Huge Lipoma of Left Parotid Region with Intra-Parotid Extension.

Lipoma is a benign mesenchymal tumor originating from adipose tissue. The occurrence of this tumor in head and neck is less frequent and it rarely involves parotid gland. These are asymptomatic and occur both in the deep and the superficial lobe of the parotid. The most favored age group is from the fifth to sixth decade of life and is 10 times more common in the males. A 66-year-old male patient, with left parotid region lipoma is reported in this article. A fine-needle aspiration biopsy and ultrasonography were performed to establish the preoperative diagnosis and to plan the correct surgical approach. It was managed by surgical excision of lipoma with removal of cuff of superficial parotid tissue on superior aspect with preserving facial nerve. Follow-up examinations were planned to assess any facial nerve injury complications.

National participation levels in the 2017-2018 Australian thoroughbred racing season.

INTRODUCTION: The social licence of the Australian thoroughbred (TB) industry relies on the general public's perception of how they manage the animal in their care. METHOD: This study examines the horse, race and activity records for the 37,704 horses racing and training in Australia from 1 August 2017 to 31 July 2018. Three-quarters (75%, n = 28,184) of TBs started in one of the 180, 933 race starts that occurred during the 2017-2018 Australian racing season. RESULTS: Horses participating in the 2017-2018 Australian racing season had a median age of 4 years, with geldings more likely to be aged 5 years and older. The majority of the TB racehorse population were geldings (51%, n = 19,210), with 44% (n = 16,617) females and only 5% (n = 1877) entire males. Horses aged 2 years were three times more likely to not start in a race in that year compared with older horses. At the end of the 2017-2018 racing season, 34% of the population had an inactive status recorded. Horses aged 2 years (median two starts) and 3 years (median five starts) had fewer starts than older horses (median seven starts). Eighty-eight percent (n = 158,339) of race starts were over distances of 1700 metres or less. Race starts by horses aged 2 years (46%, 3264 of 7100) were more likely to have occurred at a metropolitan meeting compared with starts by older horses. CONCLUSION: This study provides a national overview of the racing and training activities and TBs participating in the 2017-2018 Australian racing season.

Maternal Health Services Utilisation in Panchkhal Municipality, Kavrepalanchok, Nepal.

Background Maternal Health is a priority program of Nepal. The low utilization of maternal health services is one of the major contributing factors for high maternal morbidity and mortality in developing countries like Nepal. Objective To explore various maternal health services utilized by women and identify various factors affecting the utilization of maternal health services in Panchkhal Municipality. Method A descriptive cross-sectional study was conducted among 355 reproductive-age women who have given birth in the last 2 years in Panchkhal Municipality. The data collection period was from May to July 2020. A convenient sampling method was used to select the study population. The data analysis was done by using Statistical Package for Social Sciences (version 20.0). Variables were defined by the frequency in numbers and percentages. Result The findings from the study showed that the coverage of the antenatal care (ANC) visit was 77% and among them, 25.6% visited at least 4 antenatal care visits as recommended by the government of Nepal. Out of 355 respondents, 52.4% were delivered in the health institution, and only 20% visited postnatal care after the delivery. Among various factors, lack of treatment facilities and health facilities at a far distance were the most common factors for the underutilization of maternal health services. Conclusion The coverage of maternal health services is still low despite free maternal health services with an incentive scheme. A further detailed investigation is required to find the real scenario of the Panchkhal municipality to under-utilization of maternal health services.

Comparison of Surgical Outcome of Bipolar Scissors with Conventional Cold Dissection Tonsillectomy.

Background The tonsillectomy is the most common Ear, Nose, and Throat (ENT) surgical procedure. Different methods have been used to improve the outcome of the surgery. One such method is tonsillectomy performed with bipolar scissors. In our scenario, the comparison of bipolar scissors tonsillectomy with conventional cold dissection has not been done. Objective To compare the surgical outcomes of bipolar scissors tonsillectomy and conventional cold dissection tonsillectomy. Method A prospective randomized study was conducted in 40 patients who underwent tonsillectomy on one side using bipolar scissors and on the other side using conventional cold dissection. Intraoperative blood loss, operation time, postoperative pain, and postoperative hemorrhage were all analyzed in both surgical techniques. Result The median operative time was 10 minutes for bipolar scissors compared with 12 minutes for conventional cold dissection, with a p-value of 0.390 which was not statistically significant. The median blood loss was 48 mL on the bipolar scissors side and 60 mL on the conventional cold dissection side, with a p-value of 0.232 which was also not statistically significant. The overall postoperative hemorrhage rate was 12.5%. Of these, 4 (10%) occurred on the bipolar scissors side (left side mainly) and 1 (2.5%) on the conventional cold dissection side (also left side), with a p-value of 0.002 which was statistically significant. There was no statistically significant difference in the pain scores between the two methods in both rest and swallowing (p > 0.05). Conclusion The bipolar scissors did not show any benefit over conventional cold dissection in terms of surgical time, intraoperative blood loss, or postoperative pain. However, postoperative hemorrhage was more common with bipolar scissors. Therefore, conventional cold dissection remains a safe technique for tonsillectomy in adult patients.

Health Promoting Lifestyle during Covid-19 Pandemic among Residents of Gandaki Province, Nepal.

Background Lifestyle is an important factor to individual's health and quality of life. Although, the emergence of Corona virus disease 2019 (COVID-19) has forced billions of people to change their lifestyle overnight. Objective To identify health promoting lifestyle during COVID-19 pandemic among the residents of Gandaki Province, Nepal. Method Descriptive cross sectional web based study was conducted among 386 respondents from Gandaki Province. Adults from 18 years and above, who could fill the form online were included using purposive and snowball sampling technique. Data were collected using Health Promoting Lifestyle Profile II (HPLP II) scale and analysed using descriptive (frequency, percentage, median) and inferential statistics (Mann Whitney U test and Kruskal Wallis test). Result Only 18.7% of the respondents had an excellent health promoting lifestyle followed by good health promoting lifestyle among 60.4%. Highest median score was observed in spiritual 27(10-36), and interpersonal relationship subscale 27(9-36). Whereas, the lowest was observed in physical activity 21(8-32) followed by stress management 24(10-32). Statistically significant difference was observed in age and perception of own health status with spirituality; gender, chronic illness and perception of own health status with interpersonal subscale and age, gender, marital status, occupation and perception of own health status with physical subscale. Conclusion The study concludes the need of health education and awareness to promote healthy lifestyle behaviours with a particular emphasis on indoor physical activities and stress management skills with specific consideration to female and elderly.

Comparison of Hearing Result and Graft Uptake Rate between Temporalis Fascia and Tragal Cartilage in Endoscopic Myringoplasty.

Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing.

Does the Preoperative Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio Associate with Clinic-pathological Characteristics in Papillary Carcinoma of Thyroid.

Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR.

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.

Large magnetoresistance and quantum oscillations in Sn0.05Pb0.95Te.

We have synthesized high-quality single crystals of SnxPb1-xTe and carried out detailed studies of the magnetotransport properties of one of the samples, Sn0.05Pb0.95Te. Longitudinal magnetoresistance increases almost linearly with increasing applied field (H) and reaches ∼310% atH= 13 T. At higher fields, both longitudinal and Hall resistance show clear Shubnikov de Haas oscillations. The oscillations are smooth and periodic, and there exists only one frequency,fα∼ 57 T. However, an additional frequency,fß∼ 69 T, appears as the angle between the field direction and the normal to the sample surface (θ) is increased. Bothfαandfßexhibitθ-dependence;fαdecreases whereasfßincreases gradually with increasingθ. The presence of two frequencies in Sn0.05Pb0.95Te indicates that there exist two Fermi surface pockets (αandßpockets). We have constructed the Landau-level fan plot and determined the Berry phase (δ) for theαpocket to beδ∼ 0.1. Thisδvalue is very close to the expected value of 0 for a topologically trivial system.

Clinical Profile and Diagnosis of Obstructive Sleep Apnea Syndrome using Overnight Polysomnography in a Tertiary Care Hospital.

Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p <.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease.

Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal.

Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered.

Universal Neonatal Hearing Screening: An Experience at Tertiary Care Hospital.

Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.

Permcath - A Vascular Access for Hemodialysis, Our Experience in Last Two Years.

Background The double lumen tunneled catheter (Permcath) is mostly used as an alternative access, not as a temporary access in End Stage Renal Disease patients requiring hemodialysis. If there is no possibility of other access modalities, failed or unable to create native arteriovenous fistula (AVF), Permcath can be a very good alternative. Objective To find the indications, complications and results of Permcath insertion. Method We reviewed the results of 92 Permcath inserted under ultrasound guidance in two different hospitals, 45 in Sahid Dharma Bhakta National Transplant Center (SDNTC), Bhaktapur and 47 in Nidan Hospital Pvt. Ltd., Lalitpur from April 2016 to April 2018 retrospectively. Result We had inserted 55 Permcath (59.78%) in right internal jugular vein (IJV), 25 (27.17%) in left internal jugular vein and 12(13.04%) in femoral vein. In terms of major complications, two (2.17%) patients had profound hypotension, bradycardia and cardiac arrest due to left internal jugular vein tear. Three patients (3.26%) died within a week due to septicemia and 23 patients (25%) died with multiple causes within one year. Of the cases, till now in 39 cases (42.39%) Permcath has been removed. Major reasons of removal of Permcath are post renal transplant in 18 cases (19.57%), Arterio Venous Fistula maturation in 13 cases (14.13%), Infection in six patients (6.52%) and non functioning Permcath in two patients (2.17%). Conclusion Permcath remains a reliable method for short term vascular access, hence can be used as a bridge to renal transplant or arteriovenous fistula maturation.

