Antibiotic Resistance Pattern in Intensive Care Unit of a Tertiary Care Hospital, Nepal.

Background Intensive care unit (ICU) is the especial department of the hospital where critically ill patients are treated with the unique type of technologies to revert back to functional by body's own mechanism. Therefore, there are lots of external intervention with chance of getting bacterial infections. Antibiotics are medicines used to prevent and treat such bacterial infections. However, due to selective broad spectrum antibiotic pressure there is great chances to develop antimicrobial resistance at any time during hospital stay in intensive care unit. Objective To find out the antibiotic resistance pattern among Gram negative bacteria in Intensive Care Unit. Method A Descriptive cross-sectional study was conducted in Department of Microbiology of Tertiary care center for 18 months On the basis of previous sample load census method was used to include 500 sample from intensive care unit during study period. Among them only Gram negative bacteria were included in the study. All the samples were processed following standard methodology. Result Out of 500 samples, growth was observed in 451 (90.2%) samples. Among all the isolates Escherichia coli (29.6%) was predominant organism. It had shown high resistance towards Ciprofloxacin (93.5%) even in urine sample Ciprofloxacin (86.9%). Conclusion Our study showed Escherichia coli as a major organism in intensive care unit. This was resistant to commonly used oral antibiotic leaving restricted option for use of higher antibiotics. Therefore, continuous surveillance of such bacterial pathogen is warranted with implementation of effective Infection Prevention and Control measures in Health Care setting with emphasis to critical care units.

Review on Synthesis of 2-(2-Hydroxyaryl) Benzothiazoles (HBT) for Excited-State Intra-molecular Proton Transfer (ESIPT)-Based Detection of Ions and Biomolecules.

In this review, we present a systematic and comprehensive summary of the recent developments in the synthetic strategies of 2-(2-hydroxyarylsubstituted)-benzothiazole (HBT) framework along with incorporation of various substituents on phenolic and benzothiazole rings which affect the emission process. The literature, spanning the years 2015-2024, on excited-state intramolecular proton transfer (ESIPT)-based studies of HBT derivatives comprising the effects of solvent polarity, substituents, and extended conjugation on fluorophores has been searched. ESIPT, intramolecular charge transfer, and aggregation-induced emissions enable these fluorescent probes to specifically interact with analytes, thereby altering their luminescence characteristics to achieve analyte detection. These fluorescent probes exhibit large Stokes shifts, high quantum yields, and excellent color transitions. Finally, the applications of HBTs as ESIPT-based fluorescent probes for the detection of cations, anions, and biomolecules have been summarized. We anticipate that this review will provide a comprehensive overview of the current state of research in this field and encourage researchers to develop novel ESIPT-based fluorophores with new applications.

Dynamics of soil organic carbon of jhum agriculture land-use system in the heterogeneous hill of Arunachal Pradesh, India.

Land-use conversion affects soil organic carbon (SOC) dynamics. Therefore, an in-depth study of change in SOC, SOC pool, fractions of SOC and enzymatic activities of soil microbial biomass carbon (SMBC) and dehydrogenase (DHA) with the conversion of forest land to jhum, fallow jhum and settle cultivation use has been undertaken on the hills of Arunachal Pradesh of India. Geo-referenced soil samples from eight different locations, each from different land uses were collected at three depth. One part of the soil sample had been used for the analysis of SOC and its carbon fraction. The second portion was kept in a deep freezer for determining SMBC and DHA. The third part was used for the analysis of bulk density. The result revealed that the highest loss of SOC pool was recorded in jhum land (41.8 to 13.4%), and the labile carbon was also found to decrease in jhum land. The highest SMBC was observed on the surface soil of the natural forest; the highest DHA was found in the natural forest; and the lowest DHA was recorded in jhum land. This study found that the converting natural forest to jhum reduces SOC storage, enzymatic activities and C fractions significantly whereas fallow jhum shows sign of recovery because all of these parameters improved when compared to the jhum land-use system. This study also confirms that the fallow period helps restore the initial situation.

Demographics and appropriateness of cellular blood component irradiation practices: Ambispective analysis from a tertiary care center.

BACKGROUND: Transfusion-associated graft versus host disease (TA-GVHD) is often underreported. There may also be lapses in TA-GVHD prevention practices due to lack of revision of some of the existing clinical guidelines as well as limited audits on practices of blood component irradiation. This study was undertaken to highlight these shortcomings, and generate data for development of institutional guidelines. METHODS/MATERIALS: Study cohort was selected from patients requiring transfusion support during June 2019 to May 2020. Transfusion history of these patients were followed, both retrospectively and prospectively till July 2021. Transfusion requisitions were categorized as IR (with request for irradiation) or NIR (with no request for irradiation) and justified or unjustified according to published international guidelines. RESULTS: Total 6963 requisitions for cellular blood components were received from 255 patients included in the study cohort. Of these, 3690 (54.9 %) were IR requisitions, while remaining 3029 (45.1 %) requisitions were NIR. Overall, 4242 (63.1 %) requisition were justified for their irradiation status as per published guidelines and 1595 (23.8 %) were found to be Unjustified while justification could not be assessed for remaining 882 (13.1 %) of the requisitions. The highest proportion of Unjustified demands in NIR requisitions was observed in patients with Severe Aplastic anemia (59.4 %). CONCLUSION: Many units were unnecessarily irradiated (7.7 %) while irradiation was missed in 16 % of the requisitions included in analysis which may be attributed to lack of institutional guidelines. We recommend that every centre should adopt a published well-researched guideline including amendments based on review of practices at their center.

Impact of sequential herbicides application on crop productivity, weed and nutrient dynamics in soybean under conservation agriculture in Vertisols of Central India.

Adoption of conservation agriculture (CA) is very slow due to weed infestations. The application of herbicides is the only viable option to deal with problem of weed management to adhere with basic principles of CA. A field experiment was carried out for three years to evaluate the expediency of different herbicides and their sequential applications under CA. In this study, seven treatments comprised of either alone or sequential application of pre-emergence (PE) and post-emergence (PoE) herbicides, hand weeding and weedy check were tested in soybean. Result indicated that sequential application of glyphosate at 1 kg ai ha-1 + pendimethalin at 1 kg ai ha-1as PE followed by PoE application of imazethapyr at 100 g ai ha-1 at 30 days after sowing (DAS) proved to be the best economical option in terms of plant growth parameters, crop biomass, seed yield, weed index and carbon and nutrient recycling. Pearson's correlation coefficients matrix revealed that grain yield was significantly (P<0.0001) related to weed density at harvest (r = -0.84), (WDH) (r = -0.63), weed dry biomass (WDB) (r = -0.52), weed nitrogen (N), phosphorus (P) and potassium (K) uptake (r = -0.56, r = -0.59 and r = -0.66), respectively and weed index (WI) (r = -0.96). The bivariate linear regression study of grain yield on weed control efficiency (WCI) biomass, N, P and K uptake by grain showed a clear significant (P<0.0001) dependence with R2 value of 0.53, 0.99, 0.95 and 0.98, respectively. The fitted stepwise multiple regression model also revealed that N and P uptake in grain, weed density at 20 DAS and K uptake in weed were actual predictor for grain yield. We concluded that, effective and economical weed control under CA in soybean can be achieved through sequential application of glyphosate along with pendimethalin at 1 kg ai ha-1 each PE followed by PoE use of imazethapyr at 100 g ai ha-1 at 30 DAS.

Synthesis, prototropic tautomerism studies of indenocarbothioamides and their conversion to biologically active indenothiazole derivatives.

Indenocarbothioamides 2, obtained from reaction of indane-1,3-dione with aryl isothiocyanates, on condensation with 3-chloropentane-2,4-dione and chloroacetyl chloride furnished 1,3-indanedione coupled thiazole and thiazolidin-5-one derivatives, respectively. The structure of the obtained products was assigned on the basis of spectral data (IR, NMR and Mass). Prototropic tautomerism studies of carbothioamides 2 were carried out in solution (1H NMR, 13C NMR and UV-vis), gas phase (Mass) and solid state (IR and X-ray). X-ray diffraction studies of carbothioamide 2a have revealed the existence of enolic form in the solid state. DFT studies of various possible tautomeric forms in gas phase as well as in solution state corroborated by the experimental results. Antibacterial studies of indenothiazole and indenothiazolidin-5-one derivatives have been reported.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu.

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.

Burden of Silicosis among stone crushing workers in India.

BACKGROUND: In North India, the mining industry is disorganized and profit-driven. It predisposes its workers towards the development of silicosis. Haryana, a major North Indian state, has developed a compensation-rehabilitation policy for mining workers. AIMS: This study is the review of the policy's functioning and limitation from the first 4 years of implementation. METHODS: The labour department does surveillance of workers in the mining industry. All suspected cases of silicosis are evaluated by a multidisciplinary team. Based on the final diagnosis, the compensation is decided. RESULTS: Nearly 5000 workers were screened, and 729 appeared before the medical board. Of these 729, 465 were having silicosis, and their data are presented here (data of 7 patients were missing). All workers were males. The mean age was 44.54 ± 9.6 years, and the mean exposure (work experience) was 17.25 ± 6.7 years. Most of the workers were between the age of 40 and 50 years and had exposure for 10-20 years. Chest radiography examination showed that progressive massive fibrosis (large size type C opacities) was the most common type of presentation (23%). Smaller opacities (p, q, r and s, t, u) were combined for further analysis, given their similar prognostic significance. It was found that age and experience both had a linear and significant correlation with the severity of lung involvement. CONCLUSIONS: Nearly a quarter of subjects were suffering from the worst type of lung involvement at screening itself. The policy has laid a foundation for the welfare of workers, but there is still a long way to go.

