The Galerkin-truncated Burgers equation: crossover from inviscid-thermalized to Kardar-Parisi-Zhang scaling.

The one-dimensional Galerkin-truncated Burgers equation, with both dissipation and noise terms included, is studied using spectral methods. When the truncation-scale Reynolds number [Formula: see text] is varied, from very small values to order 1 values, the scale-dependent correlation time [Formula: see text] is shown to follow the expected crossover from the short-distance [Formula: see text] Edwards-Wilkinson scaling to the universal long-distance Kardar-Parisi-Zhang scaling [Formula: see text]. In the inviscid limit, [Formula: see text], we show that the system displays another crossover to the Galerkin-truncated inviscid-Burgers regime that admits thermalized solutions with [Formula: see text]. The scaling forms of the time-correlation functions are shown to follow the known analytical laws and the skewness and excess kurtosis of the interface increments distributions are characterized. This article is part of the theme issue 'Scaling the turbulence edifice (part 2)'.

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.

Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal.

Background Good governance and leadership are essential to improve healthy life expectancy particularly in low and middle-income countries (LMICs). This study aimed to epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases (CVD) in Nepal. Objective The objective of this study was to understand and document CVD programs and policy formulation processes and to identify the government capacity to engage stakeholders for planning and implementation purposes. Method A national-level task force was formed to coordinate and steer the overall need assessment process. A qualitative study design was adopted using "The Health System Assessment Approach". Eighteen indicators under six topical areas in leadership and governance in cardiovascular health were assessed using desk review and key informant interviews. Result Voice and accountability exist in planning for health from the local level. The government has shown a strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination has not been effective. There are strong rules in place for regulatory quality, control of corruption, and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been minimum. There is a scarcity of cardiovascular disease-specific protocols. Conclusion Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research, and work towards developing CVD-specific guidelines, protocols, and capacity building. KEY WORDS Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal.

Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort).

OBJECTIVE: Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD: Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS: Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (ß = 0.94, P = 0.016), younger age (ß = -0.07, P = 0.031) and absence of current comorbid major depression disorder (ß = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS: Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.

Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication.

Background Neck-shaft angle (NSA) is one of the prominent features in the proximal femur which is an important determinant of fracture of femoral neck. Present study evaluating the value of neck-shaft angle has relied heavily on radiographs. As knowledge of neck-shaft angle is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the two different genders and various age groups of both right and left femora of Nepalese population. Objective To ascertain the value of neck-shaft angle in the Nepalese population by means of a radiographic study and to correlate the values with regard to right neck-shaft angle/ left neck-shaft angle side (RNSA/LNSA), gender and three different age group. Method Normal pelvic radiographs of 148 patients seen at department of orthopedic and radiology, College of Medical Sciences- Teaching Hospital (COMS-TH), Bharatpur, Chitwan from the month of February 2017 to June 2017 were divided into two different gender and three different age groups (21-40 years, 41-60 years and Above 60 years) and their neck-shaft angle of both right and left sides were recorded. Result The average of RNSA and LNSA were found to be 132.96±6.05° and 131.54±13.66° respectively for male and 134±6.57° and 132.98±6.23° respectively for female. In total the average RNSA and LNSA were 133.51±6.32° and 132.26±10.61° respectively. Similarly, the average RNSA and LNSA for three different age groups (21-40 years, 41-60 years and Above 60 years) were found to be 133.76±6.44°, 133.69±6.36° and 132.50±6.06° and the 133.35±6.29°, 132.47±5.85° and 128.84±21.98° respectively. Conclusion The average neck-shaft angle recorded here shows no significant difference in both RNSA and LNSA in males except for a small and significant difference in LNSA in female of three different age groups.

Missed opportunities to diagnose syphilis prior to the development of sight-losing uveitis.

