Browsing by Author "Paudel, BH"
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Publication Can homemade alcohol (raksi) be useful for preserving dead bodies? An experiment on wistar albino rats(Kathmandu University, 2007) Dhungel, S; Maskey, D; Jha, CB; Bhattacharya, S; Paudel, BH; Shrestha, RNIntroduction: Embalming is the through disinfection and art of preserving bodies after death using chemical substances. It keeps a body life like in appearance during the time it lies in a state prior to funeral. Objective: This study was undertaken to investigate the effectiveness of Raksi in sacrificed rats in arresting postmortem changes and establishing scientific fact whether Raksi can be an alternative to standard embalming constituent if it is not available. Material and methods: 50 albino rats were systematically randomized into control and experiment groups. Raksi and distilled water were injected for embalming purpose intraventricularly in experiment and control groups of rats respectively and kept for 48 to 96 hours for observation for postmortem changes. Result: Observations made at 48 and 72 hours of embalming revealed that Raksi can arrest postmortem changes in the rats up to 72 hours (3 rd day) successfully in the experimental group whereas moderate to severe postmortem changes were seen in the control group. The experimental group showed mild degree of putrefactive changes, liberation of gases and liquefaction of tissues only at 96 hours (4th day) of embalming. Discussion: The Raksi used in this experiment contained 34% of alcohol, which was determined by an alcohol hydrometer. Experiment clearly demonstrated from its result that raksi can be utilised temporarily for embalming since it contains alcohol and has preservative, bactericidal and disinfectant properties. Conclusion: It is concluded from the study that this knowledge if applied to dead human subjects, may preserve dead bodies temporarily allowing delayed funeral. Key words: Rat, Embalming, Homemade alcohol, Raksi, FuneralPublication Clinical and Electroencephalographic Profile Of Children(Kathmandu University, 2013) Limbu, N; Paudel, BH; Thakur, DABSTRACT Background Reports on pediatric electroencephalogram of Nepalese patients are rare. Objective We aimed to study the relationship between provisional clinical and electrophysiological diagnoses of pediatric patients with documentation of demographic profiles, and type and frequency of the disorders/diseases. Methods Electroencephalographic reports of 634 children from 2006 to 2009 were analyzed at neurophysiology laboratory, department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, retrospectively. Chi-Square test was applied after detail descriptive statistics. Results Male and female were 72.2 % (n=458/634) and 27.76 % (n=176/634) respectively. Most frequent EEG abnormality was seizure disorder (n=370, 59.39%), then febrile seizure (n= 94, 15.08%) and birth asphyxia with hypoxic-induced encephalopathy (n=68, 10.91%). Electroencephalogram showed significant epileptiform discharges in seizure disorder (p=0.001, OR= 2.26, 95 % CI= 1.61 to 3.18) and in cerebral palsy (p=0.049, OR=6.88, 95 % CI=0.89 to 145.95), specifically in 6 to 12 (p=0.001, OR=2.94, 95 % CI=1.43 to 6.06) and one to five (p=0.019) years, respectively. Electroencephalogram detected significantly less epileptiform discharges (p=0.001, OR=0.25, 95 % CI= 0.15 to 0.42) in febrile seizure specifically in 1 to 5 years (p=0.003, OR=0.16, 95 % CI= 0.04 to 0.63). Conclusion Predominant Electroencephalographic abnormality was seizure disorder, followed by febrile seizure and birth asphyxia with hypoxic-induced encephalopathy respectively. Electroencephalographic abnormality was highly associated with seizure disorder and cerebral palsy but was not associated with febrile seizure. KEY WORDS Children, EEG, epileptiform dischargesPublication Effect of Sub-maximal Exercise Stress on Cold Pressor Pain: A Gender Based Study(Kathmandu University, 2013) Pokhrel, BR; Malik, SL; Ansari, AH; Paudel, BH; Sinha, R; Sinha, MABSTRACT Background Analgesic effect of exercise is a well established fact; however available reports are contradictory on gender differences in pain perception following exercise stress test. Objective The current study is prospectively designed to evaluate and compare the effect of acute bout of sub-maximal exercise stress on cold pressor pain in normal adult males and females. Method The experimental study design involved healthy adults (n= 41); females (n = 18) and males (n=23) aged between 18 to 25 years and included them into four sets of experiments: SET I (Control), “resting blood pressure, radial pulse and respiratory rate were recorded after 15 minutes of complete supine relaxation. SET II (Cold Pressor Pain Test): Pain Threshold, Pain Tolerance, and Pain Duration in seconds were taken. SET III (Exercise Stress Test): Sub-maximal exercise of 70 to 75% of maximum predicted heart rate was given for 6 minutes. SET IV (Cold Pressor Pain Test immediately after Exercise Stress Test): At 0 minute of recovery again the pain parameters; Pain Threshold, Pain Tolerance, and Pain Duration in seconds were taken. SET I, SET II were performed in order on the first day and SET III and SET IV on the second day to ensure only a single Cold Pressor Pain Test is performed in each day. Result The data (Mean ±SD) analysis showed significant increased in pain threshold (males: 14.36±10.6 Vs 21.47±13seconds, p<0.001, females: 14.1±11.5 Vs 23.81± 20.22 seconds, p<0.001) and pain tolerance time (males: 41.3±19.31Vs 54.1±21.7 seconds, p<0.001) in both sexes after 6 min of acute bout of sub-maximal exercise stress test with comparable age, BMI and baseline resting values of pain parameters and pulse rate and blood pressure. The percentage increment pain tolerance time following the exercise stress in female is higher than male (78.6 Vs 68.9%). Conclusion The result suggests that pain sensation decreases immediately after a brief period of exercise challenge irrespective of gender, and the analgesic effect of the acute bout of exercise in terms of pain tolerant time is more enhanced in females than males. KEY WORDS Analgesia, exercise, gender, pain tolerancePublication Effectiveness of Teachers’ Training in Assessment Techniques: Participants’ Perception(Kathmandu University, 2011) Baral, N; Gautam, A; Lamsal, M; Paudel, BH; Das, BK Lal; Aryal, MABSTRACT Background Medical education has experienced a rapidly changing scenario especially during the past three decades. Teachers’ training programs have emerged in recent years as a more in depth and comprehensive mechanisms for strengthening instructional skills and formulating assessment techniques among faculty members. Objective The present study was carried out with the aim of assessing effectiveness of teacher’s training workshop on assessment techniques at B.P. Koirala Institute of Health sciences (BPKIHS), Dharan, Nepal. Methods: In this prospective questionnaire based study, the 26 entry level teachers were enrolled. They were requested to fill the questionnaire before and after the workshop on the assessment techniques at BPKIHS, Dharan. Methods Twenty six teachers majority of whom were entry level teachers comprising of medical, dental, nursing and allied sciences participated in pre- and post test analysis on the various components of written and oral examinations. A two and half days long training was conducted having 9 hours of teaching interactive sessions, 6 hours of group exercises, daily evaluation and 3 hours of presentation by participants. There was high degree of agreement with most topics of the assessment training. Results There was a significant gain in knowledge (p< 0.001) by the participants. All the participants (100%) agreed upon the training being informative and learned new things about assessment. More practice session with longer duration with invited resource persons were also suggested for an effective session. Conclusion Thereis an immense opportunity for a better and comprehensive training in evaluation techniques in medical education.. KEY WORDS evaluation system, faculty development, medical education, teacher training.Publication Examination of Relationships of Scores Obtained in Grades 10 and 12 with the Entry and Success in Undergraduate Medical Education(Kathmandu University, 2012) Gautam, A P; Paudel, BH; Agrawal, CS; Niraula, SR; Van Dalen, JABSTRACT Background Entrance examination (admission test) is the most important and widely accepted method of student selection for admission into medical schools in Nepal. For many schools it is the only criterion of student selection. Objectives To examine relationships of scores obtained in schooling (grade 10 and 12), medical entrance and MBBS professional examinations in a cohort to identify predictive strength