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Abstract Background This study was conducted to assess the knowledge and ongoing practices of plagiarism among the journal editors of Nepal. Methods This web-based questionnaire analytical cross-sectional was conducted among journal editors working across various journals in Nepal. All journal editors from NepJOL-indexed journals in Nepal who provided e-consent were included in the study using a convenience sampling technique. A final set of questionnaires was prepared using Google Forms, including six knowledge questions, three practice questions (with subsets) for authors, and four (with subsets) for editors. These were distributed to journal editors in Nepal via email, Facebook Messenger, Viber, and WhatsApp. Reminders were sent weekly, up to three times. Data analysis was done in R software. Frequencies and percentages were calculated for the demographic variables, correct responses regarding knowledge, and practices related to plagiarism. Independent t-test and one-way ANOVA were used to compare mean knowledge with demographic variables. For all tests, statistical significance was set at p

Backgrounds: Problem-based learning (PBL) is a learner-centered pedagogical approach in which a person learns about a subject by working in groups to solve an open-ended problem. The objective of the present study was to assess students' perceptions and attitudes toward Problem-based learning and the role of tutors in Problem-based learning. Methods: This quantitative study was conducted among second-year medical and dental undergraduate students from November 2022 to November 2023. The students were divided into eight groups, and each group was facilitated by tutors. A Problem-based learning tutor guide, with a case on the topic of diarrhea/dysentery, was designed as a module with six triggers and given to the groups. At the end of nine days of PBL sessions, feedback from students on the process of Problem-based learning and tutors was received using the 'Dolmans and Schmidt' and 'Dolmans and Ginns' questionnaires, respectively. The level of attitude of the students based on their feedback toward the Problem-based learning process and the tutors were also assessed. The data were entered into Microsoft Excel, and descriptive analysis was performed using the Statistical Package for Social Sciences (SPSS), version 21. Results: Among the 79 responses received, 72 (92.4%) students gave a good rating of the process of Problem-based learning, indicating a favorable attitude. The participants agreed with the themes based on the influence of discussion, content tested, course objectives, lectures, tutors, and reference literature. Similarly, 63 (81%) students gave a good rating of the tutorials’ performance, suggesting a favorable attitude. They agreed that tutors facilitated active, self-directed, contextual, and collaborative learning. Conclusions: This study revealed the positive perceptions and attitudes of medical and dental undergraduate students regarding the PBL process and the role of tutors in Problem-based learning. The outcomes of this study have provided a foundation for implementing Problem-based learning in Nepal's medical and dental undergraduate curricula. Keywords: Dental education; diarrhea; dysentery; medical education; problem-based learning.

Abstract Background Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death. Methods A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death. Results Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p

No Abstract available.

Abstract Background Imidacloprid, a neonicotinoid insecticide, is widely used in agricultural settings. Consequently, cases of accidental and suicidal poisoning are increasingly seen in clinical practice. Although cases with varied clinical presentations and toxicological profiles have been reported, standard management principles are lacking. Case presentation We present a case of Imidacloprid poisoning in a 25-year-old previously healthy indigenous Tamang female without a classic toxidrome requiring ventilatory support, complicated by a prolonged neuropsychiatric sequela. Conclusions Although uncommonly reported, imidacloprid toxicity may lead to life-threatening complications and hence should be suspected in cases of unidentified poisoning with a relevant toxidrome. Vigilance on the part of treating physicians plays a crucial role in appropriate management.

