Study of surface tension and viscosity of Cu-Fe-Si ternary alloy using a thermodynamic approach.

The surface tension and viscosity of Cu-Fe-Si ternary alloys were computed at different temperatures using thermodynamic approaches. The thermodynamic data of the alloy were optimized in the framework of the Redlich-Kister (R-K) polynomials and exponential temperature dependent coefficients of the R-K polynomial were obtained. These coefficients were used to compute the excess Gibbs free energy of mixing of the alloy and the partial excess free energy of the components. The partial excess free energy so obtained was used to compute the surface tension of the ternary Cu-Fe-Si alloy system and its binary sub-systems. The enthalpy of mixing was also optimized and it was used to compute the viscosity of the sub-binary and ternary alloys.

Quality of Life of Menopausal Women in Majhifeda VDC, Kavrepalanchok, Nepal.

Background Menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. This is established fact that the quality of life of menopausal women deteriorates as the effect of menopausal symptoms. Objective To assess the physical domain, psychological domain, vasomotor domain for quality of life and its association with selected socio-demographic variables of menopausal women. Method Descriptive cross-sectional study was conducted among the menopausal women aged 45-60 years whose menstruation has ceased for a complete one year naturally excluding those having thyroid disorders and mentally disable. Structured questionnaire was used adopting Nepali version of Modified Menopause-Specific Quality of Life (MENQOL) questionnaire. Data collection was accomplished during August - September 2016. Data entered in MS excel were analysis using SPSS version 21. Descriptive as well as inferential statistics were applied for the data analysis. Result Among vasomotor domain hot flushes or flashes (81.9%), sweating (76.7%) and night sweats (73.3%); among psychosocial domain accomplishing less than I used to (94.8%), experiencing poor memory (80.2%), being impatient with other people (76.7%), feeling depressed down or blue (71.6%), feeling anxious or nervous (55.2%), feeling of wanting to be alone (55.2%) and being dissatisfied with my personal life (37.1%). Among physical domain aching in muscles and joints (94.8%), decrease in physical strength (94.8%), low backache (88.8%), feeling tired or worn out (84.0%), difficulty sleeping (81.0%), aches in back of neck or head (76.7%) were the major symptoms. Among sexual domain vaginal dryness during sexual intercourse (60.3%), avoiding intimacy (52.6%) and change in sexual desire (55.2%) were the major symptoms. Overall observation is that vasomotor symptoms were highest followed by sexual, psychosocial and physical symptoms having statistically significant association between vasomotor symptoms and ethnicity (p=0.019) and sexual symptoms and marital status (p=0.010). Conclusion Majority of the study subjects were from the marginalized groups of people. Vasomotor symptoms had highest prevalence followed by sexual, psychological and physical symptoms. As significant associations were observed between vasomotor symptoms and ethnicity and sexual symptoms and marital status, awareness and periodical checkups were recommended.

Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital.

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value < 0.05) for communication skills of nurses. Conclusion Majority of patients have positive perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal.

INTRODUCTION: Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here. METHODS: This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed. RESULTS: Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients. CONCLUSIONS: Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function.

Nephron sparing surgery in a tertiary care center in Nepal--an initial experience.

BACKGROUND: Malignant renal mass accounts for 2 to 3% of all malignant diseases in adults. Radical surgery used to be the treatment of choice with high propensity to develop chronic kidney disease in the compromised contralateral kidney. Currently, nephron sparing surgery is considered to be the standard of care with equivalent oncological outcome. METHODS: This was a retrospective chart review of patients with renal mass less than seven cm in size who had open nephron sparing surgery from July 2012 to Sep 2013 at Tribhuvan university teaching hospital, Nepal. Latest follow up either from record or over telephone was documented. RESULTS: Eight patients (mean age 45 years, male: female ratio1:1.6) underwent nephron sparing surgery over the specified period. Mean size of tumor was 4.75 cm. Mean ischemia time was 16.37 min. Histopathological diagnosis was benign in two and renal cell carcinoma in six patients. CONCLUSIONS: Nephron sparing surgery is safe in low stage renal tumors. It also prevents unnecessary nephrectomy in benign lesions and prevents negative sequelae of long term chronic renal impairment in remaining contralateral kidney.

Phaeochromocytoma in Nepal--a single centre experience.

