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Nepal government provided COVISHIELD vaccine first to the hospital employees and other front liners in January 2021. The objective of our study was to observe the adverse effects of the COVISHIELD among hospital employees of Nepal Medical College and Teaching Hospital (NMCTH). This was a descriptive cross-sectional study conducted from March to August 2021. The study was commenced after obtaining ethical clearance from the Institutional Review Committee of NMCTH. Self-reported socio-demographic details and symptomatic adverse effects reported after the first and second dose of COVISHIELD were noted. The data were entered in SPSS 16 and analysed. Out of 436 participants, 360 (82.6%) and 243 (55.7%) had reported adverse effects after the first and second dose of the COVISHIELD respectively. The adverse effects reported following COVISHIELD were common and predictable.

Appendectomy is one of the most common emergency surgical procedures performed in the world. The inflammation of the appendix triggers severe pain in the right lower quadrant of the abdomen. Additionally, the post-operative incision site pain may be distressing to the patients. Analgesic drugs like tramadol (opioid analgesics) and ketorolac (nonsteroidal anti-inflammatory drug - NSAID) are used to manage post-operative pain. The objective was to compare tramadol and ketorolac for pain management by observing the pain-free interval in post-operative patients with appendectomy. A descriptive cross-sectional study was conducted in the department of surgery from November 2019 to May 2020 to observe the duration of pain-free intervals between tramadol and ketorolac. The total number of appendectomy patients selected was 100. Fifty patients received tramadol and the next 50 patients received ketorolac. The data was entered in SPSS and an independent sample t-test was applied to determine the difference in duration of the pain-free interval between ketorolac and tramadol. The average duration of pain-free for the tramadol group was 4.95±1.19 hours (4 hours 57 minutes) while for the ketorolac group was 5.24±1.36 hours (5 hours 14 minutes). The difference was statistically insignificant. We also observed that the tramadol group (88%) received more anti-emetic drugs than the ketorolac group (24%). Therefore, post-operative pain management with ketorolac was found to be as effective as tramadol with comparable duration of the pain free interval.

Heart valve tissue engineering aims at creating living valves through colonization of scaffolds with patient’s own cells. Various cell sources have been explored focusing mainly on endothelialization of the scaffold surface. Endothelial like cells, such as endothelial progenitor cells (EPCs), which can be isolated from peripheral blood or bone marrow could be a suitable option. In this study we investigated cell colonization potential of ovine EPCs (OEPCs) on thermoplastic silicone-based polyurethane (TSPU) polymer scaffolds. TSPU nonwovens with and without vascular endothelial growth factor (VEGF) functionalization were used. SEM images showed that by day 3 the cells were growing as patches on the surface of both polymer groups. The cell patches continued growing and started covering more of the nonwoven surface. On day 7 the cells had almost covered the scaffold surface. The cells were more uniformly distributed as monolayer on the functionalized TSPU compared to the non-functionalized nonwovens. Live/Dead staining provided bright green fluorescence on the samples, indicating metabolically active alive cells. These static cell seeding experiments demonstrated that functionalized TPSU nonwovens support endothelialization. The feasibility of TPSU nonwovens as heart valve prosthesis scaffold could be further explored with animal studies in an ovine model.

Fever is defined as rise in normal body temperature above 98.6°F. Clinical thermometer is a medical instrument for measuring human body temperature. The traditionally used mercury in glass thermometer was replaced by digital thermometer due to mercury toxicity. Non-contact infra-red thermometer is a non-invasive thermometer used for un-cooperative pediatric patients. The objective of this study is to determine the clinical efficiency of non-contact infrared thermometer over axillary digital thermometer and mercury in glass thermometer over a range of body temperature by using paracetamol in febrile patients. This descriptive hospital based cross sectional study was conducted from 5th December 2019 till 23rd August 2020 after ethical approval from Institutional Review Committee of Nepal Medical College and Teaching Hospital. Mercury in glass thermometer, axillary digital thermometer and non-contact infrared thermometer were used to measure body temperature in febrile patient. Body temperature was re-measured one hour after administration of paracetamol. Data was entered and analyzed with statistical package for social sciences version 16. Axillary digital thermometer has high predictability in the upper body temperature range (in febrile state) but its predictability is low in lower body temperature range (our normal body temperature). Non-contact infrared thermometer in comparison with axillary digital thermometer has lower predictability in both upper and lower body temperature range. Clinical efficiency of non-contact infrared thermometer is less than that of axillary digital thermometer and mercury in glass thermometer in febrile patients.

