Demographic and Clinical Profiles of Patients with Traumatic Brain Injury Managed in a District Hospital in Nepal.

Background Traumatic brain injury (TBI) is a significant cause of disability and mortality globally. Information regarding clinical presentation and management of TBI patients in the district hospital settings is inadequate, especially in low- and middle-income countries. Objective This study aims to describe the demographic and clinical profiles of traumatic brain injury patients in a district hospital setting in Nepal. Method This study was done at Chautara Hospital in Sindhupalchowk district from December 2021 to June 2022. Sixty-one patients were included using non-probability sampling. The age and sex of patients, cause of injury, distance from the hospital, the severity of the injury based on the Glasgow Coma Scale, site of trauma on the head, and disposition of patients were analyzed. Result Sixty-one patients met the inclusion criteria out of which 29 were males and 32 were females. The mean age of the patients was 42.5 years. The most frequent cause was fall from height (23), and the most common injury site was the frontal region of the head (29). Most patients had a mild injury (52) followed by severe (five). Only two patients had moderate injury. Forty-two patients sustained injury within 5 kilometres of the hospital. Thirty patients were referred to higher centres for further treatment. Conclusion Falls from height is the most common cause of traumatic brain injury followed by road traffic accidents. As most of the cases are mild in severity, the availability of trained human resources and telemedicine consultation in district hospitals can substantially decrease referral to higher centres and therefore decrease the burden of traumatic brain injury patients in the higher centres.

Feedback effect during ultrafast demagnetization dynamics in ferromagnets.

Motivated by the recent controversy about the importance of spin-flip scattering for ultrafast demagnetization in ferromagnets, we study the spin-dependent electron dynamics based on a dynamical Elliott-Yafet mechanism. The key improvement to earlier approaches is the use of a modified Stoner model with a dynamic exchange splitting between majority and minority bands. In the framework of our microscopic model, we find a novel feedback effect between the time-dependent exchange splitting and the spin-flip scattering. This feedback effect allows us to reproduce important properties of the demagnetization dynamics quantitatively. Our results demonstrate that in general Elliott-Yafet spin-flip scattering needs to be taken into account to obtain a microscopic picture of demagnetization dynamics.

Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient.

Parvo B19 is a single stranded DNA virus, which typically has affinity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the first such case report from Nepal.

Favorable outcome in atheroembolic renal disease with pulse steroid therapy.

Atheroembolic renal disease is characterized by renal failure secondary to occlusion of renal vasculature by cholesterol containing atheromatous plaques. Clinical presentations of this disease entity are myriad, with limited therapeutic options and unfavorable outcomes. This report describes an elderly male patient with peripheral vascular disease who developed acute renal failure during hospital admission for rectal bleed, and was diagnosed with atheroembolic renal disease on renal biopsy. The patient was managed with pulse steroid therapy and had a favorable outcome.

Acute intradialytic complications in end stage renal disease on maintenance hemodialysis.

INTRODUCTION: Hemodialysis is the preferred method of treatment for Nepalese patients with end stage renal disease. Despite the technological advances and better understanding of physiology associated with hemodialysis, a number of complications are known to be associated with hemodialysis. This study was undertaken to study the frequency of acute intradialytic complications in patients undergoing hemodialysis. METHODS: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2007 to 15 December, 2007. A total of 28 patients were included in the study. Patients with acute renal failure and acute on chronic renal failure were excluded from the study. RESULTS: Total sessions of hemodialysis during the period were 1455. Hypotensive episode were 66 (4.5%) and was the commonest complication and followed by hypertensive episodes were 58 (3.8%). Other problems encountered were transfusion reactions were 23 episodes (1.5%), rigors not related to transfusions were 13 episodes (0.8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%). CONCLUSIONS: The frequency of intradialytic complications is low and many of them are not life threatening.

Evaluation of aquatic toxicities of chromium and chromium-containing effluents in reference to chromium electroplating industries.

This study evaluated aquatic toxicities of chromium and chromium-containing laboratory samples representative of effluents from chromium electroplating industries, and compared the aquatic environmental risks of hexavalent and trivalent chromium electroplating operations. Trivalent chromium electroplating has emerged as an acceptable alternative to hazardous hexavalent chromium electroplating. This process substitution has reduced the human health impact in the workplace and minimized the production of hazardous sludge regulated under the Resource Conservation and Recovery Act (RCRA). The thrust behind this research was to investigate whether trivalent chromium electroplating operations have lower adverse impacts on standardized toxicity test organisms. Ceriodaphnia dubia and Pimephales promelas were used to investigate toxicities of trivalent chromium (Cr (III)), hexavalent chromium (Cr (VI)), and industrial effluents. In agreement with previous studies, Cr (III) was found to be less toxic than Cr (VI). Despite having several organic and inorganic constituents in the effluents obtained from trivalent chromium plating baths, they exhibited less adverse effects to C. dubia than effluents obtained from hexavalent chromium electroplating baths. Thus, transition from hexavalent to trivalent chromium electroplating processes may be justified. However, because of the presence of organic constituents such as formate, oxalate, and triethylene glycol in effluents, trivalent chromium electroplating operations may face additional regulatory requirements for removal of total organic carbon.

Quantitative bioregeneration of granular activated carbon loaded with phenol and 2,4-dichlorophenol.

Lignite based granular activated carbon of 20x30 mesh size was used to investigate the extent of bioregeneration of phenol and 2,4-DCP in a batch system. The adsorption isotherm fits very well with the Freundlich isotherm and it is apparent that 2,4-DCP is more adsorbable than phenol. The degree of reversible adsorption for phenol and 2,4-DCP were 32.9 and 10.6 %, respectively. The low percentages of their reversibility meant that the adsorption phenomena of both phenol and 2,4-DCP were not fully physicosorption. The microorganisms can regenerate 31.4% (21.2 mg g(-1)) of GAC loaded with phenol and 14.3% (24.8 mg g(-1)) of GAC loaded with 2,4-DCP over a period of 7-10 days. The bioregeneration of phenols closely followed the first order kinetics with the rate constant of 0.046 day(-1) at initial phenol concentration of 100 mg l(-1) and biomass concentration of 20 mg l(-1) MLVSS. The rate constant was 0.021 day(-1) at initial 2,4-DCP concentration of 200 mg l(-1) and 200 mg l(-1) MLVSS. In addition, the increasing in initial concentration of biomass in the solution shortened the time required to reach the asymptotic limit on the bioregeneration but rendered little impact on the bioregeneration percentage.