BACKGROUND: Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability. OBJECTIVES: To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal. METHODS: Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up. RESULTS: Twelve cases of phaeochromocytomas were operated. The mean age was 36.41+/-14.07 years. There were 2 bilateral phaeochromocytomas and 1 extraadrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure postoperatively, but were effectively managed with antihypertensives. CONCLUSION: Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome.

Primary mucinous adenocarcinoma of the renal pelvis and ureter.

Mucinous adenocarcinomas of the renal pelvis and ureter are among the rarest upper urinary tract neoplasm. We report a case of multifocal primary mucinous adenocarcinoma of the renal pelvis and ureter occurring in association with a staghorn calculus and pyonephrosis. A 68 year old man had suffered from right flank pain and upper abdominal swelling for one year. After a series of investigation, a right staghorn stone with pyonephrosis leading to non-functioning kidney was found. Right nephrectomy was performed. The pathological report showed mucinous adenocarcinoma with ureteric margin positive for tumour deposits. Patient was reoperated; right ureterectomy with removal of bladder cuff was done. Although uncommon, the possibility of a tumor should be kept in mind especially in patients with a long standing urolithiasis accompanied by hydronephrosis and/or infection.

Pattern of renal cell carcinoma - a single center experience in Nepal.

BACKGROUND: Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. OBJECTIVES: To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. METHODS: The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. RESULTS: Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman nuclear grade 2 was found in 50%. CONCLUSION: Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype.

Job satisfaction among nurses in a hospital.

BACKGROUND: Nursing is one of the stressful jobs in health sector. The level of job satisfaction in the profession remains a matter of concern. This study means to explore the job satisfaction among the nurses of Dhulikhel Hospital. METHODS: A Descriptive cross sectional study design was conducted in Dhulikhel Hospital; a community based Hospital of Nepal Health Research Council from January to December 2009. All the nursing staffs that consented to the study filled up a standard questionnaire. RESULTS: A total of 85 nurses completed the study. The mean age of the respondents' was 23. 80.6% of the nursing staffs were satisfied. "Being considered a resource of health" provided highest sense of satisfaction, while "Lack of opportunities for further education and training" provided lowest sense of satisfaction. CONCLUSIONS: Majority of the nurses were satisfied with their present condition of work. Since job satisfaction is a dynamic process, the result may not be static or consistence. Working environment and employees expectations should receive attention.

Nurses' views on need for professional development in Nepal.

INTRODUCTION: This study explores the nurses' views on need for professional development and barriers in Nepal. METHODS: This is a qualitative content analysis study conducted among nurses from different health institutes. In-depth interviews and focus group discussions were used to obtain their views on need of professional development and major barriers against professional development in Nepal. Eleven nurses for in-depth interviews and three groups of six nurses each for focus group discussions were selected purposefully from Kathmandu University Hospital, Dhulikhel and Tribhuban University Teachng Hospital, Kathmnadu. RESULTS: Five themes emerged from qualitative data. "Continuing professional development", "supportive management", "nursing leadership", "recognition and respect" and "professional networking" were considered as essential factors for professional development. Lack of "commitment by the nurses", "female gender professional" and "lack of autonomy" were felt as barriers for the nursing professioanl development. CONCLUSIONS: Continuing professional development and supportive working environment are crucial to make nursing profession more dynamic and appealing in Nepal.

Penile fracture at Tribhuvan University Teaching Hospital: a retrospective analysis.

Fracture of the penis is rupture of the tunica albuginea and the usual cause is abrupt bending of the erect penis by blunt trauma. Trauma during sexual relation is responsible for approximately one third of all cases. The incidence of urethral injuries associated with this condition ranged from 2.0% to 38.0%. Twelve patients who presented to emergency over a period of 4 years with diagnosis of penile fracture were reviewed retrospectively. Patient's profile and all relevant data were noted from charts. The etiology of fracture was related to coital activity in 6 (50.0%) cases while other denied such act. Surgery was performed on all the patients and discharged from hospital on removal of urethral catheter. Follow up continued until restoration of normal penile function without complaint. So fracture of the penis is an injury that can be diagnosed clinically and needs emergency surgical correction for better result.

Renocolic fistula following percutaneous nephrostomy: a case report.

Renocolic fistula is a rare clinical entity. In the past, its incidence was high due to infection, especially tuberculosis, and renal stone complications; which gradually reduced with advancements in antimicrobial therapy and better stone management. The incidence of renocolic fistulae, specifically iatrogenic one, has re-emerged due to minimally invasive renal surgery and regular percutaneous nephrostomy placement for various reasons. We reported a case of fifty-five-years-old gentleman who presented to emergency room with left lithiasic pyonephrosis for which percutaneous nephrostomy was placed. Follow up antegrade pyelography diagnosed hydronephrotic left kidney with stone in renal pelvis with fistula communicating to descending colon. Contrast enhanced computer tomography revealed left non excreting kidney with retrorenal colon and percutaneous nephrostomy tube passing through the descending colon. The final diagnosis of post percutaneous nephrostomy renocolic fistula with non excreting left kidney was made and treated with ligation of fistulous tract and nephrectomy. Patient had uneventful recovery and histopathology showed chronic pyelonephritis.

Management of urethral strictures and their outcome.

Urethral stricture is a challenging surgical problem since the ancient time. Its outcome is very poor because of the high recurrence rate 40.0-50.0% whatever procedure is conducted to treat the condition. Between January 2004 to December 2007, 61 cases with urethral stricture were treated in our hospital. Management of stricture was decided according to the grading of urethral stricture. Of 61 cases, 42 (68.8%) had grade I-II, 10 (16.4%) had grade III and 9 (14.8%) had grade IV strictures. They were treated with optical internal urethrotomy (OIU), modified railroading and end to end anastomotic urethroplasty respective to gradings. During the average 2 years follow up period, outcome of strictures were analyzed. Recurrence of stricture was noted 31.0% in grade I-II after OIU and 11.0% in grade IV after urethroplasty. However, in cases with grade III stricture recurrence rate was observed in 60.0% after modified railroading. During the follow up period, 50.0% of the grade III strictures were converted to urethroplasty. It is suggested that, OIU is still a gold standard procedure to manage the lower grade (I-II) strictures with low morbidity, minimally invasive and success rate is 69.0%. End to end anastomotic urethroplasty for grade IV stricture has very good result (89.0%) but needs skilful mobilization of distal urethra to prevent chordee. However, grade III stricture needs open urethroplasty or modified railroading by using flexible cystoscopy which may reduce recurrence rate.

Abdominal lump: a diagnostic dilemma.

Abdomen is a Pandora's Box. During our routine patient evaluation we come across different types of abdominal lumps out of which some are straight forward and diagnosed after routine clinical examinations and available investigations. At times these abdominal lumps present differently from their usual presentations and create confusions despite undergoing necessary investigations. The truth is explored only after opening the Pandora's Box. We present a case of 21 years old male who presented with history of gradually increasing right sided upper abdominal lump of three years duration. He was thoroughly investigated with USG and CT scan abdomen along with other supportive investigations and was diagnosed to have Hydatid cyst of liver. Accordingly patient was prepared for surgery and it was only at the time of laparotomy that he was found to have right sided giant hydronephrosis with a nonviable renal parenchymal tissue. He underwent right sided nephrectomy and had a good postoperative recovery. So at times the abdominal lumps keep on creating diagnostic dilemmas.

Asymptomatic vesicoureteral reflux in children.

Between 1973 and 1992, a routine voiding cystourethrography screening was performed in all children attending our urological clinic. A total of 1023 children were diagnosed as cases of primary vesicoureteral reflux; 166 (210 renal units) of them were asymptomatic and were studied retrospectively. Ninety-one patients presented with enuresis, 39 with hypospadias, 14 with undescended testis, 8 with asymptomatic proteinuria and 14 had other manifestations such as intersexuality, inguinoscrotal swelling, abnormal external genitalia, etc. We documented high-grade reflux (IV-V) in 16.2% and renal scarring in 16.7% of the 210 renal units. None of the children showed features of urinary tract infection (UTI) or had a definite history in the past, but 23.5% of the 166 cases developed UTI during their follow-up period. Spontaneous resolution of reflux was observed in 52.7% of the 150 renal units and progression of renal scarring in 20% during follow-up. Antireflux operation was performed in 15 cases (26 renal units). In 9 children (5.4%) we found gross renal damage which progressed in two cases to end-stage renal disease followed by renal transplantation. A small kidney was noted in 5 patients and hypertension in two. It is concluded that the natural history of asymptomatic reflux is almost the same as in symptomatic reflux. Thus, routine voiding cystourethrography is suggested in all children attending a urological clinic in order to detect reflux as early as possible.