓN: REPERCUSIONES PARA EL DESARROLLO Y LA INSERCIÓN INTERNACIONAL DE PARAGUAY. PERIODO 1989 - 2019
Authors: Cabral López María Antonella 
Published: May 2022

El contrabando y la falsificación son flagelos que afectan a distintos países y al sistema internacional en general. Paraguay no es una excepción, por ello en este artículo se aspira a describir cuáles podrían ser las repercusiones que estas actividades delictivas tuvieron para su desarrollo e inserción internacional durante el periodo 1989-2019. Con este propósito se recurrió a una metodología bibliográfica-documental, de nivel descriptivo. Entre los principales resultados se pudo apreciar la complejidad de estas problemáticas, sus generalidades en el país, cómo pueden influir en el desarrollo del país y su inserción internacional, además de proponer algunas líneas de acción para su abordaje.
Palabras clave: desarrollo económico, inserción internacional, Paraguay, crimen transnacional
Pesquisa-Desenvolvimento em Instituições de Ensino integrantes da Rede Leite
Authors: Uhde Leonir Terezinha , Félix Rosane Rodrigues , Vicenci Fernandes Sandra Beatriz , Maixner Engenheiro Adriano Rudi , Martins da Silva Gustavo 
Published: May 2022

Este trabalho descreve as contribuições recíprocas entre as Instituições de Ensino (UNIJUÍ, UNICRUZ, UFSM e Instituto Federal Farroupilha – Campus Santo Augusto) e o Programa em Rede de PesquisaDesenvolvimento em Sistemas de Produção com Atividade Leiteira na Região Noroeste do Rio Grande do Sul (Rede Leite). Tal abordagem se justifica, na medida em que as Instituições de Ensino, ajudam a compor os alicerces da Rede Leite desde a sua criação e, em razão do cunho acadêmico-científico e de formação humana e profissional em distintas áreas do conhecimento, contribuem e se beneficiam de forma singular dos processos de gênese e consolidação da Rede Leite. As Instituições de Ensino tiveram que criar uma série de condições para que as ações de seus recursos humanos conseguissem ser respaldadas e reconhecidas. A tríade ensino-pesquisa-extensão é integralmente necessária, mas incentivada de forma desigual. O ensino é a obrigação básica das Instituições de Ensino, pois a sua função essencial é promover formação humana e técnica qualificada aos jovens profissionais e cidadãos egressos dos bancos acadêmicos. A pesquisa, sempre que possível, é incentivada a fim de qualificar a formação dos quadros docentes e colaborar na geração de conhecimentos indispensáveis ao progresso das sociedades. Nas atividades da Rede Leite, porém, a praxe dos estudos setorializados e produtivistas não é aplicável, por tratar de uma forma distinta de abordagem científica, com metodologias diferenciadas e suficientemente abrangentes para que se possa entender a diversidade e complexidade das situações problema. Palavras-chaves: Abordagem sistêmica. Atividade leiteira. Indissociabilidade entre ensino-pesquisa-extensão.
Palavras-chaves: Abordagem sistêmica. Atividade leiteira. Indissociabilidade entre ensino-pesquisa-extensão