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This study characterized cytochrome P450 enzyme CYP154C7 from Streptomyces sp. PAMC26508, emphasizing its capability to hydroxylate steroids, especially at the 16α-position. The enzymatic assay of CYP154C7 demonstrated effective conversion across a pH range of 7.2–7.6, with optimal activity at 30 °C in the Pdx/PdR plus NADH system. Kinetic analysis on most converted steroids (androstenedione and adrenosterone) was performed which shows a greater affinity for androstenedione (Km, 11.06 ± 1.903 μM; Vmax, 0.0062 ± 0.0002 sec−1) compared to adrenosterone (Km, 34.50 ± 6.2 μM; Vmax, 0.0119 ± 0.0007 sec−1). A whole-cell system in Escherichia coli, overexpressing recombinant CYP154C7, achieved substantial conversion for steroids, indicating that CYP154C7 can also be used as a potential whole-cell biocatalyst. To gain structural insights, homology models of CYP154C7 and its homologs were constructed using CYP154C5 (PDB ID: 6TO2), refined, validated, and used for docking studies. Comparative docking analysis suggests that lysine (K236) in the active site and tyrosine (Y197) in the substrate access channel of CYP154C7 are crucial for substrate selectivity and catalytic efficiency. This study suggests that CYP154C7 could be a promising candidate for developing modified steroids, providing valuable insights for protein engineering to design commercially useful CYP steroid hydroxylases with diverse substrate specificities.

Objective: This studies aims to evaluate the outcome of Microvascular Decompression (MVD) using a muscle graft for interposition in Trigeminal Neuralgia (TN), Hemifacial Spasm (HFS) and Glossopharyngeal Neuralgia (GPN). All surgeries were performed by a single surgeon (G.R.S). Methods: In total, 26 patients with TN, HFS and GPN underwent MVD from September 2007 to April 2019. All the patients were either medically refractory or poor symptom tolerance. The mean follow-up period was 72 months. Results: Each MVD was performed using an autologous muscle graft with interposition of vessels. One patient (3.84%) had reoccurrence after MVD with muscle graft and two patients (7.69%) had partial relief. Conclusion: Various types of prosthesis are used for transposition and interposition of vessels in MVD surgeries. Although in our case series we didn't use any prosthesis for the comparative outcome, the use of muscle graft showed minimal reoccurrence rate with benefit of being cost effective. Therefore, we need randomized controlled trials to prove the superiority of muscle graft from other prosthesis material.

Introduction Single burr hole surgery for Chronic subdural hematoma (CSDH) is commonly performed neurosurgical procedure with >90% favorable outcome and less hospital stay. However, sometimes hospital stay may be prolonged due to associated prognostic factors, even in patients with favorable outcome. This study aims to analyze the early outcome of single burr hole and drainage surgery and factors that may be associated with prolong hospitalization. Materials and method A retrospective analysis of the patients who underwent single burr hole and drainage for CSDH from sept 2017 to may 2020 in Nepal Mediciti hospital. The patients with B/L CSDH, who underwent double burr hole and drainage or craniotomy evacuation or conservatively managed patients were excluded from the study. Early outcome was assessed using Glasgow outcome score at 7 days. Effect of use of antiplatelet/ anticoagulant drugs, age, comorbidity, preoperative Glasgow coma score on number of hospital stay was analyzed. Chi-square test was used for statistical analysis in SPSS version 25. Results Out of 85 patients, 73 were male. Mean age was 63.8 years. Early outcome in 7 days was favorable with GOS (4-5) in 90.6%. The use of antiplatelet or anticoagulant drugs was more common amongst patients with age > 70 years (p=0.01). The number of hospital stay was associated with age (p=0.00), antiplatelet or anticoagulant drugs (p=0.00), comorbidities (p=0.001), preoperative GCS(P=0.001) and GOS at 7 days (p=0.001). Conclusion Single burr hole and drainage surgery for CSDH mostly produce favorable outcome. The use of antiplatelet or anticoagulant drugs is more common in patients above 70 years. Age, antiplatelet or anticoagulant drugs, comorbidities, preoperative GCS, GOS at 7 days are related with longer hospital stay.

Introduction: Lumbar degenerative spondylolisthesis is an acquired slippage of a vertebra due to degenerative arthritis of the facet joints without any defect in the vertebral ring. Degenerative spondylolisthesis is commonly treated with posterior decompression and posterolateral fusion. This study aims to evaluate the clinical outcome of posterior decompression and instrumented posterolateral fusion surgery by analysing patient reported outcome measures. Materials and Methods: A retrospective study in which patients who had posterior decompression and instrumented posterolateral fusion for lumbar degenerative spondylolisthesis between September 2017 and August 2019 at Nepal Mediciti Hospital were included in the study. Other types of spondylolisthesis managed with similar technique and patients who had follow up period of less than three months were excluded. Functional outcome was assessed by comparing pre and post-operative patient reported outcome measures: VAS leg pain, VAS back pain and Oswestry Disability Index (ODI). The paired t-test was used for statistical analysis. Results: Of the 16 patients, 81.25% were female. Mean age and mean follow up period were 58.81± 10.47 years and 13.56±7.15 months respectively. Seventy five percent had grade I spondylolisthesis. Most common level of spondylolisthesis was L4/5 (62.5%). Fourteen patients reported improvement in their symptoms after surgery. The changes in functional outcome scores between baseline and at follow up evaluation were as follows: 32.70 ± 17.44 points for ODI, 3 ±1.89 for VAS leg pain, and 5.37 ± 2.36 for VAS back pain (P

Background/aim To determine willingness to pay for children’s spectacles, and barriers to purchasing children’s spectacles in Cambodia.Methods We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique.Results We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p

Craniovertebral junction (CVJ) is a complex anatomic region providing stability and mobility to the most important part of the craniospinal axis. The purpose of this study is to analyse clinical characteristics and outcome after surgical management of patients with CVJ anomalies presented to Neurosurgery department, Bir hospital Kathmandu Nepal. A retrospective analysis of 21 patients, managed surgically for craniovertebral instability between 2013 and 2017, was performed. Imaging studies were reviewed for bony and soft tissue details. Patients managed with posterior approach alone (either occipitocervical fusion or C1-2 fusion with or without bony decompression) were included in the study. Outcome was assessed by comparing pre and post operative Nurick grade. Most common causes of CVJ instability were non union of old odontoid fracture (38.1%)and OsOdontoidium (38.1%). 76.2% had intramedullary high signal intensities in T2 weighted MRI while 90% had cervicomedullary compression. Pre operatively, 52.38% had Nurick grading scale of 4 to 5 while 47.62%had 0-3 Nurick grade scale. Post operatively, 71.42% improved clinically, 23.80% remained unchanged while one patient deteriorated. Mean duration of follow up was 20.87 months (6-60 months). Pre operative Nurick grade was significantly associated with post operative outcome (p=0.042). Early surgical intervention is associated with better clinical outcome. Larger prospective study with clinical and radiological follow up is recommended.

Cysts occupying the third ventricle are rare lesions and may appear as an unusual cause of hydrocephalic crisis. A 40-year old woman with headache and one episode of fainting attack was diagnosed with a cystic lesion in the third ventricle after brain MRI study. She was operated with the pre-operative diagnosis of a colloid cyst. A yellowish, thick and mucoid cyst was observed intra-operatively. The total removal of the cyst was done along with the cyst wall. On histopathological evaluation, the cyst wall was lined by ciliated cuboidal to pseudostratified columnar epithelium resting on an eosinophilic basement membrane. The ultrastructural study showed the characteristic 9+2 pattern of cilia. Immunohistochemistry showed positive staining for epithelial membrane antigen (EMA), cytokeratin (CK), and negative staining for Glial fibrillary acidic protein (GFAP). Histopathological and ultrastructural findings confirm the diagnosis of a colloid cyst of third ventricles favoring the endodermal origin of the cyst.

Rheumatoid arthritis (RA) is being increasingly recognized as an important contributor to chronic obstructive pulmonary disease (COPD). Although smoking is a major risk factor, other factors may play a role. We used National Inpatient Sample (NIS) from 2013 to explore this relationship. We used propensity matching with a 1:3 nearest-neighbor-matching algorithm to match 1 RA hospitalization to 3 age- and-sex-matched comparators. In the age- and-sex-matched population, RA had a higher odds of COPD (OR 1.20, 95% CI: 1.17–1.22, p

Background: The optometry training programme started in Nepal in 1997 with an intake of six students per year. The second optometry school was established in 2018 with an intake of 40 students per year. Aim: To establish a profile for Nepalese optometrists and understand their perspectives regarding the entrance examination, curriculum, infrastructure and recruitment of lecturers for a newly opened second optometry school. Setting: The prospective study respondents were contacted by email and the survey was administered online. Methods: A semi-structured questionnaire was emailed to 118 registered optometrists of the Nepalese Association of Optometrists, and the response rate of the survey was 69%. The questionnaire contained broad areas such as demographics of participants, their scope of practice, mode of entrance examination and content of the course curriculum, and availability of adequate infrastructure and lecturers. Results: A vast majority (93%) of the respondents suggested that optometrists should have been involved more in the planning of the programme. Over half of the respondents (57.5%) suggested that the programme should go ahead with a revised curriculum and well-equipped laboratories. The qualitative analysis produced four broad themes: (1) quality assurance and control; (2) resources; (3) curriculum development and implementation; and (4) professional standards and opportunities. The responders expressed several strategies to address these concerns, including communicating with stakeholders and filing a case in the court for starting up a new optometry school without sufficient involvement of the existing optometrists. Conclusion: The recommendations for improvement include conducting impartial entrance examinations, establishing equipped laboratories and recruiting adequate lecturers.

Optometry is an independent profession which is specialised for providing comprehensive eye care including refraction and dispensing services, diagnosis and management of eye diseases and visual rehabilitation. In clinical settings of Nepal, optometrists are primarily recognised as refractionists and are provided with working opportunities in the same area. This report highlights other optomet- ric services such as binocular vision, multifocal lenses, contact lenses and occupational lens design which can be provided by optometrists besides performing refraction and prescribing spectacles. Considering large proportion of optometrists with further education and being working outside the country, new specialised services can be introduced through training and workshop to the fellow optometrists so that specialised services can reach up to the public level. Keywords: Nepal; optometry; refraction services.

Karst groundwater is one of the primary water resources in most provinces of Southwestern China where karst topography is strongly featured. In Guizhou Province, a prominent geologic sedimentary formation is the dolomite stratum which exists as the restricted platform facies and potentially provides a large reservoir for drinking water. A proper understanding and evaluation of its hydrogeochemical characteristics and water quality is the key to ensuring the drinking water safety. In the present study, groundwater samples were collected from 25 locations of the dolomite aquifer across Guizhou to determine their major chemical compounds, including the cations (K+, Na+, Ca2+, Mg2+) and the anions (HCO3−, F−, Cl−, NO3−, SO42−), as well as the pH, total hardness, and total dissolved solids. HCO3− and Ca2+ were found to be the dominant anion and cation, respectively, which is characteristic of typical karst groundwater and supports the overall observation of a slightly weak acid to weak alkaline environment in the studied groundwater, as the pH measurements ranged from 6.80 to 8.37. Fuzzy comprehensive evaluation method is used to evaluate the groundwater quality based on typical drinking water safety standard. The results show that the groundwater in most of the studied aquifers is of reasonably good quality. However, in some aquifers, concentrations of NO3− and/or SO42− were found to be excessively high. Overall, the studied dolomite aquifer in its natural environment as investigated in the present study can be considered as a potential geological stratum for water resources exploitation in Guizhou.

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.