Background: Canines are known for their higher resistance to trauma and pathological alterations when compared to other teeth. Among all the teeth, canines show highest sexual dimorphism.Methods: This descriptive cross-sectional study was commenced from January 2019 to April 2019 after the ethical approval from Institutional Review Committee. The maximum mesio-distal widths of right and left mandibular canines and mandibular inter-canine arch width were measured on the cast with the help of a divider and digital vernier callipers. Mandibular canine index was calculated by dividing the mesio-distal width of each mandibular canine with inter-canine arch width. Data was entered and analyzed using Statistical Package for the Social Sciences version 21. Results: Sex predictability by using mandibular canine index in the present study showed poor sex predictability (57.5% - 62.5%).Conclusions: Sex determination should be done by other methods and mandibular canine index should be used cautiously in Nepalese population.Keywords: Canine dimorphism; forensic anthropology; forensic dentistry; forensic identification, sex determination.

Introduction: Drug-drug interaction is one of the causes of adverse drug reactions. Generally, drug-drug interaction is common in multidrug therapy. Diabetic patients, particularly due to associated comorbidities tend to have various drug-drug interactions due to the effect of multiple drugs. The objective of this study was to find out the prevalence of drug-drug interactions in diabetic patients. Methods: It was a descriptive cross-sectional study that was conducted among previously diagnosed diabetic patients visiting the outpatient department of medicine at a tertiary care hospital between March 2021 and August 2021. Ethical approval was taken from the institutional review committee (Ref no: 030-076/077). Data was collected from diabetic patients presenting to the outpatient department of medicine using a preformed self-constructed questionnaire. Convenient sampling was done. Statistical Package for Social Sciences version 21 and Microsoft Excel were used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: The prevalence of drug-drug interaction between hypoglycemic and non-hypoglycemic medication was 56 (44.1%) (35.5-52.7 at 95% Confidence Interval) of the patients out of which at least one drug-drug interaction was seen in 48 (37.8%) of the patients. Conclusions: Our study showed the prevalence of drug-drug interactions in diabetic patients to be higher than other studies done in similar settings. Based on the severity, we observed two types of drug-drug interactions; close monitoring drug-drug interactions and minor drug-drug interactions.

Adverse drug reaction (ADR) is an injury caused by taking medication. ADR may occur following single dose or prolong administration of drug or combination of two or more drugs. While major advancements of discipline of pharmacovigilance have taken place in the West, not much has been achieved in Asian countries. Labour is characterised by forceful and painful uterine contraction that result in cervical dilation and foetus decent from the birth canal. Anti-spasmodic drugs like hyoscine butylbromide and valethamate bromide have been used to accelerate cervical dilation and thus reduce the labor duration. The objective was to observe ADR with hyoscine and valethamate for cervical dilation during labor. It was a hospital based cross sectional study. Investigation was carried out in the form of questionnaire. All the consecutive patients who were in active stage of labor were included in the study. They were given Intravenous (IV) valethamate bromide 8mg and hyoscine butylbromide 20mg, 3 doses half an hour apart. After administration of the drug, the progress of labor was monitored and management was done as per protocol in obstetrics and gynaecology department. ADR reported were blurred vision in 47.7% of the patients, followed by dry mouth (36.9%) and tachycardia (19.2%). Other ADRs were nausea (6.2%), dizziness (3.8%), flushing (2.3%), vomiting (1.5%), fever (1.5%) and constipation (1.5%). No statistical significance was found when ADR was compared between the age group of 18-25 years and 26-35 years. Therefore, ADR reported were irrespective of the age of the patients and no life threatening or severe forms of ADR were seen with hyoscine and valethamate during cervical dilation.

Synoptic, remote sensing of the national-scale, societal response of trees and forests to human driving forces in Nepal has been a wicked problem. This problem is a complex of four ancillary issues, namely, minimum mapping unit, radiometric scatter due to terrain, modeling of human dimensions, and democratizing robust environmental analysis. Beginning with the November 2018 conference convened by the East-West Center (EWC), USA, in Nepal, the state-of-the-art and key works in this problem-solving has been reviewed in this paper. Though this technology has improved the detection of forest and tree changes due to human driving forces at earlier stages, it is still not robust enough to inform global and national policy.

Introduction: Local anesthetic used for dental extraction is 2% lidocaine hydrochloride with adrenaline (1:200000). Lidocaine is cardiac depressant and adrenaline is cardiac stimulant; it decreases or increases blood pressure respectively. Methods: A total of 100 patients (50 controlled hypertensive and 50 non-hypertensive) were selected. The study was conducted over a period of 14 months from January 2020 to February 2021. Blood pressure was measured for patients who were planned for dental extraction by auscultatory method. Following that, 1.5-3 ml (depending upon the nerve block) 2% lidocaine with adrenaline (1:200000) was injected using a 3ml syringe (26 Gauge). Blood pressure was re-recorded after 10 minutes from the time of injection. Visual analog scale pain score was obtained during administration of local anesthesia. Paired t-test was applied to compare blood pressure change before and after administration of local anesthesia in controlled hypertensive and non-hypertensive patients. Results: There was a statistically significant increase in both systolic and diastolic blood pressure in non-hypertensive patients (p = 0.008, p = 0.017). This, however, was not the case with controlled hypertensive patients. There was statistically significant increase in systolic blood pressure (p < 0.001). Pain on injection (50% in non-hypertensive and 48% in controlled hypertensive patients) was the only adverse drug reaction that was reported in both groups. Conclusion: 2% lidocaine hydrochloride with adrenaline (1:200000) increased systolic but not diastolic blood pressure in controlled hypertensive patients

Glutaraldehyde-treated, surgical bioprosthetic heart valves undergo structural degeneration within 10–15 years of implantation. Analogous preliminary results were disclosed for percutaneous heart valves (PHVs) realized with similarly-treated tissues. To improve long-term performance, decellularised scaffolds can be proposed as alternative fabricating biomaterials. The aim of this study was to evaluate whether bovine and porcine decellularised pericardia could be utilised to manufacture bioengineered percutaneous heart valves (bioPHVs) with adequate hydrodynamic performance and leaflet resistance to crimping damage. BioPHVs were fabricated by mounting acellular pericardia onto commercial stents. Independently from the pericardial species used for valve fabrication, bioPHVs satisfied the minimum hydrodynamic performance criteria set by ISO 5840-3 standards and were able to withstand a large spectrum of cardiac output conditions, also during extreme backpressure, without severe regurgitation, especially in the case of the porcine group. No macroscopic or microscopic leaflet damage was detected following bioPHV crimping. Bovine and porcine decellularized pericardia are both suitable alternatives to glutaraldehyde-treated tissues. Between the two types of pericardial species tested, the porcine tissue scaffold might be preferable to fabricate advanced PHV replacements for long-term performance. Condensed abstract Current percutaneous heart valve replacements are formulated with glutaraldehyde-treated animal tissues, prone to structural degeneration. In order to improve long-term performance, bovine and porcine decellularised pericardia were utilised to manufacture bioengineered replacements, which demonstrated adequate hydrodynamic behaviour and resistance to crimping without leaflet architectural alteration.

Xenogeneic pericardium-based substitutes are employed for several surgical indications after chemical shielding, limiting their biocompatibility and therapeutic durability. Adverse responses to these replacements might be prevented by tissue decellularization, ideally removing cells and preserving the original extracellular matrix (ECM). The aim of this study was to compare the mostly applied pericardia in clinics, i.e. bovine and porcine tissues, after their decellularization, and obtain new insights for their possible surgical use. Bovine and porcine pericardia were submitted to TRICOL decellularization, based on osmotic shock, detergents and nuclease treatment. TRICOL procedure resulted in being effective in cell removal and preservation of ECM architecture of both species&rsquo, scaffolds. Collagen and elastin were retained but glycosaminoglycans were reduced, significantly for bovine scaffolds. Tissue hydration was varied by decellularization, with a rise for bovine pericardia and a decrease for porcine ones. TRICOL significantly increased porcine pericardial thickness, while a non-significant reduction was observed for the bovine counterpart. The protein secondary structure and thermal denaturation profile of both species&rsquo, scaffolds were unaltered. Both pericardial tissues showed augmented biomechanical compliance after decellularization. The ECM bioactivity of bovine and porcine pericardia was unaffected by decellularization, sustaining viability and proliferation of human mesenchymal stem cells and endothelial cells. In conclusion, decellularized bovine and porcine pericardia demonstrate possessing the characteristics that are suitable for the creation of novel scaffolds for reconstruction or replacement: differences in water content, thickness and glycosaminoglycans might influence some of their biomechanical properties and, hence, their indication for surgical use.

In this study, a multi objective method for optimal network reconfiguration as well as reactive power dispatches of distributed generations (DGs) has been proposed to improve the network performances by using non-dominated sorting particle swarm optimisation. The various network performances in terms of multi objective function include minimisation of system power loss, voltage deviation and energy wastage from solar and wind generation system. The effectiveness of the proposed method has been tested on the IEEE 33-bus radial distribution system for different combinations of network reconfiguration and reactive power output of DGs or its varying power factor. The obtained results also compared and indicated that better network performances achieved with both network reconfiguration and power factor optimisation over other cases. In addition, this strategy also results in lesser energy wastage from distributed renewable generation over without network reconfiguration option; hence, this approach is also suitable for saving and utilising maximum capacity of available renewable sources.

Background : Vaginal discharge and associated vaginal symptoms is very common amongst women of South East Asia, hence it is necessary to make accurate diagnosis and also for appropriate treatment by identifying the causative microorganisms. Objectives : To analyze the socio-demographic and microbiological profile of vaginal discharge. Methodology : This is a prospective, non-randomized study performed in one hundred and ninety three patients attending in Department of Obstetrics and Gynecology in Kathmandu University Hospital, Dhulikhel, Nepal. The patients with vaginal discharge and age of ?16 years included. Vaginal discharge was taken from the posterior and lateral fornices. The swab was cultured on blood, chocolate and Mac Conkey’s agar and incubated at 37°C for 24-48 hours. Fungus when isolated was subcultured onto Sabouraud dextrose agar. The data were analyzed using the SPSS 11.5 software. Result : The frequency of vaginal discharge was 1.67%. Most of the patients fell within 16-25 years. 50.3% patients were illiterate whereas only 3.1% was having master degree. 50.3% patients were having class V socioeconomic status where as only 2.6% had class I status. Housewife accounted for 67.9% whereas other occupation (petty business) accounted for only 5.2%. Most of the patients with vaginal discharge were from Newar and Tamang ethnic group. Bacterial vaginosis was isolated in 36.3% and normal flora accounted for 20.7%. Conclusion : There is still lack of awareness about the vaginal discharge be it abnormal discharge or physiological leucorrhea and related problems. So, it is worthwhile to create public awareness and also to find out the socio-demographic factors affecting the pattern of microbiological flora variation in vaginal discharge, as it gives us the clue regarding the use of appropriate antimicrobial therapy and the changes that can be made to the quality of life of the women. Bangladesh Journal of Medical Science Vol.14(4) 2015 p.323-326

In order to study the physical and chemical weathering and their impact on the shear strength of the soil mass, soil samples were collected from different depths ranging from the ground surface to a depth of 15m at two different drainage wells in a Mukohidehara landslide area. These specimens represent the residual soil near the surface, specimen at a depth range of ground water level fluctuation, less weathered specimen from the depth below the ground water level fluctuation, the remolded soil from sliding zone and the specimen below sliding zone. Measurement of Atterberg's limits, particle size analysis, X-ray diffraction analysis, slake durability test and X-ray fluorescence tests were carried out. Drained simple shear tests, and drained ring shear tests were also conducted on those specimens to measure their strength characteristics.Test results showed that fully softened shear strength of the less weathered specimen was very close to the peak shear strength of the specimen from the sliding zone. Test results showed no significant variations of index properties (liquid limit, plasticity index and clay fraction) , mineral compositions and chemical compositions with depth. Residual shear strengths of the specimen also did not vary much with depth. In order to compare these findings with rocks from the other types of formation, specimens were collected from the ground surface, ground water fluctuation zone, less weathered zone and sliding zone of three other landslides sites. The test results on the index properties, shear strength properties, mineralogical analysis, and bulk chemistry, of those landslides were consistent with the findings in Mukohidehara landslide.The test results of this study suggested that physical weathering plays a major role in the reduction of shear strength of mudstone, in comparison to the chemical weathering in the form of mineralogical and chemical alteration. Test results also suggested that physical weathering by slaking and disintegration is significant at ground water fluctuation zone in those mudstone formations.

Slope stabilization procedures for seven landslides in the Niigata Prefecture of Japan had provided an excellent and rare opportunity to examine the composition of ground water, and residual shear strength of the sliding surface soil, as well as unsheared mudstone. Ring shear tests were conducted on the soil samples collected from sliding surface soil, revealed during the installation of 3 m diameter drainage galleries. Shear strength and index properties of the soil were measured by mixing the soil with distilled water and sea water, and after leaching the NaCl from the pore water. The residual shear strength of the soil sample with distilled water was 3–5° lower than that with the sea water. The residual shear strength of the intact rock powder after leaching the dissolved salt was close to that of the soil from sliding surface, and the residual shear strength of the soil from sliding surface after mixing with sea water was close to that of the intact rock powder. The increase in residual shear strength...

Slope stabilization procedures for six landslides in the Niigata prefecture in Japan afforded an excellent opportunity to examine the residual drained shear strength of weathered mudstones. Installation of 3 m diameter drainage galleries allowed undisturbed block samples to be collected which contained the slickenside surface of the failure plane. Ring shear tests were conducted on undisturbed samples and remolded samples of the same material. In addition to the laboratory testing, back analysis was performed to calculate the residual shear strength parameters of the slopes. Good agreement was found between the residual friction angles determined from back analysis, tests on undisturbed samples, and tests on remolded specimens. Many of the landslide materials exhibited a small cohesion at low values of effective normal stress, but the secant friction angle achieved a constant value at higher normal stresses.

NaCl solution has significant effect on the residual shear strength of soil from mudstone areas. Soil samples were collected from the intact rock (unsheared zone) and sliding surface (sheared zone) of five mudstone landslide areas. Mixtures of distilled water and the intact rock possessed higher electric conductivity than those of distilled water and the sliding surface soil. When these samples were leached with distilled water for five times, they showed a substantial decrease in the electric conductivity. The residual shear strength varies according to the NaCl concentration in the pore water. Ring shear tests were also carried out in the commercial standard clays as bentonite and kaoline to understand the shear strength characteristics of the mudstone soils. When bentonite was treated with NaCl solution as pore water, it showed about three times increase in residual shear strength and decrease to one quarter in liquid limit. The effect of NaCl solution as pore water in kaoline was comparatively low. The residual shear strength of soil from mudstone area also increased when it was treated with NaCl solution as pore water. The result of the X-ray diffraction analysis showed that the proportion of smectite is higher than that of kaolinite in the residual soil from mudstone. These smectite minerals were found to be highly sensitive to NaCl solution. Because of the sensitive changing character of smectite minerals to NaCl solution, soil samples with NaCl rich water showed lower value in consistency limits and higher value in the residual shear strength compared to soil samples with distilled water. The findings suggest that the residual shear strength and index properties should be considered as variable properties as a result of the change in the pore water. Such properties are useful to understand frequent re-activation of the landslide occurring in the mudstone areas.

The Mid-Niigata earthquake occurred in 2004 and taught us a lesson about the possibility of landslide damming when the earthquake occurs after the softening of the ground by rainfall. Terano Landslide was considered stable before the earthquake. However, due to the earthquake, the landslide moved extensively and dammed the Imokawa River. A main landslide block was analyzed for a seismic loading condition using the observed peak ground acceleration. Soil samples were collected from numerous sliding surfaces, and fully softened and residual shear strengths were measured. Factor of safeties were calculated for the mobilization of fully softened and residual shear strengths during different peak ground accelerations (PGA) and different pore water pressure ratios. Quantitative risk to landslide damming was evaluated for different PGA and ground water level scenarios, using the Bishop's Simplified Stability Analysis Method modified for the dynamic loading. The study results showed that the landslide mass would fail even if the earthquake of PGA more than 0.4g occurred in a dry season.

A 6.8M earthquake occurred in Niigata in October 2004 caused a huge damage that includes triggering of hundreds of landslides. Some of those landslides caused natural damming of the associated streams. Higashi Takezawa is one of the largest landslides that caused natural damming. Shear strengths of soil layers above and below the sliding surface of that landslide were remarkably different. Pseudo static analysis of the landslide showed that about 700 gal of peak ground acceleration (PGA) was enough to cause the slide moving at the time of earthquake. After the mobilization of residual shear strength, the stability was calculated and found to be reduced considerably, and about 350 gal of PGA was enough to keep the mass moving at that condition. However, if the earthquake has occurred in dry season or if the soil mass has not been softened by the excessive rainfall during the typhoon, the earthquake of that magnitude is not sufficient to cause failure. Dynamic safety factor of the landslide decreased exponentially with the increase in water pressure. This study is very useful to evaluate the stability of other potential landslides so that precaution can be taken against disaster during next earthquake events. BACKGROUND