Browsing by Author "Khanal, K"
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Publication Airborne Particulate Matter and Health Condition in Brick Kiln Workers in Kathmandu Valley, Nepal(Kathmandu University, 2016) Sanjel, S; Khanal, SN; Thygerson, SM; Khanal, K; Pun, Z; Tamang, S; Joshi, SKABSTRACT Background Air quality monitoring in brick kilns indicates very high concentrations of airborne particulate matter. Air pollution from brick kilns poses an enhanced threat to the environment and to human health. Objective To evaluate airborne particulate matter concentration and health status of brick kiln workers. Method A cross-sectional comparative study was conducted in the Kathmandu valley targeting all brick industries and their workers during January - March 2015 and March - April 2016. A total of 16 brick kilns and 800 participants (400 brick workers as exposed and 400 grocery workers as referent) were selected for study. A direct-reading, Dusttrak model 8533 was used for air sampling. Nepali version questionnaire was applied to obtain epidemiological data. SPSS version 16 was used to perform statistical analysis. Median, mean, range and proportion were calculated and Mann-Whitney U test, Kruskal-Wallis test and chi square (c2) test were applied to test significance. Result Mean values of particulate matter concentrations for brickfields were as follows: Total Suspended Particulate Matter (TSPM): 5.179 mg/m3, PM10: 4.958 mg/m3, respirable suspended particulate matter (RSPM): 4.140 mg/m3, PM2.5: 3.965 mg/m3, and PM1: 3.954 mg/m3. The mean concentrations for grocery workers were; TSPM: 0.089 mg/ m3, PM10: 0.089 mg/m3, RSPM: 0.085 mg/m3, PM2.5: 0.082 mg/m3 and PM1: 0.082 mg/m3. Among brickfield workers, red and green brick loading zones had results that exceeded the ACGIH Threshold Limit Values for TSPM and RSPM. Workers complaints of injury were 52% and 44.2%, and illnesses were 88.5% and 82.2%, respectively among exposed and referent. The occurrence of injuries/illnesses during work showed significant association between exposed and the referent groups at 0.05 level. Conclusion The high level of airborne particulate matter in the brick fields requires action for the protection of workers. The availability of health services within brick industries needs to be enhanced. KEY WORDS Brickworks, environment, health conditions, Nepal, particulate matter concentrationPublication Assessment of Knowledge Regarding Oral Hygiene among Parents of Pre-School Children Attending Pediatric Out Patient Department in Dhulikhel Hospital(Kathmandu University, 2015) Khanal, K; Shrestha, D; Ghimire, N; Younjan, R; Sanjel, SABSTRACT Background Level of knowledge regarding oral hygiene among the parents of pre-school children plays an important role on maintaining the good oral hygiene of their children. In Nepal, sufficient research has not been carried out on this area. Objective Objective of this study is to assess the level of knowledge on oral hygiene of pre- school children’s parents attending pediatric outpatient department in Dhulikhel Hospital. Method A descriptive study was conducted from November 2012 to January 2013 among one hundred parents of preschool children visiting pediatrics outpatient department of Dhulikhel Hospital. Paper and pencil based semi structured questionnaire was used for collecting data. Questions related to demographic information and knowledge were asked. Thirty questions were used for assessing knowledge level. Knowledge score was calculated by allocating one point for each correct answer and zero point for each wrong answer. Analyzed data were presented in terms of numbers and percentages. Total knowledge scores were categorized based on percentage. Knowledge score was categorized on four group - exclusive intervals - namely-poor (0-40%), moderate (40-60%), good (60-80%) and excellent (80-100%). Mann-Whitney U test and Kruskal-Wallis test were applied to check significance difference and chi- square test was used to check association among different background characteristic. Result It was found that 81% had moderate knowledge, 15% had poor knowledge and 4% had good knowledge about oral hygiene. Median knowledge score was found to be 15 with range 10 to 21. Following variables were found to be significant difference on knowledge category: Education status (p<0.001), education level (p= 0.041), past experience about oral health problem (p = 0.008), Further significant association was found between knowledge category and educational status (p < 0.001) and between knowledge category and past experience (p < 0.001). Conclusion Knowledge regarding oral hygiene was found satisfactory among the parents of preschool children visiting pediatric OPD of Dhulikhel Hospital. KEY WORDS Knowledge, oral health, parents, pre-school childrenPublication Assessment of Nutritional Status of Children