The incidence of syphilis in the UK is rapidly rising. Uveitis (intraocular inflammation) usually occurs in the secondary or later stages of syphilis infection and is sight-threatening. Methods A retrospective analysis of the demographics, presentation, diagnosis, treatment and outcomes of patients with syphilitic uveitis managed in Newcastle from 2005-2016 was carried out. Results Ten males (19 eyes) with syphilitic uveitis had a generally good visual and serological response to penicillin treatment. In eight of the patients there had been a failure to test for syphilis during assessments by various medical practitioners for unexplained symptoms that were attributable to syphilis prior to the eye involvement. Conclusion Uveitis associated with syphilis can be sight-threatening but responds well to treatment. In our case series there were multiple missed opportunities to diagnose syphilis prior to presentation with eye disease, with a general failure of healthcare professionals to take an adequate sexual history.

Role of leptin in energy expenditure: the hypothalamic perspective.

The adipocyte-derived hormone leptin is a peripheral signal that informs the brain about the metabolic status of an organism. Although traditionally viewed as an appetite-suppressing hormone, studies in the past decade have highlighted the role of leptin in energy expenditure. Leptin has been shown to increase energy expenditure in particular through its effects on the cardiovascular system and brown adipose tissue (BAT) thermogenesis via the hypothalamus. The current review summarizes the role of leptin signaling in various hypothalamic nuclei and its effects on the sympathetic nervous system to influence blood pressure, heart rate, and BAT thermogenesis. Specifically, the role of leptin signaling on three different hypothalamic nuclei, the dorsomedial hypothalamus, the ventromedial hypothalamus, and the arcuate nucleus, is reviewed. It is known that all of these brain regions influence the sympathetic nervous system activity and thereby regulate BAT thermogenesis and the cardiovascular system. Thus the current work focuses on how leptin signaling in specific neuronal populations within these hypothalamic nuclei influences certain aspects of energy expenditure.

Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis.

A 75-year-old hypertensive female with stable idiopathic intermediate uveitis presented with bilateral sequential optic neuropathy with optic disc swelling. The optic neuropathy in the first affected eye (right) was thought to be due to non-arteritic anterior ischaemic optic neuropathy (NAION). Asymptomatic left optic disc swelling was found at routine review 2 months later, and a diagnosis of giant cell arteritis (GCA) was sought. Temporal artery duplex ultrasound showed the "halo sign," but a subsequent temporal artery biopsy showed light-chain (AL) amyloidosis with no signs of giant cell arteritis. In this case, bilateral sequential ischaemic optic neuropathy mimicking non-arteritic anterior ischaemic optic neuropathy was the presenting sign of systemic amyloidosis involving the temporal arteries.

Femoral hernia: reappraisal of low repair with the conical mesh plug.

BACKGROUND: Femoral hernias, rare among groin hernias, have been dealt with using various well-established techniques in emergency and elective settings. Lockwood's description and its various modifications have been used for decades. We here describe again a simple and elegant technique for femoral hernia repair using a conical mesh plug performed in a series of 31 patients. METHOD: A prospective study of femoral hernia repair in 31 patients via a low inguinal approach using an improvised conical mesh plug is presented. Patients were followed up for any recurrence as the primary end point. The incidence of morbidity including chronic groin pain was recorded. RESULTS: Thirty-two hernias in 31 patients were managed in 2 years. The majority of patients were female (94 %) with a median age of 60 (16-70) years. Primary femoral hernias were preponderant with the majority on the left (81 %). In an average follow-up period of 18 months, there were no recurrences, minimal morbidity (3 %) and no incidence of chronic inguinodynia. CONCLUSION: The low inguinal repair with a conical mesh plug is easily reproducible, elegant and probably the best method for femoral hernia repair.

Depletion of nonlinearity in magnetohydrodynamic turbulence: Insights from analysis and simulations.

It is shown how suitably scaled, order-m moments, D_{m}^{±}, of the Elsässer vorticity fields in three-dimensional magnetohydrodynamics (MHD) can be used to identify three possible regimes for solutions of the MHD equations with magnetic Prandtl number P_{M}=1. These vorticity fields are defined by ω^{±}=curlz^{±}=ω±j, where z^{±} are Elsässer variables, and where ω and j are, respectively, the fluid vorticity and current density. This study follows recent developments in the study of three-dimensional Navier-Stokes fluid turbulence [Gibbon et al., Nonlinearity 27, 2605 (2014)NONLE50951-771510.1088/0951-7715/27/10/2605]. Our mathematical results are then compared with those from a variety of direct numerical simulations, which demonstrate that all solutions that have been investigated remain in only one of these regimes which has depleted nonlinearity. The exponents q^{±} that characterize the inertial range power-law dependencies of the z^{±} energy spectra, E^{±}(k), are then examined, and bounds are obtained. Comments are also made on  (a) the generalization of our results to the case P_{M}≠1 and (b) the relation between D_{m}^{±} and the order-m moments of gradients of magnetohydrodynamic fields, which are used to characterize intermittency in turbulent flows.

Safe and Feasible Time Limit for Early Appendectomy in Appendiceal Mass.

Background Early appendectomy in appendiceal mass is gaining popularity among some surgeons. However, it is endowed with increasing operative difficulty with time, and safe and feasible timing is not yet clear. Objective To know safe and feasible time limit for early appendectomy in appendiceal mass. Method This is a retrospective study. Between May 2009 and July 2014, 114 patients of appendiceal mass who underwent early surgical intervention by a single surgeon were studied. Group I included 98 patients operated within seven days of onset of pain and group II included 16 patients operated between 8th and 15 days of pain. Type of operative procedure, difficulties and complications were analyzed. Result There were 58 men and 56 women. Their mean age was 24.27 ± 8.7 years. In group I, 98 (100%) patients had appendectomy and adhesiolysis was safe and feasible. In group II, 5(31.25%) patients had extra-peritoneal drainage of abscess without attempt for appendectomy. Remaining 11 patients had attempt for appendectomy, but only 3(18.75%) out of 4 patients operated on the 8th day could have appendectomy. Six (37.5%) patients had just drainage of abscess. Two (12.5%) patients, operated on the 12th and 15th days of pain had just open-closed due to dense adhesion and both resolved. One patient operated on the 10th day sustained ileal injury. Surgical site infection occurred in 16.6% (14 in 86) in group I and 33.3% (5 in 15) in group B (P= 0.001). Mean operative time was 34.4 ± 9.23 minutes and 43.7 ± 16.38 minutes for group I and group II respectively. Mean hospital stay after surgery was 2.9 ± 1.1 days and 5.5 ± 1.37 days in group I and group II respectively. Conclusion Early appendectomy in appendiceal mass seems safe and feasible up to 7th day since onset of pain in my experience. However, this limit may vary with surgeon's experience, and further studies are required to better clarify this issue.

The neuroanatomical function of leptin in the hypothalamus.

The anorexigenic hormone leptin plays an important role in the control of food intake and feeding-related behavior, for an important part through its action in the hypothalamus. The adipose-derived hormone modulates a complex network of several intercommunicating orexigenic and anorexigenic neuropeptides in the hypothalamus to reduce food intake and increase energy expenditure. In this review we present an updated overview of the functional role of leptin in respect to feeding and feeding-related behavior per distinct hypothalamic nuclei. In addition to the arcuate nucleus, which is a major leptin sensitive hub, leptin-responsive neurons in other hypothalamic nuclei, including the, dorsomedial-, ventromedial- and paraventricular nucleus and the lateral hypothalamic area, are direct targets of leptin. However, leptin also modulates hypothalamic neurons in an indirect manner, such as via the melanocortin system. The dissection of the complexity of leptin's action on the networks involved in energy balance is subject of recent and future studies. A full understanding of the role of hypothalamic leptin in the regulation of energy balance requires cell-specific manipulation using of conditional deletion and expression of leptin receptors. In addition, optogenetic and pharmacogenetic tools in combination with other pharmacological (such as the recent discovery of a leptin receptor antagonist) and neuronal tracing techniques to map the circuit, will be helpful to understand the role of leptin receptor expressing neurons. Better understanding of these circuits and the involvement of leptin could provide potential sites for therapeutic interventions in obesity and metabolic diseases characterized by dysregulation of energy balance.

