Laparoscopic Cholecystectomy and Common Bile Duct Exploration in Situs Inversus Patients

Situs inversus is a congenital condition in which the major visceral organs are reversed from their normal positions, estimated to occur in 1 in 5000-20,000 births. Incidence of gallbladder stone disease is same in these patients and normal patients. Laparoscopic cholecystectomy remains the treatment modality, and performing it successfully in these patients even rarer. We report a 54 years gentleman with gall stone, and 63 years lady who had both gall stone and common bile duct stone along with situs inversus. The mirror image reversibility of the abdominal viscera was seen in both cases. Ports were placed on the opposite side as the liver and the gallbladder were on the left side. Dissection was difficult because being a righthanded surgeon, the non-dominant hand would be the working hand. However, no perioperative complications occurred. It is technically challenging and requires a proper orientation of the left upperquadrant of abdomen.

Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal

Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARSCoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 - B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal.

Comparative Efficacy and Safety of Diacerein in Patients with Knee Osteoarthritis: A Pilot Study

Background Osteoarthritis (OA) is the most common chronic rheumatic disease. The prevalence of OA is skyrocketing with time. Providing a proper treatment regimen for OA is also growing as a major public health challenge. Conventional pharmacological treatments are mainly for alleviating pain and have some severe adverse effects. Diacerein is a new oral anti-inflammatory drug especially developed for the management of OA having only mild to moderate adverse effects. However, the evidence of efficacy and safety of Diacerein in OA is not well documented and yet to be explored. Objective To compare the efficacy and safety of Diacerein in knee OA with conventional nonsteroidal anti-inflammatory drugs (NSAIDs). Method A comparative study was conducted among knee OA patients attending OutPatient Orthopedic department in Dhulikhel Hospital, Nepal from December 2019 to September 2020, using self-structured and standard questionnaire. The patients were randomized to receive either a conventional standard treatment (Treatment Group I: NSAIDs) or alternative treatment regimen (Treatment Group II: NSAIDS+ Diacerein). Patients were followed-up after two months and data were analyzed using SPSS 21.0. Result Among 72 patients enrolled in this study, majority (44.44%) were between 51-60 years of age in which 81.94% of the patients were female. Post treatment data was collected from 15 participants. The mean KOOS-PS score of the participants in Treatment Group I decreased from 35.56 ± 14.33 to 35.14 ± 12.65 while that of the Treatment Group II participants reduced from 63.31 ± 12.08 to 49.99 ± 13.10 in two months. Similarly, the mean WOMAC score decreased from 46.87 ± 17.80 to 34.37 ± 16.83 in Treatment Group I and from 54.23 ± 14.66 to 46.22 ± 12.16 in Treatment Group II. The mean Lysholm score in Treatment Group I increased from 55.57 ± 8.16 to 60.86 ± 15.01 and in Treatment Group II, it increased from 46.62 ± 13.01 to 60.25 ± 17.598. Conclusion Diacerein treatment group had better functional outcome compared to the patients in the treatment group with conventionally used drugs. Also, the adverse effects faced by the patients were minor. The current study are suggestive of better efficacy and safety of Diacerein compared to other drugs.

First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt

The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of "safety first" in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study.

Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Penetration of different molecular weight hydrolysed keratins into hair fibres and their effects on the physical properties of textured hair

Objective

To investigate the effects of different molecular weight (MW), wool derived hydrolysed keratins (i.e. peptides) on the physical properties of relaxed textured hair.

Methods

Very curly hair of African origin was relaxed using sodium hydroxide‐based treatment. Relaxed hair was treated with different MW peptides derived from keratin protein and an amino acid, L‐Leucine. The low‐MW keratin peptides were 221 Da, the mid‐MW keratin peptides were approximately 2577 Da, and the high‐MW keratin peptides were approximately 75 440 Da. The penetration of these different peptides into relaxed hair was evaluated using a laser scanning micrometre and by fluorescence microscopy. The effect of these compounds on single‐fibre mechanical properties and thermal properties was evaluated using tensile and DSC testing, respectively.

Results

Low‐ and mid‐MW compounds were able to penetrate deep into the hair cortex. High‐MW peptide adsorbed onto the hair surface and possibly slightly penetrated into the outer layers of the fibre surface. Both mid‐ and high‐MW keratin peptides, increased Young’s modulus and reduced hair breakage at 20% and 80% relative humidity. With the exception of mid‐MW peptide, other peptides and amino acid were not able to modify thermal properties of relaxed textured hair.

Conclusions

Our data suggest that low‐MW compounds may increase hair volume, and high‐MW peptides may repair damage on freshly relaxed textured hair.

Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient

Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy.

Age and Gender Differences in COVID 19 Morbidity and Mortality in Nepal

Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal.

Pregnancy Complicated by Acute Pancreatitis with Ascariasis

Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis.

Hormonal Contraceptives Use and Their Adverse Effects: A Cross-sectional Study among the Women Visiting Tertiary Care Center

Background Hormonal contraceptives are one of the most commonly used means of contraception. Lack of contraception may lead to large family size, increased preexisting illness on pregnancy, social and economic instability, risk of unsafe abortion and so on. This may also lead to unintended pregnancies which may alter the outcomes of pregnancies as well. However, improper uses are associated with several serious adverse effects. Therefore, to achieve the optimum benefit with the least adverse effects, safe and effective use of these agents with monitoring of their pattern of use and patient compliance is very essential. Objective To investigate the usage of hormonal contraceptives and the adverse effects associated with them. Method A cross-sectional study was conducted in a family planning center of a tertiary care hospital. All women of reproductive age using hormonal contraceptives for at least 1 month were included in this study. Informed consent was taken from the patients and interviewed using a structured questionnaire. Statistical analysis was performed by using SPSS 20. Result Among the 105 participants under this study, the mean (±SD) age was 29.08 (± 6.12) years. A majority (42, 40.0%) of them were using injectables. The average duration of use of hormonal contraceptives was 25.1 months ± 31.8 while a majority (60, 57.1%) were using contraceptives from < 3 months. Less chance of missed dose was the major reason (26.8%) for choosing injectable. Adverse effects were reported by 75.2% of the patients. The most common adverse effect was menstrual abnormalities (21.7%). Conclusion Among various hormonal contraceptives, injectables were more commonly used. The majority of the participants responded to use injectables because of the least chance of missing the dose. The most common adverse effect reported was menstrual abnormalities.

Analysis of Antimicrobial Drugs Usage Pattern and it's Cost Analysis in the Pediatric Department of a Tertiary Care Hospital

Background Antimicrobials agents are the most widely and often imprudently used therapeutic drugs globally. The pediatric population comprises 20-25% of the total world population, and various acute and chronic diseases are prone to this group. It is also estimated that 50% to 85% of children are prescribed with antimicrobials in developed and developing countries. The misuse of antimicrobials not only contributes not only to the development of antimicrobial resistance but also results in economic burden on the health care system. Objective To analyze the antimicrobial usage and its cost analysis in the Pediatric department of a tertiary care hospital at sub-urban area. Method A hospital based retrospective study was conducted among patient (aged 1 to 18 years) admitted in pediatric ward and intensive care unit for at least 24 hours and dispensed at least one antimicrobial drug from January 2018 to December 2019. Data were collected from electronic medical record using a structured data collection form. The data was entered and analyzed using Microsoft Excel. A descriptive analysis was presented as mean ± (standard deviation) for the continuous variables and frequencies and proportions for categorical variables. Result Among the 1,281 patients, the antimicrobials were prescribed mostly in the respiratory tract infection (39.6%), followed by sepsis (19.75%), enteric fever (11.94%), seizure (10.07%), urinary tract infection (4.29%). Penicillins (1238 times) were highly prescribed followed by Cephalosporin (733 times), Nitro-imidazole (292 times), Aminoglycosides (180 times) and Fluoroquinolones (144 times). During study period in the Pediatric Department, approximately NRs. 1,619,121.11 was spent in the antimicrobial drugs and the highest expenditure was found to be in the Cephalosporin group of antimicrobials (NRs. 530,988.6), followed by Penicillin group of drug (NRs. 3,81,842.2). Conclusion The study concludes that the Penicillin groups of drugs were the most commonly prescribed drug and the highest cost was found to be in Cephalosporin group drugs followed by Penicillin group of drugs.

Knowledge on American Heart Association Guidelines Update for Cardiopulmonary Resuscitation among the Nurses Working at University Hospital, Kavre

Background Cardiopulmonary resuscitation is the foundational technique for the emergency treatment of cardiac arrest and the standardized training of it has been emphasized more than ever. Competence of the nurses in this lifesaving procedure is a critical factor in patient outcome from cardiac arrest and can largely prevent sudden death. Objective Many evidences suggest lack of knowledge on proper cardiopulmonary resuscitation among nurses so the aim of this study was to assess the knowledge on 2015 American Heart Association guidelines update for cardiopulmonary resuscitation among nurses working at University hospital and to identify the relationship between the level of knowledge and selected variables. Method Two hundred and sixty nurses working in Dhulikhel hospital participated in the study. A cross-sectional descriptive study was conducted using a predesigned questionnaire based on 2015 guidelines updates for cardiopulmonary resuscitation that incorporated total of 20 questions. Result Total 260 participated in the study and all were female. Only one third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation. No significant results existed between the knowledge score and age of the nurses, duration of work experience. However, significant results existed between the knowledge score and qualification, designation of the nurses and previous training on cardiopulmonary resuscitation. Conclusion One third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation in this study. Thus, knowledge and practical approach has to be updated with current guidelines in cardiopulmonary resuscitation in order to improve the safety and effectiveness of patient care.

Adherence to Iron, Folic Acid and Calcium Supplement and Factors Affecting it among the Antenatal Care Attending Women in a Tertiary Care Hospital: A Cross Sectional Study

Background Pregnancy or gestation is the time during which a single or more children grows and develops inside a woman. Antenatal care improves the pregnancy outcomes under which a group of medication i.e. iron, folic acid and calcium are supplemented. Despite the effectiveness of such supplements, poor clinical outcomes are often encountered because of poor-adherence to the regimen. Objective To determine the adherence pattern and factors affecting adherence in antenatal care patients under iron, folic acid, and calcium therapy. Method A cross-sectional study was conducted in Dhulikhel Hospital, Kathmandu University Hospital. Pregnant women attending antenatal care under iron, folic acid, and calcium therapy fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 191 patients enrolled in this study majority (39.3%) of them belonged to age group 26-30 years. More than half (61.3%) of the patients were illiterate. Of the total 191, 64.40% were non-adherent to the medication. Forgetfulness was the main reason for missing the dose in majority (52.06%) of the non-adherent subjects while adverse effects (55.40%) was the most prominent cause for discontinuing the medication among non-adherent participants. Significant association was found between patients' adherence and busy work schedule, visiting doctor for follow up. Conclusion More than half of the patients had not adhered to the medication under antenatal care. Forgetfulness was the most common factor for missing the dose in nonadherent patients. Illiteracy was associated with poor adherence. Patient-provider relationship, Socio-economic factors were determined as major barrier to medication adherence.

Endoscopic Management of Foreign Body Impaction in the Upper Gastrointestinal Tract in a Tertiary Care Centre of Nepal

Background Ingested foreign body impaction on upper gastrointestinal tract is common incidence among children, older age group, mentally challenged individuals, and people the influence of alcohol. In most cases, the foreign bodies pass spontaneously and uneventfully but when this does not occur; endoscopic management to ensure removal under direct visualization is required. Relief upon removal of foreign body and prevention of complications is essential. Objective To assess the endoscopic management and outcome of foreign body impacted in the upper gastrointestinal tract. Method This is a hospital based observational retrospective cross sectional study involving 165 patients at Endoscopy Department of Dhulikhel Hospital in Nepal between November 2015 and October 2019. The data regarding the demographic profile, clinical characteristics and endoscopic findings were retrieved and analyzed to determine endoscopic interventions performed, complications and outcomes. Result One hundred and sixty five patients presenting with history of ingestion of foreign body were included in the study. The mean age of the patients was 46.8 ± 19.1 years with male predominance (60%). The most common site of foreign body impaction was oesophagus (70%). The most common foreign body encountered was bone (62.2%) among which chicken bones (91.1%) were most frequent. For the retrieval of sharp-pointed foreign bodies, rat forceps and graspers (45.7%) were most commonly used. Total 14 cases required rigid oesophagoscopy as the foreign body could not be retrieved by flexible endoscopy. Conclusion Foreign body ingestion and its impaction in the upper gastrointestinal tract has been found to be common in endoscopic practise. Early detection and timely removal of foreign bodies is of utmost importance to avoid discomfort to the patient as well as to ensure successful removal without complications.

Investigating the Efficacy of Triple Drug Therapy and Sequential Drug Therapy in the Eradication of Helicobacter Pylori with Respect to Antigen Stool test: A Pilot Study

Background Helicobacter pylori is one of the most prevalent infectious disease worldwide. The treatment regimens involve mainly two therapies: Standard Triple drug therapy and Sequential drug therapy. Several studies have shown that the sequential therapy has higher eradication rates of H. pylori than the standard triple drug therapy and since proper study on sequential drug therapy and standard triple drug therapy is still lacking in Nepal, this study is attempted to compare efficacy of Sequential Drug Therapy in the eradication of H. pylori in gastritis with respect to the Standard triple drug therapy. Objective To investigate the efficacy of Triple Drug Therapy and Sequential Drug Therapy in the eradication of Helicobacter pylori with respect to Antigen Stool test. Method This study was the prospective study conducted in 62 patients attending the Department of Gastroenterology, Dhulikhel Hospital, meeting the inclusion criteria who were confirmed as H. pylori positive by histopathology and stool antigen test. Patients were randomized into two groups. One group prescribed with Standard triple drug regimen and another group with Sequential drug regimen. Eradication of H. pylori infection was confirmed by repeating the stool antigen test at least five weeks after the completion of the regimen. Result Among the 62 participants included in this study, 54.5% of them were males. Among the study population, the eradication achieved by standard triple drug therapy was 87.8% and 89.6% with Sequential drug therapy. Higher numbers (82.3%) of patients were compliant to the prescribed medication. Forgetfulness was the main reason for missing the dose (91%) of the non-compliant patients. Conclusion The study revealed an equal efficacy of both Standard Triple drug regimen and Sequential drug regimen in the eradication of H. pylori infection. Further, Stool antigen test can be preferred as a non-invasive test, for diagnosis of H. pylori infection, monitoring the response to treatment and in epidemiological studies.

Ten-year survival outcomes for patients with early stage classical Hodgkin lymphoma: An analysis from Kentucky Cancer Registry

OBJECTIVE/BACKGROUND

Early stage classical Hodgkin lymphoma (cHL) has an excellent outcome. Recent studies focus on decreasing toxicity related to the addition of radiation along with chemotherapy. Real-life reporting of the addition of radiation to chemotherapy is lacking. This study investigates the outcomes obtained from a statewide cancer registry for early stage cHL patients treated with chemotherapy alone (CT) versus patients treated with the combined modality of chemotherapy and radiation (CMT).

METHODS

A retrospective study of cHL patients diagnosed and treated was identified using a statewide cancer registry from 2005 to 2014. Patients with early stage disease (I, II) were then grouped on the basis of the presence of B symptoms into favorable and unfavorable groups. Baseline characteristics (age, gender, extranodal involvement, and histology) as well as overall survival were compared for both groups depending on whether they received CT or CMT as first line therapy for their cHL.

RESULTS

A total of 961 patients were identified; of those, 127 were excluded as they received only radiation or another form of treatment. Of the remaining patients, 293 were categorized as early stage favorable cHL (Group 1) and 130 adults were in the unfavorable cHL (Group 2). There were 335 patients with advanced stage cHL (Group 3) and 76 patients in an unknown stage. The 10-year overall survival for Group 1 was 81.3% versus 76.3% for Group 2 and 52.7% for Group 3. For Group 1, 10-year overall survival was 86.7% with CMT versus 75.1% for those receiving CT only (p = .004). For Group 2, there was no difference in 10-year overall survival between the CMT group (80.0%) and CT (72.5%) (p = .73).

CONCLUSION

While radiation therapy might increase long-term toxicity in cHL, in our large data cohort, radiotherapy consolidation as part of the initial therapy for early stage disease provides superior survival at 10 years, especially in favorable risk cHL.

Health Care Associated Infection and Trend of Antimicrobial Resistance in Tertiary Care Hospital -A Study in Low Income Setting

Background Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the most serious public health problems and overall estimate indicates that at any point, over 1.4 million people are suffering from health care associated infection globally. According to the WHO report, the frequency of nosocomial infection is 10% in South East Asia where as 7% in developed countries. The increasing trend of AMR in pathogenic bacteria leads to complication to treat HAIs and failure in treatment and rise in mortality. Objective The study was conducted with the objective of to explore the incidence of different types of HAIs and AMR pattern in the patients admitted in a tertiary care hospital. Method The cross-sectional study was conducted at the tertiary care hospital and the patient who are one year or older and admitted for more than 48 hours were included in this study. The criteria for classification of HAIs were adapted from Centers for Disease Control. All the samples were collected then antibiotic sensitivity testing was conducted according to CLSI standards. Data were collected using a structured data collection form. Data were entered in EpiData software and analyzed using SPSS version 22. Result Among 2326 patients, female was slightly higher than male patients, where 77 (3.3%) patients experienced at least one episode of HAIs. The surgical site infection (71.42%) is the most common infection followed by Catheter Associated Urinary Tract Infection (18.18%) and Health Care Associated Pneumonia (6.49%). Mean hospitalization days is higher with HAI (14.5 days) compared to non-HAI (6.6 days). Out of 909 specimens, urine, sputum and blood were higher in numbers, where 217 bacterial isolates were isolated with Escherichia coli (83 isolates) was the most common bacteria. It is found that Escherichia coli bacterial isolates were resistance to most common antibiotics. Conclusion The study concludes that surgical site infection is the most common healthcareassociated infection and Escherichia coli is the most common bacteria responsible for HAIs. Further, surgical site infection being the most common infection, there is an urgent need to take effective infection prevention and control prevention.

Study of Prescription Pattern and Factors Associated with Clinical Outcomes in Type 2 Diabetes Mellitus with Reference to Short Term Glycemic Control

Background Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Though oral hypoglycemic agents (OHAs) or/and insulin are prescribed to control the hyperglycemia, still glycemic control is not seen in most of the cases. Evaluating the treatment pattern including the glycemic control and associated factors are of utmost importance for better patient care. Objective To investigate the treatment pattern and short term glycemic control among Type 2 Diabetes Mellitus (DM2) patients and study the factors associated with it. Method Patients meeting the inclusion criteria with DM2 attending laboratory or Out-Patient Department or Emergency Department in Dhulikhel Hospital and patients who were admitted to the ward taking various OHAs and/or insulin at the time of data collection were considered. Informed consent was taken prior to the interview. The collected data was entered as well as analyzed using the SPSS (Statistical Package for Social Sciences) version 21.0 and the p-value <0.05 was considered statistically significant. Result Among the 118 patients, 50.8% of them were males. Majority (28%) of the patients belonged to the age group of 51-60 years. Out of the 118 patients, 22% had their fasting blood glucose (FBG) level under control whereas 78% had uncontrolled FBG level. Metformin was the most (28%) commonly prescribed drug. Significant association was found between gender; knowledge about disease and medication with short term glycemic control (p=0.034, p=0.004 ans p=0.039 respectively). Conclusion All the patients enrolled in this study were under various anti-diabetic medications, however, majority of them didn't have their glycemia under control. Significant association was found between FBG level and gender, knowledge about disease and knowledge about medication.

Tracking the adoption of bread wheat varieties in Afghanistan using DNA fingerprinting

BACKGROUND

Wheat is the most important staple crop in Afghanistan and accounts for the main part of cereal production. However, wheat production has been unstable during the last decades and the country depends on seed imports. Wheat research in Afghanistan has emphasized releases of new, high-yielding and disease resistant varieties but rates of adoption of improved varieties are uncertain. We applied DNA fingerprinting to assess wheat varieties grown in farmers' fields in four Afghan provinces.

RESULTS

Of 560 samples collected from farmers' fields during the 2015-16 cropping season, 74% were identified as varieties released after 2000, which was more than the number reported by farmers and indicates the general prevalence of use of improved varieties, albeit unknowingly. At the same time, we found that local varieties and landraces have been replaced and were grown by 4% fewer farmers than previously reported. In 309 cases (58.5%), farmers correctly identified the variety they were growing, while in 219 cases (41.5%) farmers did not. We also established a reference library of released varieties, elite breeding lines, and Afghan landraces, which confirms the greater genetic diversity of the landraces and their potential importance as a genetic resource.

CONCLUSIONS

Our study is the first in wheat to apply DNA fingerprinting at scale for an accurate assessment of wheat varietal adoption and our findings point up the importance of DNA fingerprinting for accuracy in varietal adoption studies.

Diversity of Root Canal Morphology in Mandibular First Premolar

Background Mandibular first premolars have been reported to have complex anatomical aberration making them one of the most difficult teeth to manage endodontically. Objective To determine the root canal anatomy of mandibular first premolar in a Nepalese population using decalcification and clearing technique. Method One hundred and fifty extracted mandibular first premolars were collected from Nepalese population. Access cavities were prepared on the occlusal surface of each tooth. Teeth were decalcified by immerging in 5% nitric acid, dehydrated in ethyl alcohol and made transparent using methyl salicylate. Methylene blue dye was injected through access cavity and canal anatomy were observed and classified according to Vertucci's classification. Result The average length of mandibular first premolar was 20.43mm. One rooted teeth were 96% and two rooted were 4%. Vertucci's type I canal configuration was most prevalent (72%) followed by type V (18.6%), type III (3.3%), type II (2.6%) and type IV (2.6%). An unusual configuration was found in one tooth. Isthmus and apical deltas were found in 8.6%) and 14.6% of the cases respectively. Conclusion Type I canal configuration were the most frequently observed root canal configuration in mandibular first premolar followed by type V configuration. Such variation in root canal anatomy should be taken into consideration to ensure successful endodontic therapy of these teeth.

Prehypertension and its Risk Factors in Suburban Nepal -Findings from the Dhulikhel Heart Study

Background Prehypertension, defined as a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg, leads to higher rates of incident hypertension, and is associated with excess morbidity and deaths from cardiovascular diseases. Objective To estimate the prevalence of and examine the factors associated with prehypertension in Dhulikhel. Method This cross-sectional study utilized data from the 752 participants of the Dhulikhel Heart Study (DHS). The data collectors interviewed the participants at their home using a tablet based structured pre-tested questionnaire and measured blood pressure using a standard digital blood pressure machine (Microlife, Switzerland). Multivariate analysis was conducted using generalized estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, marital status, income, education, alcohol consumption, smoking, physical activity, body mass index (BMI) and food consumption. Result Males had a three-fold higher odds of prehypertension than females (OR:3.17, 95% CI:1.91-5.26). The odds of prehypertension increased with being overweight (OR:2.29, 95% CI:1.42-3.70) and with being obese (OR:5.00, 95% CI:1.81-13.79) compared to normal BMI. Education reduced the odds of developing prehypertension (OR:0.51, 95% CI:0.29-0.91). Those who met the recommended level of physical activity (OR:0.61, 95% CI:0.40-0.95) also were associated with lower prehypertension prevalence. Conclusion Obese/overweight and being male increased the odds of prehypertension whereas formal education and recommended level of physical activities were associated with lower prehypertension prevalence. Primordial prevention against cardiovascular risk factors at the community level, especially targeting the young adult male, is imperative.