Journal of the Institute of Medicine最新文献_第7页

Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal 在尼泊尔神经外科三级护理中心管理成人脊柱病理的概况和结果

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37428

Hemant Sah, B. Rajbhandari, D. Shrestha, G. Sedain, A. Pradhanang, S. Shilpakar, M. Sharma

{"title":"Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal","authors":"Hemant Sah, B. Rajbhandari, D. Shrestha, G. Sedain, A. Pradhanang, S. Shilpakar, M. Sharma","doi":"10.3126/JIOM.V42I1.37428","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37428","url":null,"abstract":"IntroductionSpine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes spine and spinal cord disease from a neurosurgical unit from a tertiary hospital in Nepal.MethodsThis is a retrospective study which meticulously reviewed all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on thespectra of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome (in 1 month) were assessed.ResultsA total of 76 patients included in this study. Male preponderance was observed in all categories. Twentyseven patients (35.5%) had traumatic spine injury and fall from height was the most common mode of injury, accounting ˷two-third of the total spinal trauma patients. Cervical segment was involved in twothirdpatients. More than one-third of the spinal patients (34%) had a degenerative disorder involving lumbar and cervical regions, 57.7% and 42.3%, respectively. Spinal infection was diagnosed in 10.5% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 18.4%. Pain improved inall patients while overall good outcome with improvement was noted in 63.2% of the patients.ConclusionOur study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement is seen. Further large scale multicenter studies are required to generalize the whole population of Nepal.Keywords: Burden, Nepal, spine trauma, spine pathology","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"54-58"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69288402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal 尼泊尔三级医疗中心患者ABO血型频率及其与急性冠状动脉综合征的关系

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37427

S. Pathak, S. Jha, R. Gajurel, C. Poudel, H. Shrestha, S. Thapa, R. Sahi, S. Thapa, P. Koirala

{"title":"Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal","authors":"S. Pathak, S. Jha, R. Gajurel, C. Poudel, H. Shrestha, S. Thapa, R. Sahi, S. Thapa, P. Koirala","doi":"10.3126/JIOM.V42I1.37427","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37427","url":null,"abstract":"IntroductionCoronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital.MethodsThis is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression.ResultsTotal 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI where as those with blood group A had increased risk of having unstable angina.ConclusionThere was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS.Keywords: ABO blood group, acute coronary syndrome, coronary artery disease.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"49-53"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47425886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Breast Cancer Surgery at a Cancer Center in Janakpurdham: An Initial Experience Janakpurdham癌症中心的乳腺癌手术:初步经验

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37449

P. Jha, Anshul Thakur, Sanjay Gupta, Richa Mishra, Y. Singh

{"title":"Breast Cancer Surgery at a Cancer Center in Janakpurdham: An Initial Experience","authors":"P. Jha, Anshul Thakur, Sanjay Gupta, Richa Mishra, Y. Singh","doi":"10.3126/JIOM.V42I1.37449","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37449","url":null,"abstract":"IntroductionBreast cancer is the second commonest cancer in Nepalese women. In most of the low income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital.MethodsSurgical service was started from April 2019 after establishing an equipped operating room and postoperative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done.ResultsSix female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disease. Two patients received neoadjuvant chemotherapy and two were subjected for upfront surgery. Modified radical mastectomy wasdone in four patients. For one patient with suspected hereditary localized breast cancer and one with Paget’s disease of the breast with non invasive ductal carcinoma, simple mastectomy was performed. Postoperative period was uneventful except one case with seroma formation. Other than one Paget’sdisease of the breast, all were triple nipple breast cancer.ConclusionBreast cancer surgery is one of the important modality of treatment even for locally advanced disease in resource limited settings.Keywords: Breast cancer, outcome, mastectomy","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"72-72"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44923088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation 术前雾化氯胺酮对气管插管全麻患者术后咽痛发生率及严重程度的影响

