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The main purpose of this study was to gain an in depth understanding of the adjustment needs of international graduate students at the host university. There are, of course, a variety of factors that play a part in the adjustment needs that plague international graduate students and their adjustment to the host university. Consequently, in order to adequately meet the needs of this student population, these factors should be understood both independently and collectively. As the number of international graduate students migrating to the U.S. continues to increase, it is critical that host university staff and domestic students work toward creating sustainable efforts that will adequately meet both the emotional and physical needs of these students. Moreover, this is both a timely and timeless topic that allows for personal introspection in eliminating any underlying bias, stereotypes, discriminatory beliefs and practices. This study's findings have the ability to broaden perspectives to include an understanding of the cyclical nature of xenophobia and just how interconnected stress and mental health are as it relates to this population.

This study explored the academic activities of academicians during the COVID-19 pandemic in Nepal. An online questionnaire was used to collect quantitative data from 361 academicians about changes in academic and extracurricular activities. The findings showed that the majority of participants (69% and 72%) agreed that both academic and extracurricular activities, respectively, were adversely affected by the lockdown during the pandemic. The results also showed that the study hours, sleeping hours, and social networking increased while concentration on academic activities decreased during the lockdown due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This study was aimed to assess the seroprevalence of Bluetongue disease and understand its associated risk factors from the international border areas of Nepal. A total of 220 blood samples were collected randomly from apparently healthy ruminants (cattle, buffalo, sheep and goat) and screened for Bluetongue virus (BTV) antibodies in sera using a cELISA kit. Out of 220 sera samples, 92 were positive for BTV, accounting for 41.8% prevalence in ruminants. Seroprevalence rate was the highest in Buffaloes (58.3%) followed by sheep and goats (each 40%), and cattle (37.5%). The BTV seropositivity varied significantly (p<0.001) among ruminants in different sampling areas with the highest prevalence in Gokuleshwor (66.6%). Interestingly, the BTV was detected higher (p<0.01) in females (48.36%) and older ruminants (49.12%). The seroprevalence of BTV showed a significant association (p<0.01) with vector density and resulted in 46.5% of seropositivity. It was concluded that bluetongue disease exists in the international border areas of Nepal and its prevalence was widespread among cattle, buffalo, sheep and goat. The present study showed sex, age and vector population as the main influential risk factors for BTV infection. Further studies are imperative to identify the vector from different agro-climatic zones at the species level and to serotype the BTV prevalent in the study areas. [ABSTRACT FROM AUTHOR]

A critical element in seismic hazard estimation is the ground motion prediction equation (GMPE) which relates expected seismic intensity at a point from an earthquake of a given magnitude and location. Presently available GMPEs for plate interface thrust earthquakes along the Himalayan arc suffer from limited number of strong motion recordings used in their derivation. In this study we use a larger dataset, including recordings from the 2015 Gorhka, Nepal earthquake (Mw 7.9) and some of its larger aftershocks, to derive GMPE for earthquakes along the Western Himalayan arc. The proposed GMPE should give more reliable estimation of ground motion parameters at hard sites along the arc and in Peninsular India, and at soft sites in the Indo-Gangetic Plains. [ABSTRACT FROM AUTHOR]

Introduction Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal. Methods This is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS). Results The study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome. Conclusion This study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome. [ABSTRACT FROM AUTHOR]

Purpose: Vision 2020 and the Global Action Plan 2013–2019 prioritise primary eye care (PEC) as an important component of reducing avoidable blindness. Studies in sub-Saharan Africa have demonstrated that current PEC provision is poor. There has been no evaluation of the current practice of PEC among primary health care workers (PHCWs) in Nepal. Methods: A mixed methods descriptive cross-sectional study with semi-structured interviews and focus group discussions (FGDs) was carried out in Eastern Nepal. Government employed PHCWs working at health posts in three districts were invited to take part in a PEC knowledge and skills assessment. Each health post was assessed for ophthalmic equipment and medications. Three focus group discussions and eight semi-structured interviews were carried out with community ophthalmic assistants, PHCWs and a district health manager. Results: 107 PHCWs in 35 health posts took part in the quantitative study. Only 8.4% had received eye care training. 27.1% PHCWs could diagnose a corneal ulcer, 83.2% conjunctivitis, 75.7% cataract and 54.2% ophthalmia neonatorum. Only 14.0% could measure visual acuity, and 5.7% of HPs had a vision chart. Ophthalmic assistants described their concern for the low level of PEC at health posts. PHCWs were keen to receive training and highlighted the need for greater government support in the provision of eye care services. Conclusion: PEC knowledge and skills among PHCWs in eastern Nepal is inadequate to provide quality PEC services. There is a pressing need for PEC training in the region, provision of ophthalmic equipment and greater government support for eye care. [ABSTRACT FROM AUTHOR]

