Perception of Nepalese nursing students toward E-learning in Nepal.

BACKGROUND: E-learning is the delivery of learning and training through digital resources. Although e-learning is based on formalized learning, it is provided through computers, tablets, and even cellular phones those are connected to the Internet. This makes it easy for users to learn anytime, anywhere, with few, if any restrictions. MATERIAL AND METHODS: A cross-sectional study was done, and data was obtained through an online survey method from September 14, 2020 to October 08, 2020. Questions were created in "Google Forms." The targeted population was all nursing students from all over Nepal. There were a total of 365 respondents. A pilot study was done on 10 students. After the pilot study, the same question was distributed to all the respondents. RESULTS: Almost half (40.8%) got disturbed in their online class because of electricity; around half of the respondents (41.9%) are disturbed in their online class because of Internet problems. Moreover, around half of the respondents (44.4%) use the data pack daily, and 38.6% use the data sometimes. CONCLUSION: The study concludes that most students suffered from Internet disturbance and electricity problems during online classes. Because of electricity and Internet problems, most students feel anxious during class, and most of the students are not able to attend classes. Most students are compelled to use data packs for online classes. However, the course may not be completed if the problems arising during online classes are not solved.

Knowledge regarding Basic Life Support among Health Care Workers of the Hospital of Nepal.

Basic life support refers to a sequence of care provided to patients who are experiencing respiratory arrest, cardiac arrest, or airway obstruction. It is a specific level of prehospital medical care provided by the trained responders, including emergency medical technicians, in the absence of advanced medical care to maintain the patient's life. BLS course trains participants to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations, and provide early use of an AED. According to American Heart Association (AHA) guidelines, every missed minute in applying defibrillation in a cardiac arrest decreases the survival rate by 70%-10%. According to European Resuscitation Council (ERC), early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival. A quantitative, descriptive study design is used in this study. A purposive sampling technique was used, and the sample size was 95. A self-structuredclose-ended questionnaire was used to assess the level of knowledge of the participants. The finding revealed that among 95 participants, only 12% had adequate, 55% had moderate, and 32% had inadequate knowledge about Basic Life Support. The study showed that knowledge among healthcare workers about basic life support is insufficient for the majority of participants. There is a significant association between dependent and independent variables.

Impact of COVID-19 pandemic on learning status of student in Nepal.

BACKGROUND: This study was designed to evaluate the impact of the COVID-19 pandemic on the learning status of students from different educational boards and universities of Nepal. An online survey was conducted from tenth to twentieth of September 2020 to record the data. MATERIAL AND METHODS: A self-designed questionnaire link, using "Google form" was sent to the students via social networks. A total of 589 participants shared their complete information. The simple percentage distribution was employed to evaluate the learning status of the students. RESULTS: During the lockdown period, >70% of the students were engaged in online classes, most commonly by using the Zoom app. The majority of the students were using WIFI as an internet source to attend online classes. Students have been suffering from various problems related to anxiety, stress, economic crises, poor internet connectivity, deprivation of study materials, required e-learning accessories, and an unsuitable study environment. Mainly, students from remote areas and middle income families suffered enormously. Among those participants, who were able to attend the online classes, the majority of students (70%) were dissatisfied with the ongoing online classes. Only 23.3% of the participants suggested the feasibility of online classes in the near future. CONCLUSION: Our study recommended that training teachers and students about online classes might create effectiveness toward e-learning. The government needs to provide free internet services to the remote areas and the poor students since in the current scenario, huge numbers of the population are struggling with the economic burden.

Antibacterial and Antioxidant Activities of Prinsepia utilis Royle Leaf and Seed Extracts.

Our study was designed to screen the antibacterial potency of Princepia utilis leaf and seed extract and to measure their antioxidant effects, total phenol content, total flavonoid content, and total carbohydrate content. Collected samples were extracted by cold maceration. Hexane, ethyl acetate, methanol, and distilled water were used as extraction solvents. In the disc diffusion method, P. utilis ethyl acetate leaf extract was most prominent against Staphylococcus epidermis with a zone of inhibition (ZOI) of 13.83 mm. Similarly, methanolic leaf extract was most prominent against Staphylococcus aureus (ZOI-12.33 mm). Furthermore, the methanolic seed extract was most sensitive against Klebsiella pneumoniaee (ZOI-11.66 mm) Escherichia coli (ZOI-9.0 mm). The lowest minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 0.5 mg/mL and 0.6 mg/mL, respectively, were shown by ethyl acetate leaf extract against S. epidermis. Similarly, the highest values of MIC and MBC, i.e., 20.8 mg/mL and 33.3 mg/mL, respectively, were shown by hexane leaf extract against S. epidermidis. On the other hand, evaluation of antioxidant capacity revealed that ethyl acetate leaf extract showed the maximum antioxidant effect (IC50: 66.69 µg/mL). The total flavonoid contents of different extracts were measured in the range of 37 ± 0.74 µg QE/mg dry extract weight (methanolic seed extract) to 321.84 ± 4.82 µg QE/mg dry extract weight (hexane seed extract). Likewise, the total polyphenol content ranged from the hexane leaf extract (17.33 ± 0.642 µg GAE/mg dry extract weight) to ethyl acetate leaf extract (62.56 ± 1.284 µg GAE/mg dry extract weight). We found a variation in total carbohydrate content in the range of 23.55 ± 1.125 µg glucose/mg dry extract weight (hexane leaf extract) to 96.63 ± 2.253 µg glucose/mg dry extract weight (aqueous leaf extract). Overall, this study revealed that leaf and seed extract of P. utilis exhibited noteworthy antibacterial effects against diverse pathogenic microorganisms.

Caregivers' Knowledge, Attitude, and Practice towards Pressure Injuries in Spinal Cord Injury at Rehabilitation Center in Bangladesh.

The purpose of this study was to determine caregivers' knowledge, attitude, and practice (KAP) on the prevention and care of pressure injuries (PIs) in individuals with spinal cord injury. A quantitative cross-sectional study with descriptive correlation design was used to implement a modified semistructured questionnaire using a convenient sampling method. McDonald's standard of learning outcome measurement criteria was used to categorize caregivers' KAP. A Pearson product-moment correlation coefficient (r) was utilized to assess the relationships between caregivers' KAP, with a p value of 0.05 or less considered statistically significant. The study findings indicate that caregivers had a moderate level of knowledge (M = 73.68%, SD = 6.43), a neutral attitude (M = 70.32%, SD = 6.89), and a moderate level of practice (M = 74.77%, SD = 9.08). A positive correlation existed between caregivers' knowledge and attitude (r = 0.30, p < 0.01), as well as between knowledge and practice (r = 0.37, p < 0.01). Nevertheless, there was no correlation between attitude and practice (r = 0.12, p > 0.05). The study findings suggest that caregivers need to develop a positive attitude and expand their knowledge in order to improve their practice. The KAP factors that require higher priority were positioning and turning the patient, preventing skin breakdown, assessing weight changes over time, interest in patient care, additional care for PIs, frequently changing the individual's position, priority to PI care, interest in other types of care other than PIs, using special cushions, consulting doctors on a regular basis, being aware of clothing and fabrics, proper transfer technique, pressure relief, and skin inspection, among others.

Study of Antibacterial Activity of Root Bark, Leaves, and Pericarp Extracts of Diploknema butyracea and Evaluation of Prospective Antioxidant Activity.

This study was aimed to determine the antibacterial activity of root bark, leaves, and pericarp extract of Diploknema butyracea and to evaluate the prospective antioxidant activity, total flavonoid, polyphenol, and carbohydrate content. The plant parts were collected and extracted by cold maceration, using hexane, ethyl acetate, methanol, and distilled water. Phytochemical screening of different samples of D. butyracea in different solvents revealed the presence of varied extent of alkaloid, saponin, terpenoid, anthraquinones, tannin, cardiac glycoside, flavonoid, carbohydrate, polyphenol, protein and amino acid, resin, and phytosterol. Our study showed that methanolic root bark extract exhibited the potent antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermidis, and Klebsiella pneumonia with an average zone of inhibition of 17.33 mm, 14.33 mm, and 13.0 mm, respectively. Surprisingly, all of the extracts were insensitive to Escherichia coli. The lowest minimum bactericidal concentration (MBC), 4.6 mg/ml, was observed with the aqueous pericarp extract against S. epidermidis and the highest was of 50 mg/ml shown by ethyl acetate pericarp against K. pneumonia. Our results showed that both the polar and nonpolar components present in the different parts of D. butyracea exhibit prominent antibacterial activities against different bacterial strains. The in vitro 2,2'-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity showed that the methanol extract of root barks displayed the most potent antioxidant activity (IC50 : 6.1 µg/ml). The total polyphenol content of the plant part extracts was observed between 19.48 ± 0.23 and 123.48 ± 1.84 µg gallic acid equivalent/mg of dry extract weight. Likewise, flavonoid content ranged from 40.63 ± 1.28 µg to 889.72 ± 3.40 µg quercetin equivalent/mg of dry extract weight and total carbohydrate content ranged from 11.92 ± 0.60 µg to 174.72 ± 0.60 µg glucose equivalent per/mg dry extract weight. Overall, our study showed that the root bark, pericarp, and leaves extract of D. butyracea evinced prominent antibacterial properties against various pathogenic bacterial strains.

Renal angiomyolipoma with epithelial cyst.

Angiomyolipoma with epithelial cysts (AMLEC) is a recently described entity and is an uncommon subtype of kidney angiomyolipomas. AMLEC is a benign entity but usually masquerades a renal cell carcinoma on imaging examination. AMLEC has a distinct histological and immunohistochemical staining pattern, which helps in the pathological diagnosis. We present a rare case of AMLEC in a 26-year-old female, which was provisionally diagnosed as renal cell carcinoma on radiology. We also summarize the differential diagnosis of this rare variant, its characteristic features, and a review of the literature.

Renal angiomyolipoma with epithelial cyst

Angiomyolipoma with epithelial cysts (AMLEC) is a recently described entity and is an uncommon subtype of kidney angiomyolipomas. AMLEC is a benign entity but usually masquerades a renal cell carcinoma on imaging examination. AMLEC has a distinct histological and immunohistochemical staining pattern, which helps in the pathological diagnosis. We present a rare case of AMLEC in a 26-year-old female, which was provisionally diagnosed as renal cell carcinoma on radiology. We also summarize the differential diagnosis of this rare variant, its characteristic features, and a review of the literature.

Laparoscopic Intraperitonealization of Accidentally Misplaced Peritoneal Dialysis Catheter: A Salvage Procedure.

Tenckhoff catheter placement is a well-established procedure to facilitate continuous ambulatory peritoneal dialysis (CAPD) in end-stage renal disease (ESRD) management. Catheter malposition is a possible cause of catheter malfunction. Options to deal with early malfunction are re-exploration, omentectomy, repositioning, or new catheter placement. Technical malpositioning can be dealt with early, with minimal morbidity and cost. Here we report a case of a CAPD catheter accidentally placed preperitoneally which was salvaged using videolaparscopy.

Congenital bladder diverticulum presenting as bladder outlet obstruction in infants and children.

PURPOSE: Congenital primary bladder diverticulum is a rare cause of infra-vesical obstruction. We present a series of 12 cases who presented with urinary retention secondary to a large primary bladder diverticulum. The aim is to high light the diagnostic difficulties and management issues of congenital bladder diverticulae. METHODS: We reviewed the case sheets of 12 patients with congenital bladder diverticulae who presented as lower tract obstruction with or without infection at a tertiary care centre in the last 10 years. All patients had urine examinations (complete microscopic with culture), serum creatinine, ultrasonography, intravenous urogram, voiding cystourethrogram with or without cystoscopy. The cases were managed by extravesical mobilization of diverticulae, diverticulectomy, and ureteric re-implantation. All patients (aged 1-36 months, mean 16.8 months) presented with retention of urine but 4 of them had symptoms of fever, tachycardia, abdominal distension and vomiting. Serum creatinine was normal in 10 out of 12 cases, but was high in two. Urine cultures grew Escherichia coli in 5 cases. Ultrasonography showed moderate to severe hydronephrosis on the left side in 5 cases, on the right side in 4 cases and bilateral in 3 cases but diverticulae could be located in only 8 cases. Intravenous urogram revealed hydrouretero-nephrosis in 9 cases, a poor functioning kidney with hydrouretero-nephrosis in 3 cases and bilateral hydrouretero-nephrosis in 3 cases. A Voiding Cystourethrogram confirmed the diagnosis in all cases. Vesicoureteric reflux (Grade 4-5) into the ipsilateral ureter was seen in 9 children of which it was bilateral in three cases. RESULTS: All children underwent extravesical diverticulectomy with re-implantation of the ipsilateral ureter in 9 cases, bilateral in 3 cases. All had an uneventful recovery except for one who had a suprapubic leak which healed on conservative treatment. Postoperative ultrasonograms showed mild hydronephrosis in 2 cases and micturating cystourethrograms revealed a grade III V-U reflux in one case which was managed conservatively. Patients are maintaining a sterile urine culture after a follow up of 6-36 months. CONCLUSION: Primary bladder diverticulum should be kept as a differential diagnosis in cases of bladder outlet obstruction in infants and children. A carefully done voiding cystourethrogram is the hallmark of diagnosis. Good results can be achieved by diverticulectomy and primary definitive repair with ureteric re-implantation even in infants.

Dog bite injuries of genitalia in male infant and children.

The aim of the study is to highlight genital dog bites in male infant and children in developing countries and their management. We managed three cases (9 months, 5 years, and 8 years) of genital dog bite between January 1997 and July 2008. Two had unprovoked stray dog bites and the third was bitten by his pet dog when disturbed during eating. Extent of injury varied from small-lacerated wound to near emasculation. Primary repair was done after thorough washing and debridement under antibiotic cover. In the 9-month-old male infant who was near emasculated, scrotum was closed with the available skin and a small penile stump was reconstructed after meatoplasty. Immunization against tetanus and rabies was done for all cases. Postoperative recovery was uneventful, and the wound healed primarily in all cases. Parents of the infant were asked for feminizing genitoplasty but they refused so they were advised for hormonal replacement and penile reconstruction at adolescence. Male children are the most common victims of genital dog bites. These injuries can be repaired primarily with good outcome provided strict cleaning, debridement, wound repair, antibiotic cover, and immunization is applied.

In vivo femtosecond laser subsurface scleral treatment in rabbit eyes.

BACKGROUND AND OBJECTIVES: The progression of glaucoma can be reduced or delayed by reducing intraocular pressure (IOP). The properties of femtosecond laser surgery, such as markedly reduced collateral tissue damage, coupled with the ability to achieve isolated subsurface surgical effects in the sclera, make this technology a promising candidate in glaucoma management. In this pilot study we demonstrate the in vivo creation of partial thickness subsurface drainage channels with the femtosecond laser in the sclera of rabbit eyes in order to increase aqueous humor (AH) outflow. STUDY DESIGN/MATERIALS AND METHODS: A femtosecond laser beam tuned to a 1.7 microm wavelength was scanned along a rectangular raster pattern to create the partial thickness subsurface drainage channels in the sclera of one eye of each of the four rabbits included in this pilot study. IOP was measured before and 20 minutes after the laser treatment to evaluate the acute effect of the procedure. RESULTS: OCT images verified the creation of the partial thickness subsurface scleral channels in the eyes of the in vivo rabbits. Comparison of pre- and postoperative IOP measurements in treated and control eyes revealed a reduction in the intraocular pressure due to the increased rate of AH outflow resulted in by the presence of the partial thickness scleral channels. CONCLUSIONS: The creation of partial thickness subsurface drainage channels was demonstrated in the sclera of in vivo rabbit eyes with a 1.7 microm wavelength femtosecond laser. Reduction in IOP achieved by the partial thickness channels suggests potential utility in the treatment of elevated IOP.

3D finite element model of aqueous outflow to predict the effect of femtosecond laser created partial thickness drainage channels.

BACKGROUND AND OBJECTIVES: Partial thickness drainage channels can be created with femtosecond lasers in the translucent sclera for the potential treatment of glaucoma. We present a 3D finite element model (FEM) that can predict the effect of these channels on aqueous humor (AH) outflow and intraocular pressure (IOP). STUDY DESIGN/MATERIALS AND METHODS: A 3D model was developed based on a 2D model for the intact eye using COMSOL (Comsol, Inc., MA) finite element software. Different values of permeability were entered into the 3D model for the AH pathway and for the partial thickness channel. To obtain experimental data for model validation, one partial thickness channel was created in each of three enucleated rabbit eyes with a femtosecond laser tuned to 1.7 microm wavelength. Aqueous outflow rates were measured with the perfusion method before and after the laser treatments at different levels of IOP and then compared to IOP values predicted by the model. RESULTS: The experiments indicated that the rate of the AH outflow was increased in each of three eyes after the laser treatment. Assuming a constant rate of AH production the 3D model predicted IOP reductions ranging from 67.2% to 80.6% as the effect of the laser created channels. These predictions were in reasonable agreement with experimentally adjusted IOP values during the perfusion measurements. CONCLUSIONS: The developed 3D FEM has the potential to predict IOP reduction caused by partial thickness drainage channels created with the femtosecond laser in the sclera. Such a model may also be used to determine optimal channel dimensions for a specified increase in outflow facility and reduction in IOP.