Abstract Background: The effectiveness of online classes is always a concern, and it can be overcome by opting for active learning strategies like team-based learning (TBL). This study was conducted to find out the effectiveness of online TBL as an active learning strategy. We also aimed to explore the satisfaction and perception of students toward TBL. Methods: This is a mixed-method study conducted among 29 third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using purposive sampling method in the duration of January to September 2021. Three two hours online TBL sessions were used for teaching introduction to medical ethics. The individual readiness assurance test (IRAT) scores were compared to the group readiness assurance test (GRAT) scores to evaluate the effect of TBL through cooperative learning. Learner reactions and satisfaction of students towards TBL were assessed using a validated questionnaire comprising of a five-point Likert scale. An open-ended question asking the participants to describe their overall experience of the TBL sessions was also included to explore their perceptions towards TBL. The data were collected using Google form and exported to Microsoft Excel and the quantitative data were then analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. To check the normal distribution of the data, Kolmogorov Smirnov and Shapiro-Wilk test were used. Non-parametric tests were used for the non-normally distributed data. P value of

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Locally prepared liquor, which is not standardized or regulated, though cheap can contain various toxic ingredients and even may be fatal. We report a case series of four adult males who died within 18.5 h due to the effect of local liquor consumption in a hilly district of Gandaki Province of Nepal. Methanol toxicity due to illicitly produced alcohol consumption should be managed with adequate supportive care and administration of specific antidotes such as ethanol or fomepizole. Liquor production should be standardized, and quality checks should be done before the sale for consumption.

Abstract Background Perinatal and neonatal death rates have decreased recently but it still poses a major challenge to the health system of Nepal. The study was conducted to explore the pattern and causes of perinatal deaths. Methods This was a descriptive cross-sectional study conducted from September 2020 to June 2021 using the data of perinatal mortality of three years from June 15, 2017, to June 14, 2020. The demographic parameters of the mother consisted of maternal age, place of residence, ethnicity, antenatal care, the number of antenatal visits, gravida, gestational weeks, and the mode of delivery. The causes of death were categorized into fetal and early neonatal deaths. Fetal deaths were further classified as macerated stillbirth and fresh stillbirth. The attribution of the causes of deaths to fetal/neonatal and maternal conditions was done as per the guidelines of the WHO application of ICD-10 to deaths during the perinatal period. Results There were a total of 145 perinatal deaths from 144 mothers among which 92 (63.5%) were males. Ten mothers (6.9%) had not sought even single antenatal care, whereas 32 (22.9%) had visited for antenatal care one to three times. At least one cause of death was identified in 114 (78.6%) and remained unknown in 31(21.4%) cases. Among the 28 cases of macerated stillbirths, the cause of death was not identified in 14 (50%), whereas preterm labor was attributed to the cause of death in four (14.3%). In 53 of the fresh stillbirths, intrapartum hypoxia was identified as the cause of death in 20 (37.7%) cases, preterm labor in nine (17%), and was left unknown in 15 (28.3%) cases. Among the 64 early neonatal deaths, prematurity was attributed as the cause of death in 32 (50%) cases, birth asphyxia, and infections each in 11 (17.2%). Conclusions The perinatal mortality surveillance system identified the causes of death in most of the cases in our observation. Prematurity was identified as the commonest cause of early neonatal deaths and preterm labor was the commonest cause responsible for perinatal deaths overall. The perinatal deaths should be investigated to establish exact causes of deaths which can be useful to develop prevention strategies.

IntroductionBronchial asthma continues to be a problem in the Himalayan country of Nepal. This study explored the impact of bronchial asthma on patients' lives in a hill village in Syangja district, Nepal, and obtained information about the perceived impact of the illness, knowledge of the disease, self-care behaviors and treatment among patients.Material and methodsThe study site is the village of Jyamire (located at an elevation between 900 to 1200 m) Syangja district. Individuals suffering from asthma residing in the village aged 18 years or above were included. Semi-structured interviews were conducted face-to-face with the respondents at their homes using an interview guide. The interviews were audio recorded, transcribed in the Nepali language, and then translated into English for further analysis.ResultsMost participants were female, between 18 to 60 years of age, and housewives. Most houses were built of mud and poorly ventilated. Gas was used for cooking though firewood was also used. Most used to get an average of three serious attacks a year both during winter and summer. The themes that emerged were the number and seasonal variation in attacks, the perceived effect of asthma on their lives and social interactions, the knowledge of the interviewee about the disease, the impact of asthma on their socioeconomic status, and treatment and self-care behaviors. Residing in a hill village required them to walk up and down several times a day and the disease seriously impacted their lives. The smoke produced during different ceremonies and during cooking also worsened their asthma.ConclusionFindings suggest, the existence of multiple factors, a few unique to Nepal contributing to poor asthma control. Though the recent socioeconomic improvement has led to improved prevention and treatment options, asthma seriously affected the patients.

