Examining the Relationship Between Workplace Industry and COVID-19 Infection: A Cross-sectional Study of Canada's Largest Rapid Antigen Screening Program.

OBJECTIVES: To control virus spread while keeping the economy open, this study aimed to identify individuals at increased risk of COVID-19 transmission in the workplace using rapid antigen screening data. METHODS: Among adult participants in a large Canadian rapid antigen screening program (January 2021-March 2022), we examined screening, personal, and workplace characteristics and conducted logistic regressions, adjusted for COVID-19 wave, screening frequency and location, role, age group, and geography. RESULTS: Among 145,814 participants across 2707 worksites, 6209 screened positive at least once. Workers in natural resources (odds ratio [OR] = 2.1 [1.73-2.55]), utilities (OR = 1.67 [1.38-2.03]), construction (OR = 1.35 [1.06-1.71]), and transportation/warehousing (OR = 1.32 [1.12-1.56]) had increased odds of screening positive; workers in education/health (OR = 0.62 [0.52-0.73]), leisure/hospitality (OR = 0.71 [0.56-0.90]), and finance (OR = 0.84 [0.71-0.99]) had lesser odds of screening positive, compared with professional/business services. CONCLUSIONS: Certain industries involving in-person work in close quarters are associated with elevated COVID-19 transmission. Continued reliance on rapid screening in these sectors is warranted.

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Cystic endometriosis in a degenerated sub-serous myoma in a sub-fertile woman: A case report.

INTRODUCTION AND IMPORTANCE: Leiomyoma is the most common gynecologic tumor which may show atypical locations and degenerations. Cystic degeneration is said to be found in 4 % of all degenerations. Endometriosis, the presence of endometrial glands and stroma at extrauterine sites, is a common gynaecological condition seen in 10 % to 15 % of reproductive-age women usually being associated with various degrees of fertility problems. CASE PRESENTATION: 40 years old woman with P1L1A2, with secondary sub-fertility for 5 years, presented with chief complaints of dysmenorrhoea for 1 year initially around the menstrual cycle relieving with analgesics but later not limited to the menstrual cycle and pain not relieving with analgesics since 1 month. The patient underwent fertility-sparing laparoscopic removal avoiding a laparotomy and definitive hysterectomy. Manual morcellation was achieved. CLINICAL DISCUSSION: Cystic degeneration is rare in Leiomyoma although it is the more common gynaecological tumor in women and is associated with endometriosis probably due to retrograde menstruation. CONCLUSIONS: Laparoscopic removal of leiomyoma without laparotomy and definitive hysterectomy for a case of cystic endometriosis in a degenerated subserous myoma which to the best of our knowledge according to our search of articles on the relevant topic is the first reported case pertaining to the topic from Nepal.

Large-area and low-cost SERS substrates based on a gold-coated nanostructured surface fabricated on a wafer-scale.

This paper demonstrates a method to fabricate plasmonic nanostructures over a large area that can be implemented as SERS substrates. The proposed method comprises batch processes such as spin coating, reactive ion etching, and thin metal deposition. These processes can be performed on large wafers, resulting in large numbers of SERS substrates in a single run. The effects of different process parameters were studied to optimize the performance of the SERS substrates. The study of sensitivity on the optimized SERS substrates was conducted using the SERS-active molecule pMBA. The SERS substrates thus fabricated were able to detect molecule concentrations as low as 100 nM. The SERS substrates were also evaluated for uniformity across the sample and for sample-to-sample reproducibility. Finally, the SERS substrates were applied to demonstrate label-free detection of organophosphorous pesticides - paraoxon ethyl and paraoxon methyl.

Large-scale implementation of rapid antigen testing system for COVID-19 in workplaces.

The transmission of coronavirus disease 2019 (COVID-19) in workplaces has been a persistent issue throughout the pandemic. In response, a not-for-profit initiative emerged to mitigate COVID-19 workplace transmission in Canada. We report the process for establishing a workplace frequent rapid antigen test (RAT) program. The screening program identified 473 asymptomatic individuals who tested positive on the RAT and confirmed positive by a nasopharyngeal polymerase chain reaction (PCR) diagnostic test. One in 4300 RATs was presumptive positive but later tested PCR negative, and thus, false positives did not meaningfully disrupt workplace operations. Most employers rated the program highly and felt strongly that the program contributed to workplace and community safety. The findings describe a sustained and scalable implementation plan for establishing a frequent workplace testing program. High-frequency testing programs offer the potential to break chains of transmission and act as an extra layer of protection in a comprehensive public health response.

Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study.

BACKGROUND: The maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries. This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality. METHODS: This is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year's study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics. RESULTS: There was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%). CONCLUSIONS: Despite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.

Nanostructured plasmonic chips employing nanopillar and nanoring hole arrays for enhanced sensitivity of SPR-based biosensing.

We present a theoretical analysis of the different nanostructured plasmonic sensor chips-consisting of plasmonic nanostructures present on the surface of plasmonic thin films-interrogated using the Kretschmann configuration for highly sensitive localized sensing, with high tunability from the visible to the infrared regions. Rigorous coupled-wave analysis is performed to analyze all the proposed nanostructured sensor chips and compare their sensing performance. The sensitivity parameters are defined to focus on the detection of a thin layer of biomolecules on the surface of nanostructures. The dimensions of the nanostructures and the incident angle shift the plasmon resonance wavelengths and can be used to tune the operating wavelength. The nanostructured films create local regions of high electric fields, which results in enhanced sensitivity of the proposed structures. The proposed sensors can be used in surface plasmon resonance imaging to detect multiple biomolecules in a single measurement. An extremely high surface sensitivity and figure of merit (FOMS) of 91 nm nm-1 and 0.59 nm-1 has been found, respectively, for one of the proposed nanostructured sensing platforms. Moreover, we demonstrate a very high differential reflectance of 55% per nm thickness of the biolayer.

Emergency laparoscopic repair of coitus-induced vaginal cuff dehiscence: a case report.

BACKGROUND: Vaginal cuff dehiscence is a rare but potentially grave complication after total hysterectomy. Abdominal or pelvic contents are at risk of evisceration through the vaginal opening. It is associated with significant risk for patient morbidity, such as peritonitis, bowel injury, and sepsis. CASE PRESENTATION: We report a case of vaginal cuff dehiscence in a 45-year-old multiparous Taiwanese woman who had undergone abdominal total hysterectomy and presented with vaginal cuff dehiscence precipitated by sexual intercourse. Immediate laparoscopic repair was done. Few authors have reported the utilization of the laparoscopic approach. It allows thorough inspection, visualization, and irrigation of the abdominal cavity. It is also associated with fewer intraoperative and postoperative complications. CONCLUSION: Laparoscopic repair is a safe treatment option to manage vaginal cuff dehiscence after total hysterectomy.

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital.

INTRODUCTION: Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. METHODS: A descriptive cross-sectional study was done at a tertiary care hospital among 1912 patients who had major gynecological surgeries from January 2017 to December 2019. Ethical clearance was obtained from the institutional review committee (ref. no. ACD 935/076/077). Convenient sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: During the study period, there were 1,912 major gynecological surgeries and the prevalence of hysterectomy was 1,131 (59.15%) (56.94-61.35 at 95% Confidence Interval). Fibroid uterus was the most common clinical indication for hysterectomy which was done in 397 (35.10%) patients, followed by uterovaginal prolapse in 254 (22.46) patients, adnexal mass in 210 (18.56%), and abnormal uterine bleeding in 117 (10.34%) patients. CONCLUSIONS: Hysterectomy, being the most common gynecological surgery, selection of the most appropriate route is of paramount importance. As for any other surgery, it is not without complication and hysterectomy should always be justified. With the advancement in the conservative approaches, these organ-preserving options should be explored rigorously before opting for hysterectomy.

Two-color pyrometry system to eliminate optical errors for spatially resolved measurements in flames.

Two-color (2C) pyrometry has long been used to measure flame temperature and soot concentration from radiative emission in flames. While 2C pyrometry is not an absolute measurement in non-axisymmetric flames (such as diesel spray combustion), it is a desirable diagnostic for semi-quantitative or qualitative measurements since it requires minimal optical access and can utilize high-speed imaging to attain exceptional temporal and spatial resolutions. In this work, an improved optical configuration of 2C pyrometry is presented that (1) eliminates optical errors inherent in other designs and (2) uses off-the-shelf optics and a single camera. In particular, this work analyzes the impact of parallax and path length differences on the 2C pyrometry measurement and exemplifies how the present design eliminates associated errors by design rather than in post-processing. The theoretical range of measurements were generated a priori and overlaid with experimental data to illustrate the dynamic range over which 2C pyrometry can determine the soot concentration and temperature in theory and in practice.