Dairy industry is growing in Nepal and western dairy pocket area is the main milk producing area in Chitwan district. This study was carried out to determine the seroprevalence and risk factors associated with N. caninum in western dairy pocket area in Chitwan district of Nepal. A cross-sectional study was conducted from April 2014 to July 2014 among the small holder dairy farms, and out of 2188 animals from different sampling villages, 186 (8.5%) animals were randomly selected. Individual blood samples (5-10 ml) were collected and screened for N. caninum antibodies by ELISA test kit. The study showed that apparent overall prevalence of N. caninum to be 4.84% and true prevalence, 4.07%. The prevalence varied from a low of 0% to a high of 13.16% in various VDCs. The prevalence rates among Holstein-Friesian cross and Jersey cross Cattle were 6.94% and 3.51% respectively. The seroprevalence of N. caninum was found to be 16.13% and 2.5% in animals with and without history of abortion respectively, showed statistically significant different (p value <0.05). Similarly, prevalence were 13.64% and 3.66% in animals with and without presence of dog respectively and 8.5%, 3.39% and 0% in the animals of age group of 3-5 years, 1-3 years and above 5 years respectively, showed statistically non-significant association (p value <0.05). This study shows that N. caninum is associated with abortion in dairy cattle of Chitwan region. The study may contribute the base line data of N. caninum in Nepal for future preventive strategy for stake-holders and government. [ABSTRACT FROM AUTHOR]

Scapania davidiiPotemkin, previously known from the Xizang district of China, East Nepal and India (West District of Sikkim), is now reported from Bhutan and the North and East Districts of Sikkim and Anjaw District of Arunachal Pradesh in India. Female plants with well-developed perianths are described and illustrated here for the first time. The differentiation ofS. davidiifromS. ornithopoides(With.) Waddel is discussed. The distinguishing features ofS. davidiiare hemispherically convex, broadly oval to nearly reniform leaf lobes, the subequal size of the dorsal and ventral lobes resulting in the formation of very compact head-like shoot apices, the decurrency of the dorsal lobe, contrasting deep brown pigmentation of marginal teeth, formation of variable paraphyses in the axils of vegetative leaves and the male and female bracts, and the morphology of the perianth with 1–2-celled cilia on its inner surface closer to the perianth-mouth. An expanded description, illustrations and map showing the spatial distribution of vegetative, male and female plants are provided. [ABSTRACT FROM AUTHOR]

The vast Indo-Gangetic Plains (IGP) south of the Himalaya are subject to dense fog every year during winter months (December–January), severely disrupting rail, air and public transport of millions of people living in northern India, Pakistan, Nepal and Bangladesh. Air pollution combined with high moisture availability in the shallow boundary layer, are important factors affecting the persistence and widespread nature of fog over the IGP. Despite the environmental significance and impacts on the public at-large, an in depth understanding of the long-term spatial-temporal distribution of the south Asian fog, is presently not available in the literature. We utilize infrared remote sensing techniques to develop a high-resolution (≈1 km × 1 km) fog/low-stratus detection climatology over the past two decades (2002−2020), using Aqua/MODIS satellite observations. A dynamic brightness temperature difference threshold (involving 3.96 μm and 11.03 μm bands) for nighttime fog/low-stratus detection is constructed based on systematic radiative transfer simulations involving cloud effective radius, cloud top height, liquid water path and satellite viewing geometry. Our satellite-based fog/low-stratus detection is consistent with theoretical simulations of fog characterization and is also found to be well-correlated with near-surface visibility observations of dense fog (r = 0.89, p-value << 0.01). We also provide satellite-derived nighttime estimates of fog/low-cloud effective radius that are comparable to the operational daytime MODIS cloud data product and limited in situ observations. In terms of fog/low-stratus frequency, the IGP is relatively uniformly covered by widespread fog/low-stratus occurrences with the largest frequency found in the low-lying Terai region, bordering India and Nepal, which is also consistently observed in our daytime fog/low-stratus detection results over the last two decades. Additionally, the interannual variations in fog/low-stratus occurrences track closely with that of relative humidity in the IGP, which is associated with shallow boundary layer conditions during winter-time favoring the formation and persistence of fog. Overall, these long-term satellite-derived results present new high-resolution data and insights into the dense and often intense winter fog occurrences which routinely engulf the entire stretch of the Indo-Gangetic Plains and cause significant degradation to ground visibility in one of the world's most densely populated regions. • Development of a high-resolution (1 km × 1 km) fog data record over south Asia. • Mapping and quantifying winter fog occurrences from 2002 to 2020 using MODIS data. • Both nighttime and daytime spatial-temporal distribution of fog cover is generated. • Satellite-derived fog detection results closely track ground-observed poor visibility. [ABSTRACT FROM AUTHOR]

