Whey removal characteristics during conventional production of chhana

Whey removal phenomena generally studied in terms of whey removal rate, chhana weight and moisture content during chhana production process. Despite all these above factors, moisture content concerned to be the important one to maintain its soft texture and suitability for manufacturing of diversified products. The present study was undertaken to identify best model to express whey draining process so as to predict the relevant characteristics such as moisture ratio, moisture content and moisture removal rate. Whey removal rate was pursued for different cow milk quantities (5, 10, 15 and 20 kg) using delayed straining technique for gravimetric removal of whey from the chhana mass. Among the mathematical models, Logarithmic model was found best in describing the whey draining characteristics and predicting the moisture ratio of chhana. Whey removal characteristics provides important insights for the development of equipments for chhana production, downstream processing equipments for whey and online sensors for monitoring the process that regulates the moisture content and final quality of chhana and chhana based products. The novelty of the work lied on the incorporation of mathematical modeling to the chhana production process.

Mechanisms associated with the rapid decline in sea ice cover around a stranded ship in the Lazarev Sea, Antarctica

In the satellite data era starting from 1979, the extent of Antarctic sea ice increased moderately for the first 37 years. However, the extent decreased to record low levels from 2016 to 2020, with the drop being greatest in the Weddell and Lazarev Seas of the Southern Ocean. An important question for the scientific fraternity and policymakers is to understand what ocean-atmospheric processes triggered such a rapid decline in sea ice. We employ in-situ, satellite, and atmospheric reanalysis data to examine the causative mechanism of anomalous sea ice variability in the Lazarev Sea at a time of ice growth in the annual cycle (March-April 2019), when a cargo ship was stuck in extensive ice cover and freed following the unusual decline in sea ice. High-resolution Sentinel-1 synthetic aperture radar captured a distinct view of the ship location and track within extensive ice cover of fast sea ice, dense pack ice, and icebergs in the Lazarev Sea on 27 March 2019. Subsequently, the sea ice cover declined and reached the fourth lowest extent in the entire satellite record during April 2019 which was 25.6% lower than the long-term mean value of 2.65 × 10⁶ km². We show that the anomalous sea ice variability was due to the occurrence of eastward-moving polar cyclones, including a quasi-stationary explosive development that impacted sea ice through extreme changes in ocean-atmospheric conditions. The cyclone-induced dynamic (poleward propagation of ocean waves and ice motion) and thermodynamic (heat and moisture plumes from midlatitudes, ocean mixed layer warming) processes coupled with high tides provided a conducive environment for an exceptional decline in sea ice over the region of ship movement.

Perception of Employees Regarding the Quality Management System Implemented at a Tertiary Care Eye Hospital in North India: A Mixed-Methods Study

Background:

Quality management in healthcare is critical for hospitals and everyone in the loop —from physicians to support staff—needs to be aware of and involved in this process.

Objectives:

To assess the perception of employees about the quality management system (QMS) implemented at a tertiary care eye hospital in north India and to use it to identify scope for further improvement.

Methods:

This cross-sectional mixed-method study involved both questionnaire-based survey and an in-depth interview by a third party. The questionnaire had 12 questions to assess the changes in culture, infrastructure, environment, system, operation theatre and outpatient department. Employees shared their opinion about improvements brought by the QMS in eight years. Respondents were divided into five groups based on their job description: (i) doctors, (ii) technical staff (nursing/operation theatre/laboratory), (iii) optometrists/opticians/audiologists, (iv) patient care executives and (v) human resources/administration/others.

Results:

Of the 73 employees interviewed, 94.5% perceived an improved treatment and care process and 91.8% perceived improved treatment results. According to 83.6% of the employees, they were encouraged to report patient safety concerns and 71.2% saw improved incidence and adverse event management. The QMS has increased patient satisfaction according to 83%, while 91.8% felt it improved the profile of the hospital. The employees stated no negative effects of the QMS except a long waiting time of the patients and the duplication of paperwork.

Conclusion:

QMS has brought many positive changes across the hospital. Still, there is scope to reduce the patient waiting time and paperwork duplication.

