Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological ...findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college.
A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists.
Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination.
SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.
Countries with the highest burden of maternal and newborn deaths and stillbirths often have little information on these deaths. Since over 81% of births worldwide now occur in facilities, using ...routine facility data could reduce this data gap. We assessed the availability, quality, and utility of routine labour and delivery ward register data in five hospitals in Bangladesh, Nepal, and Tanzania. This paper forms the baseline register assessment for the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study.
We extracted 21 data elements from routine hospital labour ward registers, useful to calculate selected maternal and newborn health (MNH) indicators. The study sites were five public hospitals during a one-year period (2016-17). We measured 1) availability: completeness of data elements by register design, 2) data quality: implausibility, internal consistency, and heaping of birthweight and explored 3) utility by calculating selected MNH indicators using the available data.
Data were extracted for 20,075 births. Register design was different between the five hospitals with 10-17 of the 21 selected MNH data elements available. More data were available for health outcomes than interventions. Nearly all available data elements were > 95% complete in four of the five hospitals and implausible values were rare. Data elements captured in specific columns were 85.2% highly complete compared to 25.0% captured in non-specific columns. Birthweight data were less complete for stillbirths than live births at two hospitals, and significant heaping was found in all sites, especially at 2500g and 3000g. All five hospitals recorded count data required to calculate impact indicators including; stillbirth rate, low birthweight rate, Caesarean section rate, and mortality rates.
Data needed to calculate MNH indicators are mostly available and highly complete in EN-BIRTH study hospital routine labour ward registers in Bangladesh, Nepal and Tanzania. Register designs need to include interventions for coverage measurement. There is potential to improve data quality if Health Management Information Systems utilization with feedback loops can be strengthened. Routine health facility data could contribute to reduce the coverage and impact data gap around the time of birth.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most prominent causes of chronic liver disease. It is known that dyslipidemia in NAFLD patients may have more severe atherogenic ...potential with high triglyceride and low density lipoprotein (LDL) as well as less high density lipoprotein (HDL) level.
Objective: To determine the atherogenic dyslipidemia and associated factors among patients with NAFLD, Visiting Tertiary Care Center
Methodology: Prospective cross-sectional study was conducted at Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) from January, 2016 to December, 2016. All the patients (n= 973) diagnosed to have fatty liver during this study period were initially enrolled in this study. Patients were further asked to fill up the questioner. Out of total 973 cases, 169 patients were identified as NAFLD. Fasting blood sample and anthropometric measurements (BMI, WHR) were taken. After adjusting exclusion criteria, refusal to participate and dropout from the study, 101 patients and 92 apparently healthy age sex matched control group was selected for the study. Blood sugar level and lipid profile were analyzed to assess the risk of athrogenicity among the NAFLD.
Result: High total cholesterol was found in 64.4 %, High LDL was found in 20.8 %, Low HDL is present in 72.2% and high triglyceride is present in 65.8 % patients with NAFLD. Non-HDL cholesterol was significantly higher in NAFLD compared to control group (116.75 ± 34.38 vs. 137.63 ± 39.76, p=0.00). Similarly, calculated cardiac risk ratio (TC/HDL) was significant higher (4.15 ± 1.18 vs. 5.25 ± 1.78, p=0.00) whereas atherogenic index of plasma (AIP) was higher (0.30 ± 0.13 vs. 0.33 ± 0.19, p=0.37).
Conclusion: NAFLD is significantly associated with atherogenic dyslipidemia. Calculated cardiac risk and AIP is higher in patients with NAFLD. Therefore it may be helpful to assess dyslipidemia among the patients with NAFLD to prevent cardiovascular events.
Background: Chronic obstructive pulmonary disease is most common disease entity and third leading cause of mortality worldwide. The presence of bronchiectasis in severe chronic obstructive pulmonary ...disease patients had led to frequent exacerbation requiring hospitalizations. The purpose of this study was to identify the factors associated with bronchiectasis, using routine data collected during medical visits from patients diagnosed with chronic obstructive pulmonary disease.Materials and Methods: This is hospital based cross sectional study conducted on 120 chronic obstructive pulmonary disease patients. All patients were subjected through history, examination, pulmonary function test, sputum samples and imaging of chest.Results: Out of 120 patients among them 67 patients (55.8%) were chronic obstructive pulmonary disease without bronchiectasis while 53 patients (44.1%) had chronic obstructive pulmonary disease with bronchiectasis. Thirty patients (56.6%) having chronic obstructive pulmonary disease with bronchiectasis and 18 patient (26.8%) having chronic obstructive pulmonary disease without bronchiectasis had exacerbation in one year requiring hospitalisation. Most common organisms isolated were Pseudomonas Aeruginosa in 20 patients (55.5%), Klebsillae Pneumoniae in 6 patients (16.6%) among chronic obstructive pulmonary disease with bronchiectasis group.Conclusion: Chronic obstructive pulmonary disease patient with severe airflow limitation, with frequent exacerbation and colonisation with isolation of organisms resulting in bronchiectasis requiring frequent hospitalisation.