Phase boundary detection in transient, evaporating high-pressure fuel sprays by rainbow schlieren deflectometry.

The rainbow schlieren deflectometry (RSD) technique is used to simultaneously identify the liquid and vapor boundaries during transient evolution of evaporating high-pressure fuel sprays. Traditionally, liquid and vapor phases require separate diagnostics, whereas this work relies upon a single technique to identify each phase, in addition to the previously demonstrated capability of RSD to measure local fuel-air mixing in the vapor zone. The proposed RSD methodology is a significant improvement over a previously published technique, i.e., it is applicable to the transient period, and much less data and hence, computational effort, is required. Experiments are conducted in a constant pressure flow rig for multiple fuels and test conditions to demonstrate the capability of the proposed RSD diagnostic. For each test condition, multiple injections are performed in quick succession to obtain statistically significant data sets to depict the spray evolution at a spatial resolution of 100 µm, a camera framing rate up to 40 kHz, and an exposure time down to 1 µs. The method and the results are compared and discussed within the context of prior work using RSD, Mie-scattering, and Siebers' liquid length scaling law.

Risk Factors Related to Intrauterine Fetal Death.

BACKGROUND: Intrauterine fetal death is a traumatic event. Stillbirth rate is an important indicator to assess the quality of antenatal care. The objective of the study was to identify the risk factors related to intrauterine fetal death in patients admitted with intrauterine fetal death. METHODS: It was a descriptive study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences from January to December 2014. Patients admitted with singleton pregnancy with intrauterine fetal death after 28 weeks gestation were included. RESULTS: There were 11,006 obstetric admissions. Of them, 152 women had intrauterine fetal death. There were 128(84.2%) women between 20-35 years of age. Out of 152, 81(53.3%) women were preterm and 39(2.1%) women were postterm. Primigravida were 77(50.7%) followed by 35(23%) of second gravida. Hypertension was the commonest identified risk factor in 30(26.78%) women. Out of 152 women, 49(32.2%) had not received formal education. Ten (6.6%) women had a past history of fetal death. Four (2.6%) women had medical disorder before pregnancy. One hundred and twenty five (82.2%) women had vaginal delivery, 21(13.8%) had caesarean section and 6(3.9%) had laparotomy for rupture uterus. The commonest indication for caesarean section was placenta previa for 7(33.33%) women. Four (2.6%) women had diabetes. Ninety five (62.5%) were male and 57(37.5%) were female babies. Five (3.3%) babies had malformations. CONCLUSIONS: Hypertension in pregnancy was found to be the most common identified risk factor for intrauterine fetal death.

Accuracy of Frozen Section with Histopathological Report in an Institute.

INTRODUCTION: Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report. METHODS: This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study. RESULTS: The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%. CONCLUSIONS: The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.

Quantifying liquid boundary and vapor distributions in a fuel spray by rainbow schlieren deflectometry.

The rainbow schlieren deflectometry (RSD) technique is used to determine the liquid boundary and the fuel volume fraction distributions in the vapor region of a high-pressure fuel spray. Experiments were conducted in a constant pressure flow vessel, whereby a customized single-hole common-rail diesel injector is used to introduce n-heptane fuel into a coflow of low-speed ambient air at two different test conditions. Only the quasi-steady period of the fuel spray is considered, and multiple injections are performed to acquire statistically significant data at an image acquisition rate of 20 kHz. An algorithm to identify the liquid boundary using intensity recorded by the RSD images is presented. The results are compared against measurements obtained by the Mie scattering technique. Results demonstrate that the RSD can be a powerful optical diagnostics technique to simultaneously quantify both the vapor and liquid regions in the high-pressure fuel sprays.

A case report of hemophagocytic lymphohistiocytosis (HLH).

Hemophagocytic lymphohistiocytosis (HLH), is an uncommon, life-threatening hyperinflammatory syndrome caused by severe hypercytokinemia with excessive activation of lymphocytes and macrophages due to a highly stimulated but ineffective immune process. We report a case of Hemophagocytic Lymphohistiocytosis in a 15 year old boy presenting with fever, lymphadenopathy and pancytopenia due to infection caused by Klebsiella Pneumoniae and Acinetobacter.

Asymptomatic bacteriuria in pregnant women.

INTRODUCTION: Asymptomatic bacteriuria is the significant presence of bacteria in urine of an individual without symptoms. The aim of the study is to determine the prevalence of asymptomatic bacteriuria in pregnant women. METHODS: This study was a prospective study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences. The duration of the study was six months from January to June 2012. A total of 600 pregnant women were enrolled. All women were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into a sterile vial. The urine samples were examined for microscopic and culture sensitivity test. RESULTS: Out of 600 pregnant women, 52 were positive for significant bacteriuria with a prevalence rate of 8.7%. There was a significant difference in prevalence of asymptomatic bacteriuria with respect to trimester (p=0.005). Age did not show any significant difference in the prevalence of asymptomatic bacteriuria (p=0.807). There was not any significant difference in the prevalence of asymptomatic bacteriuria with respect to parity (p=0.864) and booking status (p=0.397). Escherichia coli (35%), Acinetobacter species (15%), Enterococcus species (12%) and Klebsiella pneumoniae (10%) were the common isolates. Most of the isolates were sensitive either to Nitrofurantoin, Norfloxacin or Amikacin. CONCLUSIONS: Asymptomatic bacteriuria is common in pregnancy. Urine culture sensitivity should be carried out routinely on all pregnant patients in order to prevent the dangerous complications associated with it.

Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy.

BACKGROUND: Perinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE) is a common problem causing multi organ dysfunction including myocardial involvement which can affect the outcome. OBJECTIVE: To evaluate the myocardial dysfunction in neonates having HIE by electrocardiographic(ECG) and cardiac enzymes (CK Total, CK-MB and Troponin I) and find out the relationship with HIE and outcome. DESIGN/METHODS: This was a hospital based prospective study. Sixty term neonates who had suffered perinatal asphyxia and developed HIE were enrolled. Myocardial involvement was assessed by clinical, ECG, and CK Total, CK-MB and Troponin I measurements. RESULTS: Of 60 cases, 13(21.7%) were in mild, 27(45%) in moderate and 20(33.3%) belonged to severe,HIE. ECG was abnormal in 46 (76.7%); of these 19 (41.3%) had grade I, 13 (28.2%) grades II and III each and 1 (2.1%) with grade IV changes. Serum levels of CK Total, CK- MB and Troponin I were raised in 54 (90%), 52 (86.6%) and 48 (80%) neonates, respectively. ECG changes and enzymatic levels showed increasing abnormalities with severity of HIE, and the differences among different grades were significant (p = 0.002, 0.02, <0.001 and 0.004, respectively). Nineteen (32%) cases died during hospital stay. The non- survivors had high proportion of abnormal ECG (p = 0.024), raised levels of CK-MB (p = 0.018) and Troponin I (p = 0.008) in comparison to survivors. CONCLUSIONS: Abnormal ECG and cardiac enzymes levels are found in HIE and can lead to poor outcome due to myocardial damage Early detection can help in better management and survival of these neonates.

Abel inversion of deflectometric data: comparison of accuracy and noise propagation of existing techniques.

Abel inverse integral to obtain local field distributions from path-integrated measurements in an axisymmetric medium is an ill-posed problem with the integrant diverging at the lower integration limit. Existing methods to evaluate this integral can be broadly categorized as numerical integration techniques, semianalytical techniques, and least-squares whole-curve-fit techniques. In this study, Simpson's 1/3rd rule (a numerical integration technique), one-point and two-point formulas (semianalytical techniques), and the Guass-Hermite product polynomial method (a least-squares whole-curve-fit technique) are compared for accuracy and error propagation in Abel inversion of deflectometric data. For data acquired at equally spaced radial intervals, the deconvolved field can be expressed as a linear combination (weighted sum) of measured data. This approach permits use of the uncertainty analysis principle to compute error propagation by the integration algorithm. Least-squares curve-fit techniques should be avoided because of poor inversion accuracy with large propagation of measurement error. The two-point formula is recommended to achieve high inversion accuracy with minimum error propagation.