Tobacco use is widely prevalent in different forms in Nepal. These habits are deeply rooted among different age groups and gender. There is no information available on all aspects of smokeless tobacco (SLT) use and its implications in Nepal. To review the types of SLT products available in Nepal, prevalence of SLT use, correlates of SLT use, SLT-related harm, and existing gaps in information and policy implications. This review is mainly based on information from literature, and some WHO and other documents. The prevalence of smokeless tobacco use is high, particularly among males and disadvantaged groups. SLT users have multiple habits of tobacco chewing, smoking and drinking. Despite SLT products being manufactured in the unorganized sector, they are also largely imported from India. People have easy access to various SLT products. There is a general lack of information on the health hazards of SLT use to the population. This calls for research on the issue. In order to succeed in reducing SLT use in Nepal, addressing the challenges of enforcing the Tobacco Control Act through a multisectoral approach and developing capacity of sectors other than health is of vital importance. [ABSTRACT FROM AUTHOR]

A varicose vein is a common venous condition which affects the great saphenous vein and small saphenous vein causing symptoms of pain, edema, itchiness, pigmentation, and ulceration. There are various modalities of the treatment of varicose veins; however, radiofrequency ablation is among the tested and proven treatments for varicose veins. With every case, there can be some unexpected or interesting scenarios which can pose both technical and surgical difficulties. The main objective of this paper is to introduce these scenarios which can occur despite following the standard protocol and methods both preoperatively and intraoperatively. In these scenarios, the surgeon quickly need to decide how to deal with the aberrations. Based on extensive literature and consensus of a team of three vascular surgeons, lists of interesting scenarios were prepared along with their definition. Any occurrences of such scenarios were noted in the operation theatre note. Here, we describe 39 (6.38%) interesting cases among 611 cases of radiofrequency ablation that was performed in Dhulikhel Hospital, Kathmandu University Hospital, from January 2014 until December 2019. Despite following the proper protocol, we can face many unexpected challenges preoperatively, peroperatively, and postoperatively. From this article, we concluded that vigilance of all the factors and proper Doppler ultrasonography can help in identifying most of these scenarios and aid in making proper surgical planning. [ABSTRACT FROM AUTHOR]

To investigate if topical chlorhexidine 0.2%, which is low cost and easy to formulate, is noninferior to topical natamycin 5% for the treatment of filamentous fungal keratitis. Randomized controlled, single-masked, noninferiority clinical trial. Adults attending a tertiary-level ophthalmic hospital in Nepal with filamentous fungal infection confirmed on smear or confocal microscopy. Participants were randomly allocated to receive topical chlorhexidine 0.2% or topical natamycin 5%. Primary analysis (intention-to-treat) was by linear regression, using baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) and treatment arm as prespecified covariates. Mixed fungal-bacterial infections were excluded from the primary analysis but included in secondary analyses and secondary safety-related outcomes. The noninferiority margin was 0.15 logMAR. This trial was registered with ISRCTN, number ISRCTN14332621. The primary outcome measure was BSCVA at 3 months. Secondary outcome measures included perforation or therapeutic penetrating keratoplasty by 90 days. Between June 3, 2019, and November 9, 2020, 354 eligible participants were enrolled and randomly assigned: 178 to chlorhexidine and 176 to natamycin. Primary outcome data were available for 153 and 151 of the chlorhexidine and natamycin groups, respectively. Of these, mixed bacterial-fungal infections were found in 20 cases (12/153 chlorhexidine, 8/151 natamycin) and excluded from the primary analysis. Therefore, 284 patients were assessed for the primary outcome (141 chlorhexidine, 143 natamycin). We did not find evidence to suggest chlorhexidine was noninferior to natamycin and in fact found strong evidence to suggest that natamycin-treated participants had significantly better 3-month BSCVA than chlorhexidine-treated participants, after adjusting for baseline BSCVA (regression coefficient, −0.30; 95% confidence interval [CI], −0.42 to −0.18; P < 0.001). There were more perforations and emergency corneal grafts in the chlorhexidine arm (24/175, 13.7%) than in the natamycin arm (10/173, 5.8%; P = 0.018, mixed infections included), whereas natamycin-treated cases were less likely to perforate or require an emergency corneal graft, after adjusting for baseline ulcer depth (odds ratio, 0.34; 95% CI, 0.15–0.79; P = 0.013). Treatment with natamycin is associated with significantly better visual acuity, with fewer adverse events, compared with treatment with chlorhexidine. Natamycin remains the preferred first-line monotherapy treatment for filamentous fungal keratitis. [ABSTRACT FROM AUTHOR]

Urban poor with limited resources and residing in precarious informal settlements are often one of the most vulnerable populations to climate variability and change. The present study seeks to assess the vulnerability of informal settlers to climate variability and change. Drawing from natural hazards, politico-economic, and ecological resilience strands of vulnerability literature we developed an integrated set of indicators for vulnerability assessment. The vulnerability of informal settlement dwellers was assessed in the hilly district of Kathmandu and the plain regions of the Nawalpur district of Nepal by collecting primary data from 300 randomly selected households, 150 from each district. Communities living in informal settlements experienced higher exposure to climate risk with lower adaptive capacity. Informal settlements with scarce resources, depilated infrastructure, fewer livelihood opportunities and knowledge gaps pose considerable vulnerability to climate variability and change. Our findings reveal that the inhabitants of informal settlements in the plain region are more vulnerable than that of the informal settlements of the hilly region due to higher exposure and sensitivity and lower adaptive capacities of the informal settlers of the plains. Enabling factors such as livelihood diversification, improved infrastructure, health facilities, social capitals, and support from local government with contextual policies and interventions, can facilitate better adaptation among the informal settlers and make them resilient to climate variability and change. • Urban informal settlers are extremely vulnerable to climate variability and change. • Informal settlers have higher exposure and sensitivity and lower adaptive capacities. • The informal settlers of the plains are more vulnerable than that of the hills. • Livelihood diversification, better physical and social capitals could make them resilient. [ABSTRACT FROM AUTHOR]

Smallholder farmers of the Eastern Indo-Gangetic Plains (EIGP) of South Asia rely mainly on cereal-based cropping systems to meet the food and nutritional demand and support their livelihood. Yet the productivity of the major cereals - rice, wheat, and maize - in the region are far lower than their potential. Nutrient management plays a crucial role in improving cereal yields and economic return, and continued improvement in nutrient management practices and their on-farm implementation is required to develop locally relevant solutions that are site-specific, easy-to-develop and geared towards system resilience. The objective of the study was to conduct the comparative assessment of three nutrient management strategies for the three major cereals considering productivity, profitability and nutrient use efficiencies (NUE); estimate their potential yields and yield gaps; and explain the causes of yield variability across farmer-participatory on-farm trials in the EIGP of Nepal. We compared three nutrient management strategies (farmer's fertilizer practice- FP, government recommendation -GR, and Nutrient Expert®- NE-based recommendation), in 600 on-farm trials. We used the NE DSS tool, APSIM – a cropping system simulation model, and machine learning (ML) approaches (Linear Mixed Effect model -LME; and Random Forest model - RF) for the three cereals using data from those trials. The NE and APSIM were chosen due to simplicity in use and their wider evaluation and application in fertilizer recommendation yield prediction; RF was chosen due to its robustness in predictive ability and identifying and ranking factors determining yield or other variables of interest. The NE-based fertilizer recommendations for maize, wheat and rice increased yield by about 3.5, 1.4, and 1.3 t ha−1 respectively, increased profits, and improved NUE over FP or GR. The risk analysis showed that at a given probability level, NE always resulted in higher yields of all cereals than GR or FP. APSIM identified 25th June as optimum transplanting date for rice and 10th December as optimum sowing date for maize and wheat and simulated long-term average potential yield of 7–7.5, 5–5.5 and 13–13.3 t ha−1 respectively for rice, wheat and maize. There were larger yield gaps between PY and FP (2.6–8.5 t ha−1) than PY and NE (2.0–3.7 t ha−1) across crops and villages. The LME model showed highly significant treatment and location effects for grain yield of all cereals. The point estimate of the difference for grain yield as estimated by Tukey's HSD test was highest for NE-FP and lowest for GR-FP for all crops. The RF model identified grain N uptake for rice and grain P and K uptakes for wheat and maize as most influential factors contributing to their grain yield under each nutrient management strategy. The NE-based nutrient management had significant effects over FP and GR leading to positive changes on yield and economic performance under varied growing environments. These findings based on novel tools and approaches have important policy implications for increasing food security and profits from the major cereals by refining or improving the GR or FP and increasing their NUE in Nepal. Studies with larger sample size across varied agro-climatic zones in the EIGP and much of South Asia would help policy makers consider DSS tools and ML approaches suitable for upscaling and large-scale adoption by smallholder farmers. [Display omitted] • Factors influencing the low and variable grain yields of rice, wheat, and maize in the eastern Gangetic Plains are not fully understood • Study assessed nutrient management options, estimation of yield potential and yield gaps, and causes of yield variability in 600 on-farm trials • APSIM Model estimated potential yield and yield gaps and identified optimum planting dates. • Random Forest identified nutrient uptake as important variable explaining yield variability. • Nutrient Expert® recommendation can increase yield, gross returns and nutrient use efficiency over farmers' practice and government recommendation. [ABSTRACT FROM AUTHOR]

Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases.

End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2 . Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula.

Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging. Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options. Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease. Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion. Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease.

Background Cardio-thoracic surgery involves open and minimally invasive techniques. Enhanced recovery after surgery is used for early recovery from surgery. Enhanced recovery after surgery decreases hospital stay duration. Patients undergoing Enhanced recovery after surgery after video assisted thoracic surgery use less pain killers and have less hospital cost. There has not been any study on outcomes on patient who follow physiotherapy protocol designed in our setting. Objective To find the physiotherapy outcomes in patients undergoing thoracic enhanced recovery after surgery (T-ERAS) based 14 step protocol locally designed at Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH). Method This is a retrospective cross sectional observational study. All the cases who underwent cardiothoracic surgery were classified based on the approach of chest surgery performed into groups Sternotomy, Thoracotomy and Video Assisted Thoracic Surgery (VATS) groups. Patients were advised for Thoracic Enhanced recovery after surgery based on the protocol that has been devised at Dhulikhel Hospital. The recovery of patients based on activities they could perform was noted and analyzed. Result Both ICU stay and hospital stay in number of days were highest in thoracotomy (6.04 days) group while that was lowest in video assisted thoracic surgery group (1.67 days). There is a similar recovery until step 5, i.e. 2 days and rapid progression in further steps in video assisted thoracic surgery group while it is much slower in both sternotomy and thoracotomy groups. Conclusion Postoperative mobilization and physiotherapy enhance early healing and decrease hospital stay. Mean hospital stay and ICU stay were shorter for video assisted thoracic surgery cases compared to Thoracotomy and Sternotomy groups and the mean days to achieve different steps varied within the protocol between groups compared.

Background Types of renal stones have profoundly changed in the last half-century, parallel to the change in lifestyle and dietary habit, with an increase of calcium stones. Among many lithogenic factors age and gender are considered to be associated with the types of renal stones. Studies evaluating the influence of age and gender on the distribution of the types of urinary calculi are scarce in Nepal. Objective To explore the influence of age and gender on different types of urolithiasis. Method This is a single center prospective study encompassing urolithiasis during a study period of 18 months. All the stone retrieved from the patients after surgery were sent for biochemical analysis of the stone. The result was then compared with the age and gender of the study population. Result Calculi from a total of 107 patients wereanalyzed (62 from malesand 45 from females). Mixed stones consisting of calcium oxalate and calcium phosphate werethe predominant constituent in 74.16% of stones, followed by uric acid, struvite and cystine stones. We found predominance of Calcium stones in males(47.66%) vs 36.44% in females and predominance of struvite stonesin females (7.47%) vs 3.73% in males. Age group of 21-40 years has the main burden of stone. Conclusion Being aware and having better knowledge of risk factors, composition and correlation with age and gender can provide personalized guidance to prevention and avoid recurrence of urolithiasis.

Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.

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.

Smoking amongst women has become significant as the number of smoking women is increasing gradually in this developing society. It affects the lungs to produce Chronic Obstructive Pulmonary Disease (COPD). Present study was conducted over 100 smoker's women and 100 non-smoker women in the age group of 30-40 Years. Three Lung Function Tests--FEVI, FVC and PEFR were employed to all smoking and non-smoking women. It was observed that all the above mentioned three parameters of lung function tests were reduced significantly among smoker women as compared to non-smoker women. These reduced parameters of lung function test among heavy smokers are suggestive of chronic obstructive lung diseases.