Faba bean (Vicia faba L.) is an annual minor grain legume locally known as Bakulla. An experiment on sowing dates and different row spacing was conducted at the National Agronomy Research Centre ...(NARC) Khumaltar from 2019/20 to 2021/22 to identify suitable sowing dates and row spacing. Three sowing dates (October 24, November 7, and November 21), row spacings (30 cm, 45 cm, and 60 cm), and plant-to-plant spacing of 10 cm were evaluated in a split plot with four replications. Plot size was maintained at 7.2 m2 (2 m x 3.6 m), the variety used was local, and the fertilizer dose applied was 20:40:20 N: P2O5:K2O kg ha-1. At physiological maturity, five plants per plot were sampled randomly for measurements of plant height, number of pods per plant, unfilled pods/plant, and 100 seed weight. Data on 50% flowering, days to 90% maturity, plant height, number of pods per plant, green pod yield, biological yield, and hundred seed weight were recorded. Combined analysis showed that sowing dates significantly influenced days to 50% flowering, final stand/m2, plant height, number of branches per plant, and number of pods per plant. The final stand/m2, plant height, straw dry matter, seed yield, and hundred seed weight were affected significantly by various row spacing. There was no significant interaction effect between sowing dates x row spacing, and all three factors (sowing dates x spacing x year) also had no significant interaction. The year they have significantly influenced all the parameters except 90% maturity and number of pods per plant. Sowing dates x year and spacing x year did not significantly influence all the parameters. Crop sown on October 24 produced the highest grain yield (1571 kg ha-1), followed by November 21 (1354 kg ha-1). Grain yields were significantly higher in 30 cm row spacing (1825 kg ha-1), mainly due to higher plant population per m2 than in 60 cm row spacing. It was concluded that the last week of October and 30 cm row spacing is suitable for faba bean production.
The conventional system of puddled transplanting of rice (PTR) with intensive tillage is common practice of rice growing in Nepal. It has many negative impacts on soil, water, labor, climate change ...and gender equality. Therefore, an alternative production system has been explored. Direct seeded rice (DSR) has been one of the potential systems of rice production in Nepal. The results of various studies on DSR revealed that it saves labor, requires less water, less drudgery, less energy, early crop maturity, low cost of production, better soil physical conditions and less greenhouse gas emission. The grain yields in DSR are comparable with PTR. However, special attentions must be given in selection of suitable cultivars, appropriate time of sowing, optimum seed rate, proper weed and water management practices. Despite its promise, the rate of its adoption is not as expected. It might be due to some of the constraints associated it. In this paper an attempt has been made to highlight the works done in DSR within and outside of the country, its constraints and the possible solutions to scale-out it.
An experiment was conducted in the summer seasons of 2021 and 2022 at the National Agronomy Research Centre's Farm Khumaltar to find out the appropriate row spacing and optimum nitrogen dose for ...maize. The experiment was laid out in a split plot design where nitrogen levels were allocated in the main plot and row spacing was assigned in subplots. The four different nitrogen levels were 120:60:40 N:P2O5:K2O kg ha-1, 150:60:40 N:P2O5:K2O kg ha-1, 180:60:40 N:P2O5:K2O kg ha-1 and 210:60:40 N: P2O5:K2O kg ha-1. Four different rows spacing were 75 cm, 60 cm, 50 cm and 43 cm. Seeds were sown at 25 cm apart. The individual plot size was 4m x 3m. Maize variety BGBY POP was used in the experiment. The sowing dates were 6 May and 19 May in 2021 and 2022 respectively. In the combined analysis of two-year data, days to 50% tasseling was found significant in 150:60:40 N: P2O5:K2O kg ha-1 while other traits were found non-significant. The mean grain yield was 4.29 t ha-1. Few traits were found significant in subplot factor i.e., cob diameter (4.38 cm), cob length (16.72 cm), ear height (107.1 cm) and seed per row (28.84) were found superior to other treatments within traits while all other traits in subplot factor were non-significant in pool analysis. Late maize sowing in the second year and rainfall during earthing up affected maize performance and gave lower maize yield. From the experiment, we could say that sowing of maize should be done within the second week of May and more experiments need to be done to conclude nitrogen optimization.
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