NepMed Repository :: Browsing by Author "Baral, P"

Browsing by Author "Baral, P"

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A Study of the relationship of structures at Mandibular Foramen
(Institute of Medicine, 2014) Baral, P; Bastola, D; Shrestha, RN
Abstract Introduction: Mandibular foramen is located on medial aspect of ramus of mandible. Inferior alveolar artery and nerve enters into the foramen and inferior alveolar vein comes out of it. Dissection studies on 16 male and 4 female cadavers suggested that inferior alveolar nerve was medial to inferior alveolar vessels and inferior alveolar artery was anterior to inferior alveolar vein. Knowledge of interrelationship of structures at mandibular foramen is important for dental surgeon or oral surgeons while giving the inferior alveolar nerve block. Keywords: mandibular foramen, inferior alveolar nerve, inferior alveolar artery
Calvarial Thickness of the Nepalese Dry Skulls
(Institute of Medicine, 2015) Baral, P; Koirala, S; Bajracharya, S; Jha, CB; Banstola, D; Shrestha, RN
Abstract Introduction: Calvarium of skull comprises frontal,parietal and occipital bone.These bones cap over the brain in cranial cavity. These bones are flat bones having outer and inner tables made up of compact bone. There is cancellous bone called as diploe in between the outer and inner table. The aim was to measure the thickness of calvaria at various points on Nepalese skull and establish Nepalese database of calvarial thickness and also to compare thickness on the right and left side for bilateral points. Methods: Around140 calvaria of dried skull were studied. Thickness of various points on the frontal, parietal and occipital bones that form calvaria were measured with spreading caliper. The inner table, diploe and outer table thickness were measured with vernier caliper. Results: The mean thickness of frontal bone is 5.6 ± 0.8 mm;out of which the outer table 1±0.2mm, the inner table 0.8±0.3mm and the diploe 3.8±0.6mm.The mean thickness of parietal bone is 4.5±0.6 mm; out of which the outer table 0.8±0.2mm, the inner table 0.6±0.2mm and the diploe 3.1±0.4mm. The mean thickness of occipital bone is 8.5±0.7 mm;out of which the outer table 2.2±0.4mm, the inner table 1±0.3mm and the diploe 5.7±0.6mm.There is significant difference in the mean thickness of the frontal, parietal and occipital bone(p<0.05). Theoverallmean thickness of the calvarium is 6.5±0.7 mm;out of which the outer table 1.5±0.3mm, the inner table 0.8±0.2mm and the diploe 4.5±0.5mm.The outer table is significantly thicker than the inner table(p<0.05). Conclusion: All these results indicate that the calvarium is not uniform in thickness and there is increased thickness towards the posterior and the outer table is thicker than the inner table. Keywords: calvarium, outer table, diploe, inner table
Dorsal Metacarpophalyngeal Dislocations of Thumb in Children-Clues to the Clinical Decision Making and a Dorsal Approach to Open Reduction
(Kathmandu University, 2018) Baral, P
ABSTRACT Dorsal Metacarpophalyngeal joint dislocation of thumb in children is a rare occurrence. All the three different types, namely Simple Complete, Complex Complete and Incomplete dislocations have been described in this article with clinical and radiological clues to differentiate the closely reducible (simple) dislocations from irreducible ones (complex). A simple approach to treatment decision making has been adopted for all cases, starting with attempt of closed reduction which if fails, moving to open reduction. First case is a simple dorsal dislocation presenting after fall injury with hyperextension deformity of thumb Metacarpophalyngeal joint that was reducible by closed maneuver. Second case presented with pain and inability to move thumb Metacarpophalyngeal joint, with less marked deformity than the first case. Closed reduction failed and open reduction was done with dorsal approach to the metacarpophalyngeal joint joint after volar plate interposed in the metacarpophalyngeal joint was pushed anteriorly. Third case was an incomplete dorsal dislocation that was reduced closed. Dorsal metacarpophalyngeal dislocation of thumb in children is rare injury. Diagnosis needs a high index of suspicion ascomplex dislocation can be missed due to less obvious deformity. Dorsal approach to open reduction of complex dislocation is a direct and reliable approach. KEY WORDS Dislocation, Joint, Metacarpophalyngeal, Volar plate
How to uphold standards of medical education in Nepal: Some recommendations
(Kathmandu University, 2009) Baral, P
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Knowledge, Attitude and Practice of Health Care Institutions and their Staff Involved in Hospital Solid Waste Management
(Institute of Medicine, 2017) Banstola, D; Banstola, R; Nepal, D; Baral, P
Abstract Introduction: Knowledge, attitude, and practice (KAP) among health care workers are first key steps in developing a successful infection control program. Without good knowledge, attitude and practice, hospital waste cannot be managed effectively. The hospital waste possesses specific problems due to presence of sharps, infectious and hazardous materials in it. The unmanaged hospital solid wastes not only affect patients, attendants, nurses and medical personnel but also have impact on general population, scavengers and sanitary personnel handling waste. On account of lack of knowledge, attitude and practice of health care institutions and their staff, hospital solid waste can be a source for transmission of infectious diseases like AIDS, Hepatitis B, Hepatitis C, Tetanus, Diarrhea, Tuberculosis, Cholera and so on. Methods: It is a descriptive cross-sectional study conducted among the waste management staff working in 14 health care institutions (HCIs) of Pokhara Sub-Metropolitan City, Kaski district, Nepal. Semi- structured, self administered questionnaire consisting of questions on knowledge, attitude and practice on hospital waste management were prepared for conducting in-depth interviews and information was recorded as provided by key respondents. Housekeeping officer, senior nurse and senior waste collector/handler of each sampled health care institutions were taken as key respondents to collect information for questionnaire survey. Results: This study assigned that 21.43% of housekeeping officers, 35.71% of senior nurses and 28.57% of senior waste collectors received training on hospital solid waste management. Out of the 14 HCIs surveyed, 100% of them were