Statistical model for prediction of ABO hemolytic disease of the fetus and newborn in India.

ABO incompatibility is the most common cause of immune hemolytic disease of the fetus and newborn (HDFN). The American Academy of Pediatrics lists blood group incompatibility as one of the major risk factors for severe hyperbilirubinemia in newborns. We have estimated the risk of ABO HDFN to determine the need for its routine screening. Blood group data from all blood donors who donated in the last 10 years were collected and analyzed. The population prevalence of ABO blood group genes using the phenotype data of blood donors was estimated. This information was further used to calculate an incidence of ABO HDFN requiring intervention in the population. ABO blood group typing was analyzed in 425,743 blood donors. The ABO phenotypes of A, B, O, and AB were 22.48, 36.73, 31.59, and 9.2 percent, respectively. The gene frequencies were 0.1733, 0.2647, and 0.5620 for A, B, and O, respectively. It was estimated that 13.84 percent of group O women would give birth to a non-group O baby and that approximately 2.77 percent of deliveries would likely have ABO HDFN in the study population. In India, the estimated risk of ABO HDFN is 2.9 percent, with a daily 2196 babies at risk of ABO HDFN requiring intervention. This analysis estimates the overall burden of ABO HDFN in the population, which could aid in the decision-making of policymakers, physicians, and community health practitioners to improve neonatal care.ABO incompatibility is the most common cause of immune hemolytic disease of the fetus and newborn (HDFN). The American Academy of Pediatrics lists blood group incompatibility as one of the major risk factors for severe hyperbilirubinemia in newborns. We have estimated the risk of ABO HDFN to determine the need for its routine screening. Blood group data from all blood donors who donated in the last 10 years were collected and analyzed. The population prevalence of ABO blood group genes using the phenotype data of blood donors was estimated. This information was further used to calculate an incidence of ABO HDFN requiring intervention in the population. ABO blood group typing was analyzed in 425,743 blood donors. The ABO phenotypes of A, B, O, and AB were 22.48, 36.73, 31.59, and 9.2 percent, respectively. The gene frequencies were 0.1733, 0.2647, and 0.5620 for A, B, and O, respectively. It was estimated that 13.84 percent of group O women would give birth to a non­group O baby and that approximately 2.77 percent of deliveries would likely have ABO HDFN in the study population. In India, the estimated risk of ABO HDFN is 2.9 percent, with a daily 2196 babies at risk of ABO HDFN requiring intervention. This analysis estimates the overall burden of ABO HDFN in the population, which could aid in the decision-making of policymakers, physicians, and community health practitioners to improve neonatal care.

Effect of Breastfeeding on Relieving Pain during Immunization in Infant.

Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson's Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants.

Feasibility of a modified Atkins diet in glioma patients during radiation and its effect on radiation sensitization.

Background: Gliomas are the most dreaded primary brain tumour because of their dismal cure rates. Ketogenic-type diets (kds) are high-fat, low-protein, and low-carbohydrate diets; the modified Atkins diet (mad) is a less-stringent version of a kd that still generates serum ketones in patients. The purpose of the present study was to retrospectively examine the feasibility of attaining ketosis and the safety of the mad in patients undergoing radiation and chemotherapy treatment for glioma. The rate of pseudoprogression (psp) after treatment was also assessed as a marker of radiation sensitization. To our knowledge, this dataset is the largest published relating to patients with glioma undergoing kd during radiation and chemotherapy. Methods: We retrospectively studied 29 patients with grades ii-iv astrocytoma following the mad during standard radiation and chemotherapy. Feasibility of attaining ketosis was assessed though levels of beta hydroxybutyrate in blood. Pre- and post-radiation magnetic resonance images were evaluated for psp by a neuroradiologist blinded to patient data. Results: In the 29 patients who started the mad during radiation, ketosis was achieved in all 29 (100%). No serious adverse events occurred secondary to the mad. Of those 29 patients, 19 had glioblastoma multiforme. Of the latter 19 patients, 11 (58%) showed psp after mad and radiation and temozolomide therapy. Conclusions: A modified Atkins diet is feasible and safe for glioma patients during radiation and chemotherapy treatment. The mad and resulting ketosis could play a role as a radiation sensitizer.

