Functional Status of Senior Citizens of a Metropolitan City in Morang.

Background Functional abilities start to decelerate after the age of 70 and causes need for assistance to do their basic activities of daily living (BADL) as well as instrumental activities of daily living (IADL). Objective To find out the functional status of senior citizens of a Metropolitan city in Morang. Method A descriptive cross-sectional study was carried out at Biratnagar Metropolitan City among 254 senior citizens receiving old age allowance using cluster sampling technique. Data were collected through face to face interview and measuring height and weight by researcher herself for the period of four weeks. Basic activities of daily living and instrumental activities of daily living were assessed using Katz Index of Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living tool with some modifications. Chi square test was used to assess the association between variables. Result About 48.4% and 90.6% of senior citizens had dependency in Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living respectively. The most common dependency for Basic Activities of Daily Living and Instrumental Activities of Daily Living was control of urination and defecation (31.9%) and using telephones (75.2%) respectively. Basic activities of daily living was significantly associated with age (p=0.0017), sex (p=0.013), literacy status (p=0.001), years of smoking (p=0.0029), social participation (0.0029) and history of fall within 1 year (p=0.038). Likewise Instrumental Activities of Daily Living was significantly associated with age (p=0.03), sex (p=0.035), literacy status (p=0.002), exercise (p=0.033) and social participation (p= 0.001). Conclusion It is concluded that about half of the senior citizens are dependent in Basic Activities of Daily Living and almost all of them are dependent in Instrumental Activities of Daily Living. So senior citizen clubs/ groups are suggested to be strengthened which may.

Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal.

Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography. Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics. Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 nondiabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI. Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration < 10 years (64.7% vs. 35.3%, P < 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c > 8.5%). 72.2% of the patients with HbA1c > 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c < 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration <10 years.

Coxsackie B Virus Infection as a rare cause of Acute Renal Failure and Hepatitis.

We report a 37 year female patient, admitted with complains of fever, jaundice and myalgia of seven days. There was no history of trauma, drug abuse, seizure or vigorous exercise nor history of renal and musculoskeletal disease. Here we have discussed the clinical features, biochemical derangements, diagnosis of coxsackie B virus, multi organ involvement and need of urgent hemodialysis for appropriate management of the case.

Perceived Health Promoting Education Needs of Middle-aged Population in Dhulikhel Municipality of Nepal.

Background Health promoting education need assessment is of utter importance while conducting health promoting education programs. However little efforts have been put on this by the policy level authorities and there are no studies to assess the perceived health promoting education needs of the middle aged population of Nepal till date. Objective The objective of this study was to assess the perceived health promoting education needs of middle-aged population in Dhulikhel municipality. Method A descriptive cross-sectional study was conducted among 300 respondents using two staged cluster and systematic technique. Face to face interview technique was used for data collection. T-test was used for comparison of dependent variables with independent variables. Result The study revealed that the mean education need score was 66.66±16.09 (in a score of minimum 25 and maximum 125). Cancer prevention was perceived as the topic of highest education need and retirement planning as the topic of least education need. There was statistically significant difference in the mean perceived education need score between male and female (p=0.048), respondents with exposure and non-exposure to health related programs on mass-media (p=0.020) and mental component summary score < 50 and mental component summary scores >=50 (p=0.048). Conclusion This study suggested that the community people have perceived moderate level of health promoting education need. Since cancer prevention was the highest rated topic followed by chronic illness prevention and dementia, it is recommended to focus on these topics while organizing any health promoting education programs in the community.

Superhalogen properties of CumCln clusters: theory and experiment.

Using a combination of density functional theory and anion photoelectron spectroscopy experiment, we have studied the structure and electronic properties of CuCl(n)(-) (n = 1-5) and Cu(2)Cl(n)(-) (n = 2-5) clusters. Prominent peaks in the mass spectrum of these clusters occurring at n = 2, 3, and 4 in CuCl(n)(-) and at n = 3, 4, and 5 in Cu(2)Cl(n)(-) are shown to be associated with the large electron affinities of their neutral clusters that far exceed the value of Cl. While CuCl(n) (n ≥ 2) clusters are conventional superhalogens with a metal atom at the core surrounded by halogen atoms, Cu(2)Cl(n) (n ≥ 3) clusters are also superhalogens but with (CuCl)(2) forming the core. The good agreement between our calculated and measured electron affinities and vertical detachment energies confirm not only the calculated geometries of these superhalogens but also our interpretation of their electronic structure and relative stability.

Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel.

BACKGROUND: Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. OBJECTIVE: To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. ELIGIBILITY CRITERIA: All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. SOURCES OF EVIDENCE: PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. CHARTING METHODS: Evidence was searched according to clinically relevant topics and PICO questions. RESULTS: Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. CONCLUSIONS: Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.

Heterotopic pregnancy with spontaneous intrauterine conception: a rare clinical entity with diagnostic dilemma.

Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score.

Ultrasound evaluation of normal orbital preseptal thickness.