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37418

B. M. Shakya, Prajjwol D Bhatta, N. Bista, M. Marhatta, Ninadini Shrestha

{"title":"Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation","authors":"B. M. Shakya, Prajjwol D Bhatta, N. Bista, M. Marhatta, Ninadini Shrestha","doi":"10.3126/JIOM.V42I1.37418","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37418","url":null,"abstract":"IntroductionPostoperative sore throat (POST) has a reported incidence of up to 62% following general anaesthesia. POST was rated by patients as the eighth most undesirable outcome in the postoperative period. The objective of this study was to compare the incidence and severity of postoperative sore throat after saline and ketamine nebulization in patients undergoing general anaesthesia with endotracheal intubation.MethodsThe study was prospective double blinded randomized controlled trial . One hundred patients belonging to American Society of Anesthesiologists physical status I–II undergoing surgery under general anaesthesia with endotracheal intubation were randomized into two groups; group Saline (S) received nebulization with 5 ml of normal saline and group Ketamine (K) received nebulization with 1 ml of ketamine of concentration 50 mg/ml mixed with 4 ml saline. POST was assessed at zero hour, two hour, four hour, six hour, eight hour and 24 hour.ResultsThe overall incidence of POST was 28%. Twenty two (44%) patients in group S and six (12%) patients in group K had postoperative sore throat at some point of the study. The POST was significantly reduced in group K at zero hour 3(6%), two hour 3(6%), four hour 4(8%), six hour 5(10%) and eight hour 3(6%) with p value <0.05 . The severity of POST was also significantly decreased in group K at zero hour, two hour, four hour, six hour, eight hour with p value <0.05.ConclusionPreoperative nebulization with ketamine reduces the incidence and severity of POST after general anaesthesia with endotracheal intubation.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"12-16"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43617875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review 儿童食管纽扣电池的疗效回顾性分析

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37425

B. Gyawali, Rajendra P Sharma Guragain, Y. Neupane, H. Dutta, L. Shrestha, R. Pradhananga

{"title":"Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review","authors":"B. Gyawali, Rajendra P Sharma Guragain, Y. Neupane, H. Dutta, L. Shrestha, R. Pradhananga","doi":"10.3126/JIOM.V42I1.37425","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37425","url":null,"abstract":"IntroductionForeign body in oesophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the oesophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in oesophagus following accidental ingestion.MethodsThis was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery oesophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patientdemographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up.ResultsOur final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer wereseen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications.ConclusionButton battery in oesophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve.Keywords: Alkaline button battery, oesophagus, rigid oesophagoscopy","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"44-48"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49438089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Risk Factors Among Breast Cancer Patients Being Treated in Tertiary Level Hospital of Nepal: A Case Control Study 尼泊尔三级医院乳腺癌患者的危险因素:一项病例对照研究

