Effects of Lateral Ligament Sectioning on the Stability of the Ankle and Subtalar Joint

Patients with subtalar joint instability are often diagnosed with ankle instability. Only after a prolonged period of time in which a patient does not improve after treatment for ankle instability is subtalar joint instability considered. To develop a clinically relevant method to diagnose subtalar joint instability, the kinematics of the simulated unstable subtalar joint were examined. A 6 degree-of-freedom positioning and loading device was developed. Plantarflexion/dorsiflexion, inversion/eversion, and internal/external rotation were applied individually or as coupled motions along with an anterior/posterior drawer. Kinematic data were collected from sensors attached to the calcaneus, talus, and tibia by keeping all the ligaments intact, and by serially sectioning anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), cervical ligament, and talocalceneal interosseous ligament. Kinematic results were reported using Euler angles. The ATFL and CFL contributed talocrural instability, similar to previous studies. The interosseous ligament was the greatest contributor to subtalar joint stability. The hindfoot motion (calcaneus relative to tibia) showed significant increases in motion when the ankle and/or subtalar joint was made to be unstable. Therefore, it is difficult to diagnose subtalar joint instability on physical examination alone. (C) 2011 Orthopaedic Research Society

Letter to the Editor

Introduction: A medical humanities (MH) module, Sparshanam has been conducted for all first year undergraduate medical students at KIST Medical College, Nepal, since 2008. Knowledge, attitude and perceived skills in empathy, what it means to be sick in Nepal, the doctor, the patient, the family, doctor-patient relationship and professional values in medicine were studied at the beginning and conclusion of the module conducted from December 2011 to March 2012. Methods: A questionnaire was developed to study respondents’ perception regarding knowledge, attitude and perceived skill levels in the areas mentioned above. Total scores in different areas and overall score were calculated. All scores were normally distributed (one sample Kolmogorov-Smirnov test). Scores among different subgroups of respondents and before and after the module were compared using appropriate tests (

Economics of climate change in the water sector in Nepal : a stakeholder-focused approach; a case study of the Rupa Watershed, Kaski, Nepal

Nepal’s National Adaptation Programme of Action (NAPA) shows the watershed area is vulnerable to climate change, with landslides a particular concern. The region in general has experienced increased temperatures and erratic and intense rainfall. The main objective of the study was to explore the options for managing Rupa Lake even under the extreme conditions of climate change, through implementing adaptation measures as chosen by local stakeholders. Two options were presented for cost-benefit analyses: construction of gabion check dams in the river, and construction of an earth-fill dam in the lake. The Rupa Watershed is typical of mountain ecosystems

Faculty Development Program in Nepalese Medical Schools: Past, Present, and Future Perspectives

Teaching medical students is an art that requires expertise in the core content of the subject and specialized teaching techniques. Learning to teach medical students and teachers learning from those teachings themselves is a lifelong process. Short medical teacher training courses in various specialized teaching techniques lay the foundation for a positive teaching experience that can substantially impact medical education. The Faculty Development Program is one such training course for medical teachers, designed to be an essential step toward becoming a student-centered facilitator. This article sheds light on the current status and significance of the faculty development program in Nepalese medical education. It also offers suggestions and critical strategies to improve the program in the future with available resources and to integrate it further into medical education. Keywords: Faculty development program; medical education; Nepal; teacher trainin

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanitie

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanitie

Perceptions of Medical Students About Bedside Teaching in a Medical School

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching

Recent Developments in the Detection and Management of Acute Kidney Injury

Acute kidney injury (AKI) is a common condition in children admitted to hospital and existing serum and urine biomarkers are insensitive. There have been significant developments in stratifying the risk of AKI in children and also in the identification of new AKI biomarkers. Risk stratification coupled with a panel of AKI biomarkers will improve future detection of AKI, however, paediatric validation studies in mixed patient cohorts are required. The principles of effective management rely on treating the underlying cause and preventing secondary AKI by the appropriate use of fluids and medication. Further therapeutic innovation will depend on improving our understanding of the basic mechanisms underlying AKI in children

Abdominal Wall Dyskinesia in a Child Presenting as Belly Dancers’ Syndrome: A Case Report

Belly dancer’s dyskinesia or syndrome is a rare condition characterized by involuntary, undulating, infrequent diaphragm movements. The etiologies for this disorder include nervous system disorders (peripheral or central), drug-induced, psychological, or idiopathic. This article describes a 10-year-old boy with an underlying psychological stressor who suddenly experienced involuntary abdominal wall movements after salbutamol nebulization. After a detailed history, physical examination, and abdominal ultrasound that revealed rapid rhythmic diaphragm movements, the child was diagnosed with salbutamol-induced belly dancer's dyskinesia with an underlying psychological problem. These movements subsided with medical and psychological therapy for two weeks. Belly dancer’s dyskinesia is a complex disorder that is difficult to diagnose but can be managed with medical treatment and psychological counseling alone in a few patients. In contrast, in other cases, surgical intervention may be required

Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre

Introduction: Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting. Conclusions: The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings