Sensitivity and Specificity of Lateral Flow Antigen Test Kits for COVID-19 in Asymptomatic Population of Quarantine Centre of Province 3.

Background Nearly after 6 months of the spread of Corona Virus Disease 19, along with the world Nepal is still trying to control the spread and prevent general population from acquiring it. With limited resources in manpower, technology and evidence it has been a difficult battle. But with time and more understanding of the virus new technology to detect the virus are coming up. It is a major breakthrough in the diagnostic field as this helps us in not only detecting the virus but also helps us to mobilize our human resources. This comes in a time where the cases are increasing at an alarming rate. Although numbers of Polymerase Chain Reaction testing have increased but due to the time consuming and the cost wise, we need a faster and equally reliable alternative. Antigen test approved by different countries can be used for point of care, screening and surveillance depending upon the requirements after calculating its sensitivity, specificity and accuracy. Objective To find out sensitivity and specificity of the Antigen test kit for COVID-19. Method Antigen tests were compared with Reverse Transcription Polymerase Chain Reaction as a reference standard in calculated sample size of 113 subjects in a high risk population. Both Reverse Transcription Polymerase Chain Reaction and antigen test were performed in a same subject with in maximum of 2 days' interval. Convenience sampling technique was used to select the subjects. Ethical approval was taken from Nepal Health Research Council before data collection. Study was done from August to September 2020 from Quarantine center of Province 3. Result There were total of 113 test carried out, among those 47 were positive and 66 were negative in Reverse Transcription Polymerase Chain Reaction. After preparing two by two table, Sensitivity and specificity of the tested was calculated which came out to be 85% and 100% respectively, with accuracy of 93.80%. Conclusion Even though the sensitivity and specificity came to be higher, this test should be interpreted cautiously depending upon the prevalence of Corona Virus Disease 19 in that particular community and the clinical and epidemiological context of the person who has been tested. When in doubt by clinical correlation should be confirmed with Reverse Transcription Polymerase Chain Reaction.

Virtual pedagogy in neurosurgery during the COVID-19 pandemic: Perspectives from university hospital in Nepal.

Objectives: Since the onset of the COVID-19 pandemic many large institutions have turned towards virtual education. Neurosurgery in our institute, recognizing its benefits, readily embraced the virtual learning experience using Zoom Inc (San Jose, California) beginning on May 21, 2020. The result of this form of educational experience may not be apparent readily. Hence, nearing the end of one year of monthly Zoom meetings, an effort was undertaken to assess the feasibility and the barriers of effective virtual teaching learning activity in neurosurgery among the participants. Methods: The participants consisted of neurosurgeons and trainees from department of neurosurgery Tribhuvan University Teaching Hospital in Nepal, neurosurgeons based in Seattle, United States of America and neurosurgeons based in Sweden, who have been regularly attending the monthly virtual education organized by Dr. Wohns. At the end of one-year experience of monthly Zoom teaching and learning activities between the participants a questionnaire comprising objective questions related to their experience of virtual education in neurosurgery was distributed to the participants and answers were collected and analyzed. Results: A total of 18 persons out of 25 responded to the questionnaire. Majority of participants responded favorably to virtual education. A few responders faced disturbance in internet connectivity affecting the quality of video and sound during the presentations. None of the participants faced inconvenience due to time difference. Most responders preferred to continue virtual education even after the pandemic. Conclusions: Overall most participants responded favorably to virtual education which has helped them increase their participation and hence broaden their knowledge in the field. Most participants look forward to continuing this form of education even in future. Thus, this form of education may be incorporated at least in part in the future of neurosurgical training.

Anaerobic pond treatment of wastewater containing sulphate.

Anaerobic ponds are usually used for treatment of industrial and agricultural wastes which contain high organic matter and sulphate. Competition for substrate between sulphate reducing bacteria and methane producing archaea, and the inhibitory effects of sulphide produced from microbial sulphate reduction reported in the literature varied considerably. In this research, a laboratory scale column-in-series anaerobic pond reactor, consisting of five cylindrical columns of acrylic tubes, was operated to evaluate the effect of COD and sulphate ratio on pond performance treating wastewater containing high organic matter and sulphate from a tapioca starch industry. The result depicted that no adverse effect of COD:SO4 ratios between 5 and 20 on overall COD removal performance of anaerobic pond operated with organic loading rate (OLR) of 150 to 600 g COD/m3d. Sulphate reducing bacteria could out-compete methane producing archaea for the same substrate at COD:SO4 ratio equal to or lower than 5 and OLR greater than 300 g COD/m3d. Sulphide inhibition was not observed on overall performance of pond up to an influent sulphate concentration of 650 mg/L.

Modeling of anaerobic treatment of wastewater in ponds.

A mathematical model to simulate the performance of anaerobic ponds was developed incorporating both settling of particulate components and the biological anaerobic digestion process. The biological activity includes solubilization of particulate organic matter; methanogenesis and the sulphate reduction process. The model considers that an anaerobic pond comprises a series of equal size columns. Each column has three compartments viz. liquid layer, active sediment layer and inert sediment layer. The existence of organic matter and sulphate removal mechanisms both in the bulk as well as sediment layer of the ponds and the exchange of the soluble components between the layers has been included in the model. The model was transferred to a computer program using VisSim Basic software. The model was verified by comparing simulated results with full-scale as well as with laboratory-scale anaerobic pond performance data. A good agreement between the simulated and the observed pond performance was achieved.

Bioremediation of sediments from intensive aquaculture shrimp farms by using calcium peroxide as slow oxygen release agent.

A viable treatment procedure was developed in this research with calcium peroxide (CaO2) as a slow oxygen (O2) release agent for bioremediation of polluted sediments from intensive shrimp farms containing high organic carbon, nitrogen and phosphorus. Experiments with sediment treatment by CaO2 were carried out with, as well as without, biomass seeding at pH ranging from 6.5 to 8.5. The sediment treatment applying CaO2 without seeding yielded a BOD5, organic-C and organic-N removal up to 95%, 17.6% and 75%, respectively compared to the removal of 66%, 8.6% and 57%, respectively in the controlled treatment without CaO, addition. The investigations were also carried out with CaO2 dosage with biomass seeding at different food-to-microorganisms (F/M) ratio between 0.1 and 0.25. The BOD, organic-C and organic-N removal up to 92%, 17.6% and 73%, were achieved for a F/M ratio 0.1. The experimental results indicated complete organic-P removal within 5-7 days of treatment without seeding and within the initial 2 days of treatment with seeding. The present research revealed that, the application of CaO2 could enhance the degradation of organic-C, organic-N and organic-P during the treatment of polluted sediment.

Anaerobic ponds treatment of starch wastewater: case study in Thailand.

Anaerobic ponds are particularly effective in treating high-strength wastewater containing biodegradable solids as they achieve the dual purpose of particulate settlement and organic removal. Performance of an anaerobic pond system for treatment of starch wastewater containing high organic carbon, biodegradable starch particulate matter and cyanide was assessed under tropical climate conditions. Approximately 5000 m3/d of wastewater from starch industry was treated in a series of anaerobic ponds with a total area of 7.39 ha followed by facultative ponds with an area of 29.11 ha. Overall COD and TSS removal of over 90% and CN removal of 51% was observed. Active biomass obtained from the anaerobic ponds sediments and bulk liquid layer exhibited specific methanogenic activity of 20.7 and 11.3 ml CH4/g VSS d, respectively. The cyanide degradability of sludge at initial cyanide concentration of 10 and 20 mg/l were determined to be 0.43 and 0.84 mg CN-/g VSS d, respectively. A separate settling column experiment with starch wastewater revealed that a settling time of approximately 120 min is sufficient to remove 90-95% of the influent TSS.

Modeling response of nitrifying biofilm to inhibitory shock loads.

To study the response of nitrifying biofilm to inhibitory shock loads, a lab-scale nitrifying biofilm reactor was operated in ambient conditions. Shock loads of various concentrations of inhibitory compound were applied to the biofilm. Aniline was used as an inhibitory compound. The experimental results were utilized to develop a model for predicting the variation of effluent nitrate concentration from the biofilm reactor for given shock loads of aniline concentration and exposure time both in exposure as well as in recovery phase. Close agreement between model and experimental observation of bulk aniline concentration and effluent nitrate concentration was obtained which indicates the usefulness of the model to estimate bulk aniline concentration and to predict the response of inhibitory shock loads on nitrifying biofilm.

An analysis of surgical complications; a tool to improve surgical outcome.

Complications in surgery are an important cause of morbidity and mortality. Complications may result in an increased length of stay in hospital, repeat surgery, additional medical treatment, legal issues and increased costs. Classification and regular audit of complications is a useful tool to improve patient safety and surgical outcome. The purpose of this study is to identify and classify surgical complications and evaluate the various contributing factors. The complications were categorized by Clavein Dindo system as Grade 1:52 (29.1%), Grade II :45 (25.1%),Grade IIIa:26 (14.5%), Grade IIIB:25 (14%), Grade IVa:5 (2.8%), Grade IVb:0 and Grade V:26 (14.5%) . The complication rate was 5.3% and mortality rate was 0.8% in total 3336 surgical procedures. There was significantly higher mortality in complications due to patient related factors 23.4% (11/47), compared to technical factors 4.2% (2/48) and other factors 15.4% (13/84) (p value = 0.024). The mortality was significantly higher in the patients who required ICU care, 54% (20/37), in class B surgical procedures 22.4% (22/98) and those who developed complications after emergency procedures were 31% (14/45). The mortality was significantly higher in the patients who required medical intervention for various medical complications 30.1% (19/63) compared to those who required surgical intervention 8.4% (5/59) or were managed conservatively 3.5% (2/57) (p value = 0.0001).