Under Five years of age in rural Nepal(Kathmandu University, 2016) Chataut, J; Khanal, KABSTRACT Background Nutritional status of children is one of the major predictors of child survival. However, malnutrition is a major public health problem in most of the developing countries and occurs prominently among under-five children. In context of Nepal, nearly 37% children are suffering from underweight, 41% from stunting and 11% are suffering from wasting. These children are at a substantially greater risk of severe acute malnutrition and death. Objective The objective of the study was to assess the nutritional status of children under five years of age and to find the factors associated with malnutrition. Method A cross-sectional study was conducted in Dolakha and Kavre districts of Nepal for assessing the nutritional status of under-five children and associated factors. A total of 243 under five children were included from two purposively selected village development committees (VDCs) i.e. one from each district. Statistical Package for the Social Sciences (SPSS) 22 Version and ENA Software Version 2011 were used for analyzing the data. Result Out of 243 children, according to WHO based on weight for height assessment, 17 (7.0%) were wasted, in height for age analysis, 97 (39.9%) were stunted and in weight for age assessment, 46 (18.9%) were underweight. Conclusion In the study population, there is high prevalence of malnutrition, especially stunting among under-five. Taking into account weight, height, age, and mid upper arm circumference (MUAC) measurements of malnourished children more than three- fifths of them were found below -2SD and nearly one-fourths below -3SD which needs intervention. KEY WORDS Associated factors, nutritional status, under-five years childrenPublication Assessment of the Knowledge and Attitude on HIV/AIDS Among Drivers’ Wives(Kathmandu University, 2012) Prajapati, LM; Sanjel, S; Khanal, KABSTRACT Backgroud It is generally accepted and well-documented that long distance drivers remain one of the key forces in the spread of HIV/AIDS as they are highly mobile and spending long hours on the road away from their families which makes them very likely to use the services of commercial sex workers (CSWs). Objectives To identify the knowledge and attitude among Drivers’ wives on HIV/AIDS. Methods A cross-sectional survey was conducted between August and September 2010 to assess the knowledge and attitude of drivers’ wives on HIV/AIDS in Banepa, Dhulikhel and Panuti Municipalities, Kavre district central Nepal. Using social network sampling technique 248 drivers’ wives were selected. Data were obtained using the structured and semi-structured questionnaire through interview technique. Verbal consent was taken before collecting data. Both descriptive and inferential statistics were computed. Results Ninety six percent of the respondents heard of HIV/ AIDS. Majority (65.7%) of the sources of the information were television followed by radio (56.5%), friends (33.5%), husband (19.4%), newspapers (17.7%) and posters (17.3%). The educational status and economic status of the respondents show significant association. The parameters regarding attitude revealed statistical significant. Conclusion The age and ethnicity of the respondents did not exhibit the association with awareness on HIV/ AIDS whereas, educational status and economic status of the respondents and the parameters regarding attitude revealed statistical show significant association. KEY WORD AIDS, attitude, drivers’ wives, HIV, knowledgePublication Association of Cardiovascular Risk Factors and Coronary Artery Lesion Among Coronary Artery Disease Patients(Kathmandu University, 2014) Koju, R; Humagain, S; Khanal, KABSTRACT Background Coronary artery disease (CAD) is associated with the numbers of risk factors causing coronary atherosclerosis. Coronary artery stenosis is mostly caused by coronary atherosclerosis. Objective This study aims to analyze the association between coronary artery stenosis and cardiovascular risk factors. Methods An observational study was conducted among CAD patients. The diagnostic coronary angiogram was performed from femoral approach using standard catheters and techniques to find out any abnormalities. Result A total 73 patients (44 male and 29 female) with coronary artery disease undergoing diagnostic coronary angiography was included with the documented cardiovascular risk factors. The coronary stenosis was found in 40 patients on the basis of stenosis grading. Among the established cardiovascular risk factors, sex, diabetes mellitus and smokers show are significantly associated with coronary stenosis among CAD patients. The present study shows the significant association of coronary stenosis among male CAD patients (OR 2.47; CI 0.94 – 6.48, p <0.05) and similar association has been observed in diabetes mellitus (OR 3.32; CI 1.12 – 9.84, p <0.05) and smoking (OR 4.10; CI 1.45 – 11.61, p <0.01). Conclusion The prevalence of CAD is increased with numbers of presence of cardiovascular risk factors. Male gender, diabetes mellitus and smoking are significantly associated with coronary stenosis among CAD patients. However, hypertension and dyslipidemia are comparable between coronary stenosis and no significant stenosis group. KEY WORDS Acute coronary syndrome, coronary angiography, coronary artery disease, stable anginaPublication Awareness Regarding Preventive Measures of Avian Influ- enza Among the Adult People of Thimi Municipality, Nepal(Kathmandu University, 2013) Manandhar, K; Chataut, J; Khanal, K; Shrestha, A; Shrestha, S; Shrestha, SABSTRACT Background Avian influenza is considered as a threat to global public health. Prevention and control depends on the awareness of the general population as well as high risk- groups. The avian influenza should be viewed more seriously because it may lead to pandemic influenza when the virus mutates its strain with the common human influenza. Thus, this study aims to explore the awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. Objective The objective of this study was to explore awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. Methods It is a cross-sectional, population based study. It was carried out in Thimi Municipality from May 15 to June 15, 2012. Pre tested structured questionnaire was used for face to face interview with randomly selected 250 subjects. Results Out of 250 subjects, 123 (49.2 %) were males. The mean age of subjects was 36 ± 11.8 year. Among total subjects, 94.4 percent had heard about avian influenza. The main source of information was television (94.1%). Majority of subjects (84.9 %) thought that keeping infected birds and poultry as the mode of transmission followed by eating not well cooked poultry meat (82.8 %). Out of total study subjects, 165 (66.0 percent) mentioned fever and 138 (55.2 percent) thought fatigue as the signs and symptoms. As for knowledge about preventive measures, majority (85.6%) stated that cleaning the surfaces that had come in contact with the poultry could prevent the disease and 83.2 % had knowledge that the infection could be prevented by washing hands with soap and water after poultry handling. Awareness regarding preventive measures was found significantly low in females, middle adults, illiterates, and house wives. Conclusion The awareness regarding avian influenza was quite satisfactory among the adult people of Thimi Municipality. However level of awareness was seen lower in female, illiterate and middle adult. So that along with large scale mass education, there should be specific health education program for the specific group of population. KEY WORDS Awareness, avian influenza, preventive measuresPublication Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, I; Shrestha, BL; Khanal, K; Amatya, RCMABSTRACT Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome. Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post- operative symptoms scores. Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (ρ =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation. KEY WORDS Eagle’s syndrome, elongated styloid process, three dimensional computed tomographyPublication Publication Education: The Key to Curb HIV and AIDS Epidemic(Kathmandu University, 2013) Bhatta, DN; Aryal, UR; Khanal, KABSTRACT Overwhelming impact has been established among different aspects and burden of incurable HIV and AIDS is increasing day-by-day globally. The aim of this article is to discuss the potential benefits and strengths of an education system in the absence of remedy and help to develop future strategies. Education has great impact on HIV and AIDS and vice-versa. An education plays a vital role to curb the transmission of HIV and AIDS thorough capacity building, provides information, reduces vulnerability, empowerment, improve life skill, maintain equity, reduce dependence, stigma, and discrimination, where are abundance foundations for HIV infection. HIV and AIDS has role for devastation of education system and level which has great impact on productivity, economic growth, demand, supply and daily life of human being. Low and middle income countries needs to be improve recording and reporting systems related to impact of HIV and AIDS on education. By analyzing preceding evidences, policy makers or governance feels to reformulate policies relating to education and health. Evidence based policy and program will be more useful to address distressing squall of epidemic. KEY WORDS Education, hope, impact HIV and AIDSPublication Estimation of Stature from Foot Length in Adult Nepalese Population and its Clinical Relevance(Kathmandu University, 2012) Mansur, DI; Haque, MK; Sharma, K; Karki, RK; Khanal, K; Karna, RABSTRACT