Dysnatremia in Traumatic Brain Injury and its Association with Outcome

Background Traumatic brain injury on its own results in significant mortality and morbidity but it also contributes to complications that manifest as dysnatremia in the majority of cases. Objective The objective of this study is to assess the association of hyponatremia and hypernatremia with the severity of traumatic brain injury and its impact on mortality. Method This is a retrospective, descriptive, and analytic study conducted during a 1-year period from March 2018 to March 2019. The study population was selected from the patients presenting to the emergency department with TBI in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal. All the patients that fulfilled the inclusion criteria of age were enrolled in the study. Patients with known renal disease due to the higher incidence of electrolyte disbalance were excluded. Association of outcome with hyponatremia and hypernatremia were sought using chi-square, fisher exact test and independent t test using SPSS ver 20. Result Over a period of 1 year, 367 patients with traumatic brain injuries were treated in our hospital. Hyponatremia was seen among 55 patients (14.9%) and hypernatremia was seen among 22 patients (5.99%). The age range of patients included in the study was 16 to 87 with a mean age of 37.96 ± 16.512 years. The male to female ratio was calculated as 3.2:1. Mild, moderate, and severe head injuries were 286 (77.9%), 37 (10.1%), and 44 (12%) respectively. Surgical intervention was performed among 77(21%) individuals. Our series showed an association between the severity of traumatic brain injury and hyponatremia however didn't show an association between the severity of traumatic brain injury and the development of hypernatremia. Conclusion We concluded that the severity of head injury is associated with severity of hyponatremia but not with severity of hypernatremia. Similarly, a strong association existed between the severity of hypernatremia and outcome of patients. However, such association was not seen with hyponatremia.

Anthropogenic arsenic menace in contaminated water near thermal power plants and coal mining areas of India

Coal mining and coal combustion in thermal power plants (TPPs) are the major anthropogenic sources of arsenic (As) contamination in many different industrial regions. In this study of industrial regions of West Bengal and Singrauli, it is observed that there is an anthropogenic contribution to the contamination from As-bearing coal. Up to 14.53 mg/kg of As is obtained in coal of West Bengal which also has very high average Fe concentration (16,095 mg/kg) along with high concentration of Cu, Mn and Hg. Similar observations are also found in Singrauli Industrial Region where 3.14 mg/kg of As with very high concentration of Fe 43,867 mg/kg along with high Cu, Mn and Hg concentration is found in coal samples. This low-grade bituminous coal contains arsenopyrite as observed by SEM-EDX. Arsenopyrite is converted to arsenolite upon combustion in these TPPs as observed in XRD. The fly ash has average As concentration of 1.53 mg/kg for West Bengal and 2.38 mg/kg for Singrauli Industrial Region and high concentration of toxic elements. The soil near these TPPs and mining areas is enriched in As, Fe, Hg, Cu and Mn. Not only As but high concentrations of Fe, Hg, Mn are also observed from analysis of water which relates to the anthropogenic inputs. The dissolution of arsenolite in reducing environments caused by periodic flooding releases As into water. Hence, the As contamination in the study area also has anthropogenic origin from coal consumption in TPPs.

Influence of Brassica spp. rapeseed and canola meal, and supplementation of bioactive compound (AITC) on growth performance, intestinal-permeability, oocyst shedding, lesion score, histomorphology, and gene expression of broilers challenged with E. maxima

