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Introduction: Mammography is a simple and effective tool in early detection of breast lesions. However its sensitivity is less in dense breast. The aim of the study is to see whether addition of ultrasonography adds on to the diagnostic value by finding more breast lesions in evaluation of mammographic dense breasts or not. Methods: The hospital data of all the patients who underwent mammography in the Department of Radiology of Shree Birendra Hospital, Kathmandu over a period of two and a half years from November 2017 to April 2020 were retrieved and retrospectively analyzed. The mammographic findings of patients with dense breast were compared with the corroborative ultrasonographic findings. Discrepancy in positive findings between the two imaging modalities was studied. Results: Out of 536 patients studied, 238 patients had mammographic dense breast. Comparative study showed 82 cases with positive findings on mammography alone, compared to 114 cases with positive findings on combined mammography and ultrasonography with p-value < 0.05 which is statistically significant. Conclusions: Ultrasonography is a useful additional imaging modality in evaluation of mammographic dense breast by finding more breast lesions compared to Mammography alone.

A total of 22 patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each patient was assessed light microscopically, and, in select biopsies, spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within 1 day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of eczematous dermatitis, interface dermatitis, granulomatous inflammation, and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris, and guttate psoriasis were seen in select cases. In 2 cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsy specimens of normal skin post vaccine and of skin affected by the post-vaccine eruption showed rare deep microvessels positive for spike glycoprotein with no complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from patients experiencing severe coronavirus disease 2019 (COVID-19). It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly owing to a substance found in the vaccine vehicle (eg, polyethylene glycol). An immune response that is directed against human-manufactured spike has to be considered because some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine-associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis, and subclinical hypersensitivity.

The multidrug- or extensively drug-resistant (MDR/XDR) Pseudomonas aeruginosa carrying some virulence genes has become a global public health threat. However, in Nepal, there is no existing report showing the prevalence of oprL and toxA virulence genes among the clinical isolates of P. aeruginosa. Therefore, this study was conducted for the first time in the country to detect the virulence genes (oprL and toxA) and antibiotic susceptibility pattern of P. aeruginosa. A total of 7,898 clinical specimens were investigated following the standard microbiological procedures. The antibiotic susceptibility testing was examined by the modified disc diffusion method, and virulence genes oprL and toxA of P. aeruginosa were assessed using multiplex PCR. Among the analyzed specimens, 87 isolates were identified to be P. aeruginosa of which 38 (43.68%) isolates were reported as MDR. A higher ratio of P. aeruginosa was detected from urine samples 40 (45.98%), outpatients’ specimens 63 (72.4%), and in patients of the age group of 60–79 years 36 (41.37%). P. aeruginosa was more prevalent in males 56 (64.36%) than in female patients 31 (35.63%). Polymyxin (83.90%) was the most effective antibiotic. P. aeruginosa (100%) isolates harboured the oprL gene, while 95.4% of isolates were positive for the toxA gene. Identification of virulence genes such as oprL and toxA carrying isolates along with the multidrug resistance warrants the need for strategic interventions to prevent the emergence and spread of antimicrobial resistance (AMR). The findings could assist in increasing awareness about antibiotic resistance and suggest the judicious prescription of antibiotics to treat the patients in clinical settings of Nepal.

Atopic dermatitis is a chronic inflammatory dermatoses, pruritic and relapsing, with variable density in which attacks mostly patients in pediatric age group. Therefore, the disease can cause a series of psychological and social damage because of its consequences at the family’s routine. Thus, the disease gets involved at the daily activities and interpersonal relationship. In summary, this study objective is to review articles about atopic dermatitis’ impact on the life quality of pediatric patients and their caregivers, using integrative review and literature's descriptive as a method, with a quality approach, at SciELO and Google Scholar data base in the month of June of 2021 with the words: “atopic eczema”, “children”, “relatives” and “welfare”. It was found 200 articles written in English, Portuguese and Spanish, published between 2012 and 2021 that had public access. From this number, 11 studies were selected to compose this review’s data base. In conclusion, the atopic dermatitis negatively affects the daily life of pediatric patients and their caregivers. The discomfort caused by the pruritic eczema adds to sleep deprivation and affects the children’s development at school, family and psychosocial life. The worst of this disease is related to bad quality of life index. A better understanding of atopic dermatitis’ impact can positively affect the patient’s frequent treatment and therapeutic strategies.

Reusable medical devices are decontaminated and sterilized often many times by healthcare facilities across the globe. Reprocessing of medical devices comprises several processes and water plays an important role in some of these, including cleaning and steam sterilization. The water used is required to have certain qualities to ensure the effectiveness of the processes. In this short communication, we report findings of our study which measured quality parameters (pH, total hardness) for water used for medical device reprocessing in 13 primary and secondary care public hospitals in Nepal. The mean pH of water used for reprocessing of medical devices varied from 6.48 to 8.05 across the hospitals whereas the mean total hardness of water varied from 5.93 to 402.50 mg/L CaCO3. Although the range of the mean water pH across hospitals fell within the recommended range, many of the hospitals had mean total hardness higher than recommended for cleaning medical devices. None of the hospitals had mean total hardness suitable for using as feed-water for steam generation. Public hospitals in Nepal should have appropriate water treatment systems so that the recommended water quality can be achieved to ensure effective decontamination and reprocessing of medical devices. HIGHLIGHTS We have highlighted the crucial role of water in reprocessing of reusable medical devices.; This is the first ever study reporting quality parameters of water used for medical device reprocessing in public hospitals in Nepal.; Hospitals included in the study covered all geographical terrains in Nepal.; Recommendations have been made for treatment of water to ensure adequate reprocessing of medical devices.

AIM AND OBJECTIVE: This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. MATERIALS AND METHODS: The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January-March 2020) and after lockdown (June-August 2020), were included retrospectively and compared. RESULTS: The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. CONCLUSION: The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. CLINICAL SIGNIFICANCE: This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis. How to cite this article: Panta P, Reddy P, Misra SR, et al. Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions. J Contemp Dent Pract 2021;22(5):501-505.

In this article, we propose a slice-based interactive segmentation of spectral CT datasets using a bag of features method. The data are acquired from a MARS scanner that divides up the X-ray spectrum into multiple energy bins for imaging. In literature, most existing segmentation methods are limited to performing a specific task or tied to a particular imaging modality. Therefore, when applying generalized methods to MARS datasets, the additional energy information acquired from the scanner cannot be sufficiently utilized. We describe a new approach that circumvents this problem by effectively aggregating the data from multiple channels. Our method solves a classification problem to get the solution for segmentation. Starting with a set of labeled pixels, we partition the data using superpixels. Then, a set of local descriptors, extracted from each superpixel, are encoded into a codebook and pooled together to create a global superpixel-level descriptor (bag of features representation). We propose to use the vector of locally aggregated descriptors as our encoding/pooling strategy, as it is efficient to compute and leads to good results with simple linear classifiers. A linear support vector machine is then used to classify the superpixels into different labels. The proposed method was evaluated on multiple MARS datasets. Experimental results show that our method achieved an average of more than 10% increase in the accuracy over other state-of-the-art methods.

To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.

OBJECTIVES There are limited longitudinal data regarding gingival inflammation in adults. This study aimed to assess changes in gingivitis over 4 years and to determine protective factors. METHODS A representative sample of 1023 adults living in Porto Alegre, Brazil, was obtained in the Caries-Perio Collaboration Study. At follow-up, 402 individuals were re-examined. Gingivitis was assessed by the gingival bleeding index (GB) at both time points. Individuals were dichotomized into those showing reductions ≥ 15% and those showing reductions

Introduction: Professional Developmental Activities (PDA) are the means to update the health care providers with new knowledge and help them to provide quality care and better patient outcomes. This study aims to determine the factors that influence participation in professional development activities among nursing personnel. Methods: A cross sectional study was conducted among nurses in Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu, Nepal. Simple random sampling technique was used to collect data. Data was collected through self-administered semi-structured questionnaire. The collected data were analysed for descriptive and inferential statistics using SPSS version 20. Results: Total 124 nurses participated in the study. Most (88.7%) were working as a staff nurse. Majority (60.5%) of nurses had participated in PDA within last 12 months. The most common factors which motivated nurses to participate in PDA were family / spouse support and improve knowledge (98.7%). The major hindering factors were shortage of staff (97.9%), and lack of cost (91.8%). Chi-square and Fisher exact tests were used to test the association of selected variables and PDA participation and significant association was seen between participants designation categorised as staff nurse, senior staff nurse and nursing in charge (p < 0.008) and those who were involved in professional developmental activities. Conclusions: Based on findings, the study concluded that there are several factors either hindering or motivating related to work, family, financial, personal and career that contributes to nurses participation in PDA.

Wild edible plants are those plants that are not domesticated and often neglected but have nutritional and medicinal value and can be used as a good source of diet. The study discusses and depicts the availability of wild edible plants, their taxonomical categories, species richness, distribution, preference, and their threat in the Gaumukhi area. Data were collected from 60 randomly selected wild edible plant consumers of Puja and Khung village using a semi-structured interview schedule. The study showed that 37 different species of wild plants are frequently used by respondents. It was found that the majority of the WEP’s used were trees followed by herbs and shrubs. It was found that majority of WEP's used were trees followed by herbs and shrubs. Regarding the plant parts used, most of the respondents (54%) use WEP’s in the form of vegetables followed by raw fruits (28%) users. The study revealed that the majority of WEP’s consumers (39%) were from other caste categories like Giri, Puri, Malla, etc. followed by Dalits (36%). Research indicated that most of the WEPs were collected from the forest area having an altitude of (1300-1500) masl. The major threat to wild edible plants was fuel wood collection followed by uncontrolled fire. Study preference of WEP’s among the respondents showed that Polystichumsquarrosum (Daude) was the highly preferred one followed by Diplaziumesculentum (Neuro) and Dendrocalamushamiltoni (Tama).

The cerebral arterial circle (circle of Willis) plays an important role in the redistribution of the blood flow between the anterior and posterior territories and maintains the plasticity of the cerebral blood circulation. The anatomical variability of the vascular circle often alters the cerebral hemodynamics and determines the outcomes of acute and chronic cerebrovascular disease. The heritability and prevalence of certain variants of the circle of Willis in different ethnic and racial groups are frequently disputed by authors. Our cross-sectional retrospective study aims to compare the patterns of the cerebral arterial circle in 64 Caucasian cadavers with 64 Arabic living individuals, by methods of anatomic dissection and magnetic resonance angiography, respectively. The typical structure of the circle of Willis was revealed in 8.3% of the Caucasian study group, and in 22.2% of the Arabic one. The anterior part of the circle of Willis was incomplete in 6 out of 64 of the Caucasian specimens, where the anterior communicating artery was hypoplastic (6.3%) or absent (3.1%). The posterior part of the circle of Willis had hypoplastic or absent posterior communicating artery on one side in 20, and on both sides in 12 out of 64 Caucasian specimens. In the Arabic cohort, the posterior part of the circle of Willis was incomplete in 17 out of 64 specimens, with absence of the posterior communicating artery unilaterally (in 11 cases) or bilaterally (in 6 cases). The present study reveals that the configuration of the cerebral arterial circle and distribution of the blood flow between the anterior and posterior territories have certain differences in the Caucasian study group versus the Arabic one.

In this study, an atmospheric alternating-current gliding arc device using line frequency (50 Hz) has been designed for the generation of various reactive species in different working gases. Electrical characteristics of the generated discharge are investigated by oscilloscope while the optical characteristics are analyzed using optical emission spectroscopy. The role of different working gases (oxygen, argon and air) on discharge voltages and power consumption per cycle in the discharge are calculated and compared. Electron density and electron temperature of the discharge are estimated by electrical and optical method respectively. The production of reactive species in the discharge is affirmed by optical emission spectroscopy. The outcomes of the results confirm that the GAD can generate non-equilibrium plasma having reactive nitrogen and oxygen species (RONS) which are essential for plasma chemistry applications.

Objectives: The main objective of this study was to determine the prevalence of Methicillin Resistance Staphylococcus aureus (MRSA) and MDR bacteria isolated from various clinical specimens from the patients attending Narayani Samudayik Hospital, Chitwan Methods: A cross sectional study was carried in NPI-Narayani Samudayik Hospital, Chitwan from June to December 2017. Altogether, 3610 clinical specimens mainly pus, blood and urine were collected, streaked on Mannitol Salt Agar and Blood Agar and incubated at 37°C for 24 hours. The confirmed colonies of S. aureus were sub-cultured on Nutrient Agar. The antibiotic susceptibility pattern of all isolates S. aureus was determined by Kirby Bauer disc diffusion method. Isolates resistant to cefoxitin (30mcg) were confirmed as MRSA. Result: Among 3610 total clinical samples, 17.6 % (635/3610) showed growth and 95(14.96%) S. aureus were isolated. Higher number of S. aureus was isolated from pus sample (93.15%). Out of 95 S. aureus isolates, 55 (57.89%) were identified as MRSA while 40 (42.10%) were MSSA. Vancomycin, ceftriaxone and chloramphenicol were found to be most effective antibiotic against isolates. Whereas, the least effective antibiotic was cefoxitin followed by amoxiclav, oxacillin and amoxicillin. Conclusion: This study concludes that the overall prevalence of MRSA and MDR among the bacterial isolates is higher compared to other studies. So, it is recommended to monitor the antibiotic susceptibility pattern of pathogens regularly and study the epidemiology of such isolates.

Introduction: Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. The addition of Fentanyl or Midazolam can provide excellent quality and prolong the duration of analgesia. The study aims to compare the effect of intrathecal Fentanyl with that of intrathecal Midazolam in combination with 0.5% hyperbaric Bupivacaine on the duration and quality of spinal anesthesia in patients undergoing appendicectomy.Materials and Methods: This is a prospective, comparative and interventional study where patients were randomized into two equal groups. The study was conducted in a tertiary referral hospital from July 2018 to December 2018 after ethical approval. Group BF received Fentanyl and group BM received Midazolam The outcomes measured were, peak sensory level, quality of intraoperative analgesia and motor block, duration of effective analgesia, intraoperative and postoperative complications.Results: A total of 44 patients were studied with 22 in each arm. The two groups were comparable in terms of age, weight, height, duration of surgery, and ASA status of the patients. Peak sensory level and degree of motor block were not statistically different in the two arms. Duration of effective analgesia was 293.16±35 min in the BF group and 267.80±32 min in the BM group (p=0.01). Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group.Conclusions: Fentanyl and Midazolam both are equally effi cient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy.

Low socioeconomic level may contribute to the severity of asthma, frequency of exacerbation, and hospitalization and affects the quality of life. The aim of the study was to evaluate the impact of socioeconomic status (SES) on general score of quality of life (GSQL). Methods: The study group included children aged between 8-16 years with persistent asthma, and we followed them up 12 months. We analyzed the location and the size of the household, educational level, and employment status of parents and family income. The GSQL was obtained based on the questionnaire of quality of life in children with asthma. According to the SES, we divided the study group into high income and low-income groups. Results: Half of the patients belonged to families with low income. There were no significant differences in GSQL regarding the living area, educational level, and parents' employment status. The general score of quality of life was higher in patients from the high-income group than those with lower income at the beginning of the study (5.04±1.09 versus 4.43±0.97; p=0.0101). Alter 12 months GSQL increased significantly in both groups (6.57±0.57 versus 6.49±0.56; p=0.3167). The quality of life was not affected by atopic status. Conclusions: The low income has a negative impact on children GSQL. The educational level and employment status of parents, rural area, and the association of other allergic diseases do not affect the quality of life.

Neonatal period is the most vulnerable period of the survival of the child, so good neonatal care practices is crucial for the prevention of morbidity and mortality of a neonate. Descriptive cross-sectional study design with 219 Muslim women having less than 1year old babies were selected by probability sampling technique to find out the neonatal care practices. A semi-structured interview schedule was used for data collection. Data were analyzed using descriptive and inferential statistics. Early marriage and illiteracy is common in these Muslim communities.Only around half (49.8%) of mothers had sufficient neonatal care practice. However, there is good eye care practice in those communities. All of the mothers practiced oil massage to their babies once or more than one time in a day. Regarding breastfeeding, more than four fifth (83.87%) of mothers fed exclusively to their newborn; 13.24% mothers had home deliveries, among them 75.85% of deliveries were assisted by unskilled personnel. The significant association was found betweenlevel of neonatal care practice andage of mother(p-value 0.024). Likewise, mother’s education is also associated with the feeding of colostrum (p-value 0.038). Insufficient neonatal care practiced was predominant amongmothersof those Muslim communities so there is need for strengthening community awareness by mobilizing female community health volunteers (FCHVs). Home delivery by unskilled personnel is very common so they should be motivated for institutional delivery and completion of the recommended antenatal visits.

Background Previous studies have suggested that the association between APOE ɛ 4 and dementia is moderated by physical activity (PA), but the results remain inconclusive and longitudinal data on cognitive decline are missing. In this study, we examine whether there is a gene–environment interaction between APOE and PA on cognitive decline in older adults using 9-year follow-up data of three cohort studies. Methods We followed 7,176 participants from three longitudinal cohort studies: Longitudinal Aging Study Amsterdam (LASA), InCHIANTI, and Rotterdam Study for 9 years. PA was assessed with self-reported questionnaires and was categorized in low, moderate, and high PA. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and cognitive decline was defined as a decrease of three points or more on the MMSE during 3 years follow-up. We fitted logistic regression models using generalized estimating equations adjusting for age, sex, education, depressive symptoms, and number of chronic disease. Interaction between APOE and PA was tested on multiplicative and additive scale. Results Cohorts were similar in most aspects but InCHIANTI participants were on average older and had lower education. APOE ɛ 4 carriers had higher odds of cognitive decline (odds ratio [OR] = 1.46, 95% confidence interval [CI]: 1.29–1.64) while PA was not significantly associated with cognitive decline overall (moderate PA: OR = 0.87, 0.67–1.13; high PA: OR = 0.71, 0.36–1.40). There was no evidence for an interaction effect between PA and APOE ɛ 4 in cognitive decline in older adults (APOE × moderate PA: p = .83; APOE × high PA: p = .90). Conclusions Previous claims of a gene–environment interaction between APOE ɛ 4 and PA in cognitive decline are not supported by our results.

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

Background: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. Clinical diagnosis plays a vital role in appendicitis. The treatment of acute appendicitis remains a health problem and significant morbidity and mortality are still associated with it. Morbidities such as perforation, abscess formation, appendicular lump and surgical site of infection are well reported. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this region of Nepal. Methods: This cross sectional retrospective study was carried out in the Karnali academy of health sciences, Jumla. The data includes the 5 years period from June 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication. Results: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix. Two had abscess in 29 cases of appendicular mass. 2 had a surgical site infection. Conclusion: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication was the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment were equally feasible for acute appendicitis according to the cases presented in the hospital.

Introduction: Osteoporosis is a bone disorder characterized by a reduction in bone density accompanied by increasing porosity and brittleness. It is one of the major public health problem globally and its prevalence is rapidly increasing particularly in women. Osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Therefore the objectives of the study was to assess the existing awareness and health belief of osteoporosis among middle aged women. Methods: Descriptive cross-sectional research design was used on a sample of 328 middle aged women residing in Nagarjun Municipality, Kathmandu. Non probability purposive sampling technique was used to collect the data. Data was collected after informed consent through face to face interview schedule using Osteoporosis Knowledge Assessment Tool (OKAT) and Osteoporosis Health Beliefs Scale (OHBS). Descriptive statistics and inferential statistics (Chi-Square test) were used for data analysis at 5% level of significance. Results: The overall osteoporosis awareness and health beliefs mean scores were9.39 ± 2.93 and 146.18 ±11.58 respectively. Majority(60.0%) of the respondents were unaware of osteoporosis. Existing awareness of respondents was significantly associated with age (p

Hypothyroidism is a common endocrine disorder with a prevalence of 1-2% in the world. The symptoms of hypothyroidism includes, cardiac dysfunction, dyspnea and reduced exercise tolerance, overt cardiovascular diseases, and diabetes mellitus. The aim of the study was to access Knowledge, awareness and, the practice of patient with primary hypothyroidism among the patient attending at endocrinology care center. In this study, most of the female patients were seen hypothyroid than males. Out of a total of 164 respondents, 5.5% were age group of 15-24, 52.4% were age group 25-44, 39% were from the age group 45-64 and 3% were above 65. Among the studied population, 93.9% were male and e other ware female. The majority of the respondent was in the age group of 25-44 years (52.4%). Major differences were seen after the intervention regarding the Knowledge about thyroid and hypothyroidism. Before intervention respondent was more unknown towards the test required for treatment and similarly after the intervention improved the understanding level of patients towards hypothyroidism. Hence this study suggested advantages of intervention by pharmacist in improving knowledge, attitude and practice of patients towards management of disease.

Introduction: Cervical degenerative disc diseases leading to cervical spondylotic myelopathy (CSM) is one the most common cause of disability in elderly population that progresses with age with continuation of degree of degeneration. Objective: To assess the functional outcome following ACDF in single-level cervical degenerative disc disease in terms of improvement in the mJOA scoring system and postoperative complications. Materials and methods: Eighteen patients with single level cervical degenerative disc diseases who presented at the college of medical sciences from May 2018 to October 2019 fulfilling the inclusion criteria (single-level cervical degenerative disc disease with age between 40 to 70 years with progressive neurological deficits, features of cervical spondylotic myelopathy and patients with mild grade who failed four weeks of conservative treatment and progressed to moderate or severe grades) were included in the study. All patients underwent Anterior Cervical Discectomy and Fusion (ACDF); with tricortical iliac crest graft with cervical plate and screws in 13 patients and polyether ether ketone (PEEK) cage placement in five patients. Patients were assessed using mJOA scoring system and graded into mild, moderate and severe myelopathy. Post-operatively patients were assessed for improvement in terms of mJOA scores at four weeks and three months follow-up. They were also assessed for development of any post-operative complications and documented accordingly. Statistical analysis was done using the Statistical Package for the Social Sciences version 20 software. Results: Out of 18 patients, at the time of presentation 12 were in moderate grade and six were in severe grade. During subsequent follow up at four weeks and three months, patients showed progressive improvement. 15 patients improved to mild grade while two remained in moderate grade and one in severe grade during three months postoperative assessment. One patient each developed dysphagia, hoarseness and superficial wound infection that were managed conservatively. Conclusion: Anterior cervical discectomy and fusion is one of the effective and safe treatments for single-level degenerative cervical disc disease associated with cervical spondylotic myelopathy with minimal complications.

Introduction: Mobile medical and surgical camps are one of the means of providing medical and surgical facilities to people living in rural areas of developing country like Nepal. Methods: An observational cross-sectional descriptive retrospective study was done collecting data from surgical camps done by Nepali Army in six years from February 2013 to February 2019 AD. Total number of surgical cases requiring anaesthesia along with type of anaesthesia, American Society of Anaesthesiologist physical status classification and anaesthesia related complications were collected. Results: In a six year period, total 12 mobile surgical camps were conducted by Nepali Army. Out of which, two were done in collaboration with Ministry of Health, Government of Nepal. Total 703 surgical cases were conducted. Out of which, 583 were general surgical cases and 120 were gynaecological cases. 262 cases were done in local anaesthesia, 242 cases were done in spinal anaesthesia, 108 cases were done in total intravenous anaesthesia and 91 cases were done in general anaesthesia. Hypotension, nausea, vomiting, shivering, failed spinal and difficult airway were the complications noticed during intra-operative and postoperative period. Conclusions: Surgical outreach camps are beneficial in providing surgical care to unaffordable people living in rural and remote areas where health care facilities are limited and inaccessible. Safety of patient is the key concern in such camps. Proper organised plan is required selecting target group of populations with target surgeries per day for successful conduction of safe surgeries in such camps. Key words: anaesthesia; camps; mobile; surgical

Introduction: Laryngoscopy and tracheal intubation are two powerful noxious stimuli that can be potentially deleterious especially in hypertensive patients. This study evaluated the efficacy of low dose oral pregabalin used as a premedication for attenuation of this marked sympathetic response of airway instrumentation.Materials and Methods: This was a double-blind randomised study done at a tertiary level referral hospital. The trial was registered as UMIN-000037103 (https://www.umin.ac.jp/ctr/). Patients were randomly assigned into two groups. Placebo arm received multivitamin capsule and treatment arm received Cap. Pregabalin (75 mg), 60 minutes before the induction of general anesthesia. The level of preoperative sedation was assessed with the Ramsay Sedation Scale. Heart rate, systolic, diastolic and mean arterial blood pressure were monitored and recorded before and during induction, during laryngoscopy and 1, 3 and 5 minutes of intubation.Results: A total of 50 patients, 25 in each arm were enrolled. The baseline characteristics were comparable. SBP was significantly lower in the Pregabalin group than in Placebo at all the periods of recording, however, DBP and MAP decreased significantly during, after 1 and 3 minutes of laryngoscopy (p=0.001). Sedation was significantly better in the Pregabalin group with 86% in RSS 3 compared to 80% of a placebo arm in RSS2 (P

When aggregating neuroimaging data across many subjects, an important consideration is establishing some group-level uniformity prior to further statistical analysis. Spatial normalization and motion correction are two important preprocessing steps that help achieve this goal. Researchers have also often excluded left-handed subjects due to presumptions about variable asymmetries relating to both brain structure and function, which may interfere with achieving a desired level of group homogeneity. It is well-known, however, that hand-preference is not a binary attribute and is not a perfect representation of structural asymmetry or hemispheric specialization. In an effort to demonstrate a more objective, data-driven approach for quantifying asymmetries across handedness, we tested the reliability of single-subject classification of handedness using data obtained from structural MRI in extant samples. We utilized data from deformation fields created during the spatial normalization process within a priori regions of interest (ROIs), including the motor and somatosensory cortex, and Broca's and Wernicke's areas. Using these deformation fields as features in machine learning classifiers, we achieved classification accuracies greater than 75% across two independent datasets (i.e., a sample of incarcerated adult offenders and a sample of community adults from the Netherlands). These results demonstrate reliability of morphological features attributable to handedness as represented in neuroimaging data and further suggest that application of data-driven techniques may be a principled approach for addressing asymmetries in group analysis.

This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.

Introduction: Total joint replacement of hip and knee is considered as one of the most successful orthopedic surgeries in the twenty-first century because of the only solution to end-stage arthritis of these joints. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to describe the demographic findings of the joint replacement surgeries among total lower limb surgeries in a tertiary care hospital. Methods: This cross-sectional survey was conducted using the hospital records of 73 total joint replacement surgeries of the lower limb in the Department of Orthopedics of a tertiary care hospital from November 2016 to November 2020. Ethical approval was taken from the Institutional Review Committee (reference number: 077/78-011). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: There were 73 total joint replacement of hips and knees. Of which, 32 (43.84%) total hip replacements were done in which one (3.13%) patient had a simultaneous bilateral hip replacement in single-stage and the other one (3.13%) had two-stage bilateral hip replacement. Forty one (56.16%) total knee replacements were done in which 18 (24.65%) had a simultaneous bilateral knee replacement and five (6.85%) had a unilateral knee replacement. Conclusions: Total joint replacements of the hip were more common among the lower limb surgeries.

The traditional Indian healthcare system of Yoga contains a wealth of health-promotional practices-some of which are based on "humming." "Humming" is produced when a wordless sound is forced to exit through the nose while keeping the mouth either fully closed or nearly closed; it is a low, prolonged, and buzzing sound. In humming practices like "Bhramari pranayama" (normal inhalation followed by lengthened exhalation + bee-like humming), there is a full-mouth closure,1 and in practices like "OM chanting" (normal inhalation followed by lengthened exhalation +OM humming), there is a near-closure. Besides these, other mantra-oriented practices also generate a similar humming effect.

Dentigerous cysts are seen in the maxillary canine and third molars. We report a case of dentigerous cysts invading the maxillary sinus, which was managed surgically by endoscopic‐assisted transantral and transnasal approach., Combined endoscopic‐endonasal approach may be a good method for dentigerous cysts at unusual locations.

The in trust sweetpotato collection housed by the International Center of Potato (CIP) is one of the largest assemblages of plant material representing the genetic resources of this important staple crop. The collection currently contains almost 6,000 accessions of Ipomoea batatas (cultivated sweetpotato) and over 1,000 accessions of sweetpotato crop wild relatives (CWRs). In this study, the entire cultivated collection (5,979 accessions) was genotyped with a panel of 20 simple sequence repeat (SSR) markers to assess genetic identity, diversity, and population structure. Genotyping and phenotyping of in vitro plantlets and mother plants were conducted simultaneously on 2,711 accessions (45% of the total collection) to identify and correct possible genetic identity errors which could have occurred at any time over the thirty plus years of maintenance in the in vitro collection. Within this group, 533 accessions (19.6%) had errors in identity. Field evaluations of morphological descriptors were carried out to confirm the marker data. A phylogenetic tree was constructed to reveal the intraspecific relationships in the population which uncovered high levels of redundancy in material from Peru and Latin America. These genotypic data were supported by morphological data. Population structure analysis demonstrated support for four ancestral populations with many of the accessions having lower levels of gene flow from the other populations. This was especially true of germplasm derived from Peru, Ecuador, and Africa. The set of 20 SSR markers was subsequently utilized to examine a subset of 189 accessions from the USDA sweetpotato germplasm collection and to identify and reconcile potential errors in the identification of clones shared between these collections. Marker analysis demonstrated that the USDA subset of material had 65 unique accessions that were not found in the larger CIP collection. As far as the authors are aware, this is the first report of genotyping an entire sweetpotato germplasm collection in its entirety.

Introduction: Primary congenital glaucoma is a rare vision-threatening condition of children. Primary congenital glaucoma though a rare disease it is the most common cause of childhood glaucoma with potency to cause blindness. This study was undertaken to find the prevalence of the children with primary congenital glaucoma under 3 years of age in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted at a tertiary eye center in Nepal in children (≤ 3 years) presented in the outpatient department of a tertiary eye hospital between June 2017 and June 2020. The study was approved by the hospital review committee and adhered to the declaration of Helsinki. A convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated with frequency distribution. Data analysis was conducted using Statistical Package for the Social Sciences. Results: Out of total children under 3 years who presented to the outpatient department, 46 (0.31%) at 95% Confidence Interval (0.30-0.32) had primary congenital glaucoma. Among them, 30 children (65.2%) had bilateral involvement. Mean intraocular pressure was 42.40±8.15mm Hg. The mean age of initial presentation, horizontal corneal diameter, and axial length were 12.07±8.9 months, 12.95±1mm, and 23.89±1.7mm respectively. Consanguinity was observed in 12 (26%) children. Conclusions: From the study, we conclude that there was a low prevalence of primary congenital glaucoma among children under 3 years of age who presented to the outpatient department in a tertiary care hospital.

We report the implementation of a deep convolutional neural network to train a high-resolution room-temperature CdZnTeSe based gamma ray spectrometer for accurate and precise determination of gamma ray energies for radioisotope identification. The prototype learned spectrometer consists of a NI PCI 5122 fast digitizer connected to a pre-amplifier to recognize spectral features in a sequence of data. We used simulated preamplifier pulses that resemble actual data for various gamma photon energies to train a CNN on the equivalent of 90 seconds worth of data and validated it on 10 seconds worth of simulated data.

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease. Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc. Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 &plusmn, 23.8 SD) and skin score (mRSS) (r = 0.79, p &lt, 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement. Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands.

AIM This report aims to provide the clinical and radiographic features of two symptomatic Indian patients with florid cemento-osseous dysplasia (FCOD), along with a discussion of the differential diagnosis, potential challenges, and therapeutic implications. BACKGROUND FCOD is a rare, multifocal, periapical, and bilateral condition involving the premolar and molar region of the posterior mandible and sometimes the maxilla. CASE DESCRIPTION The first patient is a 30-year-old female with a recent history of dental pain. The patient was otherwise healthy and the medical history was unremarkable. The second patient is a 50-year-old female with a history of orthodontic therapy. Radiographic evaluation using cone-beam computed tomography (CBCT) revealed bilateral involvement of the posterior mandible, sparing the entire maxilla in both patients Clinical significance: For a pathognomonic condition like FCOD, a radiology survey alone is often sufficient to arrive at the final diagnosis, and therefore surgical interventions should ideally be avoided.

Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa’s fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification.Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence.

This study was conducted to monitor the population dynamics of major insect pest of agriculture ecosystem through light trap at the agriculture farm of GAASC ,Baitadi,during the winter of 2018.The main aim of this study was to determine the status of phototatics insects pest of the farm locality.. Light trap with a 100Watt filament bulb was installed at the site at college boundary, vegetable field and wheat field for trapping purpose. The observation was done every day and data was weekly record their status and occurrences. Overall nine insect species were observed and among them click beetle(Agriotes spp.) population was observed maximum compared to other species.Insects occurrence in vegetable field is dominated by click beetle followed by moths(Pieris canidia)and cabbage semi looper(Trichoplusia spp).The total 289 of 6 different species were found from vegetable fields. Trap installed on Agronomy farm contributes clickbeetle (Agriotes spp.)The most followed by Greenleaf hopper(Nephotettix spp)., Pink borer(Chilo partellus), wasp(Vespa spp.) and grasshopper(Hieroglyphus banian),total 152 of 5 different species were found until 15 week of monitoring. Similarly, trap installed in open field obtained total 176 out of which 68 were click beetle (Agriotes spp.),47 pink borer (Chilo partellus),40 moths (Pieris canidia) and 21 wasps (Vespa spp.).

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Medical devices are sterilized before being used for invasive clinical procedures such as surgery, to prevent pathogen transfer. Failure to sterilize medical devices properly presents a risk of healthcare-associated infections. Studies and reports have indicated that inadequately sterilized medical devices are one of the causes of a higher rate of healthcare-associated infections in developing countries. Steam sterilization (autoclaving) is the most widely used method for sterilization and is considered the most robust and cost-effective method for sterilization of medical devices. The effectiveness of steam sterilization can be measured using biological indicators. A literature search was undertaken to understand the effectiveness of autoclaving in sterilizing reusable medical devices in healthcare facilities across the globe. Studies using biological indicators for measuring the effectiveness of autoclaving were obtained. Failures of steam sterilization practices were identified and discussed as a means of identifying factors that might be associated with the ineffectiveness of steam sterilization practices between different countries. The number of studies measuring the effectiveness of steam sterilization is small, and few evaluate the effectiveness of steam sterilization specifically in developing countries. There are fewer studies on higher level healthcare facilities than dental facilities. More evidence about the effectiveness of autoclaving in healthcare facilities is needed to draw firm conclusions, but the data suggest that there are inadequacies in autoclave procedures and operator education.

Background: Dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) are the two most commonly used fixation devices for inter-trochanteric fracture of femur. However, many clinical studies have shown lack of differences in the clinical outcome consistently with between these two fixation techniques. The main objective of this study is to compare the results of dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA) fixation in elderly patients with unstable inter-trochanteric fractures of femur. Methods: We retrospectively reviewed patients who underwent operative management for inter- trochanteric fractures of femur in our hospital between February 2013 and September 2017. Elderly patients (Age >60yrs) with unstable inter-trochanteric fracture of femur treated either with DHS fixation or with PFNA fixation were included and divided into two groups: DHS fixation group and PFNA fixation group. The comparative statistical analysis was done between two group using following parameters: average length of the incision, operation time, blood loss, fracture healing time, and degree of postoperative functional recovery. Results: The mean follow-up period, in DHS fixation group was 16 month (range 12 to 24 months) and in PFNA fixation group was 14 months (range 12 to 18 months). The differences between two groups regarding average length of the incision, operation time, and blood loss were statistically significant (p0.05). Conclusions: PFNA fixation may be better than DHS fixation for the treatment of unstable inter-trochanteric fractures of the femur in the elderly. However, the application and usage of DHS fixation could not be neglected and the choice of treatment depends upon the systemic condition and socioeconomic status of the patient, patient’s preferences, surgeon’s experience and availability of treatment facility.

This paper investigates the effectiveness of CAMELS (Capital Adequacy, Assets Quality, Management Efficiency, Earning Efficiency, Liquidity and Sensitivity to Market Risk) based supervision in risk management of A class commercial banks. The riskiness is measured by Downside Deviation (i. e., volatility of returns below minimum average return) and Standard Deviation of ROA and ROE. Using the Generalized Method of Moments (GMM) in secondary balanced panel data during major financial development (i. e., 2004 to 2018; BASEL-I-II-III) of all 28 commercial banks of Nepal; causal relationship between supervision and risk management has been investigated. The result shows that the commercial banks in Nepal can reduce their downside deviation as well as standard deviation of ROA and ROE by reducing the Non-Performing Loan (NPL), maintaining appropriate liquidity and by increasing management efficiency. Further, results justifies the relevance of risk based supervision adopted by central bank and interest spread set. However, increased capital base has not helped in reducing riskiness of banks. Overall, the study finds that among the six parameters of supervision (i. e., CAMELS), five parameters (i. e., AMELS in the priority order of AMLSE) are capable enough to reduce the riskiness of commercial banks if maintained strictly as guided by the central bank.

Introduction: Infertility is being a common global problem affecting one couple in six. Approximately 167 million ever-married women aged 15-49 years in developing countries were infertile. The problem of infertility has not given attention considering the fact that it is not life-threatening, but, it has substantial community health problems such as depression, anxiety domestic violence and social isolation. The purpose of the study was to explore the causes of infertility among couples who visited the infertility centre. Methodology: Hospital-based descriptive cross-sectional study had been carried out in infertility centre Kathmandu Nepal. One hundred and sixty-five married couple with infertility problem availing the infertility treatment was selected on first come first serve basic sampling method from the infertility treatment centre. Result: The infertility problem varied with the age. The problem was highest among the females of age group 26-30 years (51%), similarly, in males, it was predominant at the age of 31-35 years (45%). The most common causes of female infertility were ovarian cyst (37%) and heavy bleeding (18.7%), uterine fibroids (9%), Pelvic inflammation (9%), Thyroid disease (21.8%), whereas in males the infertility was mostly due to Oligospermia (17.5%), Azoospermia (5.5%), Hydrocele (7.8), Mumps orchids (6%). Conclusion: Infertility was due to various causes in the male or/and the female partner, however, infertility among couples were mostly due to the problem in females. Infertility is a complex problem that should be considered carefully by the individual, community peoples, government and stakeholders in each country. Keywords: Male Fertility, Female Fertility, Causes, Couple, Infertility, Ovarian Cyst DOI: http://doi.org/10.3126/jkahs.v2i2.25180

Smoking is a leading risk factor for early death and disability worldwide. Medical students and physicians are the ideal persons to educate patients about hazards of smoking. Today’s medical students will play a prominent role in future to prevent and control tobacco use. Still, the problem of smoking among the medical students is common worldwide but the pattern and extent of the problem varies from place to place. Aim of this study was to find out prevalence of smoking among medical students, factors contributing to their smoking habits, their exposure to passive smoking and to know about their knowledge about smoking related health problems. This is a cross sectional study, conducted among all first and second year MBBS students during July-September 2018. Self administered questionnaire were given to all the participants and collected after it was filled up. One hundred seventy four students participated in the study. Prevalence of smoking was 5.2% and all the students who smoked were male. The most important cause for initiation of smoking was peer pressure (56%). The average cigarettes smoked was seven sticks per day. Though 80% students knew about hazards of passive smoking, almost half of them were exposed to passive smoking. In our study we found that most of the students do not counsel their patients regarding hazards of smoking and only few participants were found to advise and encourage their patients to quit smoking.

Various scoring system have been developed and are becoming essential part of Pediatric and other critical care units. The Pediatric department wants to introduce Pediatric Index of Mortality-2 (PIM 2) as a predictive scoring system in Pediatric critical care unit of Nepal Medical College Teaching Hospital (NMCTH). This was a prospective cohort study done in Pediatric Intensive Care Unit (PICU) of NMCTH. Study was done from August 2017 to December 2018. All cases admitted in ICU were taken consecutively from term newborn to 14 yrs of age. PIM 2 scoring system was done in all patients. PIM 2 performed well in terms of discrimination with area under curve for PIM 2 scor e was 0.809 with 95% Confidence Interval of 0.0709 to 0.910 and Standard Error of 0.051. Good calibration was observed across deciles of risk as measured by Hosmer-Lemeshow goodness of fit test with P value of 0.163, chi-square value of 11.752 (8). Mortality observed in our PICU was 28.4% with standardized mortality ratio of 1. PIM 2 scoring system performed well in our PICU.

Caso clínico: paciente masculino de 81 años de edad, con cuadro de 24 horas de evolución secundario a caída, caracterizado por somnolencia, desorientación en persona, tiempo y espacio, incontinencia urinaria y dificultad para la deambulación, motivo por el cual se le efectúa una tomografía simple de cráneo encontrándose hematomas subdurales bilaterales, presenta episodios de sangrado recurrente y leucocitosis sostenida , en frotis de sangre periférica se observó 28% de blastos por lo que se realiza una biopsia de medula ósea descubriéndose un cariotipo medular compatible con leucemia mieloide aguda, debido a sus características clínicas y a su mala evolución fue catalogado como paciente paliativo. Conclusiones: la leucemia mieloide aguda es una patología hematológica cuya evolución al no ser detectada genera un alto grado de mortalidad, sobre todo en el adulto mayor comórbido.

Background: The subclavian artery is the source of blood supply to the upper limbs. It is the branch of the arch of the aorta on the left side and brachiocephalic trunk on the right side of the neck. It is used as cannulation site for cardiopulmonary bypass and for the insertion of intra-aortic balloon pumps. So its variations in the branching pattern are very important for surgeons and physician as well. Method: The study was conducted on 80 embalmed cadavers over the period of 4 years from August 2013 to August 2017 during the routine dissection for the MBBS and BDS students in dissection hall of anatomy department in Jawaharlal Nehru Medical College, Belgaum, Karnataka, India. The digital vernier calliper was used to measure the morphometric parameter. The data were analysed by using SPSS version 20. Result: Out of 80 cadavers used for dissection, 52 (65%) were male and 28 (35%) were female. The external diameter of the subclavian artery in male was 7.15mm ± 1.7mm and female was 6.85mm ± 1.5mm with significant sexual dimorphism (p=0.002). The classical course of both subclavian arteries was found in 76 (95%) of the artery and the remaining 5% of the artery was found to have an anomalous course. Conclusion: The subclavian artery in male had a larger diameter than in the female. The variation in the subclavian artery was common. The knowledge of its average size and its anomalous origin, course and branching pattern might be helpful for the surgeon as well as the physician, for the disease diagnosis, interventional therapy, and surgical procedures. Keywords: Subclavian Artery, Morphometry, Variation, Branching Pattern, Anomalous course, Costocervical trunk DOI: http://dx.doi.org/10.3126/jkahs.v2i1.24414

Stroke risk and poor stroke outcomes in postmenopausal women have usually beeen attributed to decreased levels of estrogen. However, two lines of evidence suggest that this hormone may not be solely responsible for elevated stroke risk in this population. First, the increased risk for CVD and stroke occurs much earlier than menopause at a time when estrogen levels are not yet reduced. Second, estrogen therapy has not successfully reduced stroke risk in all studies. Other sex hormones may therefore also contribute to stroke risk. Prior to menopause, levels of the gonadotrophin Follicle Stimulating Hormone (FSH) are elevated while levels of the gonadal peptide inhibin are lowered, indicating an overall decrease in ovarian reserve. Similarly, reduced estrogen levels at menopause significantly increase the ratio of androgens to estrogens. In view of the evidence that androgens may be unfavorable for CVD and stroke, this elevated ratio of testosterone to estrogen may also contribute to the postmenopause-associated stroke risk. This review synthesizes evidence from different clinical populations including natural menopause, surgical menopause, women on chemotherapy, and preclinical stroke models to dissect the role of ovarian hormones and stroke risk and outcomes.

Women are more likely to develop Post Stroke Depression (PSD) than men and generally do not respond well to anti-depressants with age. This study investigated the effect of microRNA mir363-3p treatment on PSD using a physiologically-relevant animal model. Our previous work showed that mir363-3p treatment, delivered post-stroke, effectively reduces infarct volume in the acute phase of stroke in middle-aged females but not males. Middle-aged female Sprague Dawley rats were tested for baseline sensory motor function and depressive-like behaviors, and then subjected to ischemic stroke via middle cerebral artery occlusion (MCAo) or sham surgery. Animals received either control oligos (MCAo+scrambled, Sham+scrambled) or mir363-3p (MCAo+mir363-3p, Sham+mir363-3p) treatment 4 h later. Sensory motor function and depressive-like behaviors were reassessed up to 100 d after stroke, and circulating levels of IL-6, TNF-alpha and Brain-Derived Neurotrophic Factor (BDNF) were quantified at regular intervals. Prior to termination, Fluorogold was injected into the striatum to assess meso-striatal projections. MCAo+scrambled animals had impaired sensorimotor performance in the acute phase (5 days) of stroke and developed anhedonia, decreased sociability and increased helplessness in the chronic phase. MCAo+mir363-3p animals showed significantly less sensory motor impairment and fewer depressive-like behaviors. IL-6 and TNF-alpha were elevated transiently at 4 weeks after MCAo in both groups. BDNF levels decreased progressively after stroke in the MCAo+scrambled group, and this was attenuated in the mir363-3p group. The number of retrogradely-labeled SNc and VTA cells was reduced in the ischemic hemisphere of the MCAo+scrambled group. In contrast, there was no interhemispheric difference in the number of retrogradely-labeled SNc and VTA cells of MCAo+mir363-3p treated animals. Our results support a therapeutic role for mir363-3p for long-term stroke disability.

DOI: https://doi.org/10.3126/njh.v16i1.23894 Background: Hypertension is one of the major risk factors for the rising burden of cardiovascular diseases (CVDs) in developing region. It has also been recognized as one of the major public health problems in the developing countries since the early seventies and the rate is increasing not only in urban areas but in rural areas with low socio-economic condition. Methods: A cross sectional study was conducted in Jogidaha Village Development Comittee(VDC) and Triyuga Municipality of Udaypur district of South-Eastern Nepal. A total of 430 participants of age 18-59 years were selected. Semi-structured questionnaire (WHO NCD STEPS instrument) was used to collect information on demographic variables and associated risk factors with use of show cards. Clinical and anthropometric measurement were done. Primary outcome was prevalence of hypertension. Bivariate and multivariate analysis were performed to show strength of association among various risk factors with hypertension. Results: The prevalence of hypertension was found to be 25.1%. Prevalence of overweight and obesity was found to be 49.8%. Hypertension was significantly associated with age (AOR=1.09, CI=1.05-1.10) and gender (male >female; AOR= 2.12,CI =1.22-3.68). Similarly, increased waist-hip ratio(7.12; CI 2.87-17.67),alcohol consumption(OR=2.82,CI=1.77-4.52), and use of tobacco products (OR =1.8,CI=1.02-3.20) showed significant association with hypertension. Conclusion: There is high prevalence of hypertension in rural districts of South-Eastern Nepal. A community-based preventive approach with early detection and treatment and life-style modification is needed to reduce the burden of disease and make sustainable changes. Keywords: Hypertension, Risk factors, Rural Nepal