Background Stature is the height of the person in the upright posture. It is an important measure of physical identity. Interrelationships among different body measurements may be used to estimate one from another in case of missing body parts. Objective Stature is an important indicator for identification. There are numerous means to establish stature and their significance lies in the simplicity of measurement, applicability and accuracy in prediction. The current study dealt with developing a regression equation for stature estimation from foot length and to find out the correlation between body height and foot length of Nepalese people. Methods The present study was carried out to establish the regression equation and correlation coefficient between individual’s height and mean foot length. It was conducted on 440 students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Body height and foot length were measured in centimeter. Results There was significant correlation between height and foot length (r = 0. 703, p < 0.01).The regression equation for height and foot length was found to be Y = 3.179 X + 87.65, where X is the foot length and Y the height. Conclusions This study will help in medico-legal cases in establishing identity of an individual and this would be useful for Anatomists and Anthropologists to calculate stature of adult Nepalese based on foot length. KEY WORDS Age, body height, correlation coefficient, foot length, regression equation and its coefficient.Publication Histomorphological Profile of Colonoscopic Biopsies and Pattern of Colorectal Carcinoma in Kavre District(Kathmandu University, 2013) Rajbhandari, M; Karmacharya, A; Khanal, K; Dhakal, P; Shrestha, RABSTRACT Background Colonoscopy is the method to visualize the mucosa of the entire colon and terminal ileum to detect the intestinal abnormalities and obtain biopsy for definitive diagnosis. For clinical decisions in the diagnosis of various colonic lesions unambiguous interpretation of colorectal biopsies is necessary. Objectives To assess the prevalence pattern of colonic diseases and to correlate the incidence of colorectal carcinoma with age, sex, site and symptoms presented at Dhulikhel Hospital. Methods The materials consisted of 126 biopsies which were submitted to the Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, during the period of July 2011- July 2012 .Data collected and entered in MS-Excel and were analyzed using SPSS-16. Results Out of 126 colonoscopic biopsies 34(27%) showed chronic nonspecific inflammation, followed by carcinoma 25(19.8%), non-neoplastic polyps 21(16.7%), granulomatous inflammation 14(11.1%), neoplastic polyps 8(6.3%), ulcerative colitis 4(3.2%) Miscellaneous lesions; Acute focal colitis, Eosinophilic colitis were also observed in 19 (15.1%). A higher frequency of colonic diseases in males with a male to female ratio of 1.4:1 and age range of two years to 84 years was observed. Out of 25 patients diagnosed with colorectal carcinoma,48% (n=12) were males and 52% (n=13) were females with a mean age of 55.17 years in men and 59.46 years in females. Male and female ratio among cancer groups was 1:1.08. Total 36% (n=9) were diagnosed with cancer before the age of 50. Out of these nine cases, 6( 66.7%) were males and 3(33.3%) were females. The male and female ratio in younger and older age groups were 2:1 and 1:1.7 . 17( 68%) of the lesions were left sided and 8(32%) were right sided. Below age 50 , left to Right sided lesions in males were 2:1 and in females 1:2. However, above 50 years the ratio among proximal and distal lesions were 5:1 in males and 2.3:1 in females. A statistically significant association was seen between the growth (p=0.000) and per rectal bleeding (p= 0.006) with carcinoma. Conclusion The most prevalent lesion in colorectal biopsies was non-specific colitis followed by carcinoma colon. The incidence of colorectal carcinoma is on rise in Nepalese society. Although colorectal carcinoma is more common in older age group the incidence are also increasing among young especially among women. KEY WORDS Colonoscopy, colorectal carcinomaPublication Knowledge and Practices on Preventive Measures of Blood Borne Diseases Among Non-Medical Attendants Working in Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2013) Sanjel, S; Tuladhar, S; Khanal, KABSTRACT Background Blood and certain body fluids pose the greatest threat to health due to sharp injuries spreading blood borne pathogens that cause serious illness when transmitted. Despite the high sickness rate, sanitation staff lacked awareness regarding protections from contacting soiled materials while handling biomedical wastes. Objective The study aims to find out the knowledge and practices on preventive measures of blood borne diseases among non-medical attendants. Method Descriptive cross-sectional study was