GHS-R1a signaling in the DMH and VMH contributes to food anticipatory activity.

BACKGROUND: Rats that have restricted access to food at a fixed time point of the circadian phase display high levels of food anticipatory activity (FAA). The orexigenic hormone ghrelin has been implicated in the regulation of FAA. However, it is not known via which brain area ghrelin exerts this effect. Growth hormone secretagogue receptor 1a (GHS-R1a) is highly expressed in the hypothalamus, including the dorsomedial hypothalamus (DMH) and the ventromedial hypothalamus (VMH). These two hypothalamic areas have been reported to play a role in FAA. AIM OF THE STUDY: To examine the role of GHS-R1a signaling in the DMH and VMH in FAA. DESIGN: Adeno-associated virus expressing a shRNA directed against GHS-R1a was used to establish local knockdown of GHS-R1a in the DMH and VMH in rats. Rats were subsequently subjected to a restricted feeding schedule (RFS). RESULTS: Under ad libitum conditions, knockdown of GHS-R1a in the VMH increased food intake and body weight gain. In addition, GHS-R1a knockdown in VMH and DMH reduced body temperature and running wheel activity (RWA). When rats were subjected to a RFS, the main effect of GHS-R1a knockdown in both DMH and VMH was a decrease in RWA and an attenuation of body weight loss. Rats with knockdown of GHS-R1a in DMH and VMH showed a delay in onset of FAA. In addition, GHS-R1a knockdown in DMH resulted in a reduction of FAA amplitude. CONCLUSION: This is the first study to investigate the effect of local hypothalamic knockdown of GHS-R1a on FAA. Our results implicate hypothalamic GHS-R1a signaling in the regulation of FAA. Nevertheless, some FAA remained, suggesting that a distributed network of brain areas and signaling pathways is involved in the development of FAA.

The role of melanocortins and Neuropeptide Y in food reward.

The Neuropeptide Y and the melanocortin peptides are two well-described hypothalamic feeding peptides regulating energy balance. Predominantly expressed within the arcuate nucleus, these neurons project to different brain areas and modulate various aspects of feeding. Hedonic feeding, where one overindulges in palatable food consumption beyond one's nutritional necessities, is one such aspect regulated by NPY/melanocortin signaling. Research suggests that NPY/melanocortin regulate hedonic aspects of feeding through its projections to the brain reward circuitry (ventral tegmental area, lateral hypothalamus, nucleus accumbens etc.), however, exact target areas have not yet been identified. The current work explores literature to provide a mechanistic explanation for the effects of these peptides on food reward.

Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK.

PURPOSE: To report the clinical manifestations and treatment outcomes of patients with presumed intraocular tuberculosis (TB) seen at the Newcastle Uveitis Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 10-year period. METHODS: Retrospective review of case notes. RESULTS: A total of 21 patients were identified. Occlusive retinal vasculitis was the commonest ophthalmological presentation (12 patients). Eight patients (38%) were found to have underlying active systemic TB (four with mediastinal lymphadenopathy, three with pulmonary TB, one with cutaneous TB). Constitutional or respiratory symptoms, elevated inflammatory markers, and an abnormal chest radiograph were poor indicators of active TB. Two patients had inactive intrathoracic TB. Eleven patients had latent TB. Eighteen patients received anti-tuberculous treatment. Final visual acuity was better than or equal to initial visual acuity in 14 out of 16 patients who completed at least 6 months of standard anti-tuberculous treatment. CONCLUSIONS: Most patients with presumed intraocular TB have latent TB, but a significant minority has hitherto undetected active TB. Our series suggests that either proven or presumed intraocular TB occurs frequently in the absence of constitutional or respiratory symptoms, elevated inflammatory markers, or an abnormal chest radiograph. A minimum of 6 months standard anti-tuberculous treatment provides good visual outcomes in the majority of patients.

Efficacy of isometric exercise full knee extension horizontally (FKEH)--a new and simple maneuver to predict early onset of hypertension.

Hypertension is recognized as one of the risk factors for cardiovascular mortality and morbidity. Early identification of persons at increased risk for developing hypertension is a priority, which help them, to live a healthy life by altering lifestyle. Persons having predisposing factors of hypertension (e.g., family history of hypertension) show blood pressure hyper-responsiveness to stress. Elevated blood pressure due to sympathetic stimulation prevailed longer time in susceptible persons. In previous studies some instruments (e.g., hand immersion in cold (4 degrees C) water or isometric exercise by handgrip dynamometer) were required to elicit sympathetic stimulation. In the present study a simple maneuver Full Knee Extension Horizontally (FKEH) has been introduced--a stressor that caused full isometric contraction of quadriceps femoris muscles of both sides. The test was conducted in normotensive, non-smoker males (n = 150) of age group 18-25 years. Among them some (n = 100) were from families having no history of familial hypertension and others (n = 50) were from the families with history of hypertension. The causal blood pressure and heart rate of the participants were recorded. Then the volunteers were requested to perform FKEH maneuver for one minute. Both blood pressure and heart rate were recorded immediately after and 3 minutes following FKEH. The data analyzed using t-test showed that, diastolic blood pressure didn't return and stabilized to pre-exercise level even after 3 minutes following FKEH in volunteers who were mostly from hypertensive family (P< 0.05) i.e., having predisposing factors of hypertension. This indicated those people are prone to early onset of hypertension as their Autonomic Nervous System (ANS) is not competent enough to stabilize their blood pressure to pre-exercise level. Hence, stress in the form of FKEH for one minute may be used as a bedside test to assess the competence of ANS and the proneness of developing early hypertension.

Color vision deficiency among a group of students of health sciences.

Color vision deficiency, most of the time remains an unnoticed problem; even many doctors/health professionals do not know the severity of their color vision deficiency and their disability. Some common difficulties reported by medical practitioners and students of health sciences were in recognizing- widespread body color changes (pallor, cyanosis, icterus, rashes, erythema of skin), colorful charts, slides, test-strips of blood and urine, body products: blood or bile in urine, faeces, sputum, vomitus, microscopy, oral and throat lesions, titration end-points, tissue identification (surgery) etc. The present study was undertaken to evaluate the presence of congenital color vision deficiency among the students of health sciences. The study was carried out among the medical and dental male students of Nepal Medical College and Teaching Hospital (n = 215) from November 2, 2012 to December 4, 2012 with the help of Ishihara chart which was shown to all male participants and were asked to read the impressions in the color chart. The impressions perceived by a person with normal color vision were different from the impressions perceived by a person with color vision deficiency. After careful screening, it was noted that among the study population (n = 215), 12 were color deficient (5.58% of our study population). Among them, one could not appreciate color (total color blindness according to the chart used), protanomaly was detected in 1, deuteranomaly in 3 and deuteranopia in 7 volunteers. Students of health sciences must be made aware of their congenital color vision deficiency and its effects on their work. Screening enables the students and later the health professionals to become aware of limitations in their powers of observation and devise ways of overcoming them. The patient is protected from harm and legal action may be avoided when the health professional have adapted their practice to their deficiency. Medical/ dental students and health professionals must be screened for color vision deficiency and advised about it, so that they can take special care in clinical practice.