Predicting cadmium fractions in agricultural soils using proximal sensing techniques.

Cadmium (Cd) accumulation in agricultural systems has caused global environmental and health concerns. Application of phosphate fertiliser to sustain plant production unintentionally accumulated Cd in agricultural soils over time. Rapid and cost-effective Cd monitoring in these soils will help to inform Cd management practices. Compared to total Cd analysis, examining chemical fractions by sequential extraction methods can provide information on the origin, availability, and mobility of soil Cd, and to assess the potential plant Cd uptake. A total of 87 air-dried topsoil (0-15 cm) samples from pastoral farms with a history of long-term application of phosphate fertiliser were analysed using wet chemistry methods for total Cd and Cd forms in exchangeable, acid soluble, metal oxides bound, organic matter bound, and residual fractions. The data acquired using three proximal sensing techniques, visible-near-infrared (vis-NIR), mid-infrared (MIR), and portable X-ray fluorescence (pXRF) spectroscopy were used as input for partial least squares regression to develop models predicting total Cd and Cd fractions. The average total Cd concentration was 0.58 mg Cd/kg soil. For total Cd, cross-validation (cv) results of models using individual vis-NIR, MIR, and pXRF data performed with normalised root mean squared error (nRMSEcv) of 26%, 30%, and 31% and concordance correlation coefficient (CCCcv) of 0.85, 0.77, and 0.75, respectively. For exchangeable Cd, model using MIR data performed with nRMSEcv of 40% and CCCcv of 0.57. For acid soluble and organic matter bound Cd, models using vis-NIR data performed with nRMSEcv of 11% and 33% and CCCcv of 0.97 and 0.84, respectively. Reflectance spectroscopy techniques could potentially be applied as complementary tools to estimate total Cd and plant available and potentially available Cd fractions for effective implementation of Cd monitoring programmes.

Hyperoxemia in invasively ventilated COVID-19 patients-Insights from the PRoVENT-COVID study.

OBJECTIVE: We determined the prevalences of hyperoxemia and excessive oxygen use, and the epidemiology, ventilation characteristics and outcomes associated with hyperoxemia in invasively ventilated patients with coronavirus disease 2019 (COVID-19). METHODS: Post hoc analysis of a national, multicentre, observational study in 22 ICUs. Patients were classified in the first two days of invasive ventilation as 'hyperoxemic' or 'normoxemic'. The co-primary endpoints were prevalence of hyperoxemia (PaO2 > 90 mmHg) and prevalence of excessive oxygen use (FiO2 ≥ 60% while PaO2 > 90 mmHg or SpO2 > 92%). Secondary endpoints included ventilator settings and ventilation parameters, duration of ventilation, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, and at day 28 and 90. We used propensity matching to control for observed confounding factors that may influence endpoints. RESULTS: Of 851 COVID-19 patients, 225 (26.4%) were classified as hyperoxemic. Excessive oxygen use occurred in 385 (45.2%) patients. Acute respiratory distress syndrome (ARDS) severity was lowest in hyperoxemic patients. Hyperoxemic patients were ventilated with higher positive end-expiratory pressure (PEEP), while rescue therapies for hypoxemia were applied more often in normoxemic patients. Neither in the unmatched nor in the matched analysis were there differences between hyperoxemic and normoxemic patients with regard to any of the clinical outcomes. CONCLUSION: In this cohort of invasively ventilated COVID-19 patients, hyperoxemia occurred often and so did excessive oxygen use. The main differences between hyperoxemic and normoxemic patients were ARDS severity and use of PEEP. Clinical outcomes were not different between hyperoxemic and normoxemic patients.

Study of surface tension and viscosity of Cu-Fe-Si ternary alloy using a thermodynamic approach.

The surface tension and viscosity of Cu-Fe-Si ternary alloys were computed at different temperatures using thermodynamic approaches. The thermodynamic data of the alloy were optimized in the framework of the Redlich-Kister (R-K) polynomials and exponential temperature dependent coefficients of the R-K polynomial were obtained. These coefficients were used to compute the excess Gibbs free energy of mixing of the alloy and the partial excess free energy of the components. The partial excess free energy so obtained was used to compute the surface tension of the ternary Cu-Fe-Si alloy system and its binary sub-systems. The enthalpy of mixing was also optimized and it was used to compute the viscosity of the sub-binary and ternary alloys.

Quality of Life of Menopausal Women in Majhifeda VDC, Kavrepalanchok, Nepal.