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37459

A. Rana, A. Ghimire, R. Sah, P. Pyakurel, N. Shah

{"title":"Risk Factors Among Breast Cancer Patients Being Treated in Tertiary Level Hospital of Nepal: A Case Control Study","authors":"A. Rana, A. Ghimire, R. Sah, P. Pyakurel, N. Shah","doi":"10.3126/JIOM.V42I1.37459","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37459","url":null,"abstract":"Introduction Breast cancer is the leading cause of cancer death among females worldwide. Its incidence is on the rise in Nepal. However, the risk factors have not been studied in context of Nepal. The aim of this study is to identify and quantify the association of various risk factors with breast cancer in Nepal.MethodsHospital-based age-matched case-control study was conducted among 50 cases and 150 controls visiting BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Semi-structured questionnaire was used to collect information on demographic characters, socio-economic parameters, reproductive history, dietary and personal habits, family history, history of contraception and history of benign breast disease. Height, weight, hip circumference and waist circumference were measured.ResultsMajority of the cases (52%) belonged to the age group of 46-55 years. The significant risk factors were ethnicity of Dalit/Madhesi (AOR 8.222, 95% CI 2.377-28.441, p-value 0.001), parity of 3 to 5 (AOR 5.614, 95% CI 1.140-27.639, p-value 0.03) and previous history of benign breast disease (OR 13.614, 95% CI 3.229-57.391, p-value 0.001). Hysterectomy was found to reduce the risk of breast cancer (OR 0.122, 95% CI 0.017-0.826, p-value 0.03). Knowledge of breast self-examination was significantly higher among cases than controls (AOR 36.29, 95% CI 5.788-227.555, p-value < 0.001). Knowledge of mammography was significantly lower among cases than control (AOR=0.133, 95% CI=0.028-0.647, p-value=0.01).ConclusionThis study showed a number of factors to be associated with the increased risk of breast cancer. It was observed that the mean age at diagnosis is a decade earlier than in Western countries. Genetic component was not significant in context of Nepal. It is hoped that the findings of this study will facilitate further exploration and evidenced-based preventive measures for Nepalese women.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"79-79"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46196501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Prevalence of Molecular Subtypes of Breast Cancer in a University Hospital of Nepal 尼泊尔一所大学医院乳腺癌分子亚型的患病率

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37453

S. Hirachan, Y. Singh

{"title":"Prevalence of Molecular Subtypes of Breast Cancer in a University Hospital of Nepal","authors":"S. Hirachan, Y. Singh","doi":"10.3126/JIOM.V42I1.37453","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37453","url":null,"abstract":"IntroductionBreast cancer is the second most common malignancy in Nepalese women. It represents a group of heterogenous disease with diverse biologic, clinical and molecular characteristics requiring personalized treatment. Based on Immunohistochemical markers, breast cancer is classified into distinct molecular subtypes. The aim of the study was to analyze the incidence of molecular subtypes of all breast cancer patients treated at University Hospital of Nepal in the period over 3 years.MethodsA retrospective observational study was carried out in Breast Unit of Tribhuvan University Teaching Hospital, Kathmandu. Electronic medical records of all breast cancer patients treated between January 2017 to December 2019 were retrieved from the hospital database. Patient’s characteristic, histologicalfeatures and molecular subtypes were collected and analyzed.ResultsA total of 156 surgically treated breast carcinoma patients were studied. The median age of study population was 55 years (range 28–82years). Among these, 69 (44%) were of ≤45 years and 87 (56%) were over 45 years. The mean tumor size was 29 mm (range 50-140 mm). The most common histology was invasive ductal carcinoma (93.5%). Luminal type A was positive in 68 (43%) patients while luminal type B was present in 12 (7.6%) patients. Triple negative subtype was observed in 50 (32%) patients while HER2 rich subtype was seen in 25(16%). Incidence of Triple negative subtype was highest in patients less than 45 years (42%). Luminal A subtype was correlated with low tumor grade and less positive lymph nodes metastasis.ConclusionThe most common molecular subtype of breast cancer in Nepal is Luminal A having favorable features. The incidence of triple negative breast cancer is higher in Nepal, having an aggressive and clinically distinct subtype and is important for personalized treatment plan.Keywords: Breast cancer, immunohistochemistry, molecular subtypes, Nepal","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"75-75"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46285164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Lancet Commission on Global Surgery - A Public Health Initiative 柳叶刀全球外科委员会-公共卫生倡议

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37413

G. Kurlberg

引用次数: 0

Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy 结肠镜对直肠出血患者的诊断评价

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37423

B. Malla, Suyog Simkhada

{"title":"Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy","authors":"B. Malla, Suyog Simkhada","doi":"10.3126/JIOM.V42I1.37423","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37423","url":null,"abstract":"Introduction Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults Methods One hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings. Results A total of 129 (77 male and 52 female )patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%). Conclusion Colonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population .","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41865015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis 1例噬血细胞淋巴组织细胞病的麻醉处理

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37442

G. Shrestha, H. Gulati, B. Acharya, B. Poudyal

引用次数: 0