This study was performed to investigate the effect of feeding Brassica spp. including full-fat rapeseed, canola meal, and allyl isothiocyanate (AITC) to broiler chicken challenged with E. maxima. A total of 576 one-day old male broiler chicks were completely randomized to 8 treatments with 6 replicated cages and 12 birds per cage. The treatment diets consisted of nonchallenge control (NC, corn-SBM based diet), challenge control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola (20CLM), 40% canola (40CLM), 500 ppm AITC (500AITC), and 1,000 ppm AITC (1000AITC). At d 14, all birds were challenged, except NC group, with a subclinical dose of E. maxima. Intestinal permeability was conducted on 5 d post-infection (dpi) and for oocyst shedding 5 to 6 dpi feces were pooled and collected. On 6 dpi, growth performance, lesion score, histomorphology, and gene expression were measured. The growth performance result showed that 10RS and 30RS groups had lower BW, BWG, FI, and higher FCR (P < 0.0001). During the challenge and overall periods, NC group had highest BW, BWG, and FI, and lowest FCR. The inclusion of canola meal showed lower performance during prechallenge period but was able to catch up BWG during challenge period. The AITC levels showed similar growth performance to CC group. Intestinal permeability for 20CLM, 40CLM, 500AITC and 1000AITC was similar to NC group, whereas CC, 10RS, and 30RS had higher permeability compared to NC (P < 0.0001). Oocyst shedding was significantly lower for 40CLM and NC, whereas all other treatments had higher oocyst shedding (P < 0.0001). All the challenged treatment groups had higher lesion score and microscore than NC (P < 0.0001). Histomorphology data showed that jejunum villus height (VH) for 1000AITC was similar to NC group, whereas CC group had the lowest VH (P = 0.01). The 30RS group had lower VH: crypt depth (CD) ratio in the jejunum and ileum. The gene expression at 6 dpi for claudin1, occludin, IL2, IL6, GLUT5, EAAT, BoAT, and LAT1 was significantly changed among the treatments. The results suggest that 30RS retards growth performance and deteriorate gut health during coccidiosis and should not be fed to chicken during the starter phase. Canola meal showed decline in growth prechallenge but maintained growth and intestinal health during the challenge period at 40% inclusion. AITC at 1,000 ppm showed similar growth as control group, but with improved gut health during the challenge period. Canola meal could be a good alternative to SBM especially during coccidiosis, whereas AITC needs to be tested vigorously in animal feeding regime.

A novel LOX3-null allele (lox3-b) originated in the aromatic Basmati rice cultivars imparts storage stability to rice bran

Rapid deterioration of rice bran due to the LOX3 enzyme catalysed oxidation of PUFA is the major bottleneck for its utilization in various downstream applications. In the present study, we have identified a set of nine novel LOX3-null rice accessions carrying a deletion of C residue in the exon2 causing a frameshift mutation resulting in a truncated non-functional LOX3 protein. Our study, further manifested the predominance of C deletion based LOX3-null allele, named lox3-b, in the aromatic rice germplasm particularly in the Indian Basmati rice group. The LOX3-null genotypes exhibited significantly reduced rancidity, after six months of storage. They also showed significantly lower percentage reduction of linoleic acid (LA), higher γ-oryzanol content and lower hexanal content. A functional dCAPS marker designed based on the deletion polymorphism clearly differentiated LOX3 and lox3-b alleles, and has the potential application in marker assisted rice breeding programmes to develop cultivars with better bran storability.

Revealing the effect of seed phosphorus concentration on seedling vigour and growth of rice using mutagenesis approach

The harvested plant products, specifically, the grains of cereals are major drivers of soil phosphorus (P) depletion. However, the breeding or biotechnology efforts to develop low P seeds have not been attempted because of possible adverse effects on seedling vigour and crop establishment. Several studies have contradictory observations on influence of seed P on seedling vigour. Lack of appropriate genetic material has been the major bottleneck in reaching the consensus. In this study, we used 30 EMS induced mutants of rice cultivar Nagina22 to understand the role of seed P on seedling vigour and associated physiological processes. Seedling vigour, morpho-physiological characteristics, acid phosphatases, alpha-amylase, and expression of P transporter genes were analyzed in seedlings obtained from seeds of high and low grain P mutants. The study suggests that seed P has a significant role on seedling vigour, chlorophyll content and photosynthesis process of young seedlings, and P transport from roots. Notably, we identified few mutants such as NH4791, NH4785, NH4714, NH4663, NH4614, and NH4618 which showed least influence of low seed P on seedling vigour and other metabolic processes. Therefore, these mutants can be used in breeding programs aiming for development of low P grains. Also, these and other identified mutants can be used to decipher the genetic and molecular mechanisms regulating the differential response of seed P on germination, seedling vigour and several other physiological processes influencing the crop growth and establishment.