INTRODUCTION: Orbital preseptal thickness is an important parameter not only in diagnosis of orbital cellulitis but also in recent classification and management of dark eye circle (DEC). OBJECTIVE: The aim of this study was to evaluate normal preseptal thickness and collect baseline data in normal skin in a given population with no orbital pathology. MATERIALS & METHOD: Ultrasound was performed on 42 patients (23 females and 19 males) with clinically normal eyes and orbits for evaluation of normal orbital preseptal thickness. The age ranged between 15 to 35 years with a mean age of 24.9 years. RESULTS: Our study concluded that normal preseptal thickness ranged from 2.1 mm to 5.5 mm. Mean preseptal thickness for both sides was 3.9 mm. CONCLUSION: Ultrasound can be used as quick, reliable and cost-effective modality for evaluation of orbital preseptal thickness.

LncRNA-mediated regulation of cell signaling in cancer.

To date, a large number of long non-coding RNAs (lncRNAs) have been recently discovered through functional genomics studies. Importantly, lncRNAs have been shown, in many cases, to function as master regulators for gene expression and thus, they can play a critical role in various biological functions and disease processes including cancer. Although the lncRNA-mediated gene expression involves various mechanisms, such as regulation of transcription, translation, protein modification, and the formation of RNA-protein or protein-protein complexes, in this review, we discuss the latest developments primarily in important cell signaling pathways regulated by lncRNAs in cancer.

Outcomes Bronchoscopic Evaluation in A University Hospital.

INTRODUCTION: Study of clinical profile of the patients and diagnostic yield of the selected bronchoscopic procedures gives us important information in clinical decision making and better patient care. There are hardly very few studies regarding these entities. Therefore, we decided to study clinical characteristics and outcomes of the patients who underwent bronchoscopic evaluation in our setting. METHODS: This was a cross-sectional study the consecutive patients who underwent bronchoscopy from 1st May 2013- 30th April 2015 in division of pulmonary, critical care and sleep medicine. The main procedure performed was bronchoalveolar lavage. RESULTS: The mean age was 54.71 years with 76 (76%) males. Recurrent hemoptysis in 58 (58%) patients were the commonest indication. Total 95 (95%) patients have chest X-ray abnormalities. The commonest bronchoscopic finding was bronchiectasis 23 (23%) of patients followed by chronic bronchitis in 18 (18%) and endobronchial tuberculosis in 16 (16%). Total 10 (71%) of the 14 bronchoscopically suspected lung cancer patients have intraluminal lesions. Bronchoalveolar lavage culture for tuberculosis showed growth in 46 (46%), positive for malignancy in 7 (7%) positive Ziehl Neelson stain for tuberculosis in 6 (6%). CONCLUSIONS: Bronchoscopic evaluation of patients with pulmonary diseases gives us a lot of information that may help us in better patient care and bronchoalveolar lavage has high diagnostic yield in diagnosing pulmonary tuberculosis.

Occurrence of aflatoxin in some of the food and feed in Nepal.

BACKGROUND: There are many contaminants like aflatoxin present in food products. Aflatoxin in comparison to many other contaminants is very toxic and also carcinogenic. There are reports of outbreak of aflatoxin toxicity in many parts of the world. AIM: To find out the level of aflatoxin in common food and feed. SETTING: The study was conducted in 16 districts of the Eastern region of Nepal. METHODS AND MATERIALS: Samples were collected from retailers and whole sellers from 1995 to 2003. Common food items that had high chances of infestation were collected. Food sample were taken to the laboratory to estimate the level of aflatoxin. The thin layer chromatography method was used to detect aflatoxin in the samples and comparison of fluorescence of sample spot with fluorescence of standard for estimation. RESULT: There were 832 samples for aflatoxin detection and estimation. One-third samples were found to be contaminated with aflatoxin. The highest percentage of contamination was found in peanut butter/vegetable oil (42.5%) and the lowest in areca nut (25%). Highest proportion of cornflakes samples were found to be contaminated with aflatoxin by more than the recommended value (30 ppb) and contamination in peanut was the lowest. CONCLUSION: People consume many common food items that contain aflatoxin. It is of high importance for the concerned department to give attention to this important public health issue. Even in small doses, continuous consumption can lead to many health problems. So it is of paramount importance to detect and control these contaminants in food items.

Surface determination through atomically resolved secondary-electron imaging.

Unique determination of the atomic structure of technologically relevant surfaces is often limited by both a need for homogeneous crystals and ambiguity of registration between the surface and bulk. Atomically resolved secondary-electron imaging is extremely sensitive to this registration and is compatible with faceted nanomaterials, but has not been previously utilized for surface structure determination. Here we report a detailed experimental atomic-resolution secondary-electron microscopy analysis of the c(6 × 2) reconstruction on strontium titanate (001) coupled with careful simulation of secondary-electron images, density functional theory calculations and surface monolayer-sensitive aberration-corrected plan-view high-resolution transmission electron microscopy. Our work reveals several unexpected findings, including an amended registry of the surface on the bulk and strontium atoms with unusual seven-fold coordination within a typically high surface coverage of square pyramidal TiO5 units. Dielectric screening is found to play a critical role in attenuating secondary-electron generation processes from valence orbitals.

A case report and overview of organophosphate (OP) poisoning.

A case of organophosphate (OP) poisoning who recovered after requiring almost 1000 mg of atropine, 10 gm of PAM and ventilatory support for 7 days is presented here. The overview of organophosphate poisoning and its management is given. With the approach adopted, the mortality reported in the general medicine unit in the central hospital in Nepal is 7.4%. The two important aspects of the management are vigilance of the atropine drip, especially at night, and other physical and psychological support care of the patients.