for entry into medical school and success in medical education. Methods Exam scores from grade 10 to medical entrance and professional exams of undergraduate medical education of a total of 118 medical students who entered medical school between 1994 and 1998 only through the merit of open competitive medical entrance examination at the BP Koirala Institute of Health Sciences (BPKIHS) were assessed. Results Student selection for admission in MBBS course at BPKIHS and their subsequent success were not determined by difference in outcomes of public & private management of schools at grade 10 (selection p= 0.80 & success p= 0.32 ) and grade 12 (selection p= 0.59 & success p= 0.55). Grade 12 averaged scores had no relationship in getting these students selected for admission into medical course (r= 0.08, p= 0.37), but did show correlation with the overall success in medical education (r= 0.32, p= 0.00). Scores in physics at grade 12 retained predictive strength in success in medical education (r= 0.19, p= 0.04). Conclusion The present student selection criteria for medical education are not appropriate and need to incorporate other attributes of candidates along with cognitive aspects. KEY WORDS admission test, medical education, medical students, performance, predictions, selection criteriaPublication Heart rate variability: Response to graded head up tilt in healthy men(Kathmandu University, 2009) Sharma, P; Paudel, BH; Singh, PN; Limbu, PAbstract Background: Heart rate variability is actually a misnomer for R to R variability in cardiac cycle. Variation in successive cycle length is called the heart rate variability (HRV). Head-up tilt is a model of studying cardiovascular haemodynamics, which reflects in heart rate variability (HRV). Objectives: To study the effect of 10° and 70° head-up tilt on HRV. Materials and methods: The study was done in the Department of Physiology using graded head up tilt (passive orthostatism). HRV measurement was done at 10° and 70° tilt and compared with supine using standardised methods on 30 consenting healthy males (age 25.37±3.89 years). The HRV variables across postures were compared by ANOVA and Bonferroni test. Results: The heart rate increased at 70° compared to 10° and supine (70.48±8.17 Vs 70.22±8.67 and 88.51±12.84 bpm, p<0.001). The 70° tilt decreased vagal HRV indicators compared to 10° and supine: SDNN (31.13±8.12 Vs 38.07±11.29 and 38.13±10.89 ms, p<0.05), RMSSD (20.06 ±8.47 Vs 34.23±14.22 and 36.16±12.22 ms, p<0.001), NN50 count (13.03±20.58 Vs 45.07±44.44 and 55.27±44.10, p<0.01), pNN50 (3.28±6.08 Vs 14.06±15.65 and 16.65±14.23, p<0.01), HF power (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98 Hz, p<0.05), HFnu unit (24.28±14.16 Vs 45.48±16.34 and 47.67±19.89, p<0.001). The 70° tilt increased LF power% (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98, p<0.001). LFnu unit (75.72±14.76 Vs 54.52±16.34 and 52.32±19.89, p<0.001), LF: HF (4.96±4.08 Vs 1.53±1.138 and 1.69±1.67, p<0.001) compared to 10° and supine. Conclusion: At 70° tilt, HRV measures, reflecting vagal contribution to cardiac-cycle length, decreased with reciprocal increase in sympathetic activity compared to 10° or supine leading to increase in sympathetic predominance. A 10° tilt, which is almost equivalent to lying down with pillow, did not change HRV from supine. Key words: Cardiac cycle, cardiovascular haemodynamics, head-up-tilt, heart rate variability, sympathetic activity, parasympathetic activityPublication Nerve Conduction study in healthy individuals a preliminary age based study(Kathmandu University, 2010) Thakur, D; Paudel, BH; Jha, CBABSTRACT Background Nerve conduction study assesses peripheral nerve functions and has clinical implication. Objectives To study the effect of age on nerve conduction study variables in healthy adults. Methods Cross sectional study was done from Jan 2006 to Dec 2006 in department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal. The study was done in 34 (younger, n= 18, 17 to 29 years; older, n= 16, 30 to 57 years) consenting healthy adults of either sex. The compound muscle action potential and sensory nerve action potential were recorded using standard technique. Due to the non-normal distribution of data, the effect of age on nerve conduction study variables was analyzed using Mann Whitney U test. Results Younger vs. older individuals: older had lower Compound Muscle action potential amplitude (mV) in all motor nerves except radial and left ulnar nerves. Compound Muscle action potential duration (ms) was shorter in older (p<0.05) in ulnar, tibial, right median and left common peroneal motor nerves than the younger: right median (6.92±1.3 vs. 8.5±1.88), right ulnar (7.09±1.54vs. 8.2±1.31), left ulnar (10.56±1.44 vs. 12.06±1.5), right tibial (6.28±0.81vs. 7.28±1.12), and left tibial (9.58±1.52vs.10.78±1.71). Sensory nerve actional potential amplitude (μV) was smaller in older as compared to younger: right median (19.01±7.83 vs. 26.97±10.63), right ulnar (10.9±3.44 vs.16.09±5.85) and right radial (14.31±4.34 vs.19.72±6.47). SNAP duration (ms) was longer in older: right ulnar (1.34±0.17 vs.1.26± 0.18), left ulnar (1.46±0.14 vs. 1.29±0.26), and left median (1.11± 0.14 vs. 1± 0.14). Conclusions Age has definite effects on amplitude and duration of motor and sensory nerves. Different nerves have different timing of aging. Without adjustment for age, the sensitivity and specificity of nerve conduction study will decrease whenusing the same reference data in patients with different age. Key Words age, compound muscle action potential, nerve conduction study, sensory nerve action potentialPublication Peripheral Airway Responsiveness to Sub-maximal Exercise in Asymptomatic Cigarette Smokers(Kathmandu University, 2011) Pokhrel, BR; Chatopadhyaya, S; Paudel, BHABSTRACT Background Cigarette smoking is one of the cardinal causes for the development of bronchial hyperresponsiveness among the smokers. Objectives This study was perspectively designed to determine the peripheral bronchial responsiveness to sub-maximal exercise challenge in the asymptomatic smokers. Methods The subjects were between age of 18-25 years without any findings of cardio- respiratory diseases. We performed the 5 min step test exercise at intensity of 80 to 90% of maximum predicted heart rate in 42 young adult male asymptomatic smokers to examine the effect of cigarette smoking on airway responsiveness. Forced expiratory spirogram was recorded before and at 0, 5, 10, 15 min after the completion of exercise. Pre- to post exercise drop in Forced Expiratory Volume in first second ≥ 15% was considered hyperresponsive to the challenge. Result The analysis of data (mean± SE) indicated the bronchial hyper-responsiveness in 22 (52%) smokers. The post exercise recovery time pattern showed drop in forced expiratory spirogram from the resting baseline in the responsive smokers and the maximum percentage fall in the parameters or increase in airway resistance which reflect the peripheral airway integrity such as Forced Expiratory Flow 25% (20.30 ±2.18 Vs 7.88 ±3.23, p<0.01), Forced Expiratory Flow 50% (18.46 ±4.40 Vs 1.93 ±2.78, p<0.01), Forced Expiratory Flow 75% (23.94 ±3.68 Vs 0.80 ±4.72, p<0.001) and Forced Expiratory Flow 25-75% (32.50 ±4.79 Vs 3.64 ±3.32, p<0.001) was significantly higher in the responsive than non-responsive subgroup of the smokers. Conclusion The occurrence of peripheral airway resistance is more in the responsive than non- responsive subset of smokers to the exercise challenge and hence more prone to develop obstructive airway disease in the long run. KEY WORDS airway hyper-responsiveness, cigarette smokers, forced expiratory flowPublication Preparing tutors for problem-based learning: An experience from B. P. Koirala Institute of Health Sciences, Nepal(Kathmandu University, 2010) Baral, N; Paudel, BH; Das, BKL; Aryal, M; Gautam, A; Lamsal. MAbstract Background: Problem based learning (PBL) has made major impact on curricular designing and practice in medical education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and opportunity for both educationists on how to impart change and medical teachers on how to internalise the change. Objectives: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. Materials and methods: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and Post- test question were taken from various topics relevant to PBL such as learning strategy and principles of adult learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants’ perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the questionnaire. Results: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and update with new trends and tools in PBL. Conclusion: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies in PBL. Key words: BPKIHS, Faculty Development, Problem Based Learning