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The aim of this study is to explore the experiences of women at Hazaratbal shrine in Kashmir also known as Madinut-ul-Sani (second Madina). In spite of growing interest of scholars in sacred tourism research, little efforts are made to examine female perception of holy shrine experiences. The authors collected data through interviews and participant observation of female pilgrims/visitors, at the shrine. The theoretical base of the study is the phenomenological work of Schultz. After the completion of analysis, five main categories of perceptions appeared which attract women visitors to Hazaratbal shrine namely prayer and worship, thanksgiving, healing, learning and heritage.

The Asiatic Golden Cat Catopuma temminckii is poorly studied in Peninsular Malaysia. We deployed 12 camera traps to assess the wildlife diversity in the unprotected State Land Forest of Merapoh, Pahang State. During the period from August to October 2019, one Asiatic Golden Cat was photographed at a single camera trap station. This record outside the protected area network emphasizes the importance of wildlife corridors. This State Land Forest is located between Forest Reserve and Taman Negara National Park. Therefore, appropriate conservation measures must be taken in order to maintain this site as a wildlife corridor.

Objective: To compare the outcome of standard wound care vs standard wound care with transverse distractive osteogenesis in chronic non-healing wounds of foot and ankle secondary to chronic limb ischemia. Design: A Prospective Randomized Controlled Trial Settings: Department of Orthopedics, Department of Surgery, Department of Emergency Medicine, BPKIHS, Dharan. Background: Many options are available for treatment of chronic wounds. The major hurdle for non-healing chronic wounds is the reduced vascular supply to the affected limb. This study tries to find out the true beneficial effect of transverse distractive osteogenesis which is proposed to increase vascularity and thus helping in healing of wounds. Methodology: 24 patients (From April 2017 – April 2018) were randomized to fall into two equal groups (12 each) for intervention. Group A wound receive standard wound care and Group B wound receive standard wound care combined with transverse distractive osteogenesis with Ilizarov apparatus. They were followed 3 months and assessed for various parameters for wound improvement. Results: There were total 24 patients (male n=13 and female n=11) with 12 in each group. There was no difference in age, gender, cause, timing of presentation between the two groups. Diabetic foot (75%, n=18) dominated the main cause. There was no statistical significance in Bates-Jensen wound Assessment score in initial 1 month of assessment. However, at 3 months, the mean BWAT score was 22.91 in distraction group vs 35.25 in standard wound care group; which was statistically significant (p=0.001). In the distraction groups, 2 patients had major complication of pin-tract infection and osteotomized part being sequestrum and had to be removed at 3 months. Definitive Wound closure was possible with split skin graft in 14 cases (37.5% vs 20%) and 2 reverse sural flaps (8.3%). All patients had positive culture result with monomicrobial status (74%) vs polymicrobial status (36%). No significant improvement in pain in patients with Burger’s disease was obtained. Conclusion: Distractive Angiogenesis greatly enhances the healing potential of wound secondary to chronic limb ischemia. However, the carries significant learning curve.

Epidermoid cysts are rare benign neoplasm accounting for less than 1% of all intra-spinal tumors. Congenital epidermis cysts are frequently found with syringomyelia, dermal sinus and spina bifida. Most common etiology for an acquired cyst is repeated lumbar puncture. Congenital epidermoid cysts, often associated with other spinal dysraphisms, are caused by the anomalous implantation of ectodermalcells during closure of the neural tube between the third and fifth week of embryonic life. This is a very rare case. With all these characteristics and literature review, we report this case for its rarity and unique characteristics in this part of world (Nepal). These patients commonly present late to the hospital.

Introduction: Displaced distal radius fractures are very common injuries and present regularly to all orthopaedic surgeons. Several documented treatment modalities for these fractures have been described with a recent trend for internal fixation with volar plating. However, the literature suggests that there is still no consensus as to the best treatment of these injuries. Distal radius fractures are among the most common bone fractures all over the world. Close reduction and fixation by percutaneous pinning is a less invasive method comparing with other open surgeries. There is still a dearth of prospective randomized trials in this area. Before the advent of volar locking plates the randomized trials for surgical interventions for distal radius fractures show some evidence to support the use of external fixation or percutaneous pinning however their precise role and methods are not established and whether this will produce consistently better long-term outcome is also not clear. Aim & Objective: To compare percutaneous pinning versus volar locking plate in treatment of distal radius fractures in adults in term of: fracture union, post operative pain, functunal outcome, post operative complication (stiffness, CRPS). Materials and Methods: It is Randomised Controlled Trial Study. All Adults Patients aged 16 and above with displaced distal radius fractures fpresented to the Emergency department and out Patient Department of Orthopaedics at BPKIHS from August 2010 to September 2012 were included in the study. Results: 60 patients with fracture distal end of radius who met the inclusion criteria were included in the study, out of which 30 were randamized into group A, treated by closed reduction and percutaneous fixation supplemented by cast and 30 in group B, treated by volar locking plate. The study showed mean age of incidence to be 39.22+- 14.49 years in age group ranging from 16-65 years. In our study we found that the injuries were result of high energy trauma with RTA constituting the commonest mode of injury (75%) followed by fall from height (15%) and play ground injuries (10%). Males constituted the majority of the study population(67%). Age, sex, mode of injury, type of fracture, interval to surgery duration and associated co-morbidities were equally distributed between the two groups showing success of randamization. There was a highly significant diference in the operative ime and blood loss between two groups, illustating that percutaneous fixation is much shorter procedure with mean operative time of 30 mins compared to 60mins of ORIF with volar locking plate and has less blood loss being 5-10ml to 145ml of ORIF with volar plating. Conclusion: ORIF with volar locking plating provide better radilogical outcomes with more stable fixation thus lesser degree of loss of reduction in comparation to percutaneous pinning. It also had better ROM at wrist initially however this difference is not significant in later months. Volar locking plate is more expensive with more operative time and blood loss as compared to pinning.

Background: Traumatic wounds are common cause of morbidity in Orthopaedic patients. There can be associated injury to various vital structures i.e bones, muscles, tendons, nerves and vessels. Despite recent advances in wound care, the challenge of managing chronic wounds remains compounded by a lack of consensus on clearly defined wound care principles. Methods: A randomised controlled trial was used to enrol 130 patients, out of which 65 underwent EUSOL dressing and 65 underwent collagen granules dressing, all the cases were admitted in Orthopaedics ward and were only discharge at the end of treatment or study period whichever was earlier, so there was no loss to follow up. Assessment of wound was done every week for a period of 4 weeks in terms of slough, discharge, granulation tissue, outcome and coverage. Results: Discharge from the wound was found to be lesser in collagen granules group and by the end of 3rd and 4th week it was significantly lesser in collagen granules group (P value

Background: Close reduction and intramedullary fixation of fracture shaft femur proposed by Kuntscher, is the most biological way of treating the fracture shaft femur. But an open version of this procedure, by which the fracture is stabilized by opening the fracture site and fixing it by retrograde method, became popular because of less complication and more predictable operating time. With the development and emergence of image intensifier and modification in the technique, the locked intramedullary gained popularity. Locked intramedullary nailing can be inserted in a static or dynamic fashion. Aim and Objectives: To compare outcome of open versus closed interlocking nail for fracture shaft of femur in Adults in term of: union, Blood loss, infection rate, functional outcome, Complications if any. Methods and Materials: It is Randomised Controlled Trial Study. Randamization was done using Excel random number generation technique into two groups, each of size 40. Group A:- Diaphyseal fracture treated with closed methods. Group B:- Diaphyseal fracture treated with open methods. Sample size: 40 in each group Results: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Discussion: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Conclusion: Closed IMIL nailing group needs fracture table and image intensifier. Operating time and blood loss is more in Open nailing group. Cost of treatment and union is comparable in both groups. Infection is more in open group as compared to closed group.

The patella is a rare site of primary tumors. Tumors in the patella represent 0.12% of all bone tumors. Majority of tumors are benign [1]. The most frequent benign patellar tumor is giant cell tumor (GCT). Here, we present case report of a giant cell tumor (GCT) occurring in the patella in a 32-year-old woman, who had presented to the Orthopaedic Department of B.P. Koirala Institute of Health Sciences, Dharan, Nepal with the complaint of occasional right anterior knee pain and swelling for 1year. Considering its rarity and unique characteristics, we thought that this case needs to be reported. In this part of world (Nepal) patients commonly present late to the hospital.

Objectives: Traumatic wounds are one of the common causes of morbidity in orthopaedic patients. To this date there is no RCT available that compares the healing potential of Edinburgh University Solution of Lime (EUSOL) with mupirocin in collagen granules and Metronidazole (Co-Mupimet®) as dressing[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

To date, much of the information on the clouded leopard study were more focus on Sunda clouded leopard. With the advance of technology, the use of camera trap had enhanced the opportunity for all researchers to study more deeply on species of interest in more intensely larger scale and cost benefit. This paper presents the density estimate of clouded leopard in Gunung Basor-Stong Utara Forest Complex (GB-SUFC). A total of 19 individuals of clouded leopard (14 males, 5 unknown) had been identified. Based on the spatial explicit capture-recapture model (SECR). The estimate density of the clouded leopard in GB-SUFC was (D^±SE) 1.15±0.35 adult clouded leopard/100km2. Results from this study will serve as an important baseline on the population density of clouded leopard in GB-SUFC and provides more information on clouded leopard population and ecology especially in Peninsular Malaysia and could also potentially guide and assist the authorities in formulating crucial conservation plans for this threatened species.