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Introduction: The chance of survival of a victim after cardiac arrest/foreign-body airway obstruction is doubled by early institution of Basic Life Support (BLS). Besides medical doctors, dental doctors might also encounter the patients in emergency situation requiring BLS, especially during peripheral district teaching hospital posting in internship. Objectives: The objective of this study was to assess the level of knowledge about BLS among final year dental students of BPKIHS. Methodology: In this cross-sectional study, structured questionnaires were distributed to BDS final year students (purposive sampling, sample size=53). Each question responded correctly was awarded as point +1 and total points were calculated by adding all the correct answers. The collected data were entered in Microsoft excel 2010 and descriptive analysis was done by SPSS 16. Results: Out of 53 questionnaires distributed, 49 were responded and returned (response rate= 92.45%). Twenty participants were male and twenty-nine were female. Four participants had taken BLS training in the past. Only twenty participants scored ≥ 50% and none of the participant scored ≥75%. Only one question was responded correctly by 100% participants. Ten questions were responded correctly by ≥50% participants. Although 65.3% participants were aware about high quality CPR, only 49% knew the exact location of chest compression. The chest compression to ventilation ratio for each of single rescuer and two rescuers was known by 20 participants (40.8%) and 28 participants (57.1%) respectively. Conclusion: Knowledge of BLS is poor among BDS final year students.

This paper embraces the study of quality parameters of higher education institutions responsible for producing employable graduates and thus resulting in enhanced industry acceptance and eventually employability. The newly introduced National Education Policy announced by the Government of India in 2020 is also being studied and discussed to detail the challenges associated with the Indian Education System, its current stature, and the scope of modifications with an intent to enhance the employability of young graduates. As a case study, the USA education system is studied to understand the unique quality parameters as per the global ranking agencies like THE World Ranking, QS, etc. associated with the employability and quality of education at education institutions.

Bridges are a vital part of the road transportation system used to overcome obstacles like rivers, canals, and roads. Among all the world bridges, the percentage of simple reinforced concrete (R.C.) girders is above eighty percent. In this investigation, the effectiveness of strengthening a simple R.C. girder of a bridge near Pusa Muzaffarpur, Bihar, has been discussed. In this study, a finite element model of a rectangular R.C. beam girder has been addressed on various parameters with and without fiber wrapping. This study covers the potency of different layers of fiber wrapping analyzed with ANSYS′s help, and other results are discussed before and after strengthening the girder. Finally, the strengthening of a delaminated bridge girder near Pusa Bihar using the prescribed fiber wrapping with varying layers has been performed. Static and dynamic load testing of the girder before and after strengthening was executed at the site. Deflection and natural frequency produced at different loading conditions using a loaded truck is discussed. The bridge girder's plasticity has been calculated in terms of deflection recovered when the load was removed.

The survival of low rise unconfined masonry structure against earthquakes is very rare even due to low or moderate intensity events. To understand the failure mechanism and cracking pattern of unconfined masonry, a scaled specimen of four unconfined brick was analyzed using finite element software in conjunction with experimental verification. This study started by developing 3D finite element model of unconfined masonry subjected to in-plane loading. Bricks and joints were modeled discretely in the model, allowing for nonlinear deformation characteristics of the both materials. This model exhibits the local effect and is capable of displaying the behavior of masonry walls in which high local stresses and stress gradients are presented in the color contour diagram. The overall result of stress is presented using the von Mises (distortion energy method). The analysis of the model concluded that the unconfined brick masonry specimen structure generally fails along the brick joints, although in-plane shear stresses can cause cracks through the brick in the translation to tensile stress zone.

Background: The characteristics of research proposals submitted to the Nepal Health Research Council reflect the trend of health-related researches being conducted in Nepal. The objective of the study was to analyze research proposals submitted for the ethical review in Nepal Health Research Council from 2017 to 2019.Methods: A retrospective record review of research proposals received over three years from 2017 to 2019 were analyzed. A total of 2,305 research proposals was included in the study. The number of research studies per year, types of study design, priority area of research, and rejected proposal were the intended variables for the study. Results: 91.45% (503), 92.19% (748), and 755 (80.1%) of received proposals were approved from Ethical Review Board in 2017, 2018 and 2019. The number of research proposals increased every year (550 in 2017, 812 in 2018, and 943 in 2019). Among the approved proposals non-communicable disease (n=150;15.90%) in 2019} was the topmost prioritized area in all three years followed by reproductive health [93 (9.86%) in 2019] and communicable disease [67 (7.10%) in 2019] respectively. Quantitative research was more than two-third in all the years. Among the approved proposals, more than half were for an academic purpose [ 610 (64.69%)]. The reason for the rejection of the proposal was the conduction of research before ethical approval [2 (0.36%) in 2017, 2 (0.25%) in 2018, and none in 2019].Conclusions: There was a rising trend of research proposals for ethical clearance being submitted to the Nepal Health Research Council. Research related to non-communicable disease followed by reproductive health was the commonest one. Keywords: Ethical approval; ethical review board; research proposals; record review

On-farm trial was conducted to assess the Integrated Nutrient Management (INM) techniques on yield of rice and soil health after harvest during 2018-19 and 2019-20 at ten locations. The result of three treatments viz. Farmer’s Practice, Technology Option 1 and Technology Option 2 indicated that TO1 and TO2 significantly increased the yield and yield attributing characters over farmer’s practice (FP). Significantly high yield of rice grain (41.2 q per ha) was recorded with INM techniques. The data on available N, P and K status of soil after harvest of rice crop was significantly higher under TO2 as compared to FP. Highest net-return (Rs. 44,214 per ha) with B:C ratio of 2.44 was reported under TO2. INM techniques also resulted in lowest technology gap (8.78 q per ha) and technology index (17.56%) over other treatments which suggests it’s feasibility at farmer’s field.

The choice of electrode’s material, it’s topography like shape, size, and position play a very important role in determination of sensitivity of an electrostrictive capacitive sensor. The electrode material is required to be in mechanical and electrical compliance with the dielectric material for getting optimum performance of the sensor. A mathematical analysis for the estimation of contribution from edge effect has also been carried out for different sizes of electrodes and separation between the electrodes. It has been observed that in capacitive sensors, with gap between electrodes in nanoscale and area of electrodes in millimetres, deviation of capacitance is of the order of 10-3 considering edge leakage as compared to capacitance, measured without considering edge leakage. But in nano range sensors, where both area and gap between electrodes are in nano scale, this deviation is more than 5%, which should not be neglected.

Background: To determine the clinical profile and causes of various types of secondary glaucoma. Materials and methods : This was a hospital-based cross-sectional study conducted in a tertiary eye hospital of eastern Nepal from 1st June to 30th November, 2017. Patients who met the criteria for secondary glaucoma underwent detailed ophthalmic examination. Results : Out of 7079 patients diagnosed with glaucoma or glaucoma suspects, 528 (7.4%) had secondary glaucoma. The mean age at presentation was 52 ± 17 years with male to female ratio of 1.5:1. The most common cause was lens induced 173 (32.8%) followed by neovascular 107 (20.3%), steroid induced 86 (16.3%), traumatic 76 (14.4%), post-vitrectomy 17 (3.2%), uveitic 11 (2.1%), pseudophakic 10 (1.9%), aphakic 8 (1.5%), post-keratoplasty 5 (0.9%) and miscellaneous included 35 (6.6%). Post-traumatic 31 (29.5%) was more prevalent below 41 years while lens induced glaucoma 86 (49%) above 60 years of age. At presentation, the average IOP was 40 ± 11 mmHg. 36 (6.8%) had no light perception in the presenting eye and a large number of participants 307 (58.1%) presented with visual acuity of

The diffusion of agricultural technologies is influenced by a number of factors, including the farm-, household- and location-specific characteristics, institutions, infrastructures, and agri-food policies. The empirical literature, however, focuses largely on the household-level factors, ignoring the higher-level factors that simultaneously may influence the technology diffusion process. Employing a multilevel modeling approach this paper analyzes the mutually reinforcing and reciprocal relationships between people (compositional effects) and places (contextual effects) to know the relative importance of different geographical or administrative levels in the diffusion of modern crop varieties in India. The findings show strong contextual effects of states (i.e., policies) and also equally strong compositional effects of the between household differences. These findings suggest the need for a greater policy emphasis on agricultural research and dissemination of its outputs, and redressal of the constraints that farmers face in switching over to new technologies and innovations. Further, the findings also suggest that relaxing credit and information constraints will accelerate the spread of technology diffusion. The contextual effects of the intermediate geographical levels are small, and point towards strengthening coordination between different geographical levels for faster dissemination of technologies and subsequent realization of their economic and social outcomes.

Syringomyelic affliction of spinal cord is usually seen in association with variety of craniovertebral junction anomalies i.e. Chiari malformations, basilar invagination/impression, atlantoaxial instability etc. The natural history is not very clearly understood and a majority of patient present with slowly progressive neurological deficit followed by sudden rapid deterioration. At present, there is a general consensus to offer surgical decompression in all patients diagnosed with Chiari I malformation with Syrinx irrespective of their symptoms in order to prevent delayed neurological worsening. Few authors have reported spontaneous resolution of syrinx with persistent tonsillar herniation without operative treatment. We report one such patient and propose anterior spinal cord fissuring as a plausible cause of spontaneous drainage of syrinx. We also propose an idea to keep such patients with anterior spinal cord fissure seen in index scans to be followed up conservatively closely instead of upfront Chiari decompression.

PurposeThis paper is an attempt to understand the pattern of credit among agricultural households in Eastern India and to identify the correlates of their access to institutional credit for policy imperatives.Design/methodology/approachThe study uses unit-level data from the All-India Debt and Investment Survey of the 59th and 70th rounds of the National Sample Survey Office for the years 2002–2003 and 2012–2013. Cragg's double-hurdle model and the Heckman selection model are used to estimate the determinants of access to and the amount of institutional loans taken by households. These models also account for potential selection bias in the findings.FindingsThe study reveals that access to credit is strongly associated with the socioeconomic and demographic characteristics of agricultural households. However, about half of the farmers in the eastern states of India lack access to institutional credit despite the government's attempts to include them in the ambit of formal financial services. Thus, strategies for developing agriculture in Eastern India must include efforts to bring small and marginal farmers under the coverage of institutional credit.Research limitations/implicationsThese data are based on the responses given by the sample households and not the experimental data. The data pertain to the year 2013.Originality/valueThe findings emphasize that strategies for developing agriculture in Eastern India must give special push to enhance small and marginal farmers' access to institutional credit.

OBJECTIVES: Oral Lichen Planus (OLP) is an immune mediated disease and causes oro-mucosal burning sensation that reduces food intake and hence resulting in nutritional deficiency. The present study was done to evaluate the serum levels of vitamin B12 in patients with symptomatic OLP and establish an association between reduced B12 levels and OLP. MATERIALS AND METHOD: Serum vitamin B12 was assessed in 60 symptomatic cases of oral lichen planus and 60 healthy age and gender matched controls. RESULTS: Serum vitamin B12 was significantly reduced (p value

To be inclusive, economic development in India must focus on eastern India, which has a high population growth rate, population pressure, high incidence of poverty, small landholding size in agriculture, and underdeveloped rural infrastructure. Employment diversification towards the non-farm sector in eastern India from 1993–1994 to 2011–2012 shows considerable variation by income group and farm-size. The effects of diversification—whether driven by pursuit of higher income or distress—are stratified. Estimates based on instrumental variable regressions suggest that all types of non-farm employment improve the economic well-being of households.

Fiber-reinforced polymer has eventually become a popular choice for retrofitting and strengthening of structural entities. Hence, a need arises to know the quantitative as well as qualitative effect of these techniques on the original integrity of the concerned structural entity. In the present study, the effect of change in width to depth ratio, percentage of steel and loading intensity in a simply supported reinforced concrete (RC) beam on the maximum deflection, stress, strain energy, natural frequencies and deflections of various modes of free vibration is obtained with the help of ANSYS Workbench 19.0 software till the failure of RC beam and a comparison is sought between the original beam and a failed beam retrofitted with one, two and three layers of GFRP sheets (Epoxy S-Glass UD). A standard beam of fixed dimensions and a two point loading was first simulated in the software while comparing the results with the manual calculations of maximum deflections to ascertain the most appropriate settings of the simulation in the three dimensional analysis environment of the software. Various beams were then analyzed altering the width to depth ratio, the percentage of tension steel and the loading intensity over the beam and the results of the static as well as modal (frequency) analysis were noted including the deflections, stresses, strains, strain energies, natural frequencies of first 5 modes of free vibrations and their respective displacements. The same beams were then retrofitted with layers of GFRP sheets with their principal axis inclined at an angle of 45° with the span of the beam. The same analysis was done on the beams and the results were noted. These results are compared, and a multivariate regression analysis is performed over the results to obtain equations to testify the observations and the trends. This whole process gives a conclusion that the effect of retrofitting is insignificant for single layer GFRP while the most effective results were obtained for the case of triple layer GFRP. Deflections, stress and strain energy with their relative change across various cases are accurately related to the varying parameters through regression analysis. Frequency is also accurately related but the relative change in frequency is not well established.

Strengthening of prestressed girder using FRP has rarely been performed because prestressed girder has excellent strength under service load in both tension and compression. In this study, retrofitting of a 59-year-old prestressed bridge of Indian railway at Ratlam has been executed in which multiple vertical cracks visualized in tension zone and surface deterioration were observed. Due to this, deterioration speed of the trains over the bridge was restricted up to 20 km/h. The PSC girders of the bridge were strengthened by using prestressed carbon fiber. Serviceability of the structure was monitored before strengthening and after strengthening of the bridge girder. Deflections and natural frequencies after strengthening of girder were monitored for 481 days to ascertain the improvement and consistency in behavior of girder. After strengthening, the considerable decrement in deflection was noted by dint of the speed limit of the train which is recommended to increase up to 100 km/h.

We study the effects of food safety awareness on consumers’ milk purchasing behavior in Nepal. We conducted consumer survey and employed an instrumental variable regression. We find education, income, and social network to influence food safety consciousness (FSC). Our results indicate the positive impact of FSC on weekly milk expenditure and probability of purchasing milk from milk cooperatives. Any policy that helps to improve the FSC levels will likely increase the purchase of safe milk from the modern market outlet, and lack of such awareness raising policies has prevented the market for safe food from evolving and expanding.

Tonsillectomy is still surrounded by controversy, especially regarding choice of surgical technique. Despite numerous surgical techniques are present, post-operative pain remains significant postoperative morbidities. An ideal method would lessen complications and minimize operative time and costs. This is a randomized double blinded interventional study. We enrolled 70 subjects and divided into two groups of 35 subjects in each. One group underwent traditional tonsillectomy and another underwent coblation tonsillectomy. We compared operating time, intraoperative blood loss, post-operative pain, return to normal activities and diet and post-operative hemorrhage. Mean operating time in coblation group was 18.24 ± 5.37 min and in traditional group 30.04 ± 7.08 min. The mean blood loss in coblation tonsillectomy group was 82.79 ± 21.13 ml and in traditional tonsillectomy 150.4 ± 37.91 ml. The mean of post-operative pain score in coblation tonsillectomy group was 3.2 ± 1.47 and in traditional tonsillectomy group 6.11 ± 1.61. The mean day of regaining activity in coblation tonsillectomy group was 6.26 ± 0.92 days and in traditional tonsillectomy group 8.26 ± 1.09 days. Mean time by which patients of coblation tonsillectomy group regained their diet was 4.11 ± 0.87 days whereas in traditional tonsillectomy group it was 6.14 ± 1.14 days. There was no case observed with episode of primary or secondary hemorrhage. We conclude from this study that coblation tonsillectomy takes less operating time with less blood loss, also associated with less post-operative pain, less time taken to achieve normal diet and activities.

Background Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, characterized by features of raised intracranial pressure (ICP). Existing literature is inconclusive about the role of transcranial Doppler (TCD) in the management of IIH. Objective To study the TCD changes in IIH patients, pre- and post-cerebrospinal fluid (CSF) drainage. Materials and Methods This was a prospective study, conducted between July 2017 and December 2019, in a tertiary care referral center in South India. Sixteen consecutive patients, suspected to have IIH, underwent magnetic resonance imaging ofthe brain, a baseline TCD, and lumbar puncture with CSF drainage and pressure monitoring. Post-CSF drainage, TCD was repeated and mean flow velocities, peak systolic velocities, end-diastolic velocities, and pulsatility index (PI), in the middle cerebral artery (MCA), vertebral artery, and basilar artery (BA) were noted. Thirteen patients had elevated CSF pressure, and fulfilled the diagnostic criteria for IIH. These patients were included in the final analysis and pre- and post-CSF drainage TCD blood flow velocities and PI were compared. Results The mean age of study participants was 29.92 ± 6.92 years. There was a significant reduction in the cerebral flow velocities in bilateral MCA, after CSF drainage and normalization of ICP. Flow velocities in posterior circulation and PI in MCA, PCA, and BA showed an insignificant reduction. Two patients, who did not show any reduction in flow velocities after CSF drainage, developed optic atrophy on follow-up. Conclusion TCD-derived systolic blood flow velocities can be used in the management and follow-up of patients with IIH.

Using farm‐level data from dairy farmers in India's Bihar state and the two‐stage residual inclusion method, this study investigates the impact of the adoption of food safety measures (FSMs) on milk yield and profitability of smallholder dairy farms. This study reveals that herd size and experience in dairy farming have a significant effect on the number of FSMs smallholders adopt. An additional FSM increases milk yield by about 1% and profitability by about 2.3%. An extra year of education increases yield and profits by about 3.8% and 4.9%, respectively. The government could design and incentivize policies that help increase herd size and promote better housing conditions for animals, thus promoting the uptake of FSMs and increased milk yield and profitability. [EconLit Citations: Q12, Q16, Q18].

Landfills are used worldwide for disposing of urban wastes that cannot be economically recycled or incinerated. However, due to possible contamination and risk, the selection of landfill sites is a complex process. Various multi-criteria decision-support systems have been reported in the literature for such complex decision making. This paper reports on how the analytic hierarchy process and multi-criteria techniques were used to support a landfill siting decision in India. The input parameters were extracted from a geographic information system. By using these techniques, the ranking of eight candidate landfill sites for Sultanpur city was performed and landfill suitability indices for all sites were calculated to facilitate the decision.

Background: Road traffic accidents is a leading cause of injury and death globally. The consequences of road traffic accidents are prominent in developing countries that can least afford to meet the health services, economic and societal challenges. Nepal and Bangladesh are two developing country of South Asia who bear a large share of burden due to road traffic injuries.Methods: A non-systematic review of relevant documents using Google scholar and PubMed as well as review of relevant legal documents was done. Results: Nepal and Bangladesh have traffic laws including all the key risk factors as recommended by the World Health Organization except the child restraint systems laws. The existing laws for both countries include speed, drunk driving, use of seatbelts and motorcycle helmet, driver license, vehicle condition, overloading and accident related compensations.In both the countries for post-crash response, national emergency care access number has partial coverage and in Nepal there are some provisions related to trauma registry.Vulnerable groups are pedestrians with majority of male and higher mortality found in rural areas than urban areas for both the countries.Conclusions: Both the countries have traffic laws that focus on the prevention of road traffic accidents and protection of victims. However, amendments in the existing laws are required for confronting immediate challenges of increasing accidents and injuries that both the countries face every year.Keywords: Bangladesh; Nepal; road traffic injury; road traffic accident; traffic acts and laws.

The widespread prevalence of nutrient deficiency and poor nutritional outcomes has been a significant concern in developing and emerging countries like Nepal. The level of diversity in household diets is an indirect measure of diet quality and the extent to which nutritional needs of households are being met. However, there is a limited understanding on the trends, patterns and determinants of the dietary diversity in Nepal. This study is an attempt to enrich the literature on this issue. Based on unit level data from three rounds (1995, 2004, and 2011) of the Nepal Living Standard Survey (NLSS), we used multilevel modeling, quantile regression, and the Blinder-Oaxaca decomposition method to decipher the trends, determinants and drivers of dietary diversity in Nepal. Our study finds that the changes in household socio-demographic and agricultural characteristics are very important in explaining the improvement in dietary quality. Changes in household characteristics account for at least 37% of the observed improvement and agriculture-related changes explain at least 16% of the observed improvement. Our findings are highly robust across the different model specifications and concludes by bringing a focus on multi-sectoral approach to tackle nutrition issues in Nepal.

Diabetic nephropathy is the leading cause of the end-stage renal disease (ESRD) worldwide, and it is estimated that ~ 20% of type 2 diabetic patients reach ESRD during their lifetime. The objective of the present study was to assess the drug utilization pattern, risk factors, and prevalence of diabetic nephropathy in patients with type 2 diabetes mellitus in a south Indian tertiary care hospital. A cross-sectional observational study was conducted on 613 subjects (254 with and 359 without diabetic nephropathy). Prevalence of diabetic nephropathy was measured, and risk factors for the development of diabetic nephropathy were determined by calculating odds ratios using graph-pad prism statistical software, and drug utilization pattern was assessed. Nephropathy was significantly higher in subjects who are married (98.8%, OR, 3.903; 95% CI, 1.125-13.54, P=0.0211), poorly educated (61%, OR, 0.3670;95%CI, 0.2635-0.5112, P 10 years 37%, OR, 3.606 ; 95% CI, 2.362-5.504, P

Objectives Pericoronitis of mandibular third molars is commonly encountered in our day to day practice. Most of the case extraction becomes mandatory. This study was carried out to find the incidence of periodontitis on the distal aspect of the second molar adjacent to impacted third molar. Materials and methods A total of 400 patients were included in the study. Patient selection was randomly done. Whoever came with a chief complaint of pain in the third molar area were included in the study. They were evaluated both clinically and radiographically with an orthopantomogram. Patients' age, gender, type of impaction, presence or absence of bone loss, type of bone loss, and presence or absence of caries was evaluated radiographically and noted. Results Periodontitis was observed in 39% of the cases and caries in 26% of the cases. Conclusions These percentages are alarming and could be used to prophylactically extract the impacted third molars and thereby promoting the oral health of the individual.

Background Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent and it has been shown to cause immunomodulatory effects making the individual susceptible to various diseases. Immunoglobulins (Ig) form the defense against pathogens at the mucosal surfaces and SLT might interfere with its production and function. Therefore, the present study was undertaken to estimate the level of IgG and IgA in SLT patients and establish a correlation between them. Materials and methods A total of 60 subjects (34 khaini users and 26 gutkha users) were selected for the study. Complete demographic data and history was taken and clinical examination done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the serum immunoglobulin parameters. Results Significant changes were observed in the serum IgA and IgG level in SLT users. Serum IgG level had a positive correlation whereas serum IgA had a negative correlation with the form of SLT and were statistically insignificant. Conclusion The present study might serve as an early diagnostic tool and helpful in creating awareness on the hazards of using SLT among the Indian population as a despicable substitute to smoking tobacco. It also confers an imperative role into SLT mediated effects on immunoglobulins levels.

COVID-19 is a novel virus that spreads in multiple chains from one person to the next. When a person is infected with this virus, they experience respiratory problems as well as rise in body temperature. Heavy breathlessness is the most severe sign of this COVID-19, which can lead to serious illness in some people. However, not everyone who has been infected with this virus will experience the same symptoms. Some people develop cold and cough, while others suffer from severe headaches and fatigue. This virus freezes the entire world as each country is fighting against COVID-19 and endures vaccination doses. Worldwide epidemic has been caused by this unusual virus. Several researchers use a variety of statistical methodologies to create models that examine the present stage of the pandemic and the losses incurred, as well as considered other factors that vary by location. The obtained statistical models depend on diverse aspects, and the studies are purely based on possible preferences, the pattern in which the virus spreads and infects people. Machine Learning classifiers such as Linear regression, Multi-Layer Perception and Vector Auto Regression are applied in this study to predict the various COVID-19 blowouts. The data comes from the COVID-19 data repository at Johns Hopkins University, and it focuses on the dissemination of different effect patterns of Covid-19 cases throughout Asian countries. CA extern

PURPOSE To our knowledge, we conducted the first prospective oncologic clinical trial in Nepal aimed at providing state-of-the-art chemotherapy to patients with Ewing sarcoma. The efficacy of external-beam radiotherapy (RT) as the sole local treatment modality was explored and deemed justified as a result of the lack of available advanced tumor-orthopedic services in Nepal. PATIENTS AND METHODS Twenty patients, 11 female and 9 male patients between the ages of 6 and 37 years, with newly diagnosed Ewing sarcoma were enrolled. Neoadjuvant combination chemotherapy, comprising well-established drug combinations, was administered in five courses before external-beam RT, during which one course of etoposide and ifosfamide was given. After RT, six additional chemotherapy courses were scheduled. RESULTS RT was tolerated well, providing rapid symptom relief and local tumor control, with no pathologic fractures observed among the 15 patients who received such treatment. Eleven patients completed the entire treatment protocol; seven patients were under continued follow-up, with no evidence of disease in six patients at a median follow-up time of 2.3 years (range, 1.3 to 3.1 years) and one patient alive but with a regional recurrence. Four patients experienced metastatic relapse and died as a result of their disease. Three treatment-related deaths linked to toxicity from chemotherapy occurred. Four of the six patients who refused to complete the treatment protocol and were lost to follow-up experienced progressive disease and were assumed dead. CONCLUSION This study was feasible with RT as the sole local treatment modality in combination with chemotherapy. As a result of the high number of patients lost to follow-up, no firm conclusions can be drawn, but the majority of the patients who completed treatment obtained durable long-term remissions.

Background: A high lip line often known commonly as gummy smile is seldom a cause for concern for the patient and leads to the desire for its correction. The gummy smile is usually caused by the hyperactive pull of the elevator muscles. Methods: The procedure used in this case is a modied lip repositioning procedure wherein the labial frenum is left intact in order to maintain the midline. Result: The results following the surgery one month followed by ve months were satisfactory as around 4 mm reduction in the amount of gingiva displayed was observed. Conclusion: This modied lip repositioning can be used as a non-invasive procedure can be used to reduce the excessive display of gingiva effectively

Zygomatic arch fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton; hence, it is frequently exposed to fractures. This case report presents an left‐sided isolated zygomatic arch fracture after subjected to routine investigations and radiographs like submentovertex and CT scans. The patient was operated under general anesthesia for the reduction of zygomatic arch by Gille's temporal approach with the use of Ultrasound intra‐operatively. Recommendation for the use of ultrasonography in the identification of zygomatic arch fractures intra‐operatively operatively., Ultrasonogram can be considered as the imaging of choice when there is a contraindication to CT or conventional radiograph by reducing the overall amount of radiation. Which also can be the another treatment modalities for the surgical management of close reduction of zygomatic arch fracture.

Hybrid solar energy-based power generation systems (PGS) are one of the exciting options for potential distributed networks. PV and wind grid linked PGSs are the most appropriate for its good output across various configurations. However, due to the system's complexity, special attention is required to achieve a successful engineering solution in the optimal balance between these two energy sources. This paper discusses optimum scale of PV and wind by following multiple optimization methods to various condition decision analysis (VCDA). The versatility of the VCDA algorithm was tested by taking into account several weighting parameter techniques for differing wind speeds and fluctuations in radiation levels, thus illustrating the advantages and limitations of the suggested optimum size approaches. The subsequent study may be called as a significant reference for decision makers, analysts and policymakers.

BackgroundStimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.MethodsThis is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.ResultsAmong non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, pConclusionsStimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.

Gingival recession is the apical shift of the marginal gingiva from its normal position on the crown of the tooth to levels on the root surface beyond the cemento-enamel junction.It is a widespread clinical finding in adults with more than 50% of the population having one or additional sites with gingival recession of 1mm or more and its severity increases with age. Root surfaces exposure in oral environment can cause root hypersensitivity, root caries and create esthetic problems. The pedicle graft is simple and less time-consuming surgical procedure with excellent results, without involving second surgical site for donor harvesting. In this case report the Miller’s Class-II isolated gingival recession defect was treated with lateral pedicle graft and postoperative clinical outcome showed stable & significant root coverage. Keywords: Gingival recession, Lateral pedical graft, laterally positioned flap, Root coverage, Mucogingival surgery

Out of the huge quantity of agricultural wastes produced globally, rice straw is one of the most abundant ligno-cellulosic waste. For efficient utilization of these wastes, several cost-effective biological processes are available. The practice of field level in-situ or ex-situ decomposition of rice straw is having less degree of adoption due to its poor decomposition ability within a short time span between rice harvest and sowing of the next crop. Agricultural wastes including rice straw are in general utilized by using lignocellulose degrading microbes for industrial metabolite or compost production. However, bioconversion of crystalline cellulose and lignin present in the waste, into simple molecules is a challenging task. To resolve this issue, researchers have identified a novel new generation microbial enzyme i.e., lytic polysaccharide monooxygenases (LPMOs) and reported that the combination of LPMOs with other glycolytic enzymes are found efficient. This review explains the progress made in LPMOs and their role in lignocellulose bioconversion and the possibility of exploring LPMOs producers for rapid decomposition of agricultural wastes. Also, it provides insights to identify the knowledge gaps in improving the potential of the existing ligno-cellulolytic microbial consortium for efficient utilization of agricultural wastes at industrial and field levels.

Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

Background: There has been a growing interest in ivermectin ever since it was reported to have an in-vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This trial was conducted to test the efficacy of ivermectin in mild and moderate coronavirus disease 19 (COVID-19). Methods: A double blind, parallel, randomised, placebo-controlled trial conducted among adult COVID-19 patients with mild to moderate disease severity on admission in a COVID dedicated tertiary healthcare of eastern India. Enrolment was done between 1st August and 31st October 2020. On day 1 and 2 post enrolment, patients in the intervention arm received ivermectin 12 mg while the patients in the non-interventional arm received placebo tablets. Results: About one-fourth (23.6%) of the patients in the intervention arm and one-third (31.6%) in the placebo arm were tested reverse transcriptase polymerase chain reaction (RTPCR) negative for SARS-CoV-2 on 6th day. Although this difference was found to be statistically insignificant [rate ratio (RR): 0.8; 95% confidence interval (CI): 0.4-1.4; p=0.348]. All patients in the ivermectin group were successfully discharged. In comparison the same for the placebo group was observed to be 93%. This difference was found to be statistically significant (RR: 1.1; 95% CI; 1.0-1.2; p=0.045). Conclusions: Inclusion of ivermectin in treatment regimen of mild to moderate COVID-19 patients could not be said with certainty based on our study results as it had shown only marginal benefit in successful discharge from the hospital with no other observed benefits.

OBJECTIVE: The aim of the study was to assess the impact of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, spirometric indices, and salivary MMP-8 levels in patients with chronic obstructive pulmonary disease (COPD) with concurrence of chronic periodontitis (CP) compared with systemically healthy CP. MATERIAL AND METHODS: In this prospective clinico-biochemical study, a total of 75 patients belonging to various socioeconomic strata were randomly divided into cases, that is, COPD patients as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria with concurrence of CP [at least ≥ 20 teeth with ≥ 2 tooth sites having pocket probing depth (PPD) or clinical attachment loss (CAL) ≥ 4mm and bleeding on probing (BOP)] and controls (systemically healthy CP). Both groups underwent NSPT and were evaluated for plaque index (PI), gingival index (GI), PPD, CAL, and BOP and spirometry (FEV(1)/forced vital capacity (FVC)) values at baseline, 3, 6, and 12 months and for salivary MMP-8 levels at baseline and 3 months. RESULTS: Statistical results showed that cases (COPD with CP; n = 37) were significantly older (mean age 56.16 ± 9.01 years), ex-smokers (48.6%) with male preponderance (78.4%), and belonged to the upper middle class (40.5%) as compared to controls (systemically healthy CP; n = 38). After NSPT, significant improvement in mean PI, GI, PPD, CAL, and BOP was observed in both groups at 3, 6, and 12 months with better results in controls. FEV(1)/FVC was significantly improved (P < .001) in cases with insignificant change in controls at 12 months. After 3 months, MMP-8 levels were significantly reduced in cases (P = .002) and controls (P < .001). CONCLUSION: The present study provided substantial evidence that COPD patients have poorer periodontal health as compared to systemically healthy counterparts. Further, these patients showed improvement in FEV1/FVC, however, with higher salivary MMP-8 levels despite NSPT at the end of the study, indicating a possible role of systemic inflammatory overburden of pulmonary disease.

The increase in the slaughter of pregnant cows (SPCs) for meat (except as may be approved by veterinarians on health grounds to salvage the animal) is unethical. SPCs for meat is also counterproductive, detrimental to food security, and may enhance zoonotic disease transmission. In this context, therefore, this current study examined slaughter conditions and the slaughtering of pregnant cows, and the implications for meat quality, food safety, and food security in Southeast Nigeria. The direct observational method was employed to examine the slaughterhouse activities, from when the cattle arrived at the lairage to the post-slaughter stage. A pre-tested and validated closed-ended-questionnaire was used to elicit information on causes of the SPCs and the method of disposal of eviscerated foetuses. Pregnancy status of cows slaughtered was determined by palpation followed by visual examination of the eviscerated and longitudinal incised uteri. The study lasted for six months during which 851 cows out of 1931 slaughtered cattle were surveyed. Assessment/decision-making protocol of slaughterhouse conditions, welfare conditions of slaughter- cattle, reasons for sale or slaughter of pregnant cows, distribution of pregnant cows slaughtered, method of disposal of eviscerated foetuses, and estimated economic losses of SPCs were delineated. Of the 851 cows examined, 17.4% (148/851) were pregnant while 43.2% (64/148) of the total foetuses recovered were in their third trimester. Major reasons adduced for SPCs by proportion of involved respondents were: ignorance of the animals’ pregnancy status (69.7%, 83/119), high demand for beef (61.3%, 73/119), preference for large-sized cattle (47.9%, 57/119), economic hardship (52.1%, 62/119) and diseases conditions (42.9%. 51/119). The conduct of SPCs for meat would not be profitable. This is because within six months, an estimated loss of about 44,000 kg of beef, equivalent to ₦ 70.1 million or $186,400 would be associated with SPCs and the consequential foetal wastages. If losses were to be replicated nationwide across slaughterhouses, 4.3 tons of beef estimated at ₦ 8.6 billion or $23 million would be wasted. Improving slaughter conditions and the welfare of slaughter-cattle in Nigerian slaughterhouses through advocacy, training of slaughterhouse workers, and strict implementation of laws promoting humane slaughter practices is imperative. Preventing SPCs for meat and inhumane slaughter practices at the slaughterhouse would enhance the welfare needs of slaughter cattle, grow the national herd size, and improve meat safety as well as food security. info:eu-repo/semantics/publishedVersion

Mycotoxins are produced by fungi and are known to be toxic to humans and animals. Common mycotoxins include aflatoxins, ochratoxins, zearalenone, patulin, sterigmatocystin, citrinin, ergot alkaloids, deoxynivalenol, fumonisins, trichothecenes, Alternaria toxins, tremorgenic mycotoxins, fusarins, 3-nitropropionic acid, cyclochlorotine, sporidesmin, etc. These mycotoxins can pose several health risks to both animals and humans, including death. As several mycotoxins simultaneously occur in nature, especially in foods and feeds, the detoxification and/or total removal of mycotoxins remains challenging. Moreover, given that the volume of scientific literature regarding mycotoxins is steadily on the rise, there is need for continuous synthesis of the body of knowledge. To supplement existing information, knowledge of mycotoxins affecting animals, foods, humans, and plants, with more focus on types, toxicity, and prevention measures, including strategies employed in detoxification and removal, were revisited in this work. Our synthesis revealed that mycotoxin decontamination, control, and detoxification strategies cut across pre-and post-harvest preventive measures. In particular, pre-harvest measures can include good agricultural practices, fertilization/irrigation, crop rotation, using resistant varieties of crops, avoiding insect damage, early harvesting, maintaining adequate humidity, and removing debris from the preceding harvests. On the other hand, post-harvest measures can include processing, chemical, biological, and physical measures. Additionally, chemical-based methods and other emerging strategies for mycotoxin detoxification can involve the usage of chitosan, ozone, nanoparticles, and plant extracts.

Production of high-quality seed is fundamental to modern agriculture. Seeds are the foundation of agriculture. Technology has modernized much of farming's day-to-day operations, but without a steady supply of high-quality seed, yields and crop quality would be greatly decreased. Seed quality plays an important role in the production of agronomic and horticultural crops. Characteristics such as trueness to variety, germination percentage, purity, vigor, and appearance are important to farmers planting crops. Seeds can serve as the delivery system not only for improved genetics but also for new planting and production methods and crop protection strategies that improve the overall efficiency of agriculture and reduce its environmental impact. To achieve the same a series of one day HRD Training programmes, Five day training programme on “Quality seed production of cereal crops”, trainings under HRD component and Tribal sub plan at Rajouri (J&K) were conducted by Mega Seed Project-SKUAST-Jammu in the year 2018-19. The farmers and Officers of the alien departments were benefitted for improving the quality seed production.

Background: The burden of non-communicable diseases has increased in the last few decades in low-and middle-income countries including in Nepal. There is limited data on population based prevalence of non-communicable diseases. Hence, this study aims to determine the nationwide prevalence of selected chronic non-communicable diseases in Nepal.Methods: A nationwide cross-sectional population-based study was conducted from 2016 to 2018. Data was collected electronically on android device inbuilt with research and monitoring software from 13200 eligible participants aged 20 years and above. Data was cleaned in SPSS version 20.0 and analyzed using Stata version 13.1.Results: The overall prevalence of selected non-communicable diseases was found to be chronic obstructive pulmonary disease 11.7% (95% CI: 10.5-12.9), diabetes mellitus 8.5% (95% CI: 7.8-9.3), chronic kidney disease 6.0% (95% CI: 5.5-6.6) and coronary artery disease 2.9% (95% CI: 2.4-3.4) in Nepal. Prevalence of non-communicable diseases varied across provinces. Higher prevalence of chronic obstructive pulmonary disease (25.1%, 95% CI: 18.1-33.8) in Karnali Province, diabetes (11.5%, 95% CI: 9.8-13.4) in Province 3, chronic kidney disease (6.8%, 95% CI: 5.6-8.1) in Gandaki Province and coronary artery disease in Gandaki (3.6%, 95% CI: 2.2-5.7) and Sudurpaschim Province (3.6%, 95% CI: 2.1-6.1) was observed.Conclusions: The study reported substantial proportion of adult population was found to have chronic non-communicable diseases in Nepal. The findings of this study may be useful for revising/updating multi-sectoral action plans on prevention and control of non-communicable diseases in Nepal. Keywords: Chronic kidney disease; chronic obstructive pulmonary disease; coronary artery disease; diabetes mellitus; non-communicable disease.

Background: The global prevalence of mental disorders is high and has an increasing trend. In Nepal, there is dearth in literature on prevalence of mental disorders based on national representative sample. In this study, we aim to present the findings on the prevalence of mental disorders from the pilot study of National Mental Health Survey, Nepal. Methods: A cross-sectional study was conducted among 1647 participants aged 13 years and above in three districts of Nepal: Dhanusha, Bhaktapur and Dolakha each representing three ecological regions. Mini International Neuropsychiatric Interview (MINI) standard version 7.0.2 for DSM-5 was used for adults (aged 18 years and above), and kid version of the same tool was used for children (aged 13-17 years) in Nepali language. Separate sets of questions were added for epilepsy and dissociative conversion disorder that were not in the Mini International Neuropsychiatric Interview tool. Prevalence of assessed mental disorders was reported separately for adults and children.Results: The current prevalence of mental disorders among adults and children were 13.2% and 11.2% respectively. Substance use disorder, dissociative conversion disorder, major depressive disorder, alcohol use disorder and psychotic disorder were common among adults. Similarly, psychotic disorder, agoraphobia, major depressive disorder, and anxiety disorders were common among children. Current suicidality was present among 10.9% adults and 8.7% children.Conclusions: Our findings from the pilot study have given insight into the prevalence of different mental disorders in the survey areas. These findings can be utilized for planning the National Mental Health Survey, Nepal. Keywords: Mental disorders; mental health survey; MINI; Nepal; pilot study.

Background: On the date of 24 July 2017, the major national daily newspaper reported that there were two death cases from an unknown disease in the Morang district, Sundarharicha Municipality 5, Foklan Tapu. A team of researcher and experts were mobilized in the affected area to investigate and identify the etiological and epidemiological causes.Methods: Both qualitative and quantitative methods was used to conduct the outbreak investigation. 83 blood samples were taken from the patients and microbiological analysis was done at National Public Health Laboratory, Kathmandu. Similarly, 2 verbal autopsies and 5 Key in-depth interviews were taken from a local community leader, local health service providers, medical officer of Koshi Zonal Hospital, district public health officer and medical director of WHO.Results: Out of 83 participants, 49% and 25% of the participants were positive to IgM and IgG antibodies of Leptospira species respectively. 87% of the participants were exposed to animal living in his/her home (including pets). Conclusions: An outbreak which was existing during this investigation turned out to be leptospirosis outbreak, whose exposure was consumption of unhealthy meat during social gathering.Keywords: Epidemiological; etiological; febrile illness; outbreak investigation.

Background: Soft tissue tumors are a highly heterogeneous group of tumors that are classified by the line of differentiation, according to the adult tissue they resemble. Objective of this study was to assess the utility of fine needle aspiration cytology (FNAC) in diagnosing soft tissue tumors and to do the histo-pathological correlation wherever possible. Methods: Conventional May-Grunwald Giemsa (MGG) staining was done in all the 100 cases and cytodiagnosis was rendered. Histopathology was available in 41 cases. The cytological diagnosis was correlated with histology in these cases. The accuracy rate, sensitivity, specificity, the positive and negative predictive value were calculated. P value was found by applying Fisher’s exact test. Results: The study was carried out on aspirates of 100 patients. Out of which 65 cases were benign, 30 were malignant while 5 cases were inadequate. Lipoma was the most common cytologically diagnosed benign lesion. Dermatofibrosarcoma protuberans (DFSP) and synovial sarcoma were found to be the most common malignant soft tissue tumors. Cyto-histological correlation could be achieved in 41 cases, with an accuracy of 92.7%. Conclusion: FNAC is a well-tolerated and cost-effective procedure. It provides predictive diagnosis of benign or malignant soft tissue tumors and also specific tumor type, especially after correlation with clinical and radiological findings.

DOI: https://doi.org/10.3126/jpn.v9i1.23172 Background: Skin diseases are very much prevalent in the developing countries. The pattern of skin diseases varies from country to country and even region to region within a country. The histological diagnosis is used by clinicians to aid in the management of patients & most appropriate clinical interventions. Materials and methods: The study included a total of 1040 skin biopsies from January 2016 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal. Results: The majority of the patients were in the age group of 31-40 years. The most common skin disease is non-infectious vesicobullous and vesicopustular disease (28.6%), followed by non-infectious erythematous papular and squamous disease (25.9%). The most common vesicobullous disease is spongiotic dermatitis (84.8%). Erythema dyschromicum perstans (31.8%) is the commonest non-infectious erythematous papular and squamous disease. The most common microbial disease is fungal infection, followed by leprosy. Among the neoplastic diseases of skin, tumors of epidermis are commonest diseases and the most common epidermal tumor is basal cell carcinoma. The commonest tumor of skin is melanocytic nevus. The most frequent site is upper extremities. Conclusions: Eczema is predominating non-infectious vesicobullous and vesicopustular disease. A relatively higher, prevalence of fungal infections was observed. Basal cell carcinoma is the commonest epidermal tumor and melanocytic nevus is commonest of all skin tumors. Keywords: Dermatitis; Papular; Spongiosis; Squamous lesion; Vesicobullous

Objectives. Oral and maxillofacial surgery is a relatively newer and growing specialty of dentistry in Nepal whose scope is not yet estimated. The objective of this study was to estimate the scope and the factors influencing the scope of oral and maxillofacial surgery in Nepal. Study Design. In this cross-sectional study, all the oral and maxillofacial surgeons who were registered in the Nepalese Association of Oral and Maxillofacial Surgeons (NAOMS) were included (purposive sampling). The structured questionnaires were distributed to them, the collected data were entered in Microsoft excel 2010, and variables were analyzed using descriptive statistics (percentage) by SPSS 16.0. Results. Out of 46 questionnaires distributed, 35 were responded and returned (response rate = 76%). Majority of participants (77.1%) were in 30–39 years of age group. Male to female ratio was 4 : 1. More than half (68.6%) of the participants had practice experience of 20 years. The ratio of the surgeons practiced in Medical/Dental Teaching Hospital to those in Government Hospital was 3 : 1. Sixteen (45.7%) participants practiced in Capital Valley and none in Far-Western Development Region. Traumatology was practiced by thirty-four (97.1%) participants although only twenty-three (65.7%) participants had primary interest in it. Each of oncology, orthognathic surgery, implantology, and cleft lip/palate surgery was performed by Conclusion. The scope of oral and maxillofacial surgery is limited in Nepal, and oncology, implantology, cleft lip/palate, and orthognathic surgery have received little attention.