conducted to find out the knowledge and practices on preventive measures on blood borne diseases among all the 53 non-medical personnel in Dhulikhel Hospital, Kathmandu University Hospital. Respondents scoring ≥50% on knowledge score were taken as having adequate knowledge. A Nepali version of pre-tested structured and semi-structured questionnaire was used to conduct interview. Participation in the study was voluntary and written consent was taken before inquiry. Outcomes were measured in both descriptive and inferential ways. Result The adequate knowledge was found among 86.8% of the respondents on the blood borne diseases whereas 50.9% of them had proper practice on it. Although, there is poor positive correlation between the mean knowledge score and literacy, the correlation was significant (r = 0.341, p < 0.05). Alike, the mean practice score and work experience demonstrated significant correlation (r = 0.319, p <0.05). Conclusion Although knowledge score of male was high, female had higher practices score. Both knowledge and practice score increased due to the participation in the training programs and increment in experience. There was significant positive correlation between the mean knowledge score and literacy, and the mean practice score and work experience. KEY WORDS Blood borne diseases, knowledge, non medical personnel, practicePublication Morphometry of Acromion Process of Human Scapulae and Its Clinical Importance Amongst Nepalese Population(Kathmandu University, 2012) Mansur, DI; Khanal, K; Haque, MK; Sharma, KABSTRACT Background Morphometry of the acromion process of the scapula is an important factor implicated in impingement syndrome of the shoulder joint. Authors who have studied this process have tried to classify it according to the standard Bigliani classification viz., type 1, 2 and 3. Objectives To analyze and classify the acromion process of human scapulae. Methods The present study was observational, cross-sectional and descriptive in nature. The present study was conducted on 68 adult human scapulae (30 right and 38 left) of unknown age and sex in the Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The length and breadth of the acromion process and the distances from the tip of the acromion process to the uppermost point of the glenoid cavity and to the tip of the corocoid process were measured with a help of caliper and measuring tape. Results The average length of acromion process on the right and left scapulae were 46.46 ± 5SD mm and 45.57 ± 5.21 SD mm respectively. The average breadth of acromion process of right and left scapulae were 26.63 ± 3.55 SD mm and 27.23 ± 3.06 SD mm respectively. The acromio-coracoid distance on the right and left side were 39.03 + 6.20 mm and 39.39 +5.32 mm respectively. The acromio-glenoid distance was also measured which was 31.83 +3.66 mm & 31.97 +3.96 mm on right and left side respectively. The acromion process was classified in the present study into 3 types, based on the shape as: Triangular - 36.76%, Quadrangular - 52.94% and Tubular - 10.29%. Conclusions Knowing the data on the shape and various distances of acromion may not only help the orthopaedicians during surgical repair around the shoulder joint but also may be of interest to the anthropologists when studying about the evolution of the bipedal gait. The morphometric analysis of the acromion should be used like an auxiliary to promote a better knowledge about the disease that appears in this area. KEY WORD Acromian process, corocoid process, morphometry, scapulaPublication Nuchal Translucency in Normal Fetus and Its Variation With Increasing Crown Rump Length (Crl) and Gestational Age(Kathmandu University, 2013) Karki, S; Joshi, KS; Tamrakar, SR; Regmi, S; Khanal, KABSTRACT Background Nuchal translucency (NT) is the fluid collection behind the fetal neck which can be measured by ultrasound at 11-14 weeks of gestation. Increase in the nuchal translucency thickness is associated with various congenital anomalies. Objective To study the relationship between nuchal translucency thickness, crown rump length and gestational age in normal fetus. Methods Prospective analytical study conducted on 211 pregnant women from March 2011 to August 2012. Measurement of Nuchal translucency thickness and crown rump length was performed by ultrasound at 11-14 weeks of gestation. The relationship between nuchal translucency thickness, crown rump length and gestational age was studied by using linear regression analysis. Results The mean CRL was 63.67+13.48mm (range 41.2-88mm) and mean NT thickness was 1.55+0.35mm (range 0.8-2.7mm), respectively. The median gestational age was 12.9 weeks. The regression equation which shows relation between median NT thickness and CRL was described as follows: expected NT thickness = 0.013CRL+0.725, (R2 = 0.258, p <0.001). There was increase in the incidence of NT