Search

Maxillectomy defects can result in oroantral communication leading to difficulty in swallowing, deglutition, impaired speech and not to mention the resultant facial disfigurement. Prosthetic rehabilitation of such defects is often challenging due to the extent of the defect area along with the absence of adequate retention caused by the size and weight of the prosthesis. To fabricate a lightweight prosthesis, an open hollow obturator or a closed hollow obturator is usually chosen. This case report describes a simple and one step fabrication of a closed hollow bulb obturator using the traditional lost salt technique in a patient with maxillectomy. [ABSTRACT FROM AUTHOR]

The total loss of teeth due to aggressive periodontitis is very traumatic for patient and immediate rehabilitation of such cases becomes a necessity. It is a challenging situation for a prosthodontist to rehabilitate such patient in order to preserve their aesthetic, psychological and functional wellbeing. One of the affordable and accessible options for rehabilitation of such condition is conventional immediate complete denture. The immediate replacement of missing teeth without a period of complete edentulism while maintaining the original vertical dimension and centric relation is one of the major advantages of these modality. This case report explains the method of fabrication of a conventional immediate complete denture with satisfactory retention, stability, support and aesthetics. [ABSTRACT FROM AUTHOR]

Rashmi Karki,1,2,* Samir Lamichhane,3,* Buddha Bahadur Basnet,4 Anuja Dahal,5 Bal Krishna Awal,2,6 Shyam Kumar Mishra7,8,* 1Janamaitri Foundation Institute of Health Sciences, Tribhuvan University, Nepal; 2National Public Health Laboratory, Kathmandu, Nepal; 3Department of Pharmacology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal; 4Faculty of Science, Nepal Academy of Science and Technology, Lalitpur, Nepal; 5Department of Pharmacy, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal; 6Shahid Dharmabhakta National Transplant Center, Bhaktapur, Nepal; 7School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia; 8Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal*These authors contributed equally to this workCorrespondence: Shyam Kumar MishraSchool of Optometry and Vision Science, UNSW, Sydney, NSW, AustraliaTel +61415538329Email s.mishrabaishnab@unsw.edu.auPurpose: Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Finding novel antimicrobial agents and strategies based on synergistic combinations are essential to combat MDR infections. This study was designed to determine in vitro synergy of different antimicrobials against extensively drug-resistant (XDR) Gram-negative clinical isolates.Methods: A descriptive, cross-sectional study was conducted at Human Organ Transplant Center, Nepal, for five months. Clinical isolates were checked for their drug-resistance properties including extended-spectrum beta-lactamase- (ESBL-) and metallo-beta-lactamase- (MBL-) production. The XDR isolates were further tested for antimicrobial synergy, and the results were interpreted as synergistic, additive, indifferent or antagonistic determining fractional inhibitory concentration of the antibiotics.Results: Out of total 1155 clinical samples, 308 showed significant growth. Escherichia coli was the most common isolate (n=142) followed by Klebsiella pneumoniae, Acinetobacter calcoaceticus baumannii (Acb) complex, Pseudomonas aeruginosa and miscellaneous bacteria. Out of the culture positive isolates, 21.4% were MDR and 10.06% were XDR. The XDR population comprised K. pneumoniae (18.42%), E. coli (9.86%), Acb complex (7.41%) and P. aeruginosa (4.17%). Among the culture positive isolates, 4.5% and 5.8% were ESBL- and MBL-producers, respectively. Colistin, polymyxin B, and tigecycline were the antibiotics effective in majority of MDR isolates as compared to carbapenems. The combination of antibiotics – meropenem and colistin showed the highest proportion of “synergy” among all XDR E. coli whereas the combination of amikacin and colistin showed synergistic effect in XDR K. pneumoniae.Conclusion: A significant proportion of isolates were MDR among which a large fraction was XDR. The combination of meropenem, amikacin and colistin with one another in pair showed beneficial activity in vitro. Such combinations can be utilized as effective therapy for XDR infections. Further studies are required to confirm these findings, and accordingly treatment protocols should be developed in the management of such infections.Keywords: antimicrobial synergy, ESBL, MBL, MDR, XDR

Introduction: Ano-rectal malformation (ARM) comprises a wide spectrum of diseases that involves the distal anus and rectum as well as the urinary and genital tracts. The factors that need to be considered during treatment are the type of anomaly, associated anomalies and patients general condition. The aim of this study is to analyze the types of anorectal malformations and their management in a tertiary level children's hospital. Materials and Methods: The medical records of patients with the diagnosis of anorectal malformation managed in the hospital during a period of January 2009 to January 2014 were reviewed. Results: There were 187 cases of ARM 126 (67.37%) males and 61 (32.62%) females. High/Intermediate type was 129 (68.98%). Low ARM was 58 (31.01%). In male high type ARM with recto-urethral fistula was seen in 60 (47.61%). ARM with Rectovestibular fistula(RVF) was seen in 40 (65.5%) female. High and intermediate ARMs were managed initially with colostomy and low ARM with primary anoplasty. ARM with rectovestibular fistula in females were managed with Anterior Sagittal Anorectoplasty without colostomy. Common cloaca in female was managed initially with colostomy followed by posterior sagittal ano-recto-vagino-urethroplasty. Colostomy closure was done after adequate size of anus was achieved with anal dilation. Conclusion: The type of ARM in newborn is diagnosed by perineal examination and X-rays. Low type ARM was managed by primary surgery without colostomy. High anomaly and complex defect was treated with stage surgeries. [ABSTRACT FROM AUTHOR]

Bishal Babu Basnet, Prakash Kumar Parajuli, Raj Kumar Singh, Pramita Suwal, Pragya Shrestha, Dharanidhar BaralDepartment of Prosthodontics, BP Koirala Institute of Health Sciences, Dharan, NepalBackground: Establishment of proper occlusal vertical dimension (OVD) is one of the important tasks for successful prosthodontic therapy. An ideal method for determining OVD in terms of cost, time, and instrument requirements has been sought in prosthodontics by various investigators. However, no such single method has been formulated. In the current anthropometric study, the relationship of the length of the thumb to the OVD was tested in two ethnic groups of Nepal, Aryans, and Mongoloids. The result of this study can be useful in determining proper OVD in edentulous patients.Aims and objectives: The primary aim of the present study was to evaluate the correlation between the length of the thumb and OVD in Aryan and Mongoloid ethnic groups. The secondary aim was to compare the correlation between OVD and other anatomic measurements (eye–ear distance and pupil-to-rima oris distance) in these ethnicities.Materials and methods: The OVD, thumb length, eye–ear distance and distance between pupil of eye and rima oris were measured in a total of 500 adult dentulous volunteers. The correlation between OVD and thumb length as well as other anatomic measurements was checked with Pearson's product moment correlation coefficient. Linear regression analysis was performed to determine the relationship of OVD to the length of the thumb.Results: The thumb length was significantly (P≤0.05) correlated with strong and positive values (Pearson’s coefficient =0.874 in the whole population, 0.826 in Aryans, and 0.944 in Mongoloids). Regression analysis showed that thumb length was significantly related to OVD in both ethnic groups.Conclusion: Within the limitations of the present study, the result implies that thumb length can be used as an adjunct for establishing OVD in the edentulous patients.Keywords: thumb, prosthodontic, caliper, rima oris, pupil of eye, edentulous patient

Since 1984, the 'Chilero' spring wheat line developed by CIMMYT has proven to be highly resistant to leaf rust and stripe rust. Amid efforts to understand the basis of resistance of this line, a recombinant inbred line (RIL) population derived from a cross between Avocet and Chilero was studied. The parents and RILs were characterized in field trials for leaf rust and stripe rust in three locations in Mexico between 2 0 12 and 2015 and genotyped with DArT-array, DArT-GBS, and SSR markers. A total of 6,168 polymorphic markers were used to construct genetic linkage maps. Inclusive composite interval mapping detected four colocated resistance loci to both rust diseases and two stripe rust resistant loci in the Avocet x Chilero population. Among these, the quantitative trait locus (QTL) on chromosome 1BL was identified as a pleotropic adult plant resistance gene Lr46/Yr29, whereas QLr.ciin-5DS/QYr.cim-5DS was a newly discovered colocated resistance locus to both rust diseases in Chilero. Additionally, one new stripe rust resistance locus on chromosome 7BL was mapped in the current population. Avocet also contributed two minor colocated resistance QTLs situated on chromosomes 1DL and 4BS. The flanking SNP markers can be converted to breeder friendly Kompetitive Allele Specific PCR (KASP) markers for wheat breeding programs. [ABSTRACT FROM AUTHOR]

Assessment of economic traits of germplasms, which are associated with genetic variation, is vital for mung improvement. Therefore, by wielding the randomized complete block design with 3 replications, a probe analysis using multiple trait stability indexing and analysis of variance with Duncan's test at p ≤ 0.05 is performed to compare the means of yield attributes. Moreover, simultaneous application of GA3 and NAA (50 mg/L each) was carried out at 30 DAS and at mid-flowering. Pondering not only factorial analysis but also correlation and path studies revealed that flower shedding before and 12 h after spraying is nearly detrimental to yield. In addition, yield/plant was positively (p < 0.001, r = 0.67-0.96) correlated with the harvesting index and test weight. 'Pratigya', demonstrating heightened sensitivity to environmental cues-unveils increased sensitivity-while 'VC3960A-88' flourished with hormone-boosted pod formation. 'VC6368(46-40-3)' packed 11 pods/cluster, and 'CN95' thrived, excelling in abundant grains as well as clusters. Notably, 'VC6370-A' topped yielder, whereas CN95 augmented an efficient harvest index of 0.48. Moreover, path analysis revealed that all postfertility traits are inherently associated with yield. By employing 17 % selection intensity, the MTSI unequivocally ascertained that not only 'VC6370A' but also 'CN95' are the ideal stable and prime performing genotypes for yield(3.04-2.8 tons/ha) as well as interactive traits, a marker for simultaneous selection, as well as improvement. The MTSI view of strengths and weaknesses harbingers that breeders need to focus on increasing the number of genotypes with the desired phenotypes-lower flower abscission, greater grain dimensions and pod setting, harvesting indices, and yields/ha., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background:  The ability of Staphylococcus aureus to form biofilmsâ€"architectural complexes that cause chronic and recalcitrant infectionsâ€"along with its notorious variant, methicillin-resistant Staphylococcus aureus (MRSA), leads to multidrug-resistant (MDR) infections that are challenging to treat with antibiotics. This cross-sectional study investigated the prevalence of S. aureus infections in Kanti Children’s Hospital and characterized the antibiograms of MDR, MRSA, and biofilm-forming strains, along with their coexistence., Methods:  S. aureus strains were isolated and identified from clinical samples and tested for antibiograms following standard microbiology guidelines. MDR strains were non-susceptible to at least one agent in three antimicrobial categories, whereas MRSA strains were cefoxitin-resistant. The microtiter plate method was used to detect biofilms. Statistical analyses were performed using SPSS version 17.0., Results:  S. aureus was detected in 9.0% (11.4-6.6%, 95% Confidence Interval) of 543 samples, primarily from pus (79.6%, 39/49). Children aged 1 to <3 years most commonly contracted infections (30.6%, 15/49), and males (67.4%, 33/49) had twice as many infections as females (32.7%, 16/49). As high as 84.7% (83/98) of strains were penicillin-resistant, while 18.4% (27/147) were aminoglycoside-resistant. MDR accounted for 79.6% (39/49) of all S. aureus infections, while MRSA and biofilm-formers accounted for 67.6% (33/49) and 24.5% (12/49), respectively. Fluoroquinolone resistance in non-MDR-MRSA-biofilm-formers, MDR-MRSA, MDR-biofilm-formers, and MRSA-biofilm-formers was 31.3%, 46.8%, 58.3%, and 60.0%, respectively, while aminoglycoside resistance was 0%, 32.3%, 50.0%, and 45.0%, and penicillin resistance was 87.5%, 85.5%, 100.0%, and 100.0%., Conclusions:  MDR-isolates and MRSA caused nearly four-fifths of S. aureus infections. Compared to MDR and MRSA strains, biofilm-formers triggered higher levels of antimicrobial resistance.

Introduction: Langerhans cell histiocytosis (LCH) is a rare neoplasm marked by the proliferation of Langerhans cells, primarily affecting children under 2 years old. Gastrointestinal (GI) involvement in LCH is uncommon and often part of widespread disease., Case Presentation: We report a 16-year-old female with a history of LCH, previously treated with 6-mercaptopurine and vinblastine, who presented with bloody diarrhoea, abdominal pain, and vomiting. Examination revealed hypopigmented skin lesions, lymphadenopathy, and hepatosplenomegaly. Laboratory tests indicated anaemia and eosinophilia, and colonoscopy was suggestive of GI LCH., Discussion: Gastrointestinal LCH often presents with nonspecific symptoms. It is crucial to maintain a high degree of suspicion for GI LCH in atypical GI presentations, as treatment outcomes can be challenging if diagnosed late or misdiagnosed., Conclusion: GI symptoms in LCH are rare but may occur in isolation. Early diagnosis and treatment are crucial to reduce morbidity and improve prognosis., Competing Interests: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Stroke is the third most common cause of disability and the second most common cause of death worldwide. Prognosis assessment in acute ischemic stroke is challenging for clinicians. The development of simple and easily performed prognostic markers that correlate with the outcome of patients can be of immense benefit. The aim of this study was to find out the prognostic significance of total leukocyte count, red cell distribution width and erythrocyte sedimentation rate in patients with acute ischemic stroke., Methods: A descriptive cross-sectional study was conducted in a tertiary center after ethical approval from the Institutional Review Committee. The study period spanned from April 18, 2022 to June 17, 2023, a period of 14 months. 136 patients diagnosed with acute ischemic stroke with total leukocyte count (TLC), red cell distribution width (RDW), erythrocyte sedimentation rate (ESR), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) were included in the study after fulfilling the inclusion criteria. The modified Rankin Scale (mRS) was obtained 28 days following admission. Data was collected and analyzed through Microsoft Excel 365 and SPSS version 22. Spearman Correlation and multivariate regression analysis were used to analyze the association., Results: TLC, RDW, and ESR were significantly associated with an mRS at 28 days showing a positive correlation between them. Total in-hospital mortality has been significantly associated with TLC only ( p  < 0.05)., Conclusions: The prognostic value of TLC, RDW, and ESR in patients with acute ischemic stroke was found to be significant and similar to the studies done in similar settings., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Subarachnoid hemorrhage is a neurological emergency in which arterial blood accumulates in the subarachnoid space with cerebral aneurysmal rupture being the most common cause. Subarachnoid hemorrhage is often misdiagnosed in the emergency department and mortality rates range from 8% to 67%. It may be the manifestation of the chronicity of the migraine. The difference in severity or quality compared to previous headaches, and other symptoms, particularly neck stiffness, but also seizure, syncope, focal neurological deficit, and vomiting are the key factors differentiating subarachnoid hemorrhage from the migraine. We report a case of a 37-year-old female with a previous history of migraines who presented with acute onset of excruciating headaches in the occiput associated with nausea, vomiting, and photophobia in whom a non-contrast computed tomography scan of the head showed hyper-densities involving the bilateral cerebral cortical sulcus and Sylvian fissure and the cerebral angiography showed a complex aneurysm in anterior communicating artery., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

We explore the structure and magnetic-field response of edge dislocations in Grandjean-Cano wedge cells filled with chiral mixtures of the ferroelectric nematic mesogen DIO. Upon cooling, the ordering changes from paraelectric in the cholesteric phase N^{*} to antiferroelectric in the smectic SmZ&#95;{A}^{*} and to ferroelectric in the cholesteric N&#95;{F}^{*}. Dislocations of the Burgers vector b equal to the helicoidal pitch P are stable in all three phases, while dislocations with b=P/2 exist only in the N^{*} and SmZ&#95;{A}^{*}. The b=P/2 dislocations split into pairs of τ^{-1/2}λ^{+1/2} disclinations, while the thick dislocations b=P are pairs of nonsingular λ^{-1/2}λ^{+1/2} disclinations. The polar order makes the τ^{-1/2} disclinations unstable in the N&#95;{F}^{*} phase, as they should be connected to singular walls in the polarization field. We propose a model of transformation of the composite τ^{-1/2} line-wall defect into a nonsingular λ^{-1/2} disclination, which is paired up with a λ^{+1/2} line to form a b=P dislocation. The SmZ&#95;{A}^{*} behavior in the in-plane magnetic field is different from that of the N&#95;{F}^{*} and N^{*}: the dislocations show no zigzag instability, and the pitch remains unchanged in the magnetic fields up to 1 T. The behavior is associated with the finite compressibility of smectic layers.

The coronavirus disease 2019 (COVID-19) pandemic has caused changes in the global health system, causing significant setbacks in healthcare systems worldwide. This pandemic has also shown resilience, flexibility, and creativity in reacting to the tragedy. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection targets most of the respiratory tract, resulting in a severe sickness called acute respiratory distress syndrome that may be fatal in some individuals. Although the lung is the primary organ targeted by COVID-19 viruses, the clinical aspect of the disease is varied and ranges from asymptomatic to respiratory failure. However, due to an unorganized immune response and several affected mechanisms, the liver may also experience liver cell injury, ischemic liver dysfunction, and drug-induced liver injury, which can result in respiratory failure because of the immune system's disordered response and other compromised processes that can end in multisystem organ failure. Patients with liver cirrhosis or those who have impaired immune systems may be more likely than other groups to experience worse results from the SARS-CoV-2 infection. We thus intend to examine the pathogenesis, current therapy, and consequences of liver damage concerning COVID-19., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The COVID-19 pandemic impacted healthcare systems, including resuscitation training programs such as Helping Babies Breathe (HBB). Nepal, a country with limited healthcare resources, faces challenges in delivering effective HBB training, managing deliveries, and providing neonatal care, particularly in remote areas., Aims: This study assessed HBB skills and knowledge postpandemic through interviews with key stakeholders in Nepal. It aimed to identify strategies, adaptations, and innovations to address training gaps and scale-up HBB., Methods: A qualitative approach was used, employing semistructured interviews about HBB program effectiveness, pandemic challenges, stakeholder engagement, and suggestions for improvement., Results: The study encompassed interviews with 23 participants, including HBB trainers, birth attendants, officials, and providers. Thematic analysis employed a systematic approach by deducing themes from study aims and theory. Data underwent iterative coding and refinement to synthesize content yielding following 5 themes: (1) pandemic's impact on HBB training; (2) resource accessibility for training postpandemic; (3) reviving HBB training; (4) impacts on the neonatal workforce; and (5) elements influencing HBB training progress., Conclusion: Postpandemic, healthcare workers in Nepal encounter challenges accessing essential resources and delivering HBB training, especially in remote areas. Adequate budgeting and strong commitment from healthcare policy levels are essential to reduce neonatal mortality in the future., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Post infectious glomerulonephritis remains the most common cause leading to the majority of hospital admissions in children of developing countries like ours. The aim of our study was to find the prevalence of post infectious glomerulonephritis, study the clinical profile, biochemical changes and its complication in children admitted in a tertiary care hospital of Nepal., Methods: This descriptive cross-sectional study of children admitted at a tertiary care hospital was done from May 2020 till May 2023. A census sampling method was used and sample of 1554 children was taken. Detailed socio demographic data, clinical findings and laboratory investigations were done. Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages., Results: Among 1554 patients, the prevalence of acute post-infectious glomerulonephritis was found to be 63 (4.05%) (3.07-5.03 at 95% Confidence Interval). The mean age of the patients was 9.06±3.48 years. Antistreptolysin O titer was raised in 34 (54%) patients, while low serum C3 was observed in 39 (61.90%) patients with acute post-infectious glomerulonephritis., Conclusions: Acute post-infectious glomerulonephritis (APIGN) remains a notable health concern in children, particularly in developing countries like Nepal. This highlights the need for ongoing surveillance, prevention strategies, and effective management protocols to address this burden effectively.