Abstract Background In the South Indian population, an odontometric analysis was performed with the older age group (18 to 60 years) and using the dimensionally stable polyvinyl siloxane elastomeric impression material (PVS) that can create minute detail replicas of tooth structure. Both measurements of buccolingual and mesiodistal dimensions of all permanent teeth (except third molars) were taken with a digital vernier calliper on 400 dental models as a reference sample and 80 dental models as a test sample, with the data from the reference samples subjected to an independent samples t test and stepwise logistic regression analysis. Results Independent samples t test divulged that canines were the most sexually dimorphic teeth followed by buccolingual dimensions of central and lateral incisors. All tooth variables were found greater in males, i.e. 56/56 (100%), whereas stepwise logistic regression analysis formula disclosed that the prediction accuracy in the age group of 18 to 39 years was 91%, 85% and 73% using the teeth from both the jaws, maxillary teeth and mandibular teeth respectively; similarly, in the age group of 40 to 60 years, it was 85%, 84% and 83% using teeth from both jaws, maxillary teeth and mandibular teeth respectively; finally, in the overall age group of 18 to 60 years, it was 83% and 75% using teeth from both jaws, maxillary teeth and mandibular teeth respectively. The mean percentage of sex dimorphism was found high in South Indian dentition compared with other populations. Conclusions Nonetheless, the accuracy of the results obtained can be considered moderate to high, and sexing can be achieved using regression formulas for each age group, which reflects demographic diversity.

Background: The females in the reproductive age group are vulnerable to injuries and diseases. There is no reliable evidence of the pattern of deaths in reproductive age group females from Nepal. This study was conducted to explore the patterns of deaths of females of the reproductive age group in Nepal. Methods: A multicentric quantitative cross-sectional study was conducted among the 611 deceased females of age 15 to 49 years who had undergone medico-legal autopsy in major autopsy centers of the capital cities of seven provinces of Nepal in a duration of one year. The demographic, clinical, and causes of death data were retrieved from the records and analyzed. The intentional and unintentional causes were compared with the marital status, age groups, ethnicity, and deceased of rural and urban communities. Results: Female reproductive age group deaths constituted 611 (20·64%) of the total autopsies. Suicide was the most common manner of death (413, 67·59%) followed by accident (121, 19·80%). The most common cause of suicide was hanging (258, 62·47%) followed by poisoning (149, 36·08%) whereas road traffic accident (72, 59·5%) was the commonest cause of accidental death. Intentional deaths were associated with higher risk to the females of younger age groups (p

Medical education is considered as a very significant strategy ensuring good quality in academics and health care. Currently, medical education across the world has been experiencing a major obstruction as a consequence of the novel coronavirus disease pandemic. At the same time, the rapid use of emergent technologies to maintain effective teaching and learning has become an essential component for transformative changes and the future of medical education. In this paper, we discuss the role of e-learning in medical education by outlining its components, effectiveness, barriers, all the pros and cons and future of implementation of such technology. The intention of this article is to inform all medical educators and students across the world on how the technological changes even after the pandemic can have a positive impact on medical education.

