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Background: Cancer is the second leading cause of death in the Caribbean, including the islands of Trinidad and Tobago (TT). The population of TT consists of over 1.3 million people with diverse ancestral and sociocultural backgrounds, both of which may influence cancer incidence and mortality. The objective of this study was to examine incidence and mortality patterns and trends in TT., Methods: Cancer surveillance data on 29,512 incident cancer cases reported to the Dr. Elizabeth Quamina Cancer Registry (population-based cancer registry of TT) between 1995 and 2009 were analyzed. Age-standardized rates, overall and by sex, ancestry, and geography, were reported., Results: The highest incidence and mortality rates were observed for cancers related to reproductive organs in women, namely, breast, cervical, and uterine cancers, and prostate, lung and colorectal cancers among men. Average incidence rates were highest in areas covered by the Tobago Regional Health Authority (TRHA) (188 per 100,000), while average mortality rates were highest in areas covered by the North West Regional Health Authority (108 per 100,000). Nationals of African ancestry exhibited the highest rates of cancer incidence (243 per 100,000) and mortality (156 per 100,000) compared to their counterparts who were of East Indian (incidence, 125 per 100,000; mortality, 66 per 100,000) or mixed ancestry (incidence, 119 per 100,000; mortality, 66 per 100,000)., Conclusions: Our findings highlight the need for national investment to improve the understanding of the epidemiology of cancer in Trinidad and Tobago, and to ultimately guide much needed cancer prevention and control initiatives in the near future.

Introduction: Basic life support is foundation to save lives. In contrast to the developed countries, there is still no national standard BLS training module in Nepal. Basic life support training is being provided by various institutions but lack in consistency and coordination. The Nepal basic life support Course is the video based training in Nepali language with reference to recent advances which was intended for all health care personnel of Nepal in urban as well as rural setting. We aimed to describe the features of this video based training module in local language, to analyse the differences of knowledge before and after the training and to find out the participants perception and satisfaction with this course., Methods: This is a descriptive cross-sectional study based on data of trainings conducted over the study period. Ethical approval was taken. The post-test score was recorded and compared with the occupational using ANOVA. On the spot and delayed feedbacks from the participants were collected voluntarily and summarized., Results: Total of 576 participants (435 clinical doctors, 92 nurses/paramedics, 18 non-clinical doctors and 41 intern doctors) successfully completed the training. The difference in post test scores (mean = 12.9±1.8) among the different occupational background was not significant (P=0.159). The feedbacks from the participants were mostly positive and encouraging., Conclusions: The knowledge of basic life support improved significantly irrespective of the occupation of the participants. A universal, nationwide video based training module in Nepali language should be developed focusing all health care personnel of urban as well rural Nepal.

Purpose: In Trinidad and Tobago (TT), prostate cancer (CaP) is the most commonly diagnosed malignancy and the leading cause of cancer deaths among men. TT currently has one of the highest CaP mortality rates in the world., Methods: 6,064 incident and 3,704 mortality cases of CaP occurring in TT from January 1995 to 31 December 2009 reported to the Dr. Elizabeth Quamina Cancer population-based cancer registry for TT, were analyzed to examine CaP survival, incidence, and mortality rates and trends by ancestry and geography., Results: The age-standardized CaP incidence and mortality rates (per 100,000) based on the 1960 world-standardized in 2009 were 64.2 and 47.1 per 100,000. The mortality rate in TT increased between 1995 (37.9 per 100,000) and 2009 (79.4 per 100,000), while the rate in the US decreased from 37.3 per 100,000 to 22.1 per 100,000 over the same period. Fewer African ancestry patients received treatment relative to those of Indian and mixed ancestry (45.7%, 60.3%, and 60.9%, respectively)., Conclusions: Notwithstanding the limitations surrounding data quality, our findings highlight the increasing burden of CaP in TT and the need for improved surveillance and standard of care. Our findings highlight the need for optimized models to project cancer rates in developing countries like TT. This study also provides the rationale for targeted screening and optimized treatment for CaP to ameliorate the rates we report.

Ovarian vein thrombosis is one of the rare causes for acute abdomen. Occult presentation of this disease may lead to diagnostic dilemma. A sixteen years female who was operated as a case of ectopic pregnancy was finally diagnosed as having ovarian vein thrombosis. She was successfully treated with anticoagulant.

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching., Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis., Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient's uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study., Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Purpose: To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries., Methods: Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries)., Results: Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region., Conclusions: Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.

The recent concept of microbial electrosynthesis (MES) has evolved as an electricity-driven production technology for chemicals from low-value carbon dioxide (CO 2 ) using micro-organisms as biocatalysts. MES from CO 2 comprises bioelectrochemical reduction of CO 2 to multi-carbon organic compounds using the reducing equivalents produced at the electrically-polarized cathode. The use of CO 2 as a feedstock for chemicals is gaining much attention, since CO 2 is abundantly available and its use is independent of the food supply chain. MES based on CO 2 reduction produces acetate as a primary product. In order to elucidate the performance of the bioelectrochemical CO 2 reduction process using different operation modes (batch vs. continuous), an investigation was carried out using a MES system with a flow-through biocathode supplied with 20 : 80 (v/v) or 80 : 20 (v/v) CO 2  : N 2 gas. The highest acetate production rate of 149 mg L -1 d -1 was observed with a 3.1 V applied cell-voltage under batch mode. While running in continuous mode, high acetate production was achieved with a maximum rate of 100 mg L -1 d -1 . In the continuous mode, the acetate production was not sustained over long-term operation, likely due to insufficient microbial biocatalyst retention within the biocathode compartment (i.e. suspended micro-organisms were washed out of the system). Restarting batch mode operations resulted in a renewed production of acetate. This showed an apparent domination of suspended biocatalysts over the attached (biofilm forming) biocatalysts. Long term CO 2 reduction at the biocathode resulted in the accumulation of acetate, and more reduced compounds like ethanol and butyrate were also formed. Improvements in the production rate and different biomass retention strategies (e.g. selecting for biofilm forming micro-organisms) should be investigated to enable continuous biochemical production from CO 2 using MES. Certainly, other process optimizations will be required to establish MES as an innovative sustainable technology for manufacturing biochemicals from CO 2 as a next generation feedstock.

Background.: Giardia are among the most common enteropathogens detected in children in low-resource settings. We describe here the epidemiology of infection with Giardia in the first 2 years of life in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED), a multisite birth-cohort study., Methods.: From 2089 children, 34916 stool samples collected during monthly surveillance and episodes of diarrhea were tested for Giardia using an enzyme immunoassay. We quantified the risk of Giardia detection, identified risk factors, and assessed the associations with micronutrients, markers of gut inflammation and permeability, diarrhea, and growth using multivariable linear regression., Results.: The incidence of at least 1 Giardia detection varied according to site (range, 37.7%-96.4%) and was higher in the second year of life. Exclusive breastfeeding (HR for first Giardia detection in a monthly surveillance stool sample, 0.46 [95% confidence interval (CI), 0.28-0.75]), higher socioeconomic status (HR, 0.74 [95% CI, 0.56-0.97]), and recent metronidazole treatment (risk ratio for any surveillance stool detection, 0.69 [95% CI, 0.56-0.84]) were protective. Persistence of Giardia (consecutive detections) in the first 6 months of life was associated with reduced subsequent diarrheal rates in Naushahro Feroze, Pakistan but not at any other site. Giardia detection was also associated with an increased lactulose/mannitol ratio. Persistence of Giardia before 6 months of age was associated with a -0.29 (95% CI, -0.53 to -0.05) deficit in weight-for-age z score and -0.29 (95% CI, -0.64 to 0.07) deficit in length-for-age z score at 2 years., Conclusions.: Infection with Giardia occurred across epidemiological contexts, and repeated detections in 40% of the children suggest that persistent infections were common. Early persistent infection with Giardia, independent of diarrhea, might contribute to intestinal permeability and stunted growth., (© The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society.)

Objective: To study the association between cardiac function measured by myocardial performance index (MPI), blood pressures and angiogenic factors measured at the time of echocardiography in patients with and without hypertensive disorders of pregnancy (HDP)., Methods: We prospectively studied 189 pregnant women and evaluated whether changes in cardiac function observed on echocardiography were correlated with higher blood pressures and whether higher blood pressures were associated with antiangiogenic proteins (soluble fms-like tyrosine kinase, sFlt1; soluble endoglin, sEng). Comprehensive echocardiograms, including measurement of MPI, were performed on all patients. sFlt1 and sEng levels were measured using enzyme-linked immunosorbent assay., Results: Overall, 189 patients were divided into tertiles based on mean arterial pressure (MAP). The MPI was worst in tertile 3 (0.50 ± 0.15) compared to tertile 1 (0.42 ± 0.10), p = 0.0004. sFlt1 (pg/ml) and sEng (ng/ml) were highest in tertile 3 compared to tertile 1: 15055.37 vs. 1623.01 and 33.06 vs. 8.15, respectively, with p-value <0.001. In crude multivariate regression analysis, MAP was positively correlated with MPI (r = 0.32, p < 0.001), GLS (r = 0.54, p < 0.001), sFlt1 (r = 0.60, p < 0.001) and sEng (r = 0.61, p < 0.001). After adjustment for confounders, these relationships persisted between MAP and MPI (r = 0.31, p = 0.0003), GLS (r = 0.46, p < 0.001), sFlt1 (r = 0.56, p < 0.001) and sEng (r = 0.58, p < 0.001)., Conclusion: Mean arterial pressure correlates with worsening cardiac function as measured by MPI and serum levels of angiogenic factors. Further studies are needed to evaluate whether a reduction in blood pressure will reverse changes in MPI or reduce levels of angiogenic proteins seen among women with HDP.

