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Introduction: Neonatal transport is a key component of care for neonates who require referral to tertiary care. The aim of the study is to find out correlation of TOPS score with outcome of referred neonates. Method: A prospective observational study was conducted of 200 extra mural neonates for period of 1 year from August 2012 to September 2013 at general hospital, Ahmadabad. They were assessed for pattern of referral and categorized as critical or stable & TOPS scoring was done by standard statistical method. Result: Prematurity and its complication (32%), Septicemia (15.5%) and respiratory distress (14%) were commonest morbidity among 200 neonates. Highest referred from private hospital 97(%) and 48(%) neonate were come directly. Ambulance was used only by 38 (19%) and rest by other transport system. Among them 15 were critical. Only 39 (19.5%) newborn referred after prior intimation. Commonest affected parameter of TOPS score was temperature. Among 59 neonate expired, 42 (71.18%) were critical on admission. Conclusion: Sick newborns should be transferred in equipped vehicles and skilled personnel with pre transport stabilization. Proper implementation of referral sheet and TOPS score will definitely improve outcome of newborns.

Preyssler's anion, with formula [NaP5W30O110]14-, catalyzes the oxidation of aromatic aldehydes to related carboxylic acids by hydrogen peroxide as oxidizing agent, under microwave irradiation, or at 70 ºC. Both homogeneous and heterogeneous Preyssler's catalysts (as H14[NaP5W30O110 ]) were used and had their activity compared with those of some Keggin structures. Our data indicate that Sodium30-tungsto pentaphosphate, the so-called Preyssler's anion, with high hydrolytic (pH=0-12) and thermal stability is the best catalyst with high yield and good selectivity. Under microwave irradiation, this polyanion supported on SiO2 was found to be an excellent catalyst for aldehydes with low loss factor in 1-2 min (the loss factor is a measure of the ability of the material to dissipate energy). The effects of various parameters, including catalyst type, nature of the substituent in the aldehyde and temperature, on the yield of the carboxylic acids were studied.

Urinary tract infection (UTI) is the most common bacterial infections in humans and serious health problem in many parts of the world. Carbapenem resistant Enterobacteriaceae (CRE) are increasingly reported from healthcare facilities in Nepal and around the world. This study is carried out with an objective to assess the Prevalence of ESBL and carbapenemase producing Klebsiella pneumoniae isolate from patient with suspected of UTI. Total 880 urine sample was collected during 6-month period and processed and identified by using conventional microbiological procedure and biochemical test. ESBL screening isolates were done by using Ceftazidime and Ceftazidime with clavulanic acid. Production of ESBL was determine by combination Disc Test. For the confirmation of carbapenemase producing K. pneumoniae Modified Hodge Method, Carbapenem Inactivation Method and EDTA Impregnated Disc test (MBL) was performed. Out of total sample, 9.30% (82) showed significant growth. Prevalence of UTI seen more in male as compare to female patients. Out of positive isolates, 37.8% were K. pneumoniae. K. pneumoniae were resistance with Ceftriaxone (54.8%) followed by 51.61% Ceftazidime, Cotrimoxazole. Multi drug resistance (MDR) was found to be 54.83%. Out of 31 isolates, 10(32%) were confirmed as ESBL positive by Combination Disc Assay. 14 isolates were screened as carbapenemase producers but 2(14.28%) showed positive through Modified Hodge Method, 4(28.57%) Modified Carbapenem Inactivation Method and 7(50%) EDTA impregnated Disc Test (MBL). Analytically, the sensitivity of MHT, CIM, and MBL tests was 42.81%, 58.10%, and 76.96%, respectively, all with 100% specificity. Colistin was the drug of choice, with 93.54% of isolates showing sensitivity to it. Early detection of ESBL and MBL-producing isolates is crucial for reducing mortality rates and preventing the intra-hospital spread of these strains.

Cancer metastases are the most common causes of cancer-related deaths. The formation of secondary tumors at different sites in the human body can impair multiple organ function and dramatically decrease the survival of the patients. In this stage, it is difficulty to treat tumor growth and spreading due to arising therapy resistances. Therefore, it is important to prevent cancer metastases and to increase subsequent cancer therapy success. Cancer metastases are conventionally treated with radiation or chemotherapy. However, these treatments elicit lots of side effects, wherefore novel local treatment approaches are currently discussed. Recent studies already showed anticancer activity of specially designed degradable magnesium (Mg) alloys by reducing the cancer cell proliferation. In this work, we investigated the impact of these Mg-based materials on different steps of the metastatic cascade including cancer cell migration, invasion, and cancer-induced angiogenesis. Both, Mg and Mg–6Ag reduced cell migration and invasion of osteosarcoma cells in coculture with fibroblasts. Furthermore, the Mg-based materials used in this study diminished the cancer-induced angiogenesis. Endothelial cells incubated with conditioned media obtained from these Mg and Mg–6Ag showed a reduced cell layer permeability, a reduced proliferation and inhibited cell migration. The tube formation as a last step of angiogenesis was stimulated with the presence of Mg under normoxia and diminished under hypoxia.

Milk is a highly nutritious product that is susceptible to degradation due to microbial activity. Maintaining milk quality is crucial and can be achieved by monitoring specific parameters. This helps preserve the nutritive value of milk, which is essential for proper growth and health. Adulteration and improper storage can diminish the nutritional quality of milk. Therefore, this study aimed to assess the microbial load and adulteration of milk samples collected from various regions of the Kathmandu Valley. Sixty raw milk samples were gathered from local dairies (45) and cow farms (15) between April 2019 and July 2019. These samples were evaluated for microbial quality (total plate count, total coliform count, Salmonella spp., Shigella spp., and Vibrio spp.) and adulterants (starch, table sugar, soda, soap, and hydrogen peroxide) following standard guidelines. Out of the total samples, 58.3% (35) exhibited coliform growth, while Shigella spp. and Vibrio spp. did not grow on any media. Among coliforms, Enterobacter spp. was the most prevalent at 33.3%, followed by Escherichia coli at 32%. Antibiotic susceptibility testing revealed that the highest proportion of bacteria was sensitive to Ciprofloxacin and Gentamycin, followed by Ceftazidime. Adulteration analysis indicated that 33.3% and 48.3% of samples were adulterated with sugar and soda, respectively. Starch and soap were not detected in any analyzed samples. The highest titratable acidity (0.16%) was observed in cow farms compared to dairy farms. The findings of this study suggest an urgent need for routine quality testing of milk samples available in the market to prevent the spread of milk-borne diseases and preserve the nutritive value of milk.

Abstract Background The management of enteric fever through antibiotics is difficult these days due to the emerging resistance of Salmonella to various antimicrobial agents. The development of antimicrobial resistance is associated with multiple factors including mutations in the specific genes. To know the current status of mutation-mediated fluoroquinolone-resistance among Salmonella enterica serovars; Typhi, Paratyphi A, B and C, this study was focused on detecting gyrA ser83 mutation by restriction digestion analysis of gyrA gene using HinfI endonuclease. Results A total of 948 blood samples were processed for isolation of Salmonella spp. and 3.4% of them were found to be positive for Salmonella growth. Out of the 32 Salmonella isolates, 2.2% were S. Typhi and 1.2% were S. Paratyphi A. More interestingly, we observed less than 5% of isolates were resistant to first-line drugs including chloramphenicol, cotrimoxazole and ampicillin. More than 80% of isolates were resistant to fluoroquinolones accounting for 84.4% to levofloxacin followed by 87.5% to ofloxacin and 100% to ciprofloxacin by disc diffusion methods. However, the minimum inhibitory concentration method using agar dilution showed only 50% of isolates were resistant to ciprofloxacin. A total of 3.1% of isolates were multidrug-resistant. Similarly, 90.6% of the Salmonella isolates showed gyrA ser83 mutation with resistance to nalidixic acid. Conclusions The increased resistance to fluoroquinolones and nalidixic acid in Salmonella isolates in our study suggests the use of alternative drugs as empirical treatment. Rather, the treatment should focus on prescribing first-line antibiotics since we observed less than 5% of Salmonella isolates were resistant to these drugs.

Background: Following the COVID-19 pandemic, majority of paediatric cochlear implantees (CI) lost follow ups for rehabilitation and tele-therapy was initiated. Present study thus compared the outcome measures of paediatric CI users on tele-therapy versus conventional face to face therapy following COVID-19 pandemic. Method: Twenty seven unilateral paediatric cochlear implantees in the age range of 2–11 years were divided into two groups based on the therapy modality, viz, tele- and face-to-face therapy. Based on the hearing age, participants were further divided into three groups, viz, 0–2, 2–4, and greater than four years. A complete the test battery comprising Integrated Scales of Development, Speech Intelligibility Rating scale, and Revised Categorical Auditory Perception were administered. The speech & language test battery was performed prior to initiating the rehabilitation and post 12 months of rehabilitation. Results: Results of the present study revealed that conventional rehabilitation had better outcomes compared to teletherapy. The rate of progress after one year of rehabilitation with respect to hearing-age showed a significant difference for the hearing-age group of 0–2 years across the domains of audition, speech and language. Conclusion: The present study indicates that conventional method of the speech-language and auditory rehabilitation is far better compared to the tele rehabilitation services especially for those visiting tertiary care hospitals as most of them belong to lower and middle socioeconomic status. From the results, it can be delineated that with lesser hearing experience, paediatric CI users always need to initially enroll for conventional therapy for better speech-language and auditory outcomes.

BACKGROUND: Military training activities are typically challenging and push the soldiers toward their maximum limits of capabilities to improve proficiency in real time situations. In terms of injury prevention, unit performance, and overall morale, the individual's physical capabilities must be in concert to the job demands. Hormones play an important role in regulating various physiological processes including fuel utilization by exercising muscles. AIMS AND OBJECTIVES: This study was undertaken to quantify the hormonal demand of an intense military training event. MATERIALS AND METHODS: The study was conducted at a military training center on 25 male healthy soldiers who had completed 11 week training. Venous blood samples were drawn before and immediately after the event. RESULTS: In hormonal responses, the levels of epinephrine (P < 0.001), norepinephrine (P < 0.01), cortisol (P < 0.001), serotonin (P < 0.01), and aldosterone (P < 0.001) were significantly increased while testosterone (P < 0.001) was found significantly decreased after event. The present study demonstrated that the physical proficiency training activity was highly energy demanding due to significantly increased sympathoadrenergic responses and induced a high level of acute stress due to significant reduction of testosterone. In addition to this, the significantly increased serotonergic responses indicated that the level of fatigue was high during activity. CONCLUSION: The findings of the present study may be helpful in screening of individuals before inducting into such intense military training activity to minimize the risk of injuries.

Fungal infections of hair, nail, and skin are common worldwide and tend to increase. The present study was conducted to determine the prevalence of dermatomycoses, estimate the efficiency of rapid potassium hydroxide (KOH) wet-mount, and observe the hygienic status and the predisposing risk factors. Altogether 115 samples (nail = 77, skin = 30, and hair = 8) were obtained in a duration of December 2019 to June 2020 at Grande International Hospital, Nepal. The samples were examined by KOH wet-mount microscopy and further processed for culture. The dermatophyte test medium (DTM) was used to isolate dermatophytes separately. The fungal colonies obtained in SDA, SDA with cycloheximide/chloramphenicol and dermatophyte medium were subjected to lactophenol cotton blue (LPCB) reagent to study fungal morphology. The yeast colonies grown on SDA were subjected to Gram staining, germ-tube tests, and biochemical tests for identification. CHROMagar was used to distinguish different Candida species based on its pigment production in the medium. Various factors (age, sex, occupation, and hygiene condition) were analyzed which were associated with mycological infection. Out of 115 samples, the presence of fungal elements was detected in 20 samples by KOH. Nondermatophyte molds were the most isolated fungus in nails, skin, and hair, followed by yeast and dermatophytes, respectively. Dermatomycosis molds were the most common causative agents with 22 (14.7%) cases, followed by yeasts with 6 (5.21%) cases. Candida albicans was isolated from 5 (4.3%) cases, whereas Rhodotorula species accounted for a single (0.8%) case. Dermatophytes were isolated from 5 (4.3%) cases. Among them, n = 4(3.4%) cases revealed Trichophyton rubrum and Trichophyton mentagrophytes was isolated from single (0.8%) case. The most isolated nondermatophyte mold that follows criteria as a pathogen in our study was Cladosporium species 6 (25%) out of 27 total fungal isolates. Poor hygiene and sweating were found to be statistically significant (P

