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Bamboo biomass is a potential source for the production of monomeric sugars containing high cellulose content with low amount of lignin. However, for efficient hydrolysis, the biomass treatment by effective pretreatment technique is required to minimize lignin content and other barrier components. During present study, the bamboo biomass was treated with different physical, chemical, biological and combined treatments to reduce the lignin content. Among all the pretreatments, the maximum lignin removal (14.5%) was obtained with the combined chemical and biological treatment under 2% NaOH+1% H2O2 +WDP2 fungal culture (5 plugs) conditions. In addition, lignolytic fungus and NaOH pretreatment was mainly effective in removing lignin, whereas the H2O2 pretreatment efficiently minimize cellulose crystallinity. To analyze structural changes of raw and treated biomass, we used scanning electron microscopy and fourier transform infrared spectroscopy. The structural analysis indicated that all treatments causes disruption in the biomass structure and loses the compactness of the biomass which facilitates the biomass conversion during hydrolysis process. The findings of the present study indicate effective pretreatment methods in breaching the recalcitrancy of the potential lignocellulosic biomass for maximum hydrolysis.

Lateral epicondylitis is a painful condition of the elbow, characterised by pain and tenderness with resisted wrist extension. This study was carried out to evaluate the comparative efficacy of the local infiltration of L-PRP, methylprednisolone and normal saline in patients with lateral epicondylitis.Sixty adult patients, between the ages 30 to 50 years, diagnosed with lateral epicondylitis of more than 12 weeks, were enrolled in the prospective randomised study. Their medical history and previous conservative treatment were recorded; the clinical evaluation of the tendinitis was made with the visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) outcome scores, the modified elbow performance index (MEPS), the functional assessment by patient-rated tennis elbow evaluation (PRTEE), together with the laboratory investigations. The patients were randomised using the computer-generated alphabets into three groups of 20: group A received saline, group B received PRP, and group C received corticosteroids.Patients were seen at 4, 8 and 12 weeks to evaluate the post-injection status. VAS, DASH, and PRTEE scores were significantly reduced, and MEPS was significantly improved in group B compared to group A and group C. Moreover, the reductions in VAS and PRTEE were significantly different in group C compared to group A.PRP leads to superior healing with long-term therapeutic advantages compared to corticosteroids though it takes a little longer to have its effect.

Purpose: Above-Knee Cast has been standard treatment for treating tibial fractures in children. We conducted this study to evaluate the time of union, complication and cost of treatment between above- Knee and Below-Knee Cast groups in children with isolated tibial shaft fractures. Study Design: Sixty children of age 6 months-15 years were randomized into Above-Knee and Below-Knee Cast group, who were followed and compared; till 6 months from January 2012 to March 2013. 10 children (6 torus, 2 undisplaced, 2 displaced fractures) lost to follow up at 6 months and were analyzed with missing value data analysis at 6 months. Results: All fracture united (8.30±2.69 weeks in Above-Knee Cast, 7.70±2.54 weeks in Below-Knee Cast). The pre-reduction parameters were varus (2-8o), valgus (4-8o), anterior angulation (4-9o), Posterior angulation (2-10o), Internal Rotation (3-6o), External rotation (3-6o), shortening (6.46 mm). At 6 months, above parameters were 2.83o±0.85, 3.20o±0.44, 2.83o±1.32, 2.67o±0.84, 3.40o±0.54, 2.83o±0.75, 2.67±1.15mm respectively in Above-Knee group and 2.60o±0.84, 2.50o±0.52, 3.00o±1.00, 2.93o±1.32, 3.00o±1.41, 2.33o±0.57, 2.00±0.00mm respectively in Below-Knee group. Reinforcement requirement of plaster was higher in Below-Knee cast (p=0.014). There were no refractures, residual complications. Conclusions and clinical relevance: Below-Knee cast is as effective as Above-Knee Cast for treatment of Isolated tibial shaft fractures in child with superior ROM at knee and low cost (p

Background: Pedicle screw fixation of lower cervical spine is a new technique that provides an alternative to posterior lateral mass plating. Although biomechanical studies suggest the use of pedicle screws to reconstruct the cervical spine, placing screw in small cervical pedicle poses a technical challenge. Penetreation of screw in pedicle is a primary complication associated with screw insertion in the lower cervical spine. Aim and Objective: To manage the cervical spine injuries by pedicle screw presented to department of Orthopaedics, BPKIHS, Dharan. Materials and methods: This is retrospective interventional study done at the department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal over a period of 2 years from March 2012 to April 20014. A total of 55 patients with cervical spine injuries were treated by pedicle screw. The patient’s age ranged from 20 to 60 years and the mean follow-up was 12 weeks. Results: The study comprised of 55 patients with cervical spine injuries were treated by pedicle screw The age incidence in this series ranged from 20 years to 60 years. 40 patients were males and 20 was female. All had fractures or fracture dislocation at different levels of lower cervical spine. The mechanism of injury included falls from height (80%), motor vehicle accidents (18%) and sports related injury (2%). Discussion: Pedicle screw insertion into the pedicles in the lower cervical spine is technique that requires a solid knowledge of 3-dimensional anatomy of cervical spine and experience of pedicle screw fixation in thoracolumbar spine. The biomechanical advantages of pedicle screw fixation in cervical spine is obvious, but data are limited. However, safety and role of pedicle screw fixation in reconstruction in the lower cervical spine have not been defined. Conclusion: It is indicated in patients with osteoporotic bone or when rigid internal fixation can not be achieved by conventional techniques.

Background: Total joint replacement is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic device called prosthesis. The prosthesis is designed to replicate the movement of a normal, healthy joint. The goal of orthopedic treatment is to relieve pain and restore function. Aim and Objective: To diagnose and manage the damaged joints by Total joint replacement presented to department of Orthopaedics, BPKIHS, Dharan. Materials and methods: This is retrospective interventional study done at the department of Orthopaedics, BPKIHS, Dharan, Nepal over a period of 4 years from 2010 to 2014. A total of 25 patients with problems of either knee/Hip joint were treated by toal joint replacement. The patient’s age ranged from 30 to 65years and the mean follow-up was 24 weeks. Results: The study comprised of 65 patients with problems of either knee/Hip joints were treated by total joint replacement. The age incidence in this series ranged from 30 years to 65 years. Among 65 patients, 15 cases were knee and 50 cases were hip. Among 15 cases of knee, 1 case was bilateral. 47 patients were males and 18 were female. Discussion: Several conditions can cause joint pain and disability and lead patients to consider joint replacement surgery. In many cases, joint pain is caused by damage to the cartilage that lines the ends of the bones (articular cartilage)-either from arthritis, a fracture, or another condition. The majority of patients are able to perform daily activities more easily after joint replacement surgery. Most people can expect their joint replacement to last for many years, providing them with an improved quality of life that includes less pain, along with improved motion and strength that would not have been possible otherwise. Conclusion: Total joint replacement is excellent treatment methods for damaged joints of knee and hip. Our early results show the same.

Introduction: Displaced distal radius fractures are very common injuries and present regularly to all orthopaedic surgeons. Several documented treatment modalities for these fractures have been described with a recent trend for internal fixation with volar plating. However, the literature suggests that there is still no consensus as to the best treatment of these injuries. Distal radius fractures are among the most common bone fractures all over the world. Close reduction and fixation by percutaneous pinning is a less invasive method comparing with other open surgeries. There is still a dearth of prospective randomized trials in this area. Before the advent of volar locking plates the randomized trials for surgical interventions for distal radius fractures show some evidence to support the use of external fixation or percutaneous pinning however their precise role and methods are not established and whether this will produce consistently better long-term outcome is also not clear. Aim & Objective: To compare percutaneous pinning versus volar locking plate in treatment of distal radius fractures in adults in term of: fracture union, post operative pain, functunal outcome, post operative complication (stiffness, CRPS). Materials and Methods: It is Randomised Controlled Trial Study. All Adults Patients aged 16 and above with displaced distal radius fractures fpresented to the Emergency department and out Patient Department of Orthopaedics at BPKIHS from August 2010 to September 2012 were included in the study. Results: 60 patients with fracture distal end of radius who met the inclusion criteria were included in the study, out of which 30 were randamized into group A, treated by closed reduction and percutaneous fixation supplemented by cast and 30 in group B, treated by volar locking plate. The study showed mean age of incidence to be 39.22+- 14.49 years in age group ranging from 16-65 years. In our study we found that the injuries were result of high energy trauma with RTA constituting the commonest mode of injury (75%) followed by fall from height (15%) and play ground injuries (10%). Males constituted the majority of the study population(67%). Age, sex, mode of injury, type of fracture, interval to surgery duration and associated co-morbidities were equally distributed between the two groups showing success of randamization. There was a highly significant diference in the operative ime and blood loss between two groups, illustating that percutaneous fixation is much shorter procedure with mean operative time of 30 mins compared to 60mins of ORIF with volar locking plate and has less blood loss being 5-10ml to 145ml of ORIF with volar plating. Conclusion: ORIF with volar locking plating provide better radilogical outcomes with more stable fixation thus lesser degree of loss of reduction in comparation to percutaneous pinning. It also had better ROM at wrist initially however this difference is not significant in later months. Volar locking plate is more expensive with more operative time and blood loss as compared to pinning.

Background: Traumatic wounds are common cause of morbidity in Orthopaedic patients. There can be associated injury to various vital structures i.e bones, muscles, tendons, nerves and vessels. Despite recent advances in wound care, the challenge of managing chronic wounds remains compounded by a lack of consensus on clearly defined wound care principles. Methods: A randomised controlled trial was used to enrol 130 patients, out of which 65 underwent EUSOL dressing and 65 underwent collagen granules dressing, all the cases were admitted in Orthopaedics ward and were only discharge at the end of treatment or study period whichever was earlier, so there was no loss to follow up. Assessment of wound was done every week for a period of 4 weeks in terms of slough, discharge, granulation tissue, outcome and coverage. Results: Discharge from the wound was found to be lesser in collagen granules group and by the end of 3rd and 4th week it was significantly lesser in collagen granules group (P value

Background: Close reduction and intramedullary fixation of fracture shaft femur proposed by Kuntscher, is the most biological way of treating the fracture shaft femur. But an open version of this procedure, by which the fracture is stabilized by opening the fracture site and fixing it by retrograde method, became popular because of less complication and more predictable operating time. With the development and emergence of image intensifier and modification in the technique, the locked intramedullary gained popularity. Locked intramedullary nailing can be inserted in a static or dynamic fashion. Aim and Objectives: To compare outcome of open versus closed interlocking nail for fracture shaft of femur in Adults in term of: union, Blood loss, infection rate, functional outcome, Complications if any. Methods and Materials: It is Randomised Controlled Trial Study. Randamization was done using Excel random number generation technique into two groups, each of size 40. Group A:- Diaphyseal fracture treated with closed methods. Group B:- Diaphyseal fracture treated with open methods. Sample size: 40 in each group Results: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Discussion: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Conclusion: Closed IMIL nailing group needs fracture table and image intensifier. Operating time and blood loss is more in Open nailing group. Cost of treatment and union is comparable in both groups. Infection is more in open group as compared to closed group.

The patella is a rare site of primary tumors. Tumors in the patella represent 0.12% of all bone tumors. Majority of tumors are benign [1]. The most frequent benign patellar tumor is giant cell tumor (GCT). Here, we present case report of a giant cell tumor (GCT) occurring in the patella in a 32-year-old woman, who had presented to the Orthopaedic Department of B.P. Koirala Institute of Health Sciences, Dharan, Nepal with the complaint of occasional right anterior knee pain and swelling for 1year. Considering its rarity and unique characteristics, we thought that this case needs to be reported. In this part of world (Nepal) patients commonly present late to the hospital.

Klebsiella pneumoniae, one of the bacterial agents associated with urinary tract infection has been often implicated as a major extended spectrum beta-lactamase (ESBL) producer in last few decades. This study was designed to assess the prevalence of ESBL producing Klebsiella pneumoniae in urinary isolates at a tertiary care hospital in Kathmandu, Nepal, from July to December 2014.One thousand nine hundred eighty six mid-stream urine specimens were collected aseptically from the clinically suspected patients of urinary tract infections attending Capital Hospital and Research Center, Kathmandu. The samples were processed following standard guidelines as recommended by American Society for Microbiology (ASM) and the isolates including Klebsiella spp. were identified using the specific biochemical and sugar fermentation tests recommended by ASM. Antibiotic sensitivity testing was done by modified Kirby-Bauer disk diffusion method and interpreted following Clinical and Laboratory Standards Institute (CLSI) guidelines. Klebsiella pneumoniae isolates showing resistance upon initial screening with ceftriaxone (30 μg) disc were then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 µg) and ceftazidime + clavulanic acid (30 µg + 10µg) and cefotaxime (30 µg) and cefotaxime + clavulanic acid (30 µg +10µg) disc as per CLSI guidelines.Out of a total 1986 specimens investigated, Escherichia coli was isolated in 309 (83.9%) and Klebsiella pneumoniae in 38 (10.3%) cases. Initial screening with ceftriaxone disc revealed 18 isolates of Klebsiella pneumoniae to be resistant. Further testing by PCDDT method confirmed 7 (18.4%) Klebsiella pneumoniae isolates to be ESBL producers.Compared to some earlier studies done in Nepal, higher prevalence of ESBL-producing Klebsiella pneumoniae was observed warranting a national surveillance for routine monitoring of ESBL producing Klebsiella pneumoniae isolates.

Particle therapy has been regarded as an effective modality for treating tumors due to higher RBE than photons and precise dose delivery to the deep seated tumors near the critical organs offering significantly sparing of the normal tissues 1 . High LET ions have been reported to kill radioresistant and hypoxic tumor cells. The large footprint, installation and operational costs of the current particle therapy facilities pose a challenge towards the widespread accessibility of particle therapy. High-power lasers have successfully demonstrated the generation of ion beams, which have been proposed as a route towards reducing the overall footprint and costs of future hadrontherapy facilities. In view of this potential future application a detailed radiobiology of the interaction of laser accelerated ions beams with biological systems is highly warranted. Radiation induced reactive oxygen species (ROS) lead to cellular damage through the induction of an array of lesions including DNA base damage, single strand beaks and double strand breaks and induce apoptosis and necrotic cell death. Under hypoxia, the proliferation rate of tumor cells beats the vasculature formation rate leading to the development of oxygen deficient zones within the tumor. Such hypoxic zones leads to reduced radiotherapy response owing to a decrease in ROS that are required to produce lethal DNA damage. In this paper we aim to study the effectiveness of laser-accelerated protons in the induction of DNA DSB damage in hypoxic human cells through a comparison to 225 kVp X-rays and cyclotron accelerated protons.

Accelerated proton beams have become increasingly common for treating cancer. The need for cost and size reduction of particle accelerating machines has led to the pioneering investigation of optical ion acceleration techniques based on laser-plasma interactions as a possible alternative. Laser-matter interaction can produce extremely pulsed particle bursts of ultra-high dose rates (≥ 109 Gy/s), largely exceeding those currently used in conventional proton therapy. Since biological effects of ionizing radiation are strongly affected by the spatio-temporal distribution of DNA-damaging events, the unprecedented physical features of such beams may modify cellular and tissue radiosensitivity to unexplored extents. Hence, clinical applications of laser-generated particles need thorough assessment of their radiobiological effectiveness. To date, the majority of studies have either used rodent cell lines or have focussed on cancer cell killing being local tumour control the main objective of radiotherapy. Conversely, very little data exist on sub-lethal cellular effects, of relevance to normal tissue integrity and secondary cancers, such as premature cellular senescence. Here, we discuss ultra-high dose rate radiobiology and present preliminary data obtained in normal human cells following irradiation by laser-accelerated protons at the LULI PICO2000 facility at Laser Lab Europe, France.