Background: Autopsy examination is mandatory in all unnatural deaths as per law of Nepal and thus all deaths due to drowning are undergone medico legal autopsy. This study aims to analyze the demographic and autopsy characteristics of drowning deaths in cases brought for medico legal autopsy at a major autopsy center of Gandaki province of Nepal. Methods: This study was conducted based on review of database in a period of two years among 53 corpses of drowning related deaths. The demographic data and relevant information from the inquest and autopsy report of such cases were collected and presented. Result: The commonest age group involved in drowning deaths was

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Background: The average stage of attrition in permanent first and second molars is an established method of age estimation in the adult population. The study was conducted with an objective of age estimation from the average stage of attrition of permanent molars. Methods: A total of 451 individuals of age more than 20 years were examined. Nepalese individuals with intact first and second permanent molars in the maxillary and mandibular arch on either side were included. The average stage of attrition of the maxillary first and second permanent molars on either side was calculated and subjected to regression analysis to derive equations. Results: Among a total of 451 participants, 231 (51.22%) were females and 220 (48.78%) males, with a mean age of 44.3 ± 13.9 years. There was a strong correlation between age and average stage of attrition of molars. The correlation was stronger for upper molars compared to the lowers. Additionally, the mean of the difference between real age and estimated age was lower for maxillary compared to mandibular molars. Compared to age estimation by univariable regression, multivariable regression had greater accuracy. Similarly, estimation of age from maxillary molars was more accurate as compared to mandibular (difference in years: 3.82 ± 3.03 for maxillary molars and 5.17 ± 4.2 for mandibular molars). Conclusions: Maxillary teeth are better for age estimation and using both maxillary first and second permanent molars gives better accuracy.

Abstract Minimal invasive tissue sampling (MITS) technique detected HIV infection and disseminated cryptococcosis in an adult female with sudden death. A proper autopsy is essential to diagnose the exact cause of death and MITS can suffice in natural deaths.

Background: Age estimation is based on general physical examination, radiological examination of bones and dental examination. The appearance of ossification center of pisiform bone is one of the important evidence for estimating age among young children between nine to 13 years. The objective of this study is to estimate the age of appearance of pisiform among the Nepalese children. Materials and methods: It is a cross sectional descriptive study conducted at the department of Radiology, Pokhara Academy of Health Sciences, Western Regional Hospital on the month of July 2020. The Antero posterior view of X Rays of either hand (left or right) including the carpal bones of the patients aged seven to 15 years of 183 Nepalese children archived at the department of Radiology were taken as samples. The X rays were checked for the appearance or non appearance of Pisiform and the age of appearance analysed. Results: One hundred and twenty seven (69.40%) of total 183 cases were males and 56 (30.60%) were females. The minimum age of appearance of pisiform was 9 years in females and 10 years in males. All the subjects had pisiform bone appeared at the age of 13 years and above. Conclusion: The minimum age of appearance of Pisiform in the study subjects was 9 years in females and 10 years in males. All the cases have pisiform ossified at the age of 13 years and above.

Introduction: The outbreak of COVID-19 as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. Methods: This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. Conclusions: The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.

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Background: Problem based learning is self-directed form of learning. Problem of Diabetes Mellitus was chosen. The objective was to evaluate perception of students towards Problem based learning and test their understanding. Methods: A descriptive study was conducted from November 2019 till October 2020. An online Problem based learning session of a week was conducted to second-year Bachelors of Dental Surgery students using online applications. Tutors facilitated students in a group of five to six each. Pre-post testing of evaluation questions was done. At end of session, feedback of students on Problem based learning and tutor of Problem based learning were received with ‘Dolmans and Schmidt’ and ‘Dolmans and Ginns’ questionnaire. Results: There was increase in correct response in nine out of 12 evaluation questions. Most students agreed to influence of discussion, content tested, course objectives, lectures, tutor and reference literature. The students agreed that tutors facilitated active, self-directed, contextual and collaborative learning. Conclusions: The influence of discussion among participants, content tested, course objectives, reference literature during the Problem based learning session were agreed upon by majority of the students. The tutors’ role was accepted by participants in terms of stimulation to self-directed, active, collaborative and contextual learning. Keywords: Diabetes mellitus; problem based learning; tutor