Influence of rapeseed, canola meal and glucosinolate metabolite (AITC) as potential antimicrobials: effects on growth performance, and gut health in Salmonella Typhimurium challenged broiler chickens

Poultry is the major sources of foodborne salmonellosis. Antibiotic resistance and a surge in zoonotic diseases warrant the use of natural alternatives. Glucosinolates (GLs) are naturally occurring antimicrobial compounds in rapeseed and canola. This study investigated the effect of feeding rapeseed, canola meal, and allyl isothiocyanate (AITC; Brassica secondary metabolites) on growth performance (GP), gut health, and the potential antimicrobial activity against nalidixic acid-resistant Salmonella Typhimurium (STNR) in chickens. A total of 640 one-day-old male Cobb 500 broilers were randomly allocated to 8 treatments with 8 replicated cages and 10 birds per cage. Dietary treatments were nonchallenge control (NC, corn-SBM based), challenge (Salmonella) control (CC), 10% rapeseed (10RS), 30% rapeseed (30RS), 20% canola meal (20CLM), 40% canola meal (40CLM), 500 ppm AITC (500AITC), and 1,500 ppm AITC (1500AITC). On d 1, all the birds except NC were orally challenged with STNR (7 log CFU/bird). The chickens were reared for 21 d, and their FI and BW were recorded weekly. Salmonella cecal colonization and fecal shedding were quantified, whereas organ translocation (OT) of STNR to the spleen, liver, and kidney was tested on 0, 3, 6, 13, and 20-d postchallenge (dpc). Data were subjected to one-way ANOVA, and the means were separated by Duncan's test, except mortality and OT data analyzed after transformation by square root of (n +1) (P < 0.05). Overall, feeding 30RS resulted in reduced BW (P = 0.003), BWG (P = 0.003), and FI (P = 0.001) compared to CC, 500AITC, and 1500AITC. Similarly, feeding 20CLM resulted in lower BW and BWG compared to CC (P < 0.05) and increased FCR compared to 1500AITC (P = 0.03). Feeding CC resulted in higher mortality compared to NC and 30RS (P = 0.03). Cecal colonization of STNR was reduced (P < 0.0001) for 30RS on 6 dpc and 500AITC on 6 and 13 dpc (P < 0.0001). Although no difference in gut permeability was observed 6 dpc (P > 0.05), OT of STNR population was the highest for CC in the spleen (P = 0.05). In the liver, 10RS showed reduced OT compared to 20CLM on 13 dpc (P = 0.03), whereas 30RS showed the lowest OT on 6 dpc in the kidney. Fecal shedding was lowest for 30RS on 6 dpc (P = 0.004). Histomorphology showed 30RS had the highest duodenum (P = 0.01) and jejunum (P = 0.02) villus height (VH) and VH to crypt depth (CD) ratio compared to the other treatments, whereas 1500AITC showed similar results to 30RS. Both 30RS and 1500AITC contained comparatively higher functional GL metabolites and were able to maintain gut health. Including higher levels of rapeseed or AITC in poultry feed can reduce Salmonella colonization in the feces and their translocation to other organs.

Sliding of HIV-1 reverse transcriptase over DNA creates a transient P pocket - targeting P-pocket by fragment screening

HIV-1 reverse transcriptase (RT) slides over an RNA/DNA or dsDNA substrate while copying the viral RNA to a proviral DNA. We report a crystal structure of RT/dsDNA complex in which RT overstepped the primer 3'-end of a dsDNA substrate and created a transient P-pocket at the priming site. We performed a high-throughput screening of 300 drug-like fragments by X-ray crystallography that identifies two leads that bind the P-pocket, which is composed of structural elements from polymerase active site, primer grip, and template-primer that are resilient to drug-resistance mutations. Analogs of a fragment were synthesized, two of which show noticeable RT inhibition. An engineered RT/DNA aptamer complex could trap the transient P-pocket in solution, and structures of the RT/DNA complex were determined in the presence of an inhibitory fragment. A synthesized analog bound at P-pocket is further analyzed by single-particle cryo-EM. Identification of the P-pocket within HIV RT and the developed structure-based platform provide an opportunity for the design new types of polymerase inhibitors.

Exploring the dNTP -binding site of HIV-1 reverse transcriptase for inhibitor design

HIV-1 reverse transcriptase (RT) plays a central role in the viral life cycle, and roughly half of the FDA-approved anti-HIV drugs are targeting RT. Nucleoside analogs (NRTIs) require cellular phosphorylation for binding to RT, and to bypass this rate-limiting path, we designed a new series of acyclic nucleoside phosphonate analogs as nucleoside triphosphate mimics, aiming at the chelation of the catalytic Mg²⁺ ions via a phosphonate and/or a carboxylic acid group. Novel synthetic procedures were developed to access these nucleoside phosphonate analogs. X-ray structures in complex with HIV-1 RT/dsDNA demonstrated that their binding modes are distinct from that of our previously reported compound series. The impact of chain length, chirality and linker atom have been discussed. The detailed structural understanding of these new compounds provides opportunities for designing new class of HIV-1 RT inhibitors.