Health Related Quality of Life of Diabetic Patients.

Background Diabetes mellitus is a common and serious global health problem. In Nepal, it is a major expanding non communicable disease that has a number of chronic effects, accompanied by marked reduction in the health related quality of life (HRQOL). Assessment of health related quality of life mainly focuses on the effect of illness and impact of treatment on health. Objective The objective of this study was to identify the health related quality of life of diabetic patients. Method A descriptive cross sectional study was conducted among 116 diabetic patients attending Diabetes, Thyroid and Endocrinology Care Center, Pokhara. Non probability purposive sampling technique was used. Data was collected using World Health Organization Quality Of Life - BREF tool and analysed using descriptive and inferential statistics such as frequency, percentage, mean, standard deviation, median, interquartile range, Mann Whitney U test, Kruskal Wallis test and Spearman's correlation coefficient test. Result The median score of HRQOL was 244 (225-275). Statistically significant difference was observed in age (p< 0.001), sex (p=0.043), living status (p=0.012), education (p=0.001), duration of illness (p=0.038) and co-morbidity (p< 0.001) with overall health related quality of life. Physical domain had strongest correlation (p< 0.000) with overall quality of life. Conclusion Diabetic patients have higher health related quality of life in the physical and social domain. Young adults, male, literate, living with spouse, duration of diabetes for less than 10 years and those without comorbidity have higher health related quality of life. Integration of routine counselling programme will be helpful in promoting health related quality of life of diabetic patients.

Oral Cysticercosis Presenting as an Innocuous Lesion.

Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, 'Cysticercus Cellulosae' primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications.

Masson's Hemangioma of the Cheek: A Case Report.

We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson's tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.

Characterisation of biomass resources in Nepal and assessment of potential for increased charcoal production.

Characterisation of 27 types of biomass was performed together with an assessment of regional resource availability. Charcoal was produced under two conditions from all samples and their yields were compared. Sugarcane bagasse, sal and pine produced the best charcoal with a low volatile matter and high calorific value. The amount of high-quality charcoal which can be made within Nepal from the biomass types tested is equivalent to 8,073,000 tonnes of firewood a year or 51% of the yearly demand. The areas which would benefit the most from charcoal making facilities are the Mid-hills of the Western, Central and Eastern Development Regions, as well as the Terai in the Central and Eastern Development Regions. The main potential benefit is to convert agricultural residues which are underutilised because, in their original form, produce large quantities of smoke, to cleaner burning charcoal. The conversion of agricultural residues to charcoal is also a viable alternative to anaerobic digestion in the Mid-hills.

Combination of thermal and electric properties' measurement techniques in a single setup suitable for radioactive materials in controlled environments and based on the 3ω approach.

We have designed and developed a new experimental setup, based on the 3ω method, to measure thermal conductivity, heat capacity, and electrical resistivity of a variety of samples in a broad temperature range (2-550 K) and under magnetic fields up to 9 T. The validity of this method is tested by measuring various types of metallic (copper, platinum, and constantan) and insulating (SiO2) materials, which have a wide range of thermal conductivity values (1-400 W m-1 K-1). We have successfully employed this technique for measuring the thermal conductivity of two actinide single crystals: uranium dioxide and uranium nitride. This new experimental approach for studying nuclear materials will help us to advance reactor fuel development and understanding. We have also shown that this experimental setup can be adapted to the Physical Property Measurement System (Quantum Design) environment and/or other cryocooler systems.

Evidence of a 2D Fermi surface due to surface states in a p-type metallic Bi2Te3.

We present a systematic quantum oscillations study on a metallic, p-type Bi2Te3 topological single crystal in magnetic fields up to B = 7 T. The maxima/minima positions of oscillations measured at different tilt angles align to one another when plotted as a function of the normal component of magnetic field, confirming the presence of the 2D Fermi surface. Additionally, the Berry phase, ß = 0.4 ± 0.05 obtained from the Landau level fan plot, is very close to the theoretical value of 0.5 for the Dirac particles, confirming the presence of topological surface states in the Bi2Te3 single crystal. Using the Lifshitz-Kosevich analyses, the Fermi energy is estimated to be [Formula: see text] meV, which is lower than that of other bismuth-based topological systems. The detection of surface states in the Bi2Te3 crystal can be explained by our previous hypothesis of the lower position of the Fermi surface that cuts the 'M'-shaped valence band maxima. As a result, the bulk state frequency is shifted to higher magnetic fields, which allows measurement of the surface states signal at low magnetic fields.