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Given the promising growth of digital payments in India, this study aims to identify motivational factors influencing digital payment acceptance among Indian consumers and how consumers perceive these services when segregated by demographic profiles of gender, age, education and income levels. An online survey targeting 386 respondents was targeted to study the key determinants of digital payments adoption. The study reveals that trust, subjective norm, perceived risk, ease of use, and usefulness are key predictors of digital payment adoption. In addition, invariance analysis provides empirical evidence of scale non-invariance when consumers are segregated by gender and education. The study is pioneering in digital payments as useful insights are gained, which can help policymakers and service providers design future strategies for wider acceptance of digital payments. [ABSTRACT FROM AUTHOR]

This paper adopts the multi-criterion decision-making model of fuzzy-TODIM and genetic algorithm (GA) for optimal portfolio allocation. We applied Markowitz's portfolio parameters as inputs for the fuzzy TODIM model to rank stocks that are constituents of each index from three different markets. Portfolios are then generated dynamically using three weighting techniques and subject to multi-objective criteria and additional constraints. The results indicate a significant variation in performance metrics between the model-generated portfolios and the market indices. Replication of the procedure produces a similar outcome. Moreover, the out-of-sample tests conducted over 3 years validate the results' robustness, indicating that fuzzy TODIM, combined with GA, can achieve superior performance in dynamic portfolio allocation. [ABSTRACT FROM AUTHOR]

Aims: The study was done to analyze the epidemiology, diagnosis and treatment aspect of patients with ectopic pregnancy at Kathmandu Model Hospital. Methods: This was a retrospective study of patients with ectopic pregnancy who received treatment at Kathmandu Model Hospital from January 2008 to September 2015. Data were analyzed from patient records and discharge summary. Delivery number was obtained from maternity record. Results: There were 61 cases of ectopic pregnancy with the hospital incidence of 1.46%. Highest number of patients 20 (32.79%) were in the age range of 28-32 years. Most of the patients were nullipara 22 (36.06%) or with parity two 20 (32.79%). Some risk factors were found in 29 (47.54%) cases. The commonest risk factor was pelvic inflammatory disease in 12 (19.67%). All presented with pain abdomen, 48 (78.68%) had per vaginal bleeding, 17 (27.87%) presented in shock. Cervical excitation was present in 38 (62.29%). Urine for pregnancy test was positive in all and 37 (60.66%) had ultrasonography. Ten (16.39%) patients underwent emergency laparoscopic surgery and 40 (65.57%) had emergency laparotomy. Salpingectomy was required in 53 (86.89%) cases. The average hospital stay was 5 days. Conclusions: The study showed that ectopic pregnancy could occur at any reproductive age without obvious risk factors. Although not all patients gave history of amenorrhoea, pain abdomen was present in all. [ABSTRACT FROM AUTHOR]

Aim: The study was done to review the demography of urogenital fistulae including obstetric fistula (OF) and its surgical outcome in the early phase of fistula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent fistula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of fistula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of fistula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic fistula was also becoming common. The success of repair depended on the type, site, size of fistula and urethral length. Majority of our cases had successful closure of fistula with some degree of stress in some patients. [ABSTRACT FROM AUTHOR]

Aims: This study was done to know the demographic profile of women undergoing second trimester abortion at Kathmandu Model Hospital. The aim was to see the success rate of combination of mifeprostone and misoprostol for the medical induction and misoprostol alone for the cervical dilation in case of surgical evacuation. Methods: A retrospective study was done by looking at the profiles of 540 clients on whom second trimester abortion was performed during the period of October 2010 to October 2014. Twenty-nine women underwent dilatation and evacuation (D&E) with misoprostol cervical priming, and 510 underwent medical induction with mifeprostone and misoprostol whereas one client absconded. Furthermore, the reasons for seeking second trimester abortion were also investigated. Results: It can be seen that the age of women undergoing second trimester abortion at Kathmandu Model Hospital was greatest (33.33%) for the age group of 26-30 years. Most women were illiterate (31.67%) and a majority of the women were housewives (89.81%). A greater proportion of the women had never undergone abortion. Mental cause appeared to be the major reason for abortion constituting 82.04%. Success was 90.58%, expulsion with total five doses of misoprostol. The median induction to abortion time was 4-7 hours. The expulsion hours increased as the gestational age increased. The median number of dose of misoprostol required was two for medical induction and three for surgical abortion. Conclusions: Mifeprostone and misoprostol, as combination was a good method for the medical induction of second trimester pregnancy and misoprostol alone for the cervical preparation in surgical evacuation was promising. [ABSTRACT FROM AUTHOR]

Aims: Laparoscopy has become the most common procedure in recent set-ups. It is now a major diagnostic as well as therapeutic modality for infertility, endometriosis, extrauterine pregnancy and benign ovarian tumors.The aim of the study was to share the experience of gynecological laparoscopic surgeries performed at Kathmandu Model Hospital. Methods: A descriptive study was carried out at Kathmandu Model Hospital from 1st January 2011 to 1st May 2017. All the patients who underwent gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications. Results: Out of 217, majority 24.4 %(n=53) patients were in age group 26-30 years. There were 51.1% (111) cases of ovarian cyst, 12.44%(27) cases of ectopic pregnancy. Eight cases were done with surgeons for cholecystectomy and ovarian cystectomy or hysterectomy. There were 15% (n=32) cases of diagnostic laparoscopy. Total laparoscopic hysterectomy was done in 16% (n=33) cases. Conversion to laparotomy was done in 3%(8) cases. There was one case of vascular injury. Most common immediate post-operative complaint was variable degree of pain, managed with parenteral and oral analgesics. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. 75% (164) cases had a hospital stay of 2 days and 25%(53) cases stayed for 3 days. Conclusions: Laparoscopic surgery at our hospital has been well demonstrated in terms of reducing postoperative pain and decreasing postoperative morbidity, short hospital stay, and less postoperative recovery time. However, adequate advanced training and devices are needed to perform skillful laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Ovarian cysts are common findings in females of reproductive age. Mostly, they are non neoplastic and hormonally dependent as follicular, simple, and corpus luteum cysts. Ovarian cysts are rarely grown to reach huge size without raising any symptoms. Most of the cases that have huge cysts present with pressure symptoms over the genitourinary system leading to urinary complaints or the respiratory system lead to respiratory embarrassment. Dermoid cysts account for 10-20% of all ovarian neoplasms. They are common in young women, especially at the age of 30 years.In most of cases, they are asymptomatic and can be discovered accidentally on clinical examination or ultrasonographic scan. They are usually indolent tumors with very slow rate of growth about 1.8 mm per year. Giant dermoid cysts have been infrequently reported in the literature. This is a case report of huge dermoid cyst weighing 25 kgs in a 42-year old perimenopausal lady that remained relatively asymptomatic. She underwent Laparotomy with ovarian cystectomy. [ABSTRACT FROM AUTHOR]

The ectopic implantation is implantation of fertilized ovum outside the uterine cavity, ampulla of fallopian tube being the most common site. A cornual or interstitial pregnancy is an ectopic pregnancy that develops in the interstitial portion of the fallopian tube which is one of the most hazardous type of ectopic gestation. Treatment depends on the week of gestation at the time of diagnosis, level of serum β HCG, findings of ultrasonography, hemodynamic stability of the patient and the choice of future fertility. In this case report, we present a case which was previously misdiagnosed as a case of missed abortion at 8 weeks of gestation by transabdominal ultrasound and patient underwent medical abortion with mefipristione and misoprostolandafter 1 month presented with pain abdomen and was confirmed as extrauterine pregnancy by transabdominal ultrasound followed by surgical management. [ABSTRACT FROM AUTHOR]

Vaginal atresia is one of the common congenital anomalies of the female lower genital tract due to incomplete canalization of Mullerian ducts. It mostly presents as primary amenorrhoea with attacks of severe lower abdominal pain at monthly interval in presence of appropriate Tanner staging secondary sex characteristics. It is diagnosed by clinical presentation, examination and imaging, usually ultrasound scan and magnetic resonance imaging. There are conservative non-surgical as well as surgical methods to correct it. A 13 years pubertal girl presented at Kathmandu Model Hospital with complaints of cyclic severe lower abdominal pain since one year with presence of appropriate secondary sexual characteristics. Ultrasound showed features suggestive of hematometra. She underwent drainage of hematocolpos with neo-vaginoplasty followed by intravaginal mould placement. She also underwent dilatation of neovagina thrice under IVA to maintain the vaginal length and function. We present here a case of isolated vaginal atresia, who underwent Mc Indoe Vaginoplasty followed by serial dilatation. [ABSTRACT FROM AUTHOR]

Transverse vaginal septum is a congenital anomaly of the female genital outflow tract. It mostly remains unrecognized till adolescence and manifests as primary amenorrhoea with cyclic lower abdominal pain in background of appropriate Tanner staging secondary sex characteristics. Diagnosis is done by clinical examination and imaging, usually Magnetic Resonance Imaging. Early surgical management by vaginal or abdominal approaches improves the outcome.A16years adolescent with appropriate Tanner staging secondary sex characteristics presented to gynecology (OPD) of Kathmandu Model Hospital with complaints of primary amenorrhoea and palpable abdominal mass of 24 weeks size with cyclic lower abdominal pain. Ultrasound showed features suggestive of hematometra. Under spinal anaesthesia, drainage and excision of the transverse vaginal septum was done followed by placement of vaginal mould post-operatively. We present here a case of primary amenorrhoea with pyometra secondary to transverse vaginal septum. [ABSTRACT FROM AUTHOR]

H9N2 avian influenza viruses are endemic in domestic poultry in Asia and are grouped into three major sublineages represented by their prototype strains A/Duck/Hong Kong/Y280/97 (Y280-like), A/Quail/Hong Kong/G1/97 (G1-like) and A/Chicken/Korea/38349-p96323/96 (Korean-like). To understand the genetic relationship of Indian viruses, we determined the partial nucleotide sequence of five H9N2 avian influenza viruses isolated from chicken in India during 2003–2004 and compared them with H9N2 sequences available in GenBank. Deduced amino acid sequence analysis revealed that four isolates shared an R–S–S–R/G motif at the cleavage site of HA, representing low pathogenicity in chickens, while one virus harbors an R–S–N–R/G motif at the same position. All the viruses maintained the human-like motif 226Lysine (H3 numbering) at the HA receptor binding site. Phylogenetic analysis showed that 50% of the genes (HA, NA, NP and M) were similar to G1-like viruses, whereas the remaining genes of the Indian isolates formed a separate, not yet defined, sublineage in the Eurasian lineage. Our finding provides evidence of a novel reassortant H9N2 genotype of G1-like viruses circulating in India. [ABSTRACT FROM AUTHOR]

Background Skin problems are the commonest reason for people accessing healthcare services in Nepal but there is little information about the prevalence of skin disease. Objectives To perform a point prevalence study of skin disease in the Terai region of Nepal. Methods Five villages were randomly selected in Bara District in the Terai region of Nepal, and 878 people were examined. Results The number of individuals identified as having a skin disease was 546. The point prevalence of identifiable skin abnormalities was 62·2% (546 of 878) (with 95% exact confidence intervals 58·9–65·4%). A wide range of dermatoses was identified. The six most prevalent were dermatophyte infections (11·4%), followed by pityriasis versicolor (8·9%), acne (7·7%), melasma (6·8%), eczema (5·6%) and pityriasis alba (5·2%). Overall, treatable skin infections and infestations were by far the commonest skin diseases identified. Conclusions Our study has demonstrated a very high point prevalence (62·2%) of skin disease in rural Nepal. This study represents the first formal survey of skin disease in Nepal and demonstrates a large burden of disease, in particular treatable infections. [ABSTRACT FROM AUTHOR]

Outbreaks of highly pathogenic avian influenza (HPAI) H5N1 virus were reported for the first time in India during February 2006. Herein, we have sequenced and analyzed the PB2 genes of five influenza virus isolates obtained from three affected states (Gujarat, Madhya Pradesh and Maharashtra) in India during the outbreaks. In the phylogenetic analysis, the Indian isolates were grouped in the mixed-migratory bird sub-lineage of the Eurasian lineage. From the phylogenetic tree, it is evident that viruses were probably introduced to India from China via Europe because they share a direct ancestral relationship with the Indian isolates. The virus might have spread through migratory waterfowls that survived the HPAI H5N1 infection. These viruses were able to replicate in cultured cells of avian and mammalian hosts and posses lysine at position 627 of the PB2 protein, indicating that they might be able to cross the host barrier to infect mammals. [ABSTRACT FROM AUTHOR]

Abdominal sacro-colpopexy (ASC) is a commonly performed procedure for the surgical treatment of pelvic organ prolapse (POP). Surgeons favor this technique because of its well-established success rates ranging from 78-100% and durability, which is attributed to reinforcement of native tissues with a graft. Despite recognition of the risk of erosion, synthetic grafts have been preferred over autologous grafts for abdominal sacro-colpopexy because they are durable, avoid the morbidity and operative time of harvesting fascia, are readily available and are relatively inexpensive. Ideally, these benefits should outweigh the possibility of erosion, which is a unique complication of using a graft. We present here a unique case of mesh erosion into bowel after sacro-colpopexy who presented with sigmoido-vaginal fistula. [ABSTRACT FROM AUTHOR]