Localized therapy approaches have emerged as an alternative drug administration route to overcome the limitations of systemic therapies, such as the crossing of the blood–brain barrier in the case of brain tumor treatment. For this, implantable drug delivery systems (DDS) have been developed and extensively researched. However, to achieve an effective localized treatment, the release kinetics of DDS needs to be controlled in a defined manner, so that the concentration at the tumor site is within the therapeutic window. Thus, a DDS, with patient-specific release kinetics, is crucial for the improvement of therapy. Here, we present a computationally supported reservoir-based DDS (rDDS) development towards patient-specific release kinetics. The rDDS consists of a reservoir surrounded by a polydimethylsiloxane (PDMS) microchannel membrane. By tailoring the rDDS, in terms of membrane porosity, geometry, and drug concentration, the release profiles can be precisely adapted, with respect to the maximum concentration, release rate, and release time. The release is investigated using a model dye for varying parameters, leading to different distinct release profiles, with a maximum release of up to 60 days. Finally, a computational simulation, considering exemplary in vivo conditions (e.g., exchange of cerebrospinal fluid), is used to study the resulting drug release profiles, demonstrating the customizability of the system. The establishment of a computationally supported workflow, for development towards a patient-specific rDDS, in combination with the transfer to suitable drugs, could significantly improve the efficacy of localized therapy approaches.

Extended-spectrum β-lactamase producing E. coli and K. pneumoniae is a serious threat to the patients. These organisms are major extended spectrum beta lactamase (ESBL) producers. The objective of this study was to determine the prevalence of Extended spectrum β- lactamase producing strains of Escherichia coli and Klebsiella spp isolates from the urine sample of children visiting International Friendship Children Hospital. During the seven months, between June 2016 to December 2016, 1018 mid-stream urine samples(MSU) were collected from patients suspected of having UTI. The samples were investigated by conventional semi-quantitative culture technique and identification of E. coli and Klebsiella spp. was done by microscopy and biochemical test. Antibiotic susceptibility test of isolates was performed by modified Kirby Bauer Disc diffusion test. ESBL screening test was done by using 3rd generation Cephalosporin and confirmation done by combination disc diffusion method. Out of total 1018 MSU samples investigated, 200(19.64%) isolates of E. coli and 28(2.7%) isolates of Klebsiella spp. making a total of 228(22.39%) were found to cause significant bacteriuria. 76(33.33%) isolates, from those causing significant bacteriuria, were Multi-drug resistant organisms. Out of 228 isolates, 54(23.68%) were ESBL producers, that includes 51(25.5%) Escherichia coli and 3(12.5%) Klebsiella pneumoniae. ESBL producers were more common in in-patient (36.17%) than out-patient (20.44%). Most of the ESBL producers were resistance to amoxicillin, followed by Cotrimoxazole and Ciprofloxacin respectively. They were highly sensitive to Imipenem, Tigecycline, Amikacin, Piperacillin-Tazobactam, and Nitrofurantoin. High prevalence of ESBL producing E. coli and Klebsiella pneumoniae was found among children. Regular and routine monitoring of ESBL producing isolates is essential.