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Background: Demirjian’s method is widely used method for dental age estimation. This study was conducted with objectives of applying Demirjian’s 8 teeth method to estimate age in Nepalese Population and to determine Nepal-specific formulas. Methods: We had used the Orthopantomographs of Nepalese people of age above five and below 23 years. The radiographs were compared to the ‘Tooth Development Chart’ and each tooth studied was assigned with any one of the 10 developmental stages using Demirijian’s 8 teeth method and total maturity scores determined. Formulas were derived using regression analysis, wherein the total maturity score obtained for each individual was considered as the independent variable and the corresponding age as the dependent variable in the STATA 15.1 statistical program. Results: There was underestimation of age in both the sexes by the original method. Regression equations were derived for males and females separately for age five to 18 years and again after adding cases up to 23 years. The estimation was better for males up to 18 years [R2=0.94, Mean Absolute Error (MAE) 0.747 years and SD 0.644] than for females up to 18 years (R2 = 0.89, MAE 0.886 years and SD 0.925). The estimation was better for up to 18 years than for up to 23 years in both sexes. Conclusions: Demirijian’s 8 teeth method underestimated age in the study population and thus population specific equations based on the method are better for dental age estimation. The age estimation utilizing the equations from Nepalese population has given acceptable results. Keywords: Age estimation; demirijian’s method; dental age estimation; forensic age estimation; tooth development chart

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Abstract Background Snake bite is a neglected public health problem in tropical and subtropical region. The study was conducted with objectives to determine the knowledge of first aid methods in snake bite and the perception of snake bite among the medical students of Gandaki Medical College, Pokhara, Nepal. Methods We conducted a cross sectional survey among 302 (231 preclinical and 71 clinical) Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using a pretested questionnaire to assess the knowledge of first aid of snake bite based on WHO protocol and perception of snakebite. The study duration was from January to May 2018. The total score of the knowledge was obtained and compared among variables using Mann-Whitney U test. Chi square test was used for comparing the responses with the level of students. P value of

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Background & Objectives: Acute Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. The study was conducted with the objective to examine the incidence of different types of adverse drug reactions in drug treated hypertensive patients.Materials & Methods: Patients (n=382) who received antihypertensive agents were selected and interviewed using a standardized questionnaire. The Naranjo Algorithm, which categorizes the causality relationship into definite, probable, possible and doubtful, was used for the assessment of the exact nature of Adverse drug reaction (ADR).Results: Calcium channel blockers (CCBs) were the drug class with highest number (22 or 32.84%) of ADRs followed by Angiotensin-converting enzyme Inhibitors (ACEI) in 17 (25.38%), Angiotensin Receptor Blockers (ARB) in 12 (17.91%), diuretics in 10 (14.92%) and beta adrenergic antagonist in six (8.95%). Cardiovascular system (40 or 59.70%) was the most affected followed by central nervous system (16 or 23.88%) and respiratory and dermatological system each in 11 (16.42%) cases. On Naranjo’s probability scale, nine (13.4%) of the ADRs were definite, 39 (58.2%) possible, 16 (23.9%) probable and three (4.5%) doubtful. Conclusion: Calcium channel blockers were mostly associated with ADRs while Cardiovascular system was the most frequently affected.

The peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) belongs to a heterogeneous class of aggressive neoplasms. Although several morphologic subtypes of this tumor have been described, no particular genetic, immunological, or distinct clinical features define this disease. Patients can experience night sweats, fever, lymphadenopathy, weight loss, splenomegaly, and/or skin changes. Common laboratory tests reveal that patients have anemia, thrombocytosis, lymphocytosis, eosinophilia, hypergammaglobulinemia, or increased lactate dehydrogenase. In this case study, a patient presented with massive lymphadenopathy and right lower limb swelling, which he developed over 6 weeks. A tissue biopsy and supporting investigations confirmed the diagnosis of PTCL, NOS.

Background & Objectives: The objectives the study was to explore the, attitude and perception of medical interns, who are in the verge of being registered medical practitioners about abortion care services in Nepal.Materials & Methods: This is a questionnaire based descriptive-cross-sectional study conducted among the 96 interns of the College of Medical Sciences. The questionnaire was semi structured consisting of questions on self-assessed educational program characteristics, attitudes and perceptions regarding abortions in the context of Nepal.Results: The response rate of the participants was 88.07%. The mean age of the respondents was 24.43±1.449 years. A total of 65 (67.7%) responded that the topic of reproductive health was adequately covered in their course of study and 31 (32.3%) opined that the topic was somewhat covered. Only two of the respondents self-assessed that their theoretical knowledge of sexual and reproductive health was very good while 68 (70.8%) told that it was good and 26 (27.1%) graded themselves as having just fair knowledge in the field. Twenty four (25.0%) responded that they had clinical practice in abortion care services during their course of study. Conclusion: The medical interns had been adequately exposed to the reproductive health though they had less clinical practice on abortion care services. The attitude and perceptions of the future health care providers should be understood to properly orient them to the clinical practice.

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Introduction: The medico legal reports and certificates prepared by doctors can be used as valuable documentary evidence in the court of law. The study was designed with objectives to explore the perception of judges and lawyers about the quality of medico legal reports prepared by the doctors and their competence in providing the expert evidence in the court. Methods: It is a questionnaire based cross sectional study conducted among the district judges and government attorneys of 75 districts of Nepal from March to May 2016. The data obtained was analysed by SPSS version 16.0. Results: Among a total of 78 participants who responded the questionnaire, 40 (51.3%) were district judges and 38 (48.7%) district attorneys. Most of them graded that the reports prepared by the doctors were just average. Among them, 49 (63.6%) strongly agreed and 28 (36.4%) partially agreed that the reports were useful in deciding the cases. A total of 44 (56.4%) respondents strongly agreed and 34 (43.6%) partially agreed that expert opinion of the doctors in the courts were useful to decide the cases. Seventy one (92.2%) of them rated general doctors as moderately competent. Conclusions: The medical reports prepared by the Nepalese doctors were just average as perceived by judges and lawyers and the competency in presenting the evidence in courts was moderate as rated by them.

Introduction: Autopsy is an important tool to determine the cause of death. This study was conducted with the objectives to assess the knowledge and perception of Nepalese people towards medico legal autopsy. Methods: It was a questionnaire based cross sectional study performed among the general public of Nepal. A standard pretested questionnaire was used to collect the responses on knowledge and perception of the people about medico legal autopsy. Independent samples t-test was used to compare the mean score of knowledge among the various groups. P value of < 0.05 was considered significant. Results: Mean age of the respondents was 29.06 years (SD = 10.50) and 72.31% were male (n = 188, N = 260). Mean score of knowledge was 6.65 (SD = 1.76) out of a total ten. The score was significantly higher (p = 0.02) among the respondents whose relatives had undergone an autopsy than those whose were not. It was comparable among the educated and uneducated groups. A total of 75.77% respondents (n = 197, N = 260) would not reject the autopsy of their relatives. Conclusion: People lack knowledge mostly in basic elements of medico legal autopsy. Most of the people showed positive perception towards autopsy and those who were negative, feared of disfigurement of the bodies after an autopsy.

Background and Objective: The study was conducted with the objectives to establish the measurements of spinal canal and lumbar vertebra at L3 to L5 region in Nepalese population. Methodology: It is a cross-sectional study among 36 patients (17 males and 19 females) having age variation from 20-60years whose abdomen was scanned by GE bright speed 16 slice CT scanner with slice thickness 10mm and then reconstructed at 1.2mm for images in different body plains for the measurement of spinal canal. Results: Almost all the parameters increase from L3 to L4 to L5 but the difference is more between L4 and L5 than between L3 and L4 except in vertebral body width (VBW) where it increases smoothly, however canal body ratio (CBR) remained constant at 0.6. All the parameters were larger in males than in females except antero-posterior dimension of canal in transverse section (APT) which is larger in females. It also shows that none of the parameters vary significantly depending upon sex except vertebral body width (VBW) at L3 which is 39.041 ± 4.1334 in males and 36.474 ± 2.8509 in females (p=0.036). Conclusion: Antero- posterior dimension in trans-verse and sagittal is almost identical but the chances of measurement error is higher in transverse due to trigonal shape of canal so AP diameter should be done in sagittal section as this is consistent and measures 14mm at L3, 14mm at L4 and 15 mm at L5 hence defining average antero-posterior canal dimension in sagittal section to be 14 mm but CBR constant at 0.6. DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12971 JCMS Nepal 2014; 10(4):6-11

The issue of medical negligence has been catching attention of many people nowadays. With advancement of technology in medical field, many incurable diseases of past time can now be managed well at the cost of burdening expenditure. This has resulted in obvious expectations to the patient and their families that any ailment can be cured from the medical procedures and therapies. When these expectations are not met in terms of complications or death of the near ones, people get frustrated and tend to allege health care providers against medically negligent.Negligence are of two types; civil negligence where the doctors are alleged to have lost simple degree of care and attention to the patients thereby causing damage whereas in criminal negligence, the doctors grossly deviate from the standard of care and competence or perform activities which are understood prima facie as a crime, for eg: performing criminal abortion, organ transplantation against the law etc.Whatever the type of negligence, there are legal measures to file complaint against the doctors who are alleged to have caused negligence. Gone are the days when people regarded doctors near to gods. Medical service also falls under the consumer protection act where the patients are the consumers and medical personnel, the service providers. The patients have rights to get quality medical service under this act. If the patients or their relatives are dissatisfied with the medical service rendered to them by the health care providers, they have the right to lodge complaint to the compensation committee of the district in which chief district officer (CDO) is the chairman in each district. If there is an issue of criminal negligence, the complaint can also be filed in the concerned court.In some circumstances, when the patient develops complications or dies, the attendants accuse the doctors for the failure in treatment and protest in the hospital premises rather than opting the legal way of charging them against negligence. The health professionals are at times threatened and forced to apologize in public. Most of the times, they demand for compensation and many direct benefits to the relatives of the deceased. The hospitals and the health professionals feel insecure and often they have agreed to the demands put forth to peacefully settle the issue and to get prevented from defamation. The government is also unable to provide security. Similar cases have been reported time and again in Nepal, creating a sense of lawlessness in the country.When deciding whether a doctor is held liable for negligence, the “standard of care” should be analysed. It means the practice should be an accepted one and standard, such that doctor of the similar filed and competence would have also opted the same procedure in given circumstances. Even when a doctor has duly acted opting standard procedure, still there can be chances that a patient can develop complications. Every human body cannot react exactly same to a medical intervention though that may be a scientifically proven one as there can be chances of medical misadventure. The doctors should have possessed reasonable degree of care and skill when he is attending the patient. According to Bolam’s test, a person is said to have inappropriate standard, and becomes negligent, if it is proven that he had failed to do what a reasonable person would do in the circumstances.1 The degree of care and skill should be comparable to an average doctor in similar settings. In order to analyse these issues, expert opinion from reputable and unbiased experts of the similar field of medicine should be taken. In case of death due to alleged medical negligence, the dead body should be autopsied by qualified experts in Forensic Medicine. This can explain so many facts about the deceased which can be helpful to decide whether negligence has factually taken. It highlights the need of taking opinion from the experts of the concerned field by the councils framed to settle the cases of medical negligence, especially the consumer protection council, Nepal Medical Council, etc.It is a high time for the government to play role to address to this sensitive and quai-legal issue. If this trend is not ended, the trust of patients towards the doctors may nullify. The doctors also cannot work effectively when there is no safe working environment and may begin to have tendency to abandon handling critical cases with a fear of vulnerability to defamation if not physical assault in worst case. The situation is ultimately disastrous to the entire health care system. The very sensitive issue of health care delivery cannot be compared to any other commercial issues. The proper mechanism of addressing the issue of medical negligence should be practiced alongside encouragement from governmental urge to come up with better medicolegal systems in this regard. This is highly essential for balancing expectations of the patients and performance of medical professionals.