Background Menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. This is established fact that the quality of life of menopausal women deteriorates as the effect of menopausal symptoms. Objective To assess the physical domain, psychological domain, vasomotor domain for quality of life and its association with selected socio-demographic variables of menopausal women. Method Descriptive cross-sectional study was conducted among the menopausal women aged 45-60 years whose menstruation has ceased for a complete one year naturally excluding those having thyroid disorders and mentally disable. Structured questionnaire was used adopting Nepali version of Modified Menopause-Specific Quality of Life (MENQOL) questionnaire. Data collection was accomplished during August - September 2016. Data entered in MS excel were analysis using SPSS version 21. Descriptive as well as inferential statistics were applied for the data analysis. Result Among vasomotor domain hot flushes or flashes (81.9%), sweating (76.7%) and night sweats (73.3%); among psychosocial domain accomplishing less than I used to (94.8%), experiencing poor memory (80.2%), being impatient with other people (76.7%), feeling depressed down or blue (71.6%), feeling anxious or nervous (55.2%), feeling of wanting to be alone (55.2%) and being dissatisfied with my personal life (37.1%). Among physical domain aching in muscles and joints (94.8%), decrease in physical strength (94.8%), low backache (88.8%), feeling tired or worn out (84.0%), difficulty sleeping (81.0%), aches in back of neck or head (76.7%) were the major symptoms. Among sexual domain vaginal dryness during sexual intercourse (60.3%), avoiding intimacy (52.6%) and change in sexual desire (55.2%) were the major symptoms. Overall observation is that vasomotor symptoms were highest followed by sexual, psychosocial and physical symptoms having statistically significant association between vasomotor symptoms and ethnicity (p=0.019) and sexual symptoms and marital status (p=0.010). Conclusion Majority of the study subjects were from the marginalized groups of people. Vasomotor symptoms had highest prevalence followed by sexual, psychological and physical symptoms. As significant associations were observed between vasomotor symptoms and ethnicity and sexual symptoms and marital status, awareness and periodical checkups were recommended.

Ocular Morbidity among Children of Government Schools of Kathmandu Valley: A Follow-up Study.

INTRODUCTION: Ocular and vision defects are common among school going children. Vision disorders, especially refractive errors are the main disabilities of children and the leading cause of handicapping conditions of childhood. The present study was conducted to find out ocular morbidity among students of government schools of Kathmandu valley. METHODS: In the descriptive and cross-sectional study, 2412 students, comprising of 1114 (46.2%) males and 1298 (53.8%) females were enrolled in to the study from the five government schools of Kathmandu valley from 2012 to 2013. Detailed eye examination included distance visual acuity testing, anterior and posterior segment examinations, retinoscopy and refraction, cover test, near point of convergence, amplitude of accommodation and color vision test. The Chi-square test was performed to analyze the association between ocular morbidity, age and sex. P value was considered significant at 0.05 for 95% confidence interval. RESULTS: Majority of children were age group between 11 and 13 years (n= 783, 32.5%). A male to female ratio was 0.85. Presenting and best spectacle corrected visual acuity of 6/6 was present in 2257 (93.6%) and 2380 (98.7%) respectively. Total ocular morbidity was observed in 515 (21.4%) subjects. The most common types of ocular morbidity were refractive error in 241 (10%), conjunctivitis in 104 (4.3%) and convergence insufficiency in 82 (3.4%). CONCLUSIONS: Refractive error, conjunctivitis and convergence insufficiency represent the most common ocular morbidities among students of government schools.

Safety and Efficacy of Azathioprine as a Second Line Therapy for Primary Immune Thrombocytopenic Purpura.

INTRODUCTION: Immune thrombocytopenic purpura remains common blood disease in Nepal. Azathioprine is an oral immunosupressive medicine which has been used widely in various autoimmune disease and solid organ transplant patients. It is inexpensive, easily available and well tolerated medicine. This study was carried out to evaluate efficacy and safety of azathioprine as a second line medicine for primary ITP patients who were refractory to steroid therapy. METHODS: The observational, pre-post study was conducted at Government of Nepal Civil Service Hospital, Kathmandu from January to October 2014. Twenty four primary ITP patients who were steroid refractory were treated with Azathioprine. Patients were termed steroid refractory if platelet counts were less than 30,000/ul on day 21st of steroid therapy. From day 22 onwards oral azathioprine 2mg/kg was started and steroids were tapered 10mg/week and stopped. Platelet counts of more than 30000/ul after one month of stopping steroid, while still on azathioprine, were termed response to azathioprine. Platelet count of more than 100,000/ul was termed complete response. The associations among age, gender, duration and platelets counts were analyzed by chi square test and Fisher's exact test (when individual cell frequency was less than 5). The comparison of platelets counts among the start and day 90 of Azathioprine therapy was performed by the paired t-test. RESULTS: The study showed that there was not significant association among age and gender of the patients and their platelets count on the start of Azathioprine therapy (p value 0.354 and 0.725 respectively) and on day 90 of Azathioprine therapy (p value 0.082 and 0.762 respectively). The duration-wise comparisons of platelets count on both the start and day 90 of Azathioprine therapy were significant (p values 0.029 and 0.008 respectively). The paired comparison among platelets count on the start and day 90 of Azathioprine therapy was highly significant (p value 0.000). CONCLUSIONS: The study showed the therapeutic implication of azathioprine in ITP patients. It also showed that efficacy of azathioprine was comparable with other modes of treatment. In low income countries like Nepal azathioprine can be considered as second line treatment for steroid refractory ITP patients.