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

SETTING

Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).

OBJECTIVE

In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.

DESIGN

A cohort study using hospital data, January 2018-January 2020.

RESULTS

Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.

CONCLUSION

Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

Talin rod domain-containing protein 1 (TLNRD1) is a novel actin-bundling protein which promotes filopodia formation

Talin is a mechanosensitive adapter protein that couples integrins to the cytoskeleton. Talin rod domain-containing protein 1 (TLNRD1) shares 22% homology with the talin R7R8 rod domains, and is highly conserved throughout vertebrate evolution, although little is known about its function. Here we show that TLNRD1 is an α-helical protein structurally homologous to talin R7R8. Like talin R7R8, TLNRD1 binds F-actin, but because it forms a novel antiparallel dimer, it also bundles F-actin. In addition, it binds the same LD motif-containing proteins, RIAM and KANK, as talin R7R8. In cells, TLNRD1 localizes to actin bundles as well as to filopodia. Increasing TLNRD1 expression enhances filopodia formation and cell migration on 2D substrates, while TLNRD1 down-regulation has the opposite effect. Together, our results suggest that TLNRD1 has retained the diverse interactions of talin R7R8, but has developed distinct functionality as an actin-bundling protein that promotes filopodia assembly.

Evaluation of BenzoDODA grafted polymeric resin for rapid and reliable assaying of plutonium in sediment samples

The paper reports a new rapid radioanalytical procedure for the determination of plutonium (Pu) in sediments by solid phase extraction chromatography (SPEC) using Bis-(2-ethylhexyl) carbamoyl methoxy phenoxy-bis-(2-ethylhexyl) grafted resin, abbreviated as Benzodioxodiamide (BenzoDODA) grafted resin. The resin was synthesized and evaluated for its sorption behaviour towards Pu in batch and column mode to determine its efficacy for selective recovery of Pu from sediment samples. The analytical procedure was based on the radiochemical separation of samples by acid digestion, followed by preconcentration of actinides by co-precipitation with Fe(OH)₃ and finally selective recovery of Pu by SPEC using a column filled with BenzoDODA grafted resin. Pu was then radiometrically assayed by preparing alpha disc sources with electro-deposition followed by alpha spectrometry. The method was further validated with IAEA reference materials. This method gives reliable and reproducible results for the activity concentration of Pu in sediment samples within 24 h.

C-ARM Guided Angiogram/Angioplasty for Selected Failed Arterio Venous Fistula. A Report of a Procedure at University Hospital of Nepal

End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2 . Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula.

In Situ Fabrication of Activated Carbon from a Bio-Waste Desmostachya bipinnata for the Improved Supercapacitor Performance

Herein, we demonstrate the fabrication of highly capacitive activated carbon (AC) using a bio-waste Kusha grass (Desmostachya bipinnata), by employing a chemical process followed by activation through KOH. The as-synthesized few-layered activated carbon has been confirmed through X-ray powder diffraction, transmission electron microscopy, and Raman spectroscopy techniques. The chemical environment of the as-prepared sample has been accessed through FTIR and UV-visible spectroscopy. The surface area and porosity of the as-synthesized material have been accessed through the Brunauer-Emmett-Teller method. All the electrochemical measurements have been performed through cyclic voltammetry and galvanometric charging/discharging (GCD) method, but primarily, we focus on GCD due to the accuracy of the technique. Moreover, the as-synthesized AC material shows a maximum specific capacitance as 218 F g^-1 in the potential window ranging from - 0.35 to + 0.45 V. Also, the AC exhibits an excellent energy density of ~ 19.3 Wh kg^-1 and power density of ~ 277.92 W kg^-1, respectively, in the same operating potential window. It has also shown very good capacitance retention capability even after 5000th cycles. The fabricated supercapacitor shows a good energy density and power density, respectively, and good retention in capacitance at remarkably higher charging/discharging rates with excellent cycling stability. Henceforth, bio-waste Kusha grass-derived activated carbon (DP-AC) shows good promise and can be applied in supercapacitor applications due to its outstanding electrochemical properties. Herein, we envision that our results illustrate a simple and innovative approach to synthesize a bio-waste Kusha grass-derived activated carbon (DP-AC) as an emerging supercapacitor electrode material and widen its practical application in electrochemical energy storage fields.

Performance of cytology, acid-fast bacilli smear, gene Xpert and mycobacterial cultures in endobronchial ultrasound-transbronchial needle aspiration aspirate in diagnosing mediastinal tuberculous lymphadenitis

BACKGROUND

Diagnosis of isolated mediastinal tuberculosis (TB) can be challenging. Endobronchial ultrasound (EBUS) increases the diagnostic yield by direct sonographic visualization of mediastinal and hilar lymph nodes. With the advent of molecular techniques such as Gene Xpert, their addition to the cytology and cultures increases the diagnostic yield and detection of rifampicin resistance (RR) which helps change the effective therapeutic regimen immediately.

MATERIALS AND METHODS

Prospective analysis of all patients undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) with a clinical possibility of TB in isolated mediastinal lymphadenopathy patients at a tertiary care referral center between June 2016 and January 2018. All patients had at least five passes from each node of which two passes from each lymph node sampled in 2 ml of saline for culture and Gene Xpert for microbiologic, pathologic, and molecular analysis as per hospital protocol.

RESULTS

Out of 60 patients, 44 were diagnosed to have mediastinal tuberculous lymphadenitis, 8 sarcoidosis, 2 malignancies, and 6 reactive lymphadenitis. TBNA cytology was positive in 40/44 patients (90.9%), out of which 18 patients were culture positive with the sensitivity of 100%, specificity 47.6%, positive predictive value (PPV) 45%, and negative predictive value (NPV) 100%, (P value 0.011). TBNA acid-fast bacilli (AFB) smear was positive in 20/44 patients (45.45%) out of which 12 were culture positive, with sensitivity of 67%, specificity 80.95%, PPV 60%, NPV 85% (P value 0.011). TBNA Gene Xpert was positive in 30/44 patients (68.2%), out of which 6 (13.63%) showed RR-TB and two were cytology negative. Sixteen patients where culture positive with sensitivity of 88.89%, specificity 66.67%, PPV 53.33%, NPV 93.33% (P value of 0.005). TBNA AFB culture was positive in 18/44 patients (40.9%).

CONCLUSION

EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB, especially for mediastinal tuberculous lymphadenitis. The combination of various tests increases the diagnostic yield. Mediastinal nodal aspirates traditionally believed to be paucibacillary can still be captured by Gene Xpert.

Knowledge, Attitude and Practice Regarding COVID-19 and its Impact on Dentistry: A Cross-sectional Survey among Nepalese Dentists

Background Coronavirus Disease, 2019 (COVID-19) is a highly infectious respiratory disease with high transmissibility. Dentists are at inherent risk because of aerosol generating procedures exposing dentists to the respiratory and oral secretions of the patients. Objective To assess the knowledge, awareness, and practice (KAP) of the Dentists to combat the pandemic which could help shape future guidelines and policies to be implemented in dental settings. Method This cross-sectional descriptive study included series of multiple-choice questions distributed online, assessing dentists' KAP towards COVID-19, its impact on dentistry and their psychological well-being. Statistical analysis was performed using SPSS (Statistical Package for Social Sciences) version 20 for mac Operating System (OS). Descriptive statistics was performed, and frequencies of responses were reported in proportion. Non-parametric tests of independence and Chi-square test were performed to see the association between the categorical variables. Result Around 84% of the respondents accurately answered mode of transmission, 68% inquired about the travel history while only 49% measured the body temperature. Also, only 42% were receiving salary. A statistically significant difference concerning impact and practice during the COVID-19 was observed between general practitioner and specialist working at different work places. Conclusion Majority of Dentists have good knowledge and awareness but there were certain pitfalls in attitude and practice level calling out for more efficient training programs, precise guidelines, and treatment protocols to put into practice. Also, the mental distress and the financial impact subjected upon dentist require to be further explored determining the association between their mental health during and post COVID-19 outbreak.