Background: Liver is the largest gland in the body and it frequently gets wounded. The objective of this study was to determine the patterns, types and severities of liver injuries which were caused by mechanical trauma and to study the organs associated with liver injuries. Material and Methods: This was a hospital based, cross sectional study which was conducted on the autopsies showing the evidence of liver injuries in the mortuary of a tertiary hospital in eastern Nepal. All consecutive autopsy cases which were handled within one year’s time (n=46) were included in our study. The cases were studied in detail for liver injuries, which included age, sex, severity, associated injuries, site of the injury, description of the injury, etc. Results: The mean age of the victims was 33.87 years and there was a male: female ratio of 3.6:1. The injuries had resulted from blunt trauma in 41 (89.1%) cases, the most common of which was road traffic accidents, constituting 37(80.4%) cases. Grade III injuries were seen in 14 (30.4%) cases. Laceration of the liver was the most frequent finding that was evident in 34 (73.9%) cases. Right lobe of the liver was injured in 30 (74%) cases. The sole presence of liver injuries among abdomino-pelvic organs was seen in 14 (30.4%) cases. In 40 (87%) cases, liver injuries were associated with other regional injuries. Conclusion: Laceration is the most common liver injury among autopsy cases. Right lobe is mostly affected and grade III injuries are the most common ones. Liver injuries are frequently associated with other abdomino-pelvic organs and multiple regional injuries.

Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 1-2

Background: Substance abuse by medical students poses a significant risk not only on their personal life but also on their professional life by putting their patients at risk. Our study aims to find out the prevalence of substance abuse and factors associated with it among medical students. Methods: An online-questionnaire based, cross-sectional, analytical study was carried out at Gandaki Medical College, a medical school in Gandaki Province of Nepal. Whole sampling technique was used. SPSS-25.0 software was used for statistical analysis. Descriptive statistics were used for analyzing demographic and substance abuse related variables. Chi square and Fishers exact test was used to find out if any differences existed in substance abuse by demographic characteristics. Results: Among 420 eligible participants, 219 participated in the survey (response rate: 52.2%). Alcohol was the most commonly used substance with overall lifetime prevalence of 58% followed by cigarette smoking and illegal drug abuse at 21.9% and 13.7%, respectively. The abuse of substances was significantly higher (p Conclusions: The prevalence of substance abuse was high among medical students and was found to be associated with male gender, if offer of substances were made by friends, and amongst those who worked with an intoxicated colleague. This problem of substance abuse among medical students should be addressed timely as failing to do so might have serious consequences on the healthcare system of the country.

Background: Substance abuse by medical students poses a significant risk not only on their personal life but also on their professional life by putting their patients at risk. Our study aims to find out the prevalence of substance abuse and factors associated with it among medical students. Methods: A descriptive, online-questionnaire based, cross-sectional study was carried out at Gandaki Medical College, a medical school in Gandaki Province of Nepal. Whole sampling technique was used. SPSS-25.0 software was used for statistical analysis. Descriptive statistics were used for analyzing demographic and substance abuse related variables. Chi square and Fishers exact test was used to find out if any differences existed in substance abuse by demographic characteristics. Results: Among 420 eligible participants, 219 participated in the survey (response rate: 52.2%). Alcohol was the most commonly used substance with overall lifetime prevalence of 58% followed by cigarette smoking and illegal drug abuse at 21.9% and 13.7%, respectively. The abuse of substances was significantly higher (p Conclusions: The prevalence of substance abuse was high among medical students and was found to be associated with male gender, if offer of substances were made by friends, and amongst those who worked with an intoxicated colleague. This problem of substance abuse among medical students should be addressed timely as failing to do so might have serious consequences on the healthcare system of the country.