Muscular Hamartoma of Intestine Causing Intestinal Obstruction.

Hamartomatous causes of small bowel obstructionare uncommon and of them, most are attributed to inflammatory bowel diseases and also certain medications such as NSAIDs. We describe a case of muscular hamartoma in a patient without prior chronic medical condition with brief review of literature.

Immediate Outcome of Hypoxic Ischaemic Encephalopathy in Hypoxiate Newborns in Nepal Medical College.

BACKGROUND: Birth asphyxia is the fifth major cause of under-five child deaths after pneumonia, diarrhoea, neonatal infections and complications of preterm birth. It is one of the important causes of neonatal mortality and morbidity accounting up to 30% of neonatal death in Nepal. It is also an important cause of long-term neurological disability and impairment. The mortality rate due to birth asphyxia is considered a good guide to the quality of perinatal care. This study was conducted to assess the rate of birth asphyxia, risk factors and outcome of the babies who were asphyxiated at birth. METHODS: A prospective study was conducted during the period of one year from April 2013 to March 2014 in Nepal Medical College. All the term babies born during the period with APGAR score at 5 minutes of < 7 were considered to have birth asphyxia and included in the study. Details of maternal risk factors during pregnancy and labor were analyzed. The newborn babies were assessed for clinical features of hypoxic ischemic encephalopathy (HIE) and its immediate outcome. RESULTS: Out of 2226 live births, 47 (15.9%) newborns had birth asphyxia with the rate of 21.1/1000 live births. The mortality rate due to birth asphyxia was 4.25%. Meconium stained liquor was present in 31(65.96%) cases during delivery and prolonged rupture of membrane in 7(14.89%). CONCLUSIONS: Early identification and close monitoring of high-risk mothers with maintaining partograph during labor help to reduce birth asphyxia.

Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value < 0.05) for communication skills of nurses. Conclusion Majority of patients have positive perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital.

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Point-of-care Ultrasonography in Critically Ill Patients.

Point-of-care ultrasonography has been used frequently by the physicians involved in managing critically ill patients. It allows direct visualization of pathology or abnormal physiological state at the bed side. The examination may be safely and effectively repeated as needed to follow the evolution of illness and the response to therapy. It is helpful to guide the therapy in patients with undifferentiated shock and for bedside diagnosis of common pathological conditions in acute care setting. It can facilitate common bedside procedures and interventions.

Anaesthetic Management of Patients with Takayasu's Arteritis for Open Cholecystectomy.

Takayasu's arteritis is a well known yet rare form of large vessel vasculitis.1 This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries.2 Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure.1 We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal.

INTRODUCTION: Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here. METHODS: This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed. RESULTS: Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients. CONCLUSIONS: Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function.

Assessment of Color Vision Among School Children: A Comparative Study Between The Ishihara Test and The Farnsworth D-15 Test.

INTRODUCTION: Color vision is one of the important attribute of visual perception. The study was conducted at different schools of Kathmandu to compare the findings of the Ishihara Pseudoisochromatic test and the Farnsworth D-15 test. METHOD: A cross-sectional study was conducted among 2120 students of four schools of Kathmandu. Assessment included visual acuity measurement, slit lamp examination of anterior segment and fundus examination with direct ophthalmoscopy. Each student was assessed with the Ishihara pseudoisochromatic test and the Farnsworth D-15 test. The Chi-square test was performed to analyse color vision defect detected by the Ishihara test and the Farnsworth D-15 test. RESULTS: A total of 2120 students comprising of 1114 males (52.5%) and 1006 females (47.5%) were recruited in the study with mean age of 12.2 years (SD 2.3 years). The prevalence of color vision defect as indicated by the Ishihara was 2.6 and as indicated by the D-15 test was 2.15 in males. CONCLUSION: For school color vision screening, the Ishihara color test and the Farnsworth D-15 test have equal capacity to detect congenital color vision defect and they complement each other.

Perioperative management of two cases of hemophilia with spontaneous intracerebral hemorrhage undergoing emergency craniotomy in resource constrained setup of Nepal.

Patients with hemophilia are prone to develop spontaneous intracranial hemorrhage. It carries a significant risk of morbidity and mortality. In this case series, we report two cases of hemophilia who suffered spontaneous intracerebral hemorrhage with features of raised intracranial pressure and were successfully managed perioperatively. The patients were managed with early intensive care unit management, measures to reduce intracranial pressure, perioperative clotting factor administration, airway management and surgery to decrease the raised intracranial pressure. Both patients improved following surgery and were discharged home. Perioperative multidisciplinary management of hemophilia is discussed in this series.

Parasitization of commercially available parasitoid species against the lettuce aphid, Nasonovia ribisnigri (Hemiptera: Aphididae).

The lettuce aphid, Nasonovia ribisnigri (Mosley), is an economically important pest of lettuce worldwide. Little documentation exists for the control efficacy of aphid parasitoids against N. ribisnigri. This laboratory study evaluated three commercially available parasitoid species: Aphidius colemani (Viereck), Lysiphlebus testaceipes (Cresson), and Aphelinus abdominalis (Dalman) for their mortality impact on N. ribisnigri. The green peach aphid Myzus persicae (Sulzer) was included as a reference aphid. The study showed that A. abdominalis successfully parasitized 39 and 13% of the offered N. ribisnigri and M. persicae, respectively, within a 24-h exposure period. In contrast, none of the lettuce aphids exposed to Ap. colemani or L. testaceipes were successfully parasitized, whereas 60 and 3.5% of M. persicae, respectively, were successfully parasitized within a 6-h exposure period. Lettuce aphid mortality due to incomplete parasitization was 26 and 31% when exposed to Ap. colemani and L. testaceipes, respectively, with corresponding values for M. persicae being 5 and 10%, respectively. Mortality as a result of incomplete parasitization when aphids were exposed to A. abdominalis was low for both aphid species. The total mortality inflicted by A. abdominalis within a 24-h exposure period was 51% for the lettuce aphids and significantly less (19%) for green peach aphids. In contrast, Ap. colemani inflicted a higher mortality in M. persicae (65%) compared with N. ribisnigri (26%) within a 6-h exposure period. L. testaceipes caused a greater mortality in N. ribisnigri as compared with M. persicae. This study concludes that A. abdominalis has the potential to be used against N. ribisnigri in inoculative biocontrol programs as compared with the other parasitoid species based on successful parasitization.

Ocular injuries in the people's uprising of April 2006 in Kathmandu, Nepal.

INTRODUCTION: In April 2006, the people of Nepal organised mass demonstrations demanding the restoration of democracy in the country. The ocular injuries that resulted during the riots that ensued, their pattern and the visual outcome of the injured have not yet been reported. OBJECTIVE: To study the demographic profile, type, severity and the visual outcome of ocular injuries that occurred during the 2006 people's uprising in Nepal. SUBJECTS AND METHODS: This was a retrospective interventional series of cases involving 29 subjects. The main outcome measures were demography, laterality of injury, type of injury and the visual status before and after the trauma. RESULTS: The age of the victims ranged from 14 to 32 years. Among the victims with eye injuries, 27 (93.1 %) were males, who were unemployed youth, students and construction workers. The left eye was injured more frequently than the right. Non-lethal bullets and explosive tear gas were the commonest agents of the major ocular injuries. The main types of injuries requiring hospitalization were closed globe injuries in eight victims and open globe in six. Surgical intervention was required in 57.2 % (n = 29) of the cases. The visual outcome was poor in cases of open globe injury with posterior segment involvement. CONCLUSION: Non-lethal bullets and explosive tear gases can cause significant visual impairment. Severe open globe injury with a retained intra-ocular foreign body is associated with significant visual loss.

A comparison of midazolam co-induction with propofol priming in propofol induced anesthesia.

BACKGROUND: Combination therapy with two or more different drugs, with the intension of reaching the same therapeutic goal, was heavily criticized for a long time. However, it is accepted today, especially when advantage over monotherapy can be proved. Our study was undertaken to compare whether propofol priming and midazolam predosing would affect total induction dose requirement of Propofol. METHODS: A prospective randomized, double blind control study was conducted where 120 patients (16-65 years) were divided into 3 groups. Group P received 0.4 mg/kg of Propofol, Group M received 0.05 mg/kg of Midazolam and Group N received 3 ml of Normal Saline 5 minutes after intravenous pethidine 0.75 mg / kg given for analgesia. We compared the total dose of propofol requirement for induction of anaesthesia in all the 3 groups, taking loss of verbal contact as the end point. Additionally, changes in haemodynamic status like blood pressure and heart rate at various intervals were studied and compared among the groups. RESULTS: The groups were similar in terms of age, sex, weight and American Society of Anesesthesiologists Physical Status.The dose of Propofol required to induce anesthesia in Midazolam group was 1.58 mg/kg,1.86 mg/kg in Propofol group and 1.96 mg/kg in the control group. There were less hemodynamic changes in Midazolam group compared to the other two. CONCLUSIONS: Pre-dosing with Midazolam is more effective than Propofol priming in reducing the dose of Propofol induced anaesthesia associated with minimum hemodynamic alterations.