provided with face mask and utility gloves; 35.71% were provided with boots; 14.28% were provided with plastic apron and trousers; 7.14% were provided with eye protector and no single institution provided helmet, long sleeved shirt and respirator to waste handling staff. The study also examined that 35.71% of housekeeping officers, 50% of senior nurses, and 14.29% of senior waste collectors were vaccinated against Hepatitis B. On the other hand, 85.71% of housekeeping officers, 85.71% of senior nurses, and 71.43% of senior waste collectors were vaccinated against Tetanus. Conclusion: Knowledge, attitude and practice on hospital solid waste management were not given due attention by the HCIs and their staff involved in hospital waste management. The waste handlers were unaware about their health. The lack of awareness and accountability from actors in health care waste management lacked of well trained human resources were the major challenges to promote effective health care waste management system. Hospital solid waste management should be operated by well trained and well motivated personnel. Key respondents who should be one of the group of actors in each health care institution (HCI) should be related to waste management field and well trained to understand architecture, and chemistry of the problem. Key words: Attitude, knowledge, hospital staff, practice, waste management
Management of Hospital Solid Wastes: A study in Pokhara Sub- Metropolitan City
(Institute of Medicine, 2017) Bastola, D; Bastola, R; Nepal, D; Baral, P
Abstract Introduction: Hospital waste can be defined as the total waste stream that is generated from health care establishments. Health care wastes usually consist of sharps, human or animal tissues or body parts, their body fluids and other infectious materials produced during the course of treatment. Methods: For the purpose of the study, population was defined in terms of the medical hospital, having inpatient facilities located within Pokhara Sub-Metropolitan City (PSMC). The total numbers of health care institutions (HCIs), having inpatient facilities, were 14 and all were sampled for the study. Questionnaires were prepared to meet the objectives of the study. Results: Various categories of health care waste have been generated in the health care institutions of PSMC which depend on size of individual health care facility, types of medical specialties practiced, and nature of HCIs. Waste generated from health care activities have been categorized as general or non-hazardous waste, and hazardous waste and are separately segregated into 4 different categories, like general waste, infectious wastes, sharps, and saline bottles. Conclusion: Most health care institutions in Pokhara Sub-Metropolitan City depend upon the municipality services for the disposal of health care waste materials collected. The municipality disposed the waste without any segregation and treatment in the sanitary land fill site treating them as a municipal solid waste. There is no separate mechanism for the proper treatment of medical wastes. There should be integrated waste management system and centralized waste management system managed by the municipality under health care waste management act to solve the gravity of problems. If it is not improved the problem of serious environmental health problem will arise in future thus an appropriate management of hospital solid waste should be undertaken. Keywords: hospital waste, health care institution, waste management
Multiple arterial anomalies in upper limb
(Kathmandu University, 2009) Baral, P; Vijayabhaskar, P; Roy, S; Kumar, S; Ghimire, S; Shrestha, U
Abstract An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver . The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words : Axillary artery, Brachial artery, Radial artery, Ulnar artery, Palmar arch, Variations
Radiological Assessment of Femoroacetabular Impingement Morphology Using Computed Tomography in Asymptomatic Young Population
(Kathmandu University, 2025) Koirala, S; Gupta, MK; Baral, P; Adhikari, K
ABSTRACT Background Femoroacetabular impingement is regarded as precursor of osteoarthritis. Various studies have discussed the prevalence of femoroacetabular morphology but only few studies have been done on asymptomatic population using cross-sectional imaging. Objective To determine the prevalence of femoroacetabular impingement morphology in young asymptomatic population on computed tomography. Method This cross-sectional study was done in 200 individuals who underwent computed tomography for abdominal pathologies without any symptoms of hip pain, hip pathology or osteoarthritis. Multiplanar images were reformatted and assessed for the presence of parameters associated with femoroacetabular impingement; alpha angle greater than 55°, femoral head-neck offset less than 8 mm, angle of acetabular version less than 15°, lateral center edge angle greater than 40°. Result At least one of the femoroacetabular impingement morphology was detected in 162 hips. The prevalence of abnormal hip joint was higher in male patients than in female patients (47.3% vs 31.8%). Prevalence of cam morphology was 14.5%, pincher was 17.5% and mixed morphology was 8.5%. Prevalence of cam and mixed morphology were common in male hips however there was no statistically significant difference in prevalence of pincher morphology between male and female hips. Conclusion Femoroacetabular morphology was noted with high frequency in asymptomatic young population on computed tomography. Diagnosis of femoroacetabular impingement syndrome should be based on combination of clinical and radiological findings. KEY WORDS Alpha-angle, Cam, Femoroacetabular impingement, Pincher
Supernumerary head of biceps brachii: A rare occurrence in the Nepalese population
(Kathmandu University, 2008) Vijayabhaskar, P; Baral, P; Vaishya, R; Shrestha, RN
Abstract Unilateral three headed biceps brachii muscle was observed in the dissected cadaver of a 45-year-old Nepalese cadaver. The supernumerary head is taking origin from the tendon of deltoid and crossing in front of the long head of biceps and joining with short head of biceps brachii. The incidence of this variation is very rare and there was no available literature in Nepalese population. Presence of such variation should be kept in mind by Surgeons and Traumatologists. Key words: Biceps brachii muscle, Supernumerary head

Browsing by Author "Baral, P"

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