In microbial electrosynthesis (MES), CO 2 can be reduced preferably to multi-carbon chemicals by a biocathode-based process which uses electrochemically active bacteria as catalysts. A mixed anaerobic consortium from biological origin typically produces methane from CO 2 reduction which circumvents production of multi-carbon compounds. This study aimed to develop a stable and robust CO 2 reducing biocathode from a mixed culture inoculum avoiding the methane generation. An effective approach was demonstrated based on (i) an enrichment procedure involving inoculum pre-treatment and several culture transfers in H 2 :CO 2 media, (ii) a transfer from heterotrophic to autotrophic growth and (iii) a sequential batch operation. Biomass growth and gradual acclimation to CO 2 electro-reduction accomplished a maximum acetate production rate of 400mgL catholyte -1 d -1 at -1V (vs. Ag/AgCl). Methane was never detected in more than 300days of operation. Accumulation of acetate up to 7-10gL -1 was repeatedly attained by supplying (80:20) CO 2 :N 2 mixture at -0.9 to -1V (vs. Ag/AgCl). In addition, ethanol and butyrate were also produced from CO 2 reduction. Thus, a robust CO 2 reducing biocathode can be developed from a mixed culture avoiding methane generation by adopting the specific culture enrichment and operation procedures without the direct addition of chemical inhibitor., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Microbial catalysis of carbon dioxide (CO 2 ) reduction to multi-carbon compounds at the cathode is a highly attractive application of microbial electrosynthesis (MES). The microbes reduce CO 2 by either taking the electrons or reducing the equivalents produced at the cathode. While using gaseous CO 2 as the carbon source, the biological reduction process depends on the dissolution and mass transfer of CO 2 in the electrolyte. In order to deal with this issue, a gas diffusion electrode (GDE) was investigated by feeding CO 2 through the GDE into the MES reactor for its reduction at the biocathode. A combination of the catalyst layer (porous activated carbon and Teflon binder) and the hydrophobic gas diffusion layer (GDL) creates a three-phase interface at the electrode. So, CO 2 and reducing equivalents will be available to the biocatalyst on the cathode surface. An enriched inoculum consisting of acetogenic bacteria, prepared from an anaerobic sludge, was used as a biocatalyst. The cathode potential was maintained at -1.1 V vs Ag/AgCl to facilitate direct and/or hydrogen-mediated CO 2 reduction. Bioelectrochemical CO 2 reduction mainly produced acetate but also extended the products to ethanol and butyrate. Average acetate production rates of 32 and 61 mg/L/day, respectively, with 20 and 80 % CO 2 gas mixture feed were achieved with 10 cm 2 of GDE. The maximum acetate production rate remained 238 mg/L/day for 20 % CO 2 gas mixture. In conclusion, a gas diffusion biocathode supported bioelectrochemical CO 2 reduction with enhanced mass transfer rate at continuous supply of gaseous CO 2 . Graphical abstract ᅟ.

Organophosphorus (OP) compounds are widely used for agriculture, domestic pest-control and chemical warfare. Pesticide self-poisoning accounts for one-sixth to one-eighth of the world's suicides and a third of suicide deaths in rural Asia each year. OP pesticides inhibit cholinesterase enzymes leading to overstimulation of cholinergic receptors. Clinical features depend on the types of receptors stimulated at various sites of the body. The diagnosis of OP poisoning is made on the basis of history of poisoning, smell of pesticides, the characteristic clinical signs and reduced cholinesterase activity. Measurement of plasma cholinesterase is useful for diagnosis of OP poisoning although it may not directly correlate with severity of the poisoning. Atropine remains the main stay of treatment of OP poisoning with clear evidence of benefit if administered effectively. Atropine therapy should be monitored to maintain systolic blood pressure > 80 mmHg, pulse > 80 beats/min and clear chest on auscultation. Oximes reactivate cholinesterase enzymes and help to overcome even the nicotinic effects of OP poisoning. However, evidence for its effectiveness after self-poisoning is weak. Although several newer adjuvant therapies are tried to achieve better outcome, their potential benefits are not yet established.

Background: Alterations in circulating angiogenic factors are associated with the diagnosis of preeclampsia and correlate with adverse perinatal outcomes during the third trimester., Objective: Analysis of the sequential levels of plasma angiogenic factors among patients admitted for evaluation of preeclampsia., Study Design: We performed an observational study among women with singleton pregnancies admitted to Beth Israel Deaconess Medical Center, Boston, Massachusetts, for evaluation of preeclampsia at less than 37 weeks of gestation. Plasma samples were collected on admission and daily for the first 3 days and then weekly until delivery. Doppler ultrasound was performed on admission (within 48 hours) and then weekly (within 24 hours of blood collection) to evaluate uteroplacental and umbilical blood flows. Maternal demographics, hospital course, mode of delivery, diagnosis of hypertensive disorder, adverse maternal outcomes (elevated liver function enzymes, low platelet count, pulmonary edema, cerebral hemorrhage, convulsion, acute renal insufficiency, or maternal death), and adverse fetal/neonatal outcomes (small for gestational age, abnormal umbilical artery Doppler, fetal death, and neonatal death) were recorded. Circulating angiogenic factors (soluble fms-like tyrosine kinase and placental growth factor were measured on automated platform in a single batch after delivery and in a blinded fashion. Data are presented as median (25th to 75th centile), mean, or proportions as appropriate., Results: During the study period, data from 100 women were analyzed for the study, and 43 had adverse outcomes. Women with adverse outcomes had lower gestational age of delivery, higher systolic and diastolic blood pressures during hospitalization, and lower birthweight and placental weight (all P < .01). These patients had higher soluble fms-like tyrosine kinase and soluble fms-like tyrosine kinase/placental growth factor ratio on admission and continued to have an increase in levels throughout hospital course. The median (25th to 75th) soluble fms-like tyrosine kinase/placental growth factor ratio among patients with adverse outcomes was 205.9 (72.5, 453.1) versus 47.5 (9.7, 87.0) among women without adverse outcomes (P < .001). The median (25th to 75th) absolute change per day in soluble fms-like tyrosine kinase levels (pg/mL) was 491.0 pg/mL (120.3, 1587.2) among women with adverse outcomes versus 81.3 pg/mL (-177.9, 449.0) among women without adverse outcomes (P = .01). Similarly the absolute change per day for soluble fms-like tyrosine kinase/placental growth factor ratio was 15.1 (1.8, 58.1) versus 2.7 (-0.6, 8.3) between the two groups (P = .004). The mean (range) days from admission to delivery was 6 (0-35) among subjects with soluble fms-like tyrosine kinase/placental growth factor ratio ≥85 and 14 (0-39) below a ratio of 85 (P < .001). The positive predictive value for plasma soluble fms-like tyrosine kinase/placental growth factor ratio ≥85 at admission for indicated delivery within 2 weeks was 91% (83-99%). Admission plasma soluble fms-like tyrosine kinase/placental growth factor ratio positively correlated with pre-delivery uterine artery resistive index (r = 0.35; P = .004)., Conclusion: Among women admitted for evaluation of preeclampsia, women at risk for adverse pregnancy outcomes have higher soluble fms-like tyrosine kinase/placental growth factor ratio on admission, which continued to rise until delivery. Women with high soluble fms-like tyrosine kinase/placental growth factor ratios delivered sooner than women with low soluble fms-like tyrosine kinase/placental growth factor levels. These data support the hypothesis that targeting angiogenic imbalance in preeclampsia may lead to prolongation of pregnancy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Hypertensive disorders of pregnancy (HDP) are associated with subclinical changes in cardiac function. Although the mechanism underlying this finding is unknown, elevated levels of soluble antiangiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt1) and soluble endoglin (sEng) are associated with myocardial dysfunction and may play a role. We hypothesized that these antiangiogenic proteins may contribute to the development of cardiac dysfunction in HDP. We prospectively studied 207 pregnant women with HDP and nonhypertensive controls and evaluated whether changes in global longitudinal strain (GLS) observed on echocardiography is specific for HDP and whether these changes correlate with HDP biomarkers, sFlt1 and sEng. A total of 62 (30%) patients were diagnosed with preeclampsia (group A), 105 (51%) did not have an HDP (group B), and 40 (19%) were diagnosed with chronic or gestational hypertension (group C). Blood was drawn and sFlt1 and sEng levels measured using enzyme-linked immunosorbent assay. Comprehensive echocardiograms, including measurement of GLS, were performed on all patients. Overall, GLS was worse in women in group A (preeclampsia) than those in group B or C. Increasing sFlt1 and sEng levels correlated with worsening GLS (r=0.44 for sFlt1 and r=0.46 for sEng, both P<0.001), which remained significant after multivariable analysis (r=0.18 and r=0.22, both P≤0.01). Increasing levels also correlated with increasing left ventricular mass index, which also remained significant after multivariable analysis (r=0.20 for sFlt1 and 0.19 for sEng, both P=0.01). Elevated circulating levels of antiangiogenic proteins in HDP correlate with and may contribute to myocardial dysfunction as measured by GLS., (© 2016 American Heart Association, Inc.)

Introduction: Surgical site infection is one of the most important complication of surgery. It increases the mortality and morbidity. In order to decrease the incidence of surgical site infections perioperative antimicrobial prophylaxis has been recommended in certain types of clean and clean contaminated surgeries. Aminoglycosides are indicated as surgical prophylaxis for prevention of surgical site infection in patients with B-lactam allergy., Aim: The present study was carried out to study and compare the renal safety profile of single high dose gentamycin and amikacin as surgical prophylactic antibiotic., Materials and Methods: Prospective and randomized study was carried out on 100 patients for over one year period in a tertiary care teaching hospital of western Uttar Pradesh, India. Patients in amikacin group received amikacin 15 mg/kg + metronidazole 500 mg intravenously single dose and those in the gentamycin group had gentamycin 5 mg/kg + metronidazole 500 mg intravenously single dose, one hour prior to incision., Result: A total of 16% patients of amikacin group and 24% patients of gentamycin group developed acute kidney injury within one week of drug administration. The rise in serum creatinine was temporary as all patients had normal serum creatinine level at one month follow up., Conclusion: Aminoglycoside intravenous single high dose is not safe as surgical prophylaxis.

Background: The pathophysiology of hypertension in the immediate postpartum period is unclear., Methods and Results: We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. The angiogenic factors soluble fms-like tyrosine kinase 1 and placental growth factor, both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. Of the 184 women, 77 developed de novo hypertension in the postpartum period, and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with the development of postpartum hypertension. The antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor positively correlated with blood pressures in the postpartum period (highest postpartum systolic blood pressure [r=0.29, P<0.001] and diastolic blood pressure [r=0.28, P<0.001]). Moreover, the highest tertile of the antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor was independently associated with postpartum hypertension (de novo hypertensive group: odds ratio, 2.25; 95% confidence interval, 1.19-4.25; P=0.01; in the persistent hypertensive group: odds ratio, 2.61; 95% confidence interval, 1.12-6.05; P=0.02) in multivariable analysis. Women developing postpartum hypertension had longer hospitalizations than those who remained normotensive (6.5±3.5 versus 5.7±3.4 days; P<0.001)., Conclusions: Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension have clinical risk factors and an antepartum plasma angiogenic profile similar to those found in women with preeclampsia. These data suggest that women with postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia., (© 2015 American Heart Association, Inc.)

Carbon dioxide (CO2) reduction to multi-carbon compounds at the cathode using chemolithoautotrophs is an emerging application of microbial electrosynthesis (MES). In this study, CO2 reduction in MES was investigated at hydrogen evolving potentials, separately by a mixed culture and Clostridium ljungdahlii, using a graphite felt and stainless steel assembly as cathode. The mixed culture reactor produced acetate at the maximum rate of 1.3 mM d(-1), along with methane and hydrogen at -1.1 V/Ag/AgCl. Over 160 days of run-time in four fed-batches, 26% of bicarbonate was converted to acetate between day 28 and 41, whereas in the late batches, methane production prevailed. Out of 45 days of run-time in the C. ljungdahlii reactor, 2.4 mM d(-1) acetate production was achieved at -0.9 V/Ag/AgCl in Batch 1. Simultaneous product degradation occurred when the mixed culture was not selectively enriched. Hydrogen evolution is potentially the rapid way of transferring electrons to the biocatalysts for higher bioproduction rates., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Near-well ultrasonic processing technology is characterized by high adaptability, simple operation, low cost and zero pollution. The main plugs of oil production include paraffin deposition plug, polymer plug, and drilling fluid plug etc. Although some good results have been obtained through laboratory experiments and field tests, systematic and intensive studies are absent for certain major aspects, such as: effects of ultrasonic treatment for different kinds of plugs and whether effect of ultrasound-chemicals combination deplugging is better than that of ultrasonic deplugging. In this paper, the experiments of removing drilling fluid plug, paraffin deposition plug and polymer plug by ultrasonic wave, chemical deplugging agent and ultrasound-chemical combination deplugging respectively are carried out. Results show that the effect of ultrasound-chemical combination deplugging is clearly better than that of using ultrasonic wave and chemical deplugging agent separately, which indicates that ultrasonic deplugging and chemical deplugging can produce synergetic effects. On the one hand, ultrasonic treatment can boost the activity of chemical deplugging agent and turn chemical deplugging into dynamic chemical process, promoting chemical agent reaction speed and enhancing deplugging effect; on the other hand, chemical agent can reduce the adhesion strength of plugs so that ultrasonic deplugging effect can be improved significantly. Experimental results provide important reference for near-well ultrasonic processing technology., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Clinical treatments of significant bone defects involve invasive procedures such as the application of auto- and allografts. These procedures present many limitations including the potential for infection and rejection. There is therefore a need to develop novel therapeutic strategies able to exploit the natural regenerative potential of bone and that can be delivered in a less invasive manner. Among the materials studied for the development of novel scaffolds, stimuli-responsive gels containing hydroxyapatite and carbon nanotubes as nanofillers have generated great interest. In the present work, chitosan gels containing chitosan grafted CNTs and chitosan-hydroxyapatite complex have been formed by cross-linking with glycerol phosphate. The addition of the nanofillers afforded hydrogels with a faster sol/gel transition at 37 °C and enhanced mechanical properties. The thermosensitive composite gels also showed a good bioactivity profile associated with potential for the prolonged delivery of protein drugs. The inclusion of chemically cross-linked CNTs and HA in thermosensitive gels afforded injectable composite materials with enhanced properties, including reduction of gelation time, improved mechanical properties, good bioactivity, and prolonged drug release.

Background: End stage renal disease patients are treated with dialysis in Nepal. But there is no renal registry to indicate the burden of disease in the country., Objectives: The objective of this study is to find out the incidence of ESRD on renal replacement therapy and their out come., Materials and Methods: It is a retrospective analysis (audit) of all ESRD patients who had received dialysis inside Nepal and had under gone transplantation from 1990 to 1999. The haemodialysis (HD) registry, HD patients file, intermittent peritoneal dialysis (IPD) registry of Bir Hospital, Shree Birendra Hospital, Tribhuwan University Teaching hospital and National Kidney Center were reviewed. Acute renal failure and acute on chronic renal failure were excluded and the demographic profile, dialysis session, dialysis duration and outcome of all ESRD patients were computed. One patient was counted only once in spite of attending more than one center for dialysis. SPSS package was used for analysis., Results: Total number of 1393 ESRD patients received renal replacement therapy (RRT) in the decade. Mean age of patients were 46.7 +/- 16.7 with 70% of ESRD were between 20-60 years age with male: female ratio of 1.8:1. Initial mode of RRT was IPD in 58.2%, HD in 41.7% and pre-emptive transplantation in 0.1% patients. Records of 189 patients could not be found and out of remaining 1208 patients, 85.8% received dialysis for < 3 months, 6% received dialysis for more than a year and 9.5% had undergone kidney transplantation. The incidence of ESRD had increased gradually with 3.4 per million populations (pmp) in 1990 to 11.89 pmp in 1999 with an average annual incidence of 6 pmp and only 0.31% of expected ESRD patients received RRT., Conclusion: The incidence of ESRD is increasing but majority discontinue or die within 3 months. Dialysis centers needs to be expanded to different parts of country and prospective studies have to be carried out to fi nd out of cause of ESRD and to institute preventive measures.

Background: A clinico-epidemiological study helps to plan future preventive measures and management strategies for spinal trauma. This is a 10 years' retrospective review of spinal-injury patients treated at a tertiary health center in the eastern of Nepal to determine clinico-epidemiological aspects of spinal-injury patients in a predominantly rural population of eastern Nepal., Materials and Methods: All medical record files of patients with spinal injury from 1996 to 2005 in the Medical Record Section of BPKIHS (B. P. Koirala Institute of Health Sciences) were studied. The preformed pro forma consisting age, sex, place of living, mode of injury, hospital stay level of injury, site of injury, associated injury, Frankel grading of neural deficit and treatment modality was filled from the record files of patients. These parameters were entered in Excel 8 and analyzed by EPI INFO 2002. Details of 896 patients of spinal injury were recorded in the 10-year period of review., Results: 684 (76.35%) male and 212 (23.66%) female patients with mean age of 41.74 ± 16.53 years and 38.56 ± 15.86 years respectively were studied. Two hundred forty-two (27%) patients were from hilly districts of eastern Nepal. Fall from height [in 350 (39%) patients] was the commonest mode of spinal injury. Six hundred thirty-six (71%) patients presented with a neurological deficit. Seven hundred thirty-three (85%) patients were treated conservatively, compared to 163 (15%) surgically treated patients. One hundred forty-six (22%) patients were treated with operative interventions in the last five years., Conclusion: The study shows that the most vulnerable group for spine injury was the group of patients of productive age with late presentation (i.e., injury hospital duration - 41.64 ± 54.24 hours) without proper prehospital management. The treatment modalities have changed (from conservative to surgical) in this part of the world. These specific observations help us in further planning for preventive measures and management in our setting.

Objective: We evaluated the results of patients who were treated with Ilizarov hybrid external fixator for type IIIB open tibial fractures., Materials and Methods: 35 Gustilo grade IIIB tibial fractures of age between 18 to 42 years (22 male and 13 female) in which 12 distal fourth tibia (D/4) of C1.1 (6), C1.3 (6), 12 upper fourth Tibia (U/4) of A2 (8) and A3 (4) according to AO classification and 11 Tibial plateau fractures of Schatzker type VI (5) , V(5), IV(1) . All tibial plateau, proximal fourth fractures and lower fourth fractures of tibia and fibula (Reversed Hybrid), treated with Ilizarov hybrid fixator using two Ilizarov 5/8 rings and AO External fixator were followed up to 12-52 months., Results: D/4 fractures were united at 31.16678.3046 wks, U/4 at 24.005.2915 and Tibial plateau at 15.5454.160 weeks (p-0.00). ROM in tibial plateau type IV 130 degrees +/- 00, type V 124 degrees +/- 8.94 degrees, type VI 125 degrees +/- 7.0711 degrees, D/4 of type C1.1 (50 degrees +/- 0.00), type C1.3 (43 degrees +/- 5.7755) whereas full ROM in U/4 fractures. Pin tract infection occurred in 21% of cases. Pain on walking in 20% of cases of type VI tibial plateau fractures and 80% of cases of type IV and V. Problem free in rest of parameter of function of VI and 100% problem in IV and V. Pain at rest observed in 20% of cases in type V. In 66.67% U/4 fractures had pain on walking but no other functions were compromised. In 33% D/4 fractures of C1.1 type had pain on walking only and had 1cm of shortening., Conclusion: On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries. This fixator is safe and versatile, effective in providing stability and allowing early rehabilitation, although the indications for its use are very relatively specific.

Complex elbow dislocation1 (fracture of lateral condyle and avulsion fracture of medial epicondyle) with ipsilateral segmental fracture of radius and ulna without distal neurovascular deficit following machinery rolling belt injury in a 14 years boy presenting to emergency room of BP Koirala Institute of Health Sciences, is reported due to its complex nature of injury and good outcome after adequate follow up. The literature is reviewed for complex elbow dislocation to show its rarity.

Polyarticular tuberculosis involving bilateral hip and bilateral knee joints without obvious pulmonary or disseminated form of tuberculosis in a young boy is presented along with literature review.

We report a medial peritalar dislocation, which was treated with closed reduction and cast for 3 weeks. At follow up 12 months later, there was normal range of motion and mild pain after prolonged walking.

Osteosarcoma in pregnant women is rare. Delay in diagnosis may be due to lack of any signs or symptoms during gestation, clinical misdiagnoses, religious attitude and refusal of the patients. Most cases soft-tissue and bone tumors during pregnancy can be managed successfully with surgery during gestation. Therapies with fetal toxicity were more likely to be deferred to postpartum period. This case is rare and liable to be missed, hence is reported.

Objective: To ascertain the disease pattern and drug prescribing pattern of the patients attending Kathmandu Medical College Health Center, Duwakot., Methods: It is a cross sectional study conducted at Kathmandu Medical College (KMC) health Center, Duwakot during the month of Ashad to Mangshir, 2060. The sample size included was 292 patients attending the Health Center during this period. Prescription details were used as study tools to acquire information regarding patient's name, age, complaints for which consultation was sought, investigations, diagnosis, name of the drug which is prescribed and instruction for diet., Results: Age of patients in this study ranged from 0-80 years. A total of 165 (56.50%) were male and 127 (43.49%) were female. Out of 165 male of different age group ranging from 0-80 years, most of the patient i.e. 25(15.15%) were suffering from viral fever followed by cut/injury, allergy, diarrhoea, abdomen pain, fungal infection, HTN (hypertension), cold/cough/sore throat, sinusitis, muscular skeletal pain, joint pain, contact dermatitis, acute peptic disease (APD), headache, worm infestation, tonsillitis, pharyngitis, dizziness, eye infection, chest infection, calf and backache, viral rashes, hypo pigmentation, tension/depression, Urinary tract infection (UTI), coliolilethis, diabetes, p/r bleeding and insect bite poisoning. Out of 127 female of different age group ranging from 0-80 years 21 (16.54%) patients were suffering from viral fever, followed by backache, cold/cough/sore throat, allergy, weakness, acne, diarrhoea, sinusitis, flue, pneumonia, headache, acid peptic disease, dysmenorrhoea, Lower Respiratory Tract Infection and Upper Respiratory Tract Infection, muscular skeletal pain, joint pain, eye infection, Urinary Tract Infection, hypertension, abdomen pain, tonsillitis, tinea corporis, rhinitis, ear problems, insect bite poisoning, CSOM, trichiasis, uteric colic, otitis media, entropion and epiphora, worm infestation and pharyngitis. All together 384 drugs (23 category) were distributed to the different patient of different age group ranging from 0-80 years, to cure the different types of diseases. Among the different categories of drugs prescribed antipyretic (31.8%), antibiotics (17.2%) and (Non steroid Antiinflammatory Drugs (NSAIDs) (11.2%) were the most common., Conclusion: The assessment of the existing prescribing practices in a health facility helps to identify the specific drug use problems, which need to be understood before any meaningful intervention can take place. A prescription provides an insight into a prescriber's attitude to the disease being treated and the nature of health care delivery system in the community. The average number of drugs per prescription is an important index of a prescription audit. It is preferable to keep the number of drugs per prescription as low as possible to minimize the risk of drug interactions, development of bacterial resistance and hospital costs.

Survey data concerning the first sexual intercourse (FSI) experiences of 272 undergraduate students revealed that 6% had experienced FSI against their personal wills (victims); 1% had experienced FSI against the will of the other person (offenders); 81% had experienced FSI at the will of both participants (consenting); and 11% were virgins (does not add up to 100% because of rounding). Examination of the students' perceptions of the various factors contributing to nonconsensual sexual intercourse (NSI) showed that fewer than 50% of the students agreed that situational and psychological factors contribute to NSI. Results also indicated that being a woman and perceptions about the factors that reduce victims' resistance were significant predictors of who would be the victim of FSI. Religious background, the reasons for having a date, and perceptions regarding the factors that enhance motivation to have NSI were significant predictors of FSI offenders. Personal risk behaviors were the strongest predictors of students who experienced FSI at the will of both participants, and risk factors were inversely related to being a virgin.

A cross-sectional survey research design measured factors related to cigarette use among 2,212 senior high school students. Results showed 14.3% of the sample smoked cigarettes at least occasionally, with 5.3% reporting they were daily smokers. About 12.8% indicated they were ex-smokers. Males and females smoked at almost equal rates, and the percentage of 10th grade student smokers was slightly higher (16.4%) than the percentage of juniors and seniors who smoked. Approximately 22% of Hispanic students, 15% of Caucasian students, and 4.5% of African-American students reported smoking cigarettes at least occasionally. An initial regression analysis used 21 variables to predict cigarette smoking. A more parsimonious regression model (R2 = .28), using variables from the initial regression analysis with significance levels of .01 or less, indicated the most important predictors of cigarette use were ethnic group, attitude toward females who smoke, close friends' use of cigarettes, personal use of marijuana, best friend's use of cigarettes, personal use of alcohol, and school self-esteem. Implications for school health programs are addressed.

Data concerning self-reported driving after drinking or using other drugs were collected from 3,382 junior and senior high school students in rural central and southern Illinois. Drinking, drug use, and driving increased steadily with age, with 42% of the 12th grade class indicating they had driven a car at least one time in the past six months after drinking or using other drugs. Riding with a driver who had been drinking also increased with age; 20% of the seventh grade sample had ridden in a car with a drinking driver, while 58% of the 12th grade sample reported having done so. Slightly more females had ridden in a car with a driver who had been drinking than males, while males reported higher rates of driving after drinking or using other drugs than females. Correlation analyses indicated 22 variables related significantly to drinking, drug use, and driving. Forward stepwise multiple regression analysis showed that 11 variables related significantly to riding as a passenger with a drinking driver. Thirteen variables were related significantly to driving after drinking or using other drugs. Frequency of alcohol use variables were the most powerful indicators of self-reported driving after drinking or using other drugs in this sample.