OUP accepted manuscript

Intestinal tuberculosis (TB) is a rare condition comprising a majority of the extra-pulmonary TB cases. Owing to a similar clinical presentation, ultrasonographic and biopsy findings of intestinal TB with that of other abdominal pathologies such as carcinoma colon, their clinical delineation is very difficult unless aided with other modalities of investigations such as colonoscopy, culture of the biopsy material, etc. and even advanced methods such as polymerase chain reaction and gene X-pert of the biopsy material. Having all these investigations may not even lead to a correct diagnosis of intestinal TB as evidenced in the reported cases in the literature, advocating the need of diagnostic laparoscopy in the diagnosis of intestinal TB to eliminate extensive and unnecessary surgeries. Here, we present a case of intestinal TB in a 51-year-gentleman who got diagnosed in the course of treatment for a suspected carcinoma colon.

Mapping of a novel major effect Hessian fly field partial-resistance locus in southern soft red winter wheat line LA03136E71

Hessian fly resistance has centralized around resistance loci that are biotype specific. We show that field resistance is evident and controlled by a single locus on chromosome 7D. Hessian flies (Mayetiola destructor Say) infest and feed upon wheat (Triticum aestivum L) resulting in significant yield loss. Genetically resistant cultivars are the most effective method of Hessian fly management. Wheat breeders in the southern USA have observed cultivars exhibiting a "field resistance" to Hessian fly that is not detectable by greenhouse assay. The resistant breeding line "LA03136E71" and susceptible cultivar "Shirley" were crossed to develop a population of 200 random F_4:5 lines using single seed descent. The population was evaluated in a total of five locations in North Carolina during the 2019, 2020, and 2021 seasons. A subsample of each plot was evaluated for the total number of tillers, number of infested tillers, and total number of larvae/pupae. From these data, the percent infested tillers, number of larvae/pupae per tiller, and the number of larvae/pupae per infested tiller were estimated. In all within and across environment combinations for all traits recorded, the genotype