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Introduction: Comorbidities are frequently seen in admitted COVID-19 patients most common being hypertension, diabetes, cardiovascular diseases and chronic kidney disease. Chronic kidney disease is a slowly progressive chronic illness due to the gradual loss of kidney function or structure. The available data regarding the prevalence of chronic kidney disease and COVID-19 comorbidities is still limited. The aim of this study was to find out the prevalence of chronic kidney disease among COVID-19 patients admitted to the Department of Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Medicine of a tertiary care centre. Data of medical records between 1 August 2020 to 1 December 2022 were reviewed retrospectively. The data was collected from 20 January 2023 to 20 March 2023. Ethical approval was obtained from the Institutional Review Committee (Reference number: 646/2079/80). Data on chronic kidney disease patients among COVID-19 patients were collected from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 584 COVID-19 patients admitted, the prevalence of chronic kidney disease was 43 (7.36%) (5.24-9.48, 95% Confidence Interval). A total of 30 (69.77%) were male and 13 (30.23%) were female with a mean age of 55±16.22 years. Conclusions: The prevalence of chronic kidney disease among COVID-19 patients admitted in the department of Medicine of a tertiary care centre was found to be slightly higher than other studies done in similar settings.

Introduction: Diabetic ketoacidosis is one of the most severe acute complications of diabetes mellitus characterised by hyperglycemia, hyperketonemia, and metabolic acidosis. Prompt diagnosis and treatment of diabetic ketoacidosis can decrease severity, hospital stay, and possible mortality. This study aimed to find out the prevalence of diabetic ketoacidosis among diabetic patients admitted to the department of medicine of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted at a tertiary care centre. Data from 1 March 2022 to 1 December 2022 were collected between 1 January 2023 and 1 February 2023 from the hospital records. The ethical approval was taken from the Institutional Review Committee of the same institute (Reference number: 466/2079/80). All the diabetic patients admitted to the Department of Medicine during our study duration were enrolled for the study. Diabetic patients who left against medical advice and those with incomplete data were excluded from the study. Data were collected from the medical record section. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 200 diabetic patients, the prevalence of diabetic ketoacidosis was 7 (3.5%) (3.47-3.53, 95% Confidence Interval) among which 1 (14.29%) patients had type I diabetes mellitus and 6 (85.71%) had type II diabetes mellitus patients and the mean HbA1C level was 9.77%. Conclusions: The prevalence of diabetic ketoacidosis among diabetes mellitus patients admitted to the department of medicine of a tertiary care centre was found to be higher than in other studies done in similar settings.

The purpose of this paper is to propose an algorithm for finding a common element of the set of fixed points of relatively nonexpansive mapping and the set of solutions of split inclusion problem with a way of selecting the stepsize without prior knowledge of the operator norm in the framework of Banach spaces. Then, the main result is used to the common fixed point problems of a family of relatively nonexpansive mappings and split equilibrium problem. Finally, a numerical example is provided to illustrate the main result.

Computed tomography has become a critical component in evaluating adult patients with acute caustic ingestions and an alternative to endoscopy for detecting transmural gastrointestinal necrosis. This study assessed the performance and reliability of computed tomography findings of transmural gastrointestinal necrosis, given that the presence of the disease potentially signifies the need for surgery. A retrospective database search was performed to identify consecutive adult patients with acute caustic ingestions who had computed tomography with endoscopy or surgery within 72 h of admission. Eight physicians reinterpreted computed tomography in two separate rounds. Diagnostic performance utilized eight rounds of radiologists' reinterpretations against reference endoscopic or surgical grades. Intra- and interobserver agreements were calculated. Seventeen patients (mean age, 45.6 years; 9 men; 46 esophageal and 34 gastric segments; 16 ingested strong acid substances) met the inclusion criteria. Eight patients (10 esophageal and 13 gastric segments) had transmural gastrointestinal necrosis. The highly differentiating findings between those with and without transmural gastrointestinal necrosis were esophageal wall thickening (100% vs. 42%, P = 0.001; 100% sensitive), gastric abnormal wall enhancement and fat stranding (100% vs. 57%, P = 0.006; 100% sensitive), and gastric absent wall enhancement (46% vs. 5%, P = 0.007; 100% specific). The intra- and interobserver percentage agreements were 47–100%, and 54–100%, which increased to 53–100%, and 60–100%, respectively, when considering only radiologists’ reinterpretations. In a very small sample of adults who primarily ingested acid, contrast-enhanced computed tomography performed well when interpreted by a panel of radiologists.

