Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension.Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Factors Affecting the Uptake of Institutional Delivery, Antenatal and Postnatal Care in Nawalparasi District, Nepal

Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in lowincome countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women's literacy was associated with the uptake of antenatal services (p=< 0.001), postnatal care (p=0.04) and institutional delivery (p=< 0.001). Knowledge of antenatal (p=< 0.001) and postnatal care was also associated with uptake of respective services (p=< 0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awarenessraising interventions in this community could help improve the uptake of maternal health services.

Comprehensive case management of malaria: Operational research informing policy

In 2013, the Odisha state Vector Borne Disease Control Programme led a five year operational research project, under programmatic conditions, in close collaboration with several partners. This Comprehensive Case Management Project covered a population of 900,000 across paired control and intervention blocks in four districts, each with different transmission intensities. Key gaps in access to malaria services were identified through household surveys and a detailed situation analysis. The interventions included ensuring adequate stocks of rapid diagnostic tests and antimalarial drugs at the village level, the capacity building of health workers and ASHAs, setting up microscopy centres at the primary health care level, and conducting mass screening and treatment in poorly accessible areas. The programme strengthened the routine health system, and improved malaria surveillance as well as the access to and quality of care. Initially, the programme led to increased case reporting due to improved detection, followed by a decline in malaria incidence. Lessons from the project were then scaled up statewide in the form of a new initiative-Durgama Anchalare Malaria Nirakaran (DAMaN).

Monte Carlo Study of Unflattened Photon Beams Shaped by Multileaf Collimator

INTRODUCTION

This study investigates basic dosimetric properties of unflattened 6 MV photon beam shaped by multileaf collimator and compares them with those of flattened beams.

MATERIALS AND METHODS

Monte Carlo simulation model using BEAM code was developed for a 6MV photon beam based on Varian Clinic 600 unique performance linac operated with and without a flattening filter in beam line. Dosimetric features including lateral profiles, central axis depth dose, photon and electron spectra were calculated for flattened and unflattened cases, separately.

RESULTS

An increase in absolute depth dose with a factor of more than 2.4 was observed for unflattened beam which was dependent on depth. PDDs values were found to be lower for unflattened beam for all field sizes. Significant decrease in calculated mlc leakage was observed when the flattening filter was removed from the beam line. The total scatter factor, S_CP was found to show less variation with field sizes for unflattened beam indicating a decrease in head scatter. The beam profiles for unflattened case are found to have lower relative dose value in comparison with flattened beam near the field edge, and it falls off faster with distance.

CONCLUSION

Our study showed that increase in the dose rate and lower peripheral dose could be considered as realistic advantages for unflattened 6MV photon beams.

Retrospective study on outcome of macular hole surgery

INTRODUCTION

Macular hole is a common and treatable cause of central visual loss. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex removal and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates.

OBJECTIVE

To determine and evaluate anatomical and visual outcome of macular hole surgery.

MATERIALS AND METHODS

Retrospective analysis of all cases of macular hole surgery done by single surgeon between 2014 -2015.

RESULTS

16 eyes were analysed with follow up of 3 months. Macular hole closure after vitrectomy was 75% with visual improvement of two or more line in 62.5%.Post surgical complication included cataract 18.8%, Increased IOP 12.5% and retinal detachment 6.2%.

CONCLUSION

Vitrectomy along with ILM peeling and Gas Tamponade with effective positioning improves in visual acuity and achieve hole closure in people with macular hole.

Phytostimulatory effect of silver nanoparticles (AgNPs) on rice seedling growth: An insight from antioxidative enzyme activities and gene expression patterns

The knowledge on the mode of action, biocompatibility and ecological tolerance of silver nanoparticles (AgNPs) is gradually accumulating over the years with contradictory findings. Most of the studies indicated the toxic impact of AgNPs on plant growth and development, where induction of oxidative stress was considered to be one of the causal factors. The present study demonstrates the phytostimulatory effect of bio-synthesized silver nanoparticles (AgNPs) during seed germination and seedling growth of rice (Oryza sativa L., cv. Swarna) under in vitro condition. All the tested concentrations of AgNPs (10, 20, 40 ppm) promote both the shoot and root growth which was evident from the increased length and biomass of the seedlings. Exposure to AgNPs also significantly increased the chlorophyll a and carotenoid contents. The content and the pattern of distribution of phenolic metabolites among the different treatments are indicative of non-toxic impact of AgNP mimicking mild or no stress to the seedlings. Growth stimulation of rice seedlings by AgNPs was further supported by a low level of reactive oxygen species (ROS) concomitant with decreased amount of lipid peroxidation and H₂O₂ content, compared to control. In order to unravel the stimulatory impact of AgNPs on rice seedling growth, the present study also describes the AgNPs induced changes in antioxidative enzyme activity and related gene expression levels. Elevated levels of catalase (CAT), ascorbate peroxidase (APX) and glutathione reductase (GR) activities were recorded in all the AgNPs treated seedlings with improved growth. The activity of superoxide dismutase (SOD) was not significantly altered at low concentration of AgNPs. It appears that enzymes of ascorbate cycle, APX and GR are more active in ensuring protection against oxidative damage than SOD. There was significant up-regulation of CAT and APX gene expressions in seedlings exposed to AgNPs, whereas the expression level of CuZnSOD gene was decreased gradually with an increase in the concentration of AgNPs. The antioxidant enzyme activities and gene expression patterns coupled with the levels of H₂O₂ and lipid peroxidation indicates that the efficiency of redox reactions was increased in the presence of AgNPs and that accelerates the seedling growth.

Spin-Resolved Spectroscopy of the Yu-Shiba-Rusinov States of Individual Atoms

A magnetic atom in a superconducting host induces so-called Yu-Shiba-Rusinov (YSR) bound states inside the superconducting energy gap. By combining spin-resolved scanning tunneling spectroscopy with simulations we demonstrate that the pair of peaks associated with the YSR states of an individual Fe atom coupled to an oxygen-reconstructed Ta surface gets spin polarized in an external magnetic field. As theoretically predicted, the electron and hole parts of the YSR states have opposite signs of spin polarizations which keep their spin character when crossing the Fermi level through the quantum phase transition. The simulation of a YSR state right at the Fermi level reveals zero spin polarization which can be used to distinguish such states from Majorana zero modes in chains of YSR atoms.

C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour

INTRODUCTION

Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour.

METHODS

Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program.

RESULTS

Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (P=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (P=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (P=0.344) or periodontitis (P=0.541).

CONCLUSIONS

We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.

Blood Lead Level among school children in an Industrial city of Nepal

Background: Widespread use of lead has caused extensive environmental contamination and health problems in many parts of the world. Children are particularly vulnerable and even relatively low levels of exposure can cause serious health conditions. Our objective was to determine the prevalence of blood lead level in children in industrial city of Nepal, Birgunj.Materials and Methods: The cross sectional study was done on 50 school going student in Birgunj city, Nepal from November 2016 to January 2017. Questionnaire was used to collect data. Capillary blood was drawn and Blood Lead Level was measured immediately. SPSS ver. 22 was used to analyze the data.Results: The mean age of children in study was 12.5 ± 1.11 years.Among 50 children, 54% were male and 46% were female. The mean blood lead level was 20.33±9.36 μg/dl (male 21.08±8.87μg/dl, female 19.46±10.92 μg/dl). All the children in the study have elevated blood lead level and 84% of them have >10 μg/dl. About 26% of children have blood lead level between 15-20 μg/dl, 12% have level 20-25 μg/dl and 4% of them have more than 35 μg/dl.Conclusion: The prevalence of blood lead level in children from the industrial city of Nepal is alarmingly high. Children exposed with chipped paints have high level of blood lead level. However, further study in large population is required to address the current situation regarding the lead exposure to children.  

Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom

BACKGROUND

The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies.

AIM

The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set.

DESIGN AND METHODS

Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis.

RESULTS

Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine ( P  < 0.001). The difference remained significant after adjustment for case mix.

CONCLUSION

Specialist in acute care might facilitate discharge in a higher proportion of patients.