thickness more than or equal to 2.5mm; 1.7% in fetus between 12-12.9 weeks of gestation to 15.1% in fetus between 14.0-14.9 weeks. Conclusion Our study offers normative data of NT thickness in normal fetus, which can be used as reference to screen various chromosomal and congenital abnormalities between 11- 14 weeks of gestation. NT thickness increased with increasing CRL and a false positive rate increases with increasing gestational age. KEY WORDS Crown Rump length, gestational age, nuchal translucencyPublication Prevalence and Associated Factors of Hypertension among Adults in Rural Nepal: A Community Based Study(Kathmandu University, 2015) Chataut, J; Khanal, K; Manandhar, KABSTRACT Background Hypertension is a major health problem throughout the world and is one of the major risk factors for cardiovascular mortality. It is important to detect and manage prehypertension and hypertension to reduce the risk of correlated complications especially cardiovascular diseases. Objective The objective of the study was to find the prevalence and risk factors of hypertension among the adults in rural Nepal. Method A community based cross-sectional study was conducted among 648 respondents. The information was obtained using pre-tested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity and diet preference. Height, weight and blood pressure were recorded and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Result The overall prevalence of hypertension was 20.5 % and pre-hypertension was 46.6%. The males had higher prevalence of hypertension (30.6%) compared to females (13.8%). Bivariate analysis showed male gender, smoking and non vegetarian diet have association with hypertension. Male gender [OR 2.50 (1.68 – 3.74)] and non vegetarian diet [OR 0.11 (0.01 – 0.85)] were found to be significantly associated with hypertension in multivariate analysis. Conclusion The prevalence of hypertension and prehypertension was high in the study population. In absence of life style modification and risk reduction the individuals categorized as prehypertension have great risk of developing hypertension in the future which may pose a great challenge in the future. Hence, there is a big scope for screening and primary prevention strategies to curb the epidemic of hypertension. KEY WORDS Cross-sectional study, epidemic, hypertension, JNC VII, prehypertension prevalence, screeningPublication Relationship Between Arterial Oxygen Saturation and Hematocrit, and Effect of Slow Deep Breathing on Oxygen Saturation in Himalayan High Altitude Populations(Kathmandu University, 2012) Nepal, O; Pokharel, BR; Khanal, K; Mallik, SL; Kapoor, BK; Koju, RABSTRACT Backgroud The oxygen saturation of haemoglobin is reduced in high altitude-living organisms. Increase in the hematocrit is responsible for rise in the hemoglobin concentration so that the oxygen carrying capacity in the hypobaric hypoxic subject is elevated. Objectives To compare two different high altitude populations, in order to study the relationship between arterial oxygen saturation and hematocrit. Methods lIn the cross-sectional study of two populations residing at altitude of 2800 m and 3760 m are compared for the difference in hematocrit. The oxygen carrying capacity of arterial haemoglobin (SaO2) is determined by pulse oximetry. The sample is drawn from the natives of two small villages, Thini at Jomsom (2800 m) and Jharkot (3760 m) in Mustang district of Nepal. The natives at 2800 m are termed as lower high altitude population and local residents at 3760 m are said to be higher altitude population in this study. The sample blood was drawn by venipuncture and packed cell volume was determined by Wintrobe’s method. Results The hematocrit obtained from 3760 m altitude population and the lower high altitude population at altitude of 2800 m differ significantly with the p value < 0.0001and the SaO2 in both the population fails to show any difference with p value > 0.05. Deep breathing exercise in these populations however increased SaO2 significantly. Conclusion The higher altitude natives have greater arterial oxygen saturation than lower altitude population which is due to rise in red cell concentration. The slow deep breathing raises oxygen saturation irrespective of altitude. KEY WORDS High altitude, hematocrit, pulse, oximeter, SaO2, slow deep breathingPublication School Teachers’ Knowledge about Epilepsy in Kathmandu Metropolitan City(Kathmandu University, 2015) Khanal, K; Maharjan, R; Pokharel, BR; Sanjel, SABSTRACT Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child. Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers. Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A self- administrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher’s socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge. Result Teacher’s age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019). Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers. KEY WORDS Epilepsy, knowledge, school teachersPublication Sharing the Ideas of Meta – Science to Improve Quality of Research(Kathmandu University, 2013) Aryal, UR; Khanal, KABSTRACT Meta-Science is an interdisciplinary science which provides plenty of oppurtunity to cooperate on better understanding of micro-social dimension of science. It plays vital role to justify the conclusion, which helps to improve quality of research as well as to health services. There are various applications of meta-science for improving quality of research namely: applying theories of philosophy and different disciplines, the use of triangulation ,inductive and deductive reasoning ,ethical issues and finally fundamentals of scientific research. KEY WORDS Meta-Science, quality of researchPublication The Utilization of Health Care Services and their Determinants Among the Elderly Population of Dhulikhel Municipality(Kathmandu University, 2012) Sanjel, S; Mudbhari, N; Risal, A; Khanal, KABSTRACT Background Population ageing is a common problem faced in many countries world-wide. Due to physiological and biochemical changes in the elderly, increased incidence of diseases is observed. There is often low use of health services by the elderly for a variety of reasons. Objective To examine the status of health care utilization and to determine the factors associated with utilization of health care among the elderly population of Dhulikhel Municipality. Methods A quantitative descriptive-cross sectional study, with a total number of 200 elderly people residing in Dhulikhel Municipality, was selected for the study. Data were collected across the months of June - July 2011 applying two-staged cluster and systematic random sampling method. Both descriptive and inferential statistics were measured. Results Sixty eight percent of the elderly visited medical personnel in the past year. Eight percent of them visited the emergency department where most of them reported with symptoms attributed to heart disease. Among 200 elderly, 12.5% of them were admitted to the hospital and 53.0% utilized diagnostic services. Age, marital status, activities of daily living, and regular medication showed significant association with health services utilization at 95% level of confidence (p >0.05). Conclusion Marital status, daily living habits, existence of chronic disease, and regular medication demonstrated significant association with the utilization of health care. Social support services, informal education, and awareness programs targeting the senior citizens and studies covering a diverse population are recommended. KEY WORDS Elderly, Senior Citizens, Utilization of health carePublication Thyroid Hormone levels in Highlanders- A Comparison Be- tween Residents of Two Altitudes in Nepal(Kathmandu University, 2013) Nepal, O; Pokhrel, BR; Khanal, K; Gyawali, P; Malik, SL; Koju, R; Kapoor, BKABSTRACT Background The endocrine changes related to altitude adaptation in human have attracted physiologists around the globe for long. A number of high altitude studies to detect the physiological changes have been performed now and then. But, the study to see the hormonal changes to compare populations residing at different high altitudes is a scarce. Hence, we have performed a study in native populations of different high altitude comparing changes in thyroid hormones in western Nepal. The Jharkot population included in this study is at altitude of 3760m and Jomsom population at 2800m height from sea bed. Objective The study is to compare changes in thyroid hormones at two different high altitude natives. Methods To compare thyroid status between high altitude natives at two different altitudes a cross sectional study is performed by random sampling method. The blood sample was collected in a vacutainer from fifty eight individuals after obtaining the informed consent of participants. The blood collected from antecubital vein was centrifuged in an hour and the serum obtained was used for biochemical analysis of free triiodothyronine, free thyroxine and thyroid stimulating hormone. Results Mean free thyroxine (fT4) of Jharkot population is significantly larger (p = 0.001) than Jomsom population. Mean thyroid stimulating hormone (TSH) with p = 0.597, does not indicate the difference between this two population. There is no significant difference between mean free triiodothyronine (fT3) of Jharkot and Jomsom population (p = 0.345). Conclusion The rise in free thyroid hormone at high altitude is not dependent on the thyroid stimulating hormone released from anterior pituitary. The rise in free thyroxine is found at higher altitude and no difference in fT3 level is detected in population studied at high altitudes. KEY WORDS Free triiodothyronine, free thyroxine, TSH, high altitude, t-test