Background The dolutegravir-based antiretroviral regimen is the preferred first-line regimen for the management of people living with human immunodeficiency virus in Nepal recently. It is considered safe to transition to a dolutegravir-based regimen for children and adults on Nevirapine and Efavirenz-based regimens. Objective To determine the virologic response following the transition to a Dolutegravir-based regimen in people living with human immunodeficiency virus previously taking Nevirapine and Efavirenz-based regimen. Method This is a retrospective cohort study including people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) who were transitioned to Tenofovir/Lamivudine/Dolutegravir previously on other antiretroviral therapy regimens for at least 6 months and who had their viral load test done before transition. The medical records of patients were reviewed from records available at the antiretroviral therapy clinic of Dhulikhel Hospital. The viral load done at least 3 months after switching to the Dolutegravir-based regimen was recorded. Descriptive analysis of socio-demographic and clinical characteristics data was done. Result Fifty-seven people living with human immunodeficiency virus/ acquired immunodeficiency syndrome who transitioned to a Dolutegravir-based regimen previously on other antiretroviral therapy regimens for at least 6 months were included in this study. Tenofovir/Lamivudine/Efavirenz (47.4%), Zidovudine/ Lamivudine/Nevirapine (22.8%) and Zidovudine/Lamivudine/Efavirenz (17.5%) were the most common antiretroviral regimens before transition. The majority of the patients (86%) had suppressed viral load of fewer than 40 copies/mL before the switch. Following the transition, 96.5% of the patients had suppressed viral load of fewer than 40 copies/mL. Conclusion Dolutegravir-based antiretroviral regimen led to untransmittable viral load following a switch from Nevirapine and Efavirenz-based regimen.

The purpose of this study was to control the factors that are responsible for plants growth in hydroponics systems and automate them to reduce the human effort with less space and electricity. In this paper we used a combination of two methods: Deep water culture and Nutrient film technique for the system. In this method plants will have continuous nutrient supply. We used a linear regression method to control EC and pH of the system and the microcontroller will send signals to the system to adjust them to desired value with the help of dozers by taking average EC and pH values.

Introduction: An atd angle is one of the dermatoglyphic patterns which is an indication of the degree of distal displacement of the axial triradius on the palm. This is one of the markers of diabetes mellitus that is used as a screening tool in order to reduce the risk of onset and initiate early treatment. The aim of this study is to find the mean atd angle among type 2 diabetes mellitus patients visiting a tertiary care centre. Methods: This descriptive cross-sectional study was done among diabetic patients in a tertiary centre from 9 June 2021 to 5 May 2022. Ethical approval was taken from Institutional Review Committee (Reference number: KUSMS/IRC 40/2021). Both palm prints of study subjects were taken and the atd angle was measured. Convenience sampling was done. Point estimate and 95% confidence interval were calculated. Results: Among 133 palm prints of diabetic patients, the mean atd angle was 42.13±4.73° (male: 41.90±4.75° and female: 42.35±4.70°). The right palms showed mean atd angle of 42.31±4.42° and that of left palms was 41.94±5.04°. Conclusions: The mean atd angle among type 2 diabetes mellitus patients is similar to other studies done in similar settings.

The demands for energy and the scarcity in fossil fuel are constantly increasing. This has resulted in the search for sustainable, renewable, and low cost biofuel that has triggered the search for potential bioenergy crops. Aquatic plants that can grow rapidly with minimum resources and can produce biomass in bulk amounts are driving the attention of scientists and researchers throughout the world. The production of biofuels from such organic materials and waste components can result in developing of sustainable alternative that will not only be beneficial to the environment but also to public health. In this study, one such aquatic macro algae Azolla pinnata proved to be potential source for biofuel production. The evaluation of its growth was done and trans-esterification of Azolla pinnata lipid was carried out to produce biofuel. The species have a unique combination of physical, chemical and nutrients composition that makes it a boon to mankind. This macro algae was subjected to series of laboratory testing and evaluation for its characterization such as acid value test, trans-esterification, fatty acid methyl esters (FAMEs) test, gas chromatography which showed the feasibility of algal based biofuel. The comparison of properties of extracted biofuel (physicochemical) from Azollla pinnta was done with standardized ASTM D6751 values. The outcome of produced biofuel was very close to conventional fuel.

Novel dual acting benzofuran-based chromenochalcones were synthesized and assessed for in vitro and in vivo antihyperglycemic and antidyslipidemic activities.

We have tried to demonstrate [3+2] cycloaddition of azomethine ylides for the synthesis of several bioactive compounds. Different methodologies, including metal-catalyzed as well as metal-free asymmetric and racemic synthesis, have been explained.

The future climate which has crucial role of any hydrological events that occurs within basin will have more uncertainty. Changing the climatic variables, the water balance of the basin will more unpredictable. Not only will climatic parameter changes but also adversely affected the water management within the basin. In this study, an attempt has been carried out to compare the future River flow of Kamala basin and future water demand of Kamala irrigation command area. The CROPWAT and AQUACROP model, based on climatic, soil and crop data, was used to estimate the future Crop Water Requirement (CWR), Irrigation Water Requirement (IWR) and Biomass yield. The hydrological station, because not exist within basin, was not possible to simulate the future river flow of the Kamala basin using any hydrological model. Therefore, the WECS method is simply used to forecast the future monthly flow of Kamala River. The two emission scenarios, ssp245 and ssp585 were conducted based on cropping intensity 170% and 300 % and IWD for each sub-scenario over 12 months was estimated. For the first sixth months, IWR is increased in the future period as maximum and minimum temperature increases and the IWR for monsoon season is less required due to increases in precipitation and again for the post-monsoon season, IWR is increased compared as historical IWR. The highest irrigation water requirement occurs in March month under ssp245 and ssp585 and CI 300%. Whereas, July and August months have the lowest irrigation water demand under ssp245 and ssp585 scenarios. Based on the finding, the production of crop with irrigation system has higher than rainfed system. For paddy, the rainfed system produced dry yield of 6.58 ton/ha whereas, dry yield of irrigated field has 7.05 ton/ha. The future river flow is insufficient to meet the irrigation water demand in first five months in near future under both ssp245 and ssp585 scenarios. The magnitude of deficiency in ssp585 is comparatively higher than in ssp245. As a result, all of these findings suggest that the crop waterrequirement of KIP is insufficient in the future to provide a year-round irrigation system.

Background: A tracheostomy is a surgical procedure in which trachea is opened below the larynx from which a tube is placed in trachea to facilitate mechanical ventilation, removal of tracheo-bronchial secretions and to protect upper airway. The aim of this study is to find out the current status of decannulation following institutional guideline. Materials and methods: A cross sectional study was done among patients in neurosurgery with tracheostomy who were successfully decannulated. This study was conducted in department of neurosurgery B&C Medical College Teaching Hospital, Jhapa, Birtamode. Total 47 patients were included in this study those underwent decannulation. Various demographic data including gender age diagnosis, days of tracheostomy and decannulation started day were recorded and entered in SPSS and version 20. Results: Among 47 patients, male were 81% (38) and females 19 %( 9). Road Traffic accident is the most common diagnosis 66% (31) among tracheostomy patients. The average days with Tracheostomy were 24. And after decannulation process, the successful tracheostomy closure in 83% (39) patients was achieved. Conclusion: Patients with tracheostomy tube could be decannulated successfully by following strict institutional guidelines, adequate medical and nursing care in a center with limited resources.

Background: Blunt abdominal trauma, one of the most common injuries caused by road traffic accident are usually not obvious hence often missed unless repeatedly looked for. In view of this, the study was aimed to diagnose the solid organ injury and its incidence, mode, age, sex distribution, time of presentation, clinical course, management, time interval between injury and surgery, postoperative complications and outcomes. Methods: This prospective observational study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from August 2020 to July 2021. Data were collected with clinical history/examination, injury assessment, appropriate investigations, modes and patterns. Documentation with identification, history, clinical findings, diagnosis, management, complications and outcomes were done and analyzed with SPSS version 16. Results: Among 83 patients, most of them aged between 16-30 years (57.8%). Male to female ratio was 1.96:1. The most common mode was road traffic accidents (55.5%). Commonly injured organ was spleen (51%) and liver (30%) with associated other organs (65%). Conservative management was done in 62% and operative in 38%. Majority of patients were operated after 4-6 hours of initial presentation. The more the time interval between injury and surgery, the more the complications, duration of hospital stay and mortality. Post-operative complications were noted in 38.5% and mortality in7.22%. Conclusions: Blunt abdominal trauma was common and mainly associated with road traffic accidents. Associated abdominal and extra abdominal injury, delay presentation, diagnosis and intervention significantly predict high mortality and poor outcomes.

The purpose of this study is to look at the trends in collection and selling of Tendu leaves in the Guarella-Pendra-Marwahi district of Chhattisgarh. Chhattisgarh is the first state in India to produce high-quality Tendu leaves. For this study, the least square technique was used to fit curves and make short-term projections for Tendu Leaves collecting and sales. The data for this study came from Marwahi Van Mandal (which contains one District Union and sixteen Primary Co-operative Societies) for the years 2011 to 2020. These evaluations were carried out on a district, and societal level. The best fitted model was fourth order polynomial regression model in explaining the Tendu leaves collection and sales.

JFlex is a lexical analyzer generator and takes input requirements with a set of regular expressions and corresponding actions. It creates a program (a lexer) that reads input, matches the input against the regular expressions, and runs the matching action. This paper shows how Programming Language can be developed. This work was done to develop a simple programming language with compilers using JFlex in NetBean so that it can support assignment statements, if then else, while do and type checking and its execution. The data type included are int, real, char, and Boolean/String. The key concept used in this work was the execution of the grammar or rules in the cup file. The parse tree records a sequence of rules the parser applies to recognize the input. The tool used for the development of lexical analyzers was JFlex. JFlex Lexers was based on deterministic finite automata (DFAs). To show the implementation and working of operators, a simple calculator was designed that supports addition and multiplication operations. Further, the key compiler concepts like lexical analyzers, semantic analysis, and parse trees are discussed. This paper will help understand the syntax and way to develop simple language. For the programming language developed, the evaluations of the expressions and statements are recursively done. Type checking and Error checking are also done where two operands are checked for their compatibility with the operator and are shown if incompatible expressions are found.

The Sub-Himalaya of Nepal experiences sub-tropical climate where geologically young and delicate sedimentary rocks are prone to chemical and physical weathering and consequent erosion. The main aim of this study is to identify and evaluate the durability characteristics of some sandstones against slaking, freezing-thawing and abrasion. Lithosomes were characterized in the field. The following laboratory tests included measurements of dry density, specific gravity, water absorption, Slake Durability Index (SDI), Sulphate Soundness (SS), and Los Angles Abrasion (LAA). Sandstones from the Lower Siwalik Subgroup (LSS) are massive to cross-stratified, very fine- to medium-grained, and occasionally calcareous, whereas the sandstone from the Middle Siwalik Subgroup (MSS) are mostly cross-stratified to few massive, medium- to coarse-grained with salt-and-pepper appearance, and uncommonly calcareous. Sandstones have four different types of deterioration and had high to extremely high SDI. The majority of the sandstones have displayed similar slaking tendencies. Under the five-cycle SS test, the majority of sandstones from LSS and MSS have experienced low final weight loss (below 10%). However, two from LSS and three from MSS have experienced greater final weight loss. The LAA values range from 29.66% to 99.14%, and except two sandstones from LSS, rest of the samples have exceeded 45% abrasion showing they were incompetent in terms of abrasion test, and are highly susceptible to abrasion. The uniformity factor ranges from 0.21 to 0.44 indicating that all the sandstones were of non-uniform hardness. Correlation among physical parameter and durability indices was weak to moderate probably because of varied nature of sandstones.

High fructose flux enhances hepatocellular triglyceride accumulation (hepatic steatosis), which is a prime trigger in the emergence of hepatic ailments. Nevertheless, the pathophysiology underlying the process is not completely understood. Emerging evidences have revealed the inputs from multiple cues including inflammation, oxidative stress, and endoplasmic reticulum (ER) stress in the development of hepatic steatosis. Here, we substantiated the role of NLRP3 inflammasome and its convergence with oxidative and ER stress leading to hepatic steatosis under high fructose diet feeding. Male SD rats were fed on 60% high fructose diet (HFrD) for 10 weeks and treated with antioxidant quercetin or NLRP3 inflammasome inhibitor glyburide during the last 6 weeks, followed by metabolic characterization and analysis of hepatic parameters. HFrD-induced hepatic steatosis was associated with the activation of NLRP3 inflammasome, pro-inflammatory response, oxidative, and ER stress in liver. Treatment with quercetin abrogated HFrD-induced oxidative stress, along with attenuation of NLRP3 activation in the liver. On the other hand, inhibition of NLRP3 signaling by glyburide suppressed HFrD-induced oxidative and ER stress. Both glyburide or quercetin treatment significantly attenuated hepatic steatosis, associated with mitigated expression of the lipogenic markers in liver. Our findings verified the association of NLRP3 inflammasome with oxidative and ER stress in fructose-induced lipogenic response and indicate that in addition to be a target of oxidative/ER stress, NLRP3 can act as a trigger for oxidative/ER stress to activate a vicious cycle where these cues act in a complex manner to propagate inflammatory response, leading to hepatic steatosis.

OBJECTIVE Tailored surgery to extensively resect epileptogenic lesions using intraoperative electrocorticography (ioECoG) may improve seizure outcomes. However, resection of large areas is associated with decreased memory function postoperatively. The authors assessed whether ioECoG could provide useful information on how to minimize the focus resection and obtain better seizure outcomes without memory deterioration. They examined the postoperative seizure-free period and memory alteration in a retrospective cohort of patients with mesial temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in whom the extent of removal was determined using ioECoG findings. METHODS The authors enrolled 82 patients with TLE associated with HS who were treated surgically. Transsylvian amygdalohippocampectomy was indicated as the first step. When visual inspection identified interictal epileptic discharges from the lateral temporal lobe on ioECoG, anterior temporal lobectomy (ATL) was eventually performed. The patients were divided into the selective amygdalohippocampectomy (SA, n = 40) and ATL (n = 42) groups. Postoperative seizure outcomes were assessed at 1, 2, 3, 5, and 7 years postoperatively using the International League Against Epilepsy classification. The Kaplan-Meier survival analysis was applied to evaluate the period of seizure recurrence between the SA and ATL groups. Factors attributed to seizure recurrence were analyzed using the Cox proportional hazards model, and they were as follows: epileptic focal laterality; age at seizure onset (< 10 or ≥ 10 years old); seizure frequency (more than weekly or less than weekly seizures); history of focal to bilateral tonic-clonic seizure; infectious etiology; and surgical procedure. The Wechsler Memory Scale–Revised was used to evaluate memory function pre- and postoperatively. RESULTS Seizure outcomes were significantly worse in the SA group than in the ATL group at 2 years postoperatively (p = 0.045). The International League Against Epilepsy class 1 outcomes at 7 years postoperatively in the SA and ATL groups were 63% and 81%, respectively. Kaplan-Meier analysis showed that seizure recurred significantly earlier in the SA group than in the ATL group (p = 0.031). The 2-way ANOVA analysis was used to compare the SA and ATL groups in each memory category, and revealed that there was no significant difference regardless of the side of surgery. CONCLUSIONS Visual assessment of ioECoG cannot be used as an indicator to minimize epileptic focus resection in patients with TLE associated with HS. ATL is more effective in obtaining seizure-free outcomes; however, both ATL and SA can preserve memory function.

Adoption of Human Resource Information System (HRIS) could be instrumental in gaining competitive advantage to organizations across all sectors. However, the adoption of HRIS is scanty in many organizations, especially in the developing countries. This study attempted to investigate application of Unified Technology Acceptance and Use of Technology (UTAUT) model in the context of adoption of Human Resource Information System (HRIS) in Nepali organizations. It also examined the mediating role of Behavioral Intention for actual use of HRIS. The study further investigated the moderating role of prior exposure for generating actual use of HRIS when behavioral intention already existed. One hundred thirty employees from the Human Resource Unit of different organizations participated in the study. The results showed that three factors - facilitating condition, performance expectancy, and hedonic motivation, generate behavioral intention for adoption of HRIS. The influence of these factors on actual use of HRIS was partially mediated by behavioral intention for adoption. Prior exposure of employees moderated the positive influence of three factors on actual use of HRIS. The implications of the study are discussed and limitations of the study are highlighted.

Social protection schemes are designed to address the vulnerability of all the citizens through policy and programmes. As one of the integral agenda of the Government of Nepal, social protection programmes have covered a wide range of citizens through various schemes including cash, in-kind, and food transfers among others. Children, as the most vulnerable citizens needing support for growth, empowerment and sustenance, are the core recipients of the social protection programmes. Analysis of the current contribution of social protection programmes in child protection through the review of policy, programmes and budget allocated by the federal as well as provincial governments shows lack of compliance between the annual policy, programme and budget to shield children under social protection schemes. In addition, all the policy provisions haven’t been exclusively supported by budgetary provisions. Though significant benefits and social security allowances have been placed for children covering education, health, protection, nutrition, and development, this study shows further need of investment on children focused programmes. Similarly, it reveals that though Dalits, girls, conflict-affected, martyr’s children, children with disabilities and other most marginalised and disadvantaged are covered by the social protection programmes, a large part of the sexual and gender minority children have been excluded from these supports due to lack of awareness and accessibility to such schemes.

Hericium erinaceus, a mushroom species commonly known as Yamabushitake in Japan, is known to have a stimulatory effect on neurotrophic factors, such as brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). Hericenone C, a meroterpenoid with palmitic acid as the fatty acid side chain, is reported to be one such stimulant. However, according to the structure of the compound, the fatty acid side chain seems highly susceptible to lipase decomposition, under in vivo metabolic conditions. To study this phenomenon, hericenone C from the ethanol extract of the fruiting body was subjected to lipase enzyme treatment and observed for changes in the chemical structure. The compound formed after the lipase enzyme digestion was isolated and identified using LC-QTOF-MS combined with 1H-NMR analysis. It was found to be a derivative of hericenone C without its fatty acid side chain and was named deacylhericenone. Interestingly, a comparative investigation of the neuroprotective properties of hericenone C and deacylhericenone showed that the BDNF mRNA expression in human astrocytoma cells (1321N1) and the protection against H2O2-induced oxidative stress was considerably higher in the case of deacylhericenone. These findings suggest that the stronger bioactive form of the hericenone C compound is in fact deacylhericenone.

Background Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy. Method This was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale. Results Out of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19–75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p Conclusion Parkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery. An increase in scale is associated with an increased difficulty level of the surgery.

Inorganic metal oxide ZnO in the form of nano particles can change the way diseases are diagnosed and treated. ZnO Nps are selective in targeting cancer cells and due to its nano size can enter into cells and destroy it. Drugs, fluorescent agents (for imaging), targeting agents (to target diseased cells only) etc. be loaded on ZnO Nps to deliver drugs selectively in a controlled manner to specific site. ZnO Nps is non toxic as declared by medical community and hence can replace the inaccuracy and harmful side effects of conventional medicine in bulk form. In this review we have discussed about the preparation and characterization of ZnO Nps. Later part concentrated on applications in various fields including biomedical field.

Background Acute bacterial meningitis (ABM) is a serious health issue in Yemen where civil war, which continues unabated, has crippled the healthcare system. We conducted a nationwide retrospective observational study in Yemeni sentinel hospitals to identify the prevalence, aetiology, vaccination coverage and spatio-temporal pattern of ABM in children aged Methods Cerebrospinal fluid samples were collected from hospitalized children and were analysed macroscopically for appearance and microscopically by Gram stain and white blood cell count. Culture and latex agglutination tests were performed. Data on the prevalence of and vaccination coverage for ABM were obtained from the Ministry of Health. Joinpoint regression was used to assess the annual percent change (APC) of ABM prevalence and vaccination coverage. Pearson's correlation was used to evaluate the association between ABM prevalence and vaccination coverage. Results In total, 11 339 hospitalized children had suspected cases of ABM (prevalence, 40.07/100 000 of the whole Yemeni population) and 2.6% (293/11 339) of suspected ABM cases were confirmed (prevalence, 1.04/100 000 of the whole Yemeni population). The dominant pathogens were Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). The civil war reduced the Hib and pneumococcal vaccination coverage (APC = –1.92), reaching its lowest (79.5%) in 2018. The prevalence of suspected ABM increased (APC = 3.46), reaching its maximum (6.08/100 000 of the whole Yemeni population) in 2019. The conflict inversely correlated with the ABM prevalence and vaccination coverage (Pearson correlation coefficient (r), –0.69 to –0.53). Ta'izz region, which was severely affected by the civil war, had the highest prevalence of suspected ABM (120.90/100 000 of the whole Yemeni population) and lowest vaccination coverage (60%). Conclusions The civil war had a negative impact on vaccination coverage and coincided with increasing prevalence of ABM in Yemen. Streptococcus pneumoniae is the dominant causative pathogen.

IntroductionSalmonellaTyphi andSalmonellaParatyphi, fecal-oral transmitted bacterium have temporally and geographically heterogeneous pathways of transmission. Previous work in Kathmandu Nepal implicated stone waterspouts as a dominant transmission pathway after 77% of samples tested positive forS. Typhi and 70% forS. Paratyphi. Due to a falling water table, these spouts no longer provide drinking water, but typhoid fever persists, and the question of the disease’s dominant pathway of transmission remains unanswered.MethodsWe used environmental surveillance to detectS. Typhi and Paratyphi DNA from potential sources of transmission. We collected 1L drinking water samples from a population-based random sample of households between February and October 2019 Between November 2019 and July 2021, we collected monthly 50 mL river water samples from 19 sites along the rivers leading through the Kathmandu and Kavre Districts of Nepal. We processed drinking water samples using a single qpcr and processed river water samples using differential centrifugation and qPCR at time 0 and after 16 hours of culture enrichment. A 3-cycle threshold (Ct) decrease ofS. Typhi orS. Paratyphi, pre- and post-enrichment, was used as evidence of growth. We also performed structured observations of human-environment interactions to understand pathways of potential exposure.ResultsAmong 370 drinking water samples,S. Typhi was detected in 7 samples (1.8%) andS. Paratyphi A was detected in 4 (1.0%) samples. Among 381 river water samples,S. Typhi was detected in 171 (45%) andS. Paratyphi A was detected in 152 (42%) samples. Samples located upstream of the Kathmandu city center were positive forS. Typhi 12% of the time while samples from locations in and downstream the city had bacterial DNA detected 58% and 67% of the time respectively. Individuals were observed bathing in the rivers, washing clothes, and washing vegetables for sale in Kathmandu markets.ImplicationsThese results suggest that drinking water was not the dominant pathway of transmission ofS. Typhi andS. Paratyphi A in the Kathmandu Valley in 2019. The high degree of river water contamination and its use for washing vegetables raises the possibility that river systems srepresent an important source of typhoid exposure in Kathmandu.Author SummaryUnderstanding the dominant route of transmission of a pathogen is important for designing and implementing effective control strategies. Salmonella Typhi and Paratyphi which cause typhoid and paratyphoid fever infect an estimated 10 million people and kill more than 100,000 annually. In Kathmandu prior work suggested that stone spouts where people collected drinking water were contaminated and driving transmission of the diseases. However, many of these spouts no longer function, and people are still getting sick. We tested drinking water from households in this area as well as local river water and found that 13 drinking water samples were positive for S.Typhi and 15 were positive for S. Paratyphi and many river samples tested positive for these bacterium. River water samples were not often positive upstream of Kathmandu city center (12% positive for S.Typhi) but were often positive within the city center (58% positive for S.Typhi) and in rural areas up to 10 km downstream of the city (67% positive for S.Typhi). During sample collection, individuals were observed interacting with rivers by walking in them, washing clothes and washing vegetables for sale in markets. This study shows that drinking water may not be primary driver of typhoid transmission in the Kathmandu valley, but that sewage contaminated river water may be a foci of transmission into the wider population.

High blood cholesterol affects ~30% of adult Canadians and doubles the risk of cardiac events. Statins are widely used for lowering cholesterol levels, but statins have pleiotropic effects that can be mediated by lowering protein prenylation. The most prevalent side effect of statin therapy is myopathy. Overt myotoxicity and rhabdomyolysis are rare (S127A) in C2C12 mitigated statin-mediated increases in atrogin-1 and lower myotube diameter compared to vector/vehicle controls in LPS primed myotubes. Statins also promoted the nuclear accumulation of FOXO1 and decreased levels of phosphorylated FOXO1/3a. Restoring protein prenylation and blocking the NLRP3 inflammasome prevented statin-induced nuclear accumulation of FOXO1 and mitigated decreased levels of p-FOXO1/3a. These results showed that prenylation and activation of NLRP3 inflammasome are both upstream of the FOXO activation. Our results demonstrated that activation of YAP in the presence of statins mitigated measures of statin-induced myopathy and that NLRP3 activation is upstream of FOXO activation, which is a known regulator of Atrogin-1. Further investigation to characterize the mechanism of statin-induced myopathy can lead to an enhanced understanding of statin-induced myopathy and the establishment of next-generation statin therapies without muscular side effects. Natural Sciences and Engineering Research Council (NSERC) of Canada This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Background:Anatomical variation of aortic arch play’s significant role in diagnosing and planning further therapeutic intervention of cerebrovascular diseases. Objectives: Aim of this study was to review the neck vessels arising from the aorta and to determine the prevalence of aortic arch variation in digital subtraction angiography. Materials and methods: after ethical clearance from institutional review board, study was conducted retrospectively in 129 patients who underwent digital subtraction angiography for various reasons from December 2020 to December 2021. Age ranged between 21-87 years old. 88 were males and 41 were females. Mean age was 57.89. Results: bovine arch variations were found in 2.3% in our study population. Classic branching pattern was demonstrated in 97 % of studied cases. Conclusion: Determining bovine arch variation though rarely detected, is essential for diagnostic and therapeutic intervention of cerebrovascular conditions for uncomplicated navigation of catheters and guide wires.

Locked in syndrome is a rare neurological entity which is usually misdiagnosed as a spinal pathology. Here we report 70 years-old hypertensive and diabetic gentleman presented with quadriplegia without upsetting his conscious level.

Organophosphate being the lethal compound and easily available insecticide in the developing countries has significant potential health risk. The morbidity related to organophosphate poisoning as delayed peripheral neuropathy, extra pyramidal syndromes and neuropsychiatric manifestations are still the major consequences of secondary neuronal damage. Herein, we present a case of 23 year old lady who ingested organophosphate in the context of suicidal attempt and presented with motor neuropathy after 4 weeks.

Eight and half syndrome is one of the rare neurological disorders, which is usually overlooked in our clinical practice. Here I report 58 years-old hypertensive Indian gentleman presented with horizontal gaze palsy and facial weakness.

Introduction: Laryngoscopy and intubation are associated with transient sympathetic responses manifesting as a rise in blood pressure and heart rate. This study was conducted to evaluate the role of oral gabapentin pretreatment in the attenuation of such haemodynamic response. Materials and Methods: Sixty-two patients aged 16 to 60 years weighing 50 to 75 kg undergoing elective surgeries requiring endotracheal intubation were randomized into two groups. group G received 900 mg oral gabapentin and group P received a placebo by mouth two hours before induction of anaesthesia. Patients were induced with propofol, fentanyl, and vecuronium. Laryngoscopy was attempted after four minutes and endotracheal intubation was done. Heart rate, systolic, diastolic, and mean arterial pressure at baseline, before intubation, one, three, five, and ten minutes after intubation were compared between two groups. Patients were observed for any adverse events peri-operatively and post-operatively for the first 24 hours. Results: There was significant attenuation of the rise in blood pressure and heart rate before and after intubation in both groups compared with their corresponding baseline parameters. A significant decrease in heart rate was observed in the gabapentin group only 10 minutes after laryngoscopy and intubation (p=0.022). Conclusions: Oral Gabapentin 900 mg two hours before induction is effective in attenuating the rise in blood pressure and heart rate following laryngoscopy and tracheal intubation, though a statistically significant difference was observed only at 10 minutes after intubation, compared with a placebo group. Besides the significant incidence of pre-induction somnolence, there were no serious perioperative adverse effects.

Background and Aims: Prosthetic valve thrombosis is a life- threatening complication of post-valve replacement surgeries. A number of patients present with thrombotic complications mainly due to poor anticoagulation status with irregular INR checkup especially from remote areas of Nepal. Our aim was to study the clinical profile and management of prosthetic valve thrombosis in our center. Methods: A prospective observational study of 45 patients (July 2017 – Jun 2019) admitted at Shahid Gangalal National Heart Centre, with the diagnosis of prosthetic valve thrombosis were studied. The demographic profile, clinical parameters and in hospital and 1 year outcome were analyzed. Results: Out of 45 patients, majority were female (60%) with the age 11-67 years with mean age of 34.9 ± 6.7. Twenty nine patients (64.4%) presented with sub-therapeutic INR value at admission. 46.7% patient had atrial fibrillation at the time of presentation. 88% patients presented within one week of onset of symptoms with shortness of breath being primary complaint, present in 95.6% of the patients. Forty two (86.9%) were thrombolysed with streptokinase while 3 patients underwent surgery. Valve thrombosis was most common at the mitral position 39(87%) patients. In hospital mortality was 13.3% and there were no major bleeding events or new stroke noted. Conclusion: Majority of patients with prosthetic valve thrombosis presented with a sub-therapeutic INR value and poor patients' compliance. Thrombolysis is a useful option in the management of prosthetic valve thrombosis patients especially in countries like Nepal.

The Internet of Things (IoT) Physical objects (or Groups of such materials) sensors, processing Skills, software and the Internet or other Communication connects with other devices and systems and other in exchange via networks Described as technologies. Invalid due to Internet of Things Devices Considered by name, they are associated with the public Internet. No need to connect, just the network Should only be connected and can be addressed individually. The ability to provide Machinery and digital machines, Objects, animals or personal Identifiers (UIDs) and from man to man or without the need for man-to-computer Data transfer over a network communication. In the last few years, IoT too it is too much 21st century Has become one of the most important technologies. Nowadays, everyday items combine Kitchen appliances, cars, Thermostats, baby screens through devices embedded on the Internet, making seamless communication between people, processes and objects possible. With Low-cost computing, cloud, big data, analytics and mobile technologies, physics minimal human intervention data share and let’s collect. In this high-connected world, digital Between system connected objects collaborate.