Platelet-rich plasma and microneedling improves hair growth in patients ofandrogenetic alopecia when used as an adjuvant to minoxidil.

BACKGROUND: Platelet-rich plasma (PRP) is a popular procedure for the treatment of androgenetic alopecia (AGA). AIM: To ascertain the role of minoxidil 5% lotion alone versus minoxidil 5% lotion and PRP versus minoxidil 5% lotion, PRP with microneedling in AGA. MATERIAL AND METHODS: Ninety-three AGA patients with Hamilton-Norwood score 1-5 were grouped into three groups A, B, and C. Patients in group A (control group) were treated with minoxidil 5% lotion twice daily (n = 31), whereas patients in group B underwent treatment with minoxidil 5% lotion twice daily and PRP (n = 31), and group C patients received minoxidil 5% lotion twice daily, PRP, and microneedling (n = 31). Baseline and post-treatment photographs were taken along with dermoscopic evaluation. Selection of the dermoscopic variables included in the evaluation process was based on the published literature and dermoscopists' expertise and experience. Hair pull test was performed before and during follow-up. RESULTS: Post-treatment, hair pull test was negative in 27 patients (87.1%, P < 0.01) of group C, 20 patients (64.5%, P < 0.05) of group B, and 15 patients (48.4%) of group A. Hair growth was better appreciated in group C (26/31) compared to groups B (17/31)and A (10/31).The patients' self-satisfaction score on a Likert scale was more than seven (high satisfaction) in 24/31 patients in group C. There was a statistically significant difference between three groups in terms of hair pull test, terminal-to-vellus hair ratio, and patient satisfaction score as determined by one-way ANOVA. CONCLUSION: PRP with microneedling is better in comparison with PRP alone or minoxidil monotherapy in patients with AGA.

Differentiation of pityriasis rubra pilaris from plaque psoriasis by dermoscopy.

BACKGROUND: Diagnosing and differentiating pityriasis rubra pilaris (PRP) from other disorders can be a challenging task. Although histopathology remains the gold standard, it may not be feasible at times, especially in children. Being noninvasive, dermoscopy can be of great diagnostic importance in such a scenario. Dermoscopy overcomes the refractive properties of stratum corneum by interface medium or cross-polarization enabling easier visualization of lesions. OBJECTIVE: To study the dermoscopic features of PRP and compare them with dermoscopic features of psoriasis. PATIENTS AND METHODS: Retrospective observational analysis of dermoscopic characteristics of 28 patients with PRP (16) and psoriasis (12). Polarized dermoscopy at 10× magnification was performed and photographs were captured by Apple iPhone 7. The selection of dermoscopic variables was based on preexisting literature on the dermoscopic patterns of the 2 entities. RESULTS: The most frequent dermoscopic criteria of PRP were the presence of a central hair (16/16; 100%), follicular plugs (11/16; 68.7%), and perifollicular yellow/orange halos (9/16; 56.2%). No vascular structures were seen in our cases of PRP. Psoriasis was characterized by regularly distributed dotted vessels (12/12; 100%) and white scales (8/12; 66.6%). CONCLUSIONS: Round-to-oval yellowish areas surrounding a central hair with or without follicular plugs represents the most frequent dermoscopic pattern of PRP.

Bimatoprost in Dermatology.

Bimatoprost is a prostamide analogue used for treatment of glaucoma in ophthalmology. Surprisingly, the side effects such as increased pigmentation of eyelids and hypertrichosis in patients being treated with prostaglandin analogues for glaucoma have opened new areas of application in various dermatological disorders such as alopecia mainly affecting eyelashes, eyebrows, and vitiligo.

Olmsted Syndrome with Lateral Supraciliary Madarosis and Clubbing: A Rare Case Report.

Olmsted syndrome (OS) is a rare congenital, mutilating palmoplantar keratoderma first described by Olmsted in 1927. It starts in the neonatal period or in childhood, and has a slow but progressive disabling course. We report the case of a 16-year-old boy who presented with keratoderma of the palm and soles since childhood with lateral supraciliary madarosis and clubbing. The patient was started on oral retinoids and topical keratolytics and had partial improvement in 2 months. Keratoderma of the palms and soles along with lateral supraciliary madarosis and clubbing in our case is a very rare finding, and to the best of our knowledge, has not been reported so far.

Dermoscopy in vitiligo: diagnosis and beyond.

BACKGROUND: Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity. AIM: To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity. METHODS: Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings. RESULTS: Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo. CONCLUSION: Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.

Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes.

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.