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Background and objective Magnetic resonance spectroscopy (MRS) is a magnetic resonance imaging technique used to identify in vivo metabolites non-invasively within the tissue of interest. It plays an important role in diagnosing brain lesions, particularly tumors and infections. There are certain metabolites whose levels are increased or decreased in brain tumors, the ratios of which can also be used to grade the tumors as high- or low-grade. This study aimed to assess the spectrum of different metabolites in intraaxial gliomas using magnetic resonance spectroscopy and to assess the usefulness of their ratios for grading gliomas into high-grade and low-grade. Methods This descriptive cross-sectional study was performed in the radiology department of Nobel Medical College and Teaching Hospital, Biratnagar, Nepal over one year (September 2019 to September 2020). Thirty-five patients diagnosed as having intra-axial tumors were enrolled. After taking informed consent the examination findings were recorded in structured proforma. Siemens' 3 Tesla open magnet MAGNETOM Skyra (Siemens Healthineers AG, Munich, Germany) MR scanner was used to evaluate each patient. Data was analyzed using the software Statistical Package for Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY). Results Out of 35 patients scanned, 18 had high-grade glioma and 17 had low-grade glioma. High-grade glioma had a choline/creatine (Cho/Cr) ratio of 2.44 ± 0.78 and a choline/N-acetyl-aspartate (Cho/NAA) ratio of 2.05 ± 0.84. Low-grade glioma had a Cho/Cr ratio of 1.48 ± 0.50 and a Cho/NAA ratio of 1.41 ± 0.19. Fourteen out of eighteen high-grade gliomas had raised lipid/lactate peaks. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy for diagnosing high-grade glioma with a Cho/Cr ratio cut-off of 1.5 was 83.3 %, 82.4%, 83.3%,82.4 %, and 82.85% respectively. Conclusion MRS metabolite ratios can be used to diagnose and grade gliomas. Cho/Cr, Cho/NAA, and the presence or absence of lipid/lactate peak can significantly improve the sensitivity, specificity, predictive values, and accuracy of preoperative glioma grading when used in conjunction with conventional MRI.
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Nepal is one of the pioneers of hydropower development among Asian countries. The plethora of fast-flowing rivers provides immense potential for hydropower generation. However, Nepal still lacks a clear blueprint for the overall development and management of this sector. This paper aims to review the evolution of hydropower development, future prospects and roadblocks to hydropower development. With the growing energy demands projected to reach as high as 41,264.82 Gigawatt hours (GWh) in 2030 and 115,294.4 GWh in 2040 under different scenarios, this paper highlights the huge prospects the sector holds. It also proposes a focus on storage-type hydropower plants and concepts of energy banking to address the incipient condition of seasonal energy mismatch in the country, which has developed a condition of energy shortage during the winter and energy surplus during the monsoon. Moreover, projected changes in hydro-climatic extremes under the climate change scenarios is likely to affect water availability and subsequently the energy production in the majority of hydropower projects. Thus, this review can serve as a guideline to help understand the current scenario and make rational decisions and policies for the future management of the hydropower sector of the country.
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Introduction: Health personnel work under highly stressful conditions with long work hours, frequent night work, and shift duties resulting in sleep problems. Sleep problems lead to a decline in performance, cognition, memory, decision-making, medical errors and mental disorders. The study aimed to find out the prevalence of poor quality of sleep among healthcare workers in a tertiary care centre. Methods: This is a descriptive cross-sectional study conducted among healthcare workers (doctors, nurses, paramedics) of a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data was collected from 1 October to 1 December 2023. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 127 healthcare workers, the prevalence of poor quality of sleep was seen in 61 (48.03%) (39.34-56.72, 95% Confidence Interval). A total of 31 (50.82%) were female and 30 (49.18%) were male. Conclusions: The prevalence of poor sleep quality was found to be higher than that of other studies done in similar settings. There is a need to enhance institutional support like incorporating flexible work schedules, and regular wellness programs to alleviate poor sleep quality among healthcare workers. Keywords: health personnel; mental disorders; prevalence; quality of sleep; sleep.