Multiyear methane and nitrous oxide emissions in different irrigation management under long-term continuous rice rotation in Arkansas.

Rice paddies are one of the major sources of anthropogenic methane (CH4 ) emissions. The alternate wetting and drying (AWD) irrigation management has been shown to reduce CH4 emissions and total global warming potential (GWP) (CH4 and nitrous oxide [N2 O]). However, there is limited information about utilizing AWD management to reduce greenhouse gas (GHG) emissions from commercial-scale continuous rice fields. This study was conducted for five consecutive growing seasons (2015-2019) on a pair of adjacent fields in a commercial farm in Arkansas under long-term continuous rice rotation irrigated with either continuously flooded (CF) or AWD conditions. The cumulative CH4 emissions in the growing season across the two fields and 5 years ranged from 41 to 123 kg CH4 -C ha-1 for CF and 1 to 73 kg CH4 -C ha-1 for AWD. On average, AWD reduced CH4 emissions by 73% relative to CH4 emissions in CF fields. Compared to N2 O emissions, CH4 emissions dominated the GWP with an average contribution of 91% in both irrigation treatments. There was no significant variation in grain yield (7.3-11.9 Mg ha-1 ) or growing season N2 O emissions (-0.02 to 0.51 kg N2 O-N ha-1 ) between the irrigation treatments. The yield-scaled GWP was 368 and 173 kg CO2 eq. Mg-1 season-1 for CF and AWD, respectively, showing the feasibility of AWD on a commercial farm to reduce the total GHG emissions while sustaining grain yield. Seasonal variations of GHG emissions observed within fields showed total GHG emissions were predominantly influenced by weather (precipitation) and crop and irrigation management. The influence of air temperature and floodwater heights on GHG emissions had high degree of variability among years and fields. These findings demonstrate that the use of multiyear GHG emission datasets could better capture variability of GHG emissions associated with rice production and could improve field verification of GHG emission models and scaling factors for commercial rice farms.

Comparative Study of Common Bile Duct Diameter between Normal and Post Cholecystectomy Cases Using Trans-abdominal Ultrasonography.

Background Increase in common bile duct diameter can occur because of different causes. Post cholecystectomy status is one of the potential causes. Many studies done in the past show different results and are hence inconclusive. Objective To see if the post cholecystectomy cases would have a statistically significant change in common bile duct diameter. Method We carried out a study in 100 cases (46 post cholecystectomy cases and 54 cases with intact gall bladder, measuring their common bile duct diameters and performing an unpaired t test to see if the mean in common bile duct among these two groups of cases was statistically significant. Result One hundred cases, 46 post cholecystectomy cases and 54 cases with intact gall bladder were included in our study. An unpaired t-test was used to compare the common bile duct diameters in these two groups. Our findings showed that the difference in common bile duct diameter between the cases with intact gall bladder and those who underwent cholecystectomy was significant for both one tailed and two tailed studies (p < 0.001). Hence, it can be stated that post cholecystectomy status increases the common bile duct diameter. Conclusion An increased Common bile duct diameter in post cholecystectomy case could be because of the post cholecystectomy status itself and not due to some other obstructive cause. So careful decision is necessary before subjecting the patient to further invasive/non-invasive investigations and treatments.

Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal.

Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.

Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal.

Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.

Radiographic Study of Distal Radius Parameters in Patients Visiting Tertiary Care Hospital.

Background The important morphological parameters of distal radius namely palmar tilt, radial inclination, radial height and ulnar variance are consequential in the evaluation and management of the distal radius fracture, distal radius plate design and kinesiology. Correction of these parameters in anatomical alignment is important to restore the normal biomechanics of the wrist joint. Objective To ascertain the distal radius parameters in the patients attending tertiary care hospital with regard to gender and age. Method The wrist radiographs (postero-anterior and lateral views) of 125 patients, from 16 to above 60 years of age were used to determine the four parameters of distal radius. The subjects were divided into gender and three different age groups (16-36 years, 37-57 years and > 57 years). Independent t-test and ANOVA test was used for statistical analysis with level of significance set at p ≤ 0.05. Result The mean palmar tilt was 15.69 ± 4.84° (p-value = 0.40). The mean radial inclination was 22.58 ± 2.82° (p-value = 0.88). The mean value of radial height was 10.31 ± 1.59 mm (p-value= 0.001). Positive ulnar variance were recorded in maximum of subjects (46.40%) and the least was neutral (16.80%). Conclusion The distal radius parameters of our population were similar to the Orthopedic Trauma Association standard reference value. And there was significant difference in radial height between males and females.

Teenage Pregnancy and Associated Risk Factors and Outcome in Nepal From 2000-2020: A Systematic Review and Meta-Analysis.

Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal. Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies. Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively. Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.

Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal.

OBJECTIVES: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. METHOD: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. RESULTS: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. CONCLUSION: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.

High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal.

SETTING: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated. OBJECTIVE: To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019. DESIGN: This was a cohort study involving secondary programme data. RESULTS: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common. CONCLUSION: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.

CADRE: Neuf centres de traitement de la TB pharmacorésistante, dont certains sont financés par Action Damien au Népal où >80% des patients atteints de TB multirésistante/résistante à la rifampicine (MDR/RR-TB) sont traités. OBJECTIF: Évaluer l'utilisation, l'efficacité et l'innocuité d'un schéma thérapeutique plus court (STR) de 9-12 mois chez les patients atteints de MDR/RR-TB enregistrés de janvier 2018 à décembre 2019. MÉTHODE: Étude de cohorte comprenant des données programmatiques secondaires. RÉSULTATS: Sur 631 patients, 301 (48,0%) ont démarré et poursuivi un STR. Les raisons principales d'inéligibilité à l'instauration/la poursuite d'un STR étaient une résistance initiale ou une exposition aux médicaments de deuxième intention (62,0%), un contact avec des patients atteints de TB ultrarésistante (XDR-TB) ou de pré-XDR-TB (7,0%) et la non-disponibilité des médicaments pour le STR (6,0%). Le taux de réussite thérapeutique était de 79,6%. Les résultats liés à la non-réussite thérapeutique étaient décès (12,0%), perte de vue (5,3%), échec thérapeutique (2,7%) et absence d'évaluation (0,7%). Les résultats liés à la non-réussite thérapeutique étaient significativement associés à l'infection par le VIH et aux patients âgés ⩾55 ans avec un risque relatif ajusté de 2,39 (IC 95% 1,52­3,77) et de 3,86 (IC 95% 2,30­6,46), respectivement. Le taux de récidive post-traitement à 6 et 12 mois était de 0,5% et 2,4%, respectivement. Des évènements indésirables graves (SAE) ont été observés chez 15,3% des patients, le plus souvent hépatotoxicité et ototoxicité. CONCLUSION: Le STR a été associé à une utilisation modérée, à une réussite thérapeutique élevée et à un faible taux de récidive post-traitement. Pour une détection et une prise en charge adéquates des SAE, l'amélioration de la pharmacovigilance peut être envisagée. La disponibilité de tests diagnostiques rapides pour les médicaments de deuxième intention est essentielle à une prise en charge adéquate des patients.

Mothers' Perception of Their Children's Play in Dhulikhel Hospital, Nepal.

Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children's play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different subscales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child's choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative playamong mothers.

Role of Magnetic Resonance Cholangiopancreatography in the Evaluation of Obstructive Jaundice.

Background Magnetic Resonance Cholangiopancreatography is a reliable and highly sensitive imaging modality in the diagnosis of Obstructive jaundice. Objective To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography as compared to Endoscopic Retrograde Cholangiopancreatography. Method A prospective, analytical study was conducted in the Department of Radiodiagnosis and Imaging at Dhulikhel Hospital between October 2018 and December 2020. Altogether 100 patients of all ages with obstructive jaundice undergoing Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography were included. The causes of obstructive jaundice as identified by Magnetic Resonance Cholangiopancreatography were compared to that of Endoscopic Retrograde Cholangiopancreatography considering Endoscopic Retrograde Cholangiopancreatography as gold standard for the diagnosis. Result Magnetic Resonance Cholangiopancreatography revealed choledocholithiasis in 60 (60%) patients, benign stricture - 14(14%), malignant stricture-11(11%), periampullary carcinoma in 8(8%) and normal study in 4(4%) patients. Endoscopic Retrograde Cholangiopancreatography showed choledocholithiasis in 59(59%) patients, strictures (benign in 13%, malignant in 10%), ascariasis in 3(3%) and normal findings in 5(5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of Magnetic Resonance Cholangiopancreatography in detecting choledocholithiasis were 96.6%, 92.3%, 95%, and 95%. The same values for benign strictures were 92.3%, 97.7%, 85.7% and 98.9%, whereas those for malignant strictures were 90.9%, 98.8%, 90.9% and 98.8%. All values were 100% for peri-ampullary carcinoma and ascariasis. Hence, Magnetic Resonance Cholangiopancreatography showed good accuracy for detecting causes of obstructive jaundice (p < 0.05) as compared to Endoscopic Retrograde Cholangiopancreatography. Conclusion Magnetic Resonance Cholangiopancreatography is an accurate, non-invasive technique in evaluation of obstructive jaundice and offers similar diagnostic value compared to Endoscopic Retrograde Cholangiopancreatography.

Respiratory Failure in a Neonate with Pierre Robin Syndrome -A Challenging Proposition.

Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent imageguided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.

Dynamics of data availability in disease modeling: An example evaluating the trade-offs of ultra-fine-scale factors applied to human West Nile virus disease models in the Chicago area, USA.

BACKGROUND: Since 1999, West Nile virus (WNV) has moved rapidly across the United States, resulting in tens of thousands of human cases. Both the number of human cases and the minimum infection rate (MIR) in vector mosquitoes vary across time and space and are driven by numerous abiotic and biotic forces, ranging from differences in microclimates to socio-demographic factors. Because the interactions among these multiple factors affect the locally variable risk of WNV illness, it has been especially difficult to model human disease risk across varying spatial and temporal scales. Cook and DuPage Counties, comprising the city of Chicago and surrounding suburbs, experience some of the highest numbers of human neuroinvasive cases of WNV in the United States. Despite active mosquito control efforts, there is consistent annual WNV presence, resulting in more than 285 confirmed WNV human cases and 20 deaths from the years 2014-2018 in Cook County alone. METHODS: A previous Chicago-area WNV model identified the fifty-five most high and low risk locations in the Northwest Mosquito Abatement District (NWMAD), an enclave » the size of the combined Cook and DuPage county area. In these locations, human WNV risk was stratified by model performance, as indicated by differences in studentized residuals. Within these areas, an additional two-years of field collections and data processing was added to a 12-year WNV dataset that includes human cases, MIR, vector abundance, and land-use, historical climate, and socio-economic and demographic variables, and was assessed by an ultra-fine-scale (1 km spatial x 1 week temporal resolution) multivariate logistic regression model. RESULTS: Multivariate statistical methods applied to the ultra-fine-scale model identified fewer explanatory variables while improving upon the fit of the previous model. Beyond MIR and climatic factors, efforts to acquire additional covariates only slightly improved model predictive performance. CONCLUSIONS: These results suggest human WNV illness in the Chicago area may be associated with fewer, but increasingly critical, key variables at finer scales. Given limited resources, these findings suggest large variations in model performance occur, depending on covariate availability, and provide guidance in variable selection for optimal WNV human illness modeling.

Validating a short form of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) in Finnish language.

AIM: This study aimed to adapt the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ), and the Family Impact Scale (FIS) in the Finnish language and to test its validity and reliability. Another aim was to compare the background factors of parents with respect to P-CPQ and FIS outcomes. METHODS: This study was conducted among a convenient sample of parents who visited the public dental clinic in Sievi, Finland, from May to October 2016. A total of 54 parents of 2-8-year-old children completed the short-form of the P-CPQ questionnaire and 50 parents of 2-8-year-olds completed the FIS questionnaire while visiting for their children's routine dental check-up. Parents completed the self-administered P-CPQ and FIS questionnaires. Reliability and validity of the short-form of the P-CPQ and FIS were assessed. Differences between gender, and family size were evaluated using the Mann-Whitney U test and the differences between age groups were evaluated using the Kruskal-Wallis one-way ANOVA test. RESULT: The Finnish versions of both the short forms of the P-CPQ and FIS had alpha values within the acceptable range. The scales also showed good construct validity. Toddlers (2-4-year olds) had the highest scores for both the P-CPQ and FIS-8 subscales. Likewise, families with 5 or more children had high FIS scores. CONCLUSION: The short form of the P-CPQ and FIS in Finnish language are valid and reliable. The oral health of the child seems to have the greatest family impact among parents with five or more children and in families with 2-4-year olds.

Validating and assessing the oral health-related quality of life among Hungarian children with cleft lip and palate using Child-OIDP scale.

AIMS: To validate the Child-Oral Impact on Daily Performance (Child-OIDP) in the Hungarian language and to explore the oral health-related quality of life (OHRQoL) and associated factors among Hungarian children with cleft lip or/and palate (CLP). METHODS: This cross-sectional study consists of a survey and clinical examination among conveniently selected children with CLP visiting the Pécs cleft lip and palate clinic, Pécs, Hungary. OHRQoL was assessed using the Hungarian version of Child-OIDP. Additionally, a validated structural questionnaire was used for gathering information related to oral hygiene practice. Clinical examination was done to register the dental status using ICDAS criteria, consequences of untreated dental caries (pufa), and bleeding on probing. Results were presented as proportions, means, and standard deviations (SD). Construct validity and internal reliability of the Hungarian Child-OIDP was assessed using the Pearson and Spearman's correlation coefficients, respectively. The logistic regression model examined the association between OHRQoL and explanatory variables. RESULTS: A total of 45 children with CLP participated in this study. The Hungarian Child-OIDP had the Cronbach's alpha value 0.73, and the Spearman's correlation coefficient was 0.31. The mean (SD) Child-OIDP score among the study participants was 4.4 (7.0) and three-fifths (65.9%, n = 27) of the participants reported impact in one or more items of the OHRQoL scale. Tooth brushing was more frequent among 6-10-year-olds compared to 11-16-year-olds. The proportion of those requiring restorative treatment need (DS ≥ 1) was 90.2% (n = 37), those with PUFA/pufa (score ≥ 1) was 24.4% (n = 10), and those with bleeding on probing (> 15%) was 63.4% (n = 26). Children aged 11-16 years had a higher impact on OHRQoL compared to the younger ones. Girls had a higher impact on OHRQoL compared to boys. Children with clefts involving both lip and palate had poorer OHRQoL than the rest. The same was true for those having a high dental caries rate. CONCLUSION: The Hungarian Child-OIDP was a reliable and valid measure. There was a substantial impact on OHRQoL among Hungarian children and adolescents with CLP. Age, gender, cleft type and dental caries were associated with poor OHRQoL.

A Rare Case of Large Left Lateral Wall Vaginal Myoma.

Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall.

Risk Factors of Malnutrition among under Five Children Admitted in Kanti Children's Hospital in Nepal.

Background World Health Organization (WHO) stated that malnutrition is a major global health and social problem from which many people are suffering, particularly children. Poor feeding and care practices, insufficient nutrient intake, high rate of infection and teenage pregnancy are the immediate causes of chronic malnutrition. Objective To identify the risk factors for malnutrition among under five children. Method A case control study was carried out among the mothers having under-5 years' children who were admitted in the Kanti Children's Hospital of Nepal from 1st August 2019 to 7th September 2020. Non-probability purposive sampling technique was used to select 50 children with malnutrition and 100 children without malnutrition matched on age, sex and setting. A structured interview was used to collect data from mothers of both cases and controls. Descriptive and inferential statistics were used to analyze the data. Result Present study reveals that 58% girl got marriage before 20 years. After confounders adjusted, mother's age ≥ 20 years at marriage (OR: 2.74, 95% CI: 0.98-7.63. p=0.05), and mother's age ≥ 20 years at child birth (OR: 7.74, 95% CI: 2.37-25.27. p=0.001), were significantly associated with having malnutrition among under five children. Similarly, accessibility of health facility (OR: 3.31, 95% CI: 1-10.94. p=0.05), fathers who completed master in education (OR: 0.08, 95% CI: 0.01-0.88. p=0.04), children who lived in joint family (OR: 0.25, 95% CI: 0.07-0.86. p=0.03), child < 2.5 kg at birth (OR: 0.18, 95% CI: 0.05-0.62. p=0.01), and second and third or above in order (OR: 0.09, 95% CI: 0.01-1.04. p=0.05) had significantly less chance of having malnutrition. Children's whose birth interval was 2-3 years were significantly (OR: 9.74, 95% CI: 1.16-82.23. p=0.04) associated with the occurrence of malnutrition. Children who had suffered from multiple co-morbidities in last one year were (OR: 4.55, 95% CI: 0.48-43.03. p=0.18) more chance of having malnutrition. Likewise, the mothers who feed colostrum to their child had (OR: 2.28, 95% CI: 0.52- 9.26. p=0.29) almost two-fold less chance of having malnutrition. Mothers who had done exclusive breast feeding ≥ 4 months had (OR: 40.55, 95% CI: 3.35-1.490.92. p=0.008) significantly associated with having malnutrition. Conclusion Low education status of father, living in single family, exclusive breast feeding ≥ 4 months, lack of balance diet were significant risk factors of malnutrition. Based on finding, reliable longitudinal studies, interventions and program to educate parent for prevention of malnutrition are necessary in future.

Long-term outcome of sacral nerve stimulation for faecal incontinence.

AIM: Sacral nerve stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of 5 years' follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. METHOD: All patients implanted with SNS were identified from our prospective database. The date of implantation, first and last clinic follow-up, surgical complications and St Mark's incontinence scores were abstracted and analysed. RESULTS: From 1996 to 2014, 381 patients were considered for SNS. Of these, 256 patients met the study inclusion criteria. Median age at implantation was 52 years (range 18-81). The ratio of women to men was 205:51. Indications were urge FI (25%), passive FI (17.9%) and mixed FI (57%). The median of the incontinence score at baseline was 19/24 and this improved to 7/24 at the 6-month follow-up. Of the total cohort, 235 patients received a medium-term follow-up (median 110 months, range 12-270) with a median continence score of 10/24 which was also confirmed at the telephone long-term follow-up on 185 patients (132 months, range 60-276). CONCLUSION: This study demonstrates that SNS is an effective treatment in the long term. SNS results in an improvement of validated scores for approximately 60% of patients; however, there is a significant reduction of efficacy over time due to underlying causes.

Sexual Dimorphism of Greater Sciatic Notch among Nepalese Population by Three Dimensional CT Images of Pelvis.

Background Sex identification from the skeletal remains, is the first and the foremost step encountered by forensic experts. Hip bone being comparatively robust is resistant to damage and scores even in improperly preserved skeletons. It is also widely agreed that the greater sciatic notch (GSN) holds the greatest degree of sexual dimorphism. Objective To study the role of greater Sciatic Notch parameters in sex determination among Nepalese population by means of reconstructed Multi Slice Three-Dimensional Computed Tomography (MDCT) images. Method The CT images of individuals who underwent pelvic CT in the Department of Radiology, Dhulikhel Hospital were included in the study. Measurements of width, depth, angles and indices of greater sciatic notch were measured and calculated. Data were entered and analyzed using SPSS (Statistical Package for Social Sciences) version 25.0. Result There was a significant difference between means of all greater sciatic notch parameters (p > 0.001) between sex showing sexual dimorphism except depth (p=0.65). By using limiting point, 78.18% male and 83.64% female were correctly classified by using total width. Total angle, Posterior segment and Total width had sensitivity and specificity exceeding 80% and overall accuracy of 87% to 92% in all parameters except depth by receiver-operator characteristic curve analysis. Conclusion Application of 3D-CT virtual images in the present study helped us to easily quantify greater sciatic notch parameters. The important greater sciatic notch predictors for sex determination in Nepalese population were determined which would help forensic experts in ascertaining the sex of an unknown individual.

A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance.

Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications.