Resonance Raman spectroscopy of twisted interfaces in turbostratic multilayer graphene

Turbostratic multilayer graphene presents a unique system with a large number of twisted interfaces with variable twist angles. In this work, we have systematically studied the laser excitation energy dependence of the Raman modes of turbostratic graphene. The combination of 4 different laser energies is shown to be important to reveal the twist angles ranging from 5∘to 30∘present at the same lateral position of the sample. Rotational or R-modes and D-like modes are observed, which directly arise from additional momentum transfer from the potential of corresponding superlattices. Trends in their dispersion and intensity are discussed. The resonant window for laser excitation indicates lowered positions of the van Hove singularities. Furthermore, an anomalous broadening factor of 0.17-0.265 eV is estimated for the resonance window when compared to the literature on isolated twisted bilayer graphene. Interestingly, a weak dependence of the R-modes on the laser wavelength is also observed. Finally, the dispersion of the 2D modes is also presented.

Translation and Validation of Oral Health-Related Early Childhood Quality of Life Tool for Nepalese Preschool Children

Background Early childhood caries (ECC) in preschool children debilitate their quality of life affecting oral function, appearance and social well-being. A tool for measuring oral health-related quality of life for preschoolers may help in making clinical decisions and assist policy makers in planning and management of health programs in the country. Objective To translate oral health-related early childhood quality of life (OH-ECQoL) tool into Nepali language and test its validity and reliability. Method OH-ECQoL was translated into Nepali language by two Nepalese professional translators which was back translated by professional English translator. This was sent to three independent advisors to see the appropriateness of translation. Pilot testing was done in 20 parents and questionnaire was finalized after needed corrections. Final version was introduced to the 118 parents of children aged 24- 71 months. Caries status was recorded for all children participating in the study. Concurrent, construct, discriminant validity and internal consistency reliability, test -retest reliability were evaluated. Result OH-ECQoL scores and perception of parents for general and oral health of their children was significant (at 0.01 level). There was significant difference in OH-ECQoL scores between no ECC and severe ECC groups and moderate and severe ECC groups (at 0.05 level). There was also a significant correlation between child impact section and family impact section (at 0.01 level). Cronbach's alpha was 0.891 demonstrating good internal consistency. Intra class coefficient was 0.963 suggesting excellent testretest reliability. Ninety-one (77.1%) children had severe ECC and 40(33.9%) parents were from upper middle class. Conclusion The Nepali version of OH-ECQoL is a valid and reliable tool for assessing the oral health-related early childhood quality of life in children of Nepal.

Emergence of Primary Teeth in Children of Sunsari District of Eastern Nepal

ABSTRACT: This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups. Method: This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded. Results: This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal.

Depression among Elderly people attending at Senior Citizen Home, Bhaktapur

Introduction: Depression is the most common mental disorder in elderly people. The rapidly increasing growth of elderly population in developing countries including Nepal is at risk of increased population with depression.The objective of this study is to assess the prevalence and level of depression among elderly people attending day care center at Sidhi Saligram Senoir Citizen Home.Methodology: A descriptive cross-sectional study design was carried out among the elderly people attending day care center at Siddhi Shaligram Senior Citizens Home, Bhaktapur. Non-probability convenience time frame sampling technique was used to collect the data. The total sample was112 respondents. Face-to-face interview was carried out using Geriatric Depression Scale Long Form. Data analysis was done with SPSS 16 version and simple descriptive statistics and chi-square were applied for data interpretationResults: The study findings show that the prevalence of depression, i.e. 56.2% had depression. Among the depressed respondents, 77.8% had mild depression and 22.2% had severe depression. Depression among elderly people was found to be significantly associated with the sex (p=0.05) and the presence of chronic illness (p=0.000). However association was not seen among the age, educational level, and marital status, type of family, Income and disability.Conclusion: Prevalence of depression was found high among elderly people. Counseling and group discussion in day care center with psycho social support focused to female suffering from chronic illness is recommended.Journal of Manmohan Memorial Institute of Health SciencesVol. 3, No. 1, 2017, page: 36-44

Adrenal histoplasmosis : a rare cause of bilateral adrenomegaly

Histoplasmosis is an opportunistic infection caused by a dimorphic fungus Histoplasma capsulatum. Histoplasmosis causing bilateral adrenal involvement is rare and usually occurs only in immunocompromised individuals with disseminated disease.  Here we report a case of bilateral adrenal histoplasmosis with disseminated disease in an immunocompetent patient.

Early warning score in predicting the severity of acute pancreatitis

Introduction: Acute Pancreatitisis leading causes of morbidity and mortality worldwide. A third of patientsdevelop severe pancreatitis with progressive organ dysfunction caused by systemic inflammatory response syndrome.Early identification of severe pancreatitis is essential for proper care and preventing complications. Various scoring systems have been developed to determine the severity.An ideal prognostic marker would be that is easily measurable, reproducible and cost effective. Early Warning Score is a simple physiological scoring system that can be reliably measured at the patient’s bedside. This study was aimed to determine the relationship between early warning score and severity of pancreatitis.Methods: Patients admitted with diagnosis of acute pancreatitis were included. Early warning score was calculated four hourly for 72 hours. Modified Marshall Score was determined at admission and at 48 hours. Severity of acute pancreatitis as defined by revised Atlanta Classification. EWS was correlated with severity of AP. EWS≥3 for more than 48 hours were regarded as severe pancreatitis and EWS≥3 at any time was regarded as a predictor of severe pancreatitis.Results: Eighty-six patients were included with 24 (27.9%) with severe pancreatitis. The sensitivity, specificity,positive andnegative predictive valueof EWS≥3 persistent for 48 hours or more in predicting severity were 87.5%, 98.38%, 95.45% and 95.31% respectively. Correlation between EWS and severity of pancreatitis was statistically significant.Conclusion: EWS is useful as an easy and reliable prognostic marker of the evolution and complications of acute pancreatitis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 16-20

Permanent Teeth Emergence Time and Sequence in Children of Kavre District, Nepal

Background Population specific standards on the timing and sequence of emergence of permanent teeth are essential in planning dental care for children. There is only a single study on the emergence of permanent teeth in Nepalese children. Objective To determine the standards for permanent teeth emergence time and sequence in children of Kavre district, Nepal. Method A descriptive cross sectional study was conducted in 623 children of age 5 to 14 years from six different schools of Kavre district. The number of permanent tooth erupted except third molar was recorded along with age and gender. Data were analysed using SPSS 20.0. Descriptive statistics was used to determine the number and percentage of permanent teeth emerged at different ages and the mean age of emergence of each tooth. Student 't' test was used to determine the inter jaw differences in the mean age of emergence of each tooth. Result The study population constituted 50.7% boys and 49.3% girls of the total sample. The first tooth to emerge was mandibular first molar, whereas maxillary second molar tended to be the last to emerge in both the genders. Though in general, mandibular teeth tended to precede the corresponding maxillary teeth in emergence but significantly only mandibular central, lateral and second premolar emerged earlier than maxillary.( p ≤ 0.05) Conclusion This study can be used as a reference data for clinical and academic purpose especially for the children of Kavre district, Nepal.

In vitro Temocillin efficacy against extended spectrum β-lactamase producing multidrug resistant gram negative bacterial isolates from Nepal

Temocillin is relatively more stable against most β-lactamases and requires re-evaluation to include it in common clinical practice as a therapeutic alternative. At the National Reference Laboratory of Nepal, we evaluated multidrug resistance (MDR) and extended spectrum β-lactamase (ESBL) phenotypes among 292 gram-negative clinical bacterial isolates of 18 different genera during 2009/2010 by Kirby-Bauer disc diffusion method following CLSI guidelines. ESBL screen positive isolates were tested for Temocillin efficacy by disc diffusion method following British Society of Antimicrobial Chemotherapy (BSAC) guidelines and other antibiotics following Clinical and Laboratory Standards Institute (CLSI) guidelines. Of the 292 isolates, 75.0% isolates were MDR, among which 61.6% were primarily screened positive for ESBL production but only 38.8% were confirmed as ESBL producers. We report relatively lower Temocillin resistance of 28.9% and 15.6% among MDR and ESBL positive populations, respectively. Among ESBL positive isolates, no Proteus mirabilis, 19.7% Escherichia coli and 33.3% Klebsiella oxytoca showed resistance to Temocillin, although such resistance was higher among Acinetobacter spp. (66.7%) and K. pneumoniae 50.0%. Among ESBL negative isolates, none of the K. oxytoca and few (13.3%) Acinetobacter spp. were resistant to Temocillin, while all Citrobacter freundii, Pseudomonas aeruginosa (85.7%) and K. pneumoniae (66.7%) showed Temocillin resistance. Only 14.8% and 3.0% of total MDR isolates were resistant to Imipenem and Meropenem, respectively. However, Imipenem resistance was remarkably high (86.7%) among ESBL negative Acinetobacter spp. than Meropenem (13.3%). Temocillin showed comparable efficacy against MDR and ESBL producing bacterial isolates and could be a next therapeutic option.

Extended spectrum â-lactamase producing multidrug resistant clinical bacterial isolates at National Public Health Laboratory, Nepal

Extended Spectrum â-lactamase (ESBL) producing multidrug resistant bacteria complicate therapeutic management and limit treatment options. Therefore, detection of ESBL-producing multidrug resistant (MDR) pathogens has a paramount importance. Between April 2009 and January 2010, a prospective study was carried out in National Public Health Laboratory with an objective to determine the status of ESBL producing MDR bacterial isolates from different clinical samples. Identification of the isolates was done by standard microbiological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening among MDR isolates was done using Ceftriaxone, Aztreonam, Cefotaxime, Ceftazidime and Cefpodoxime followed by confirmation using MASTDISCS ID ES2L Detection Discs (CPD10). Data analysis was done by SPSS 16 software. Of the 314 bacterial isolates from 1601 different clinical specimens, 199 (63.4%) were MDR. Cefotaxime was found the reliable screening agent for ESBL detection with sensitivity and positive predictive value of 98.6% and 76.4% respectively. Sixtey nine (62.7%) isolates of the 110 tested MDR isolates were ESBL positive with at least one of the Combined Disk (CD) Assays. Escherichia coli (80%) was the major ESBL producer followed by Klebsiella pneumoniae (5.8%). A statistically significant relationship was found between increasing spectrum of drug resistance and ESBL production (p<0.05). Thus it is concluded that a higher rate of ESBL production prevail among MDR clinical bacterial isolates underscoring the need for routine ESBL detection in clinical laboratories.

Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound

BACKGROUND

The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy.

MATERIALS AND METHODS

200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann's pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot's triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed.

RESULT

In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05).

CONCLUSION

Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomy.

Emergence of primary teeth in children of Sunsari district of Eastern Nepal

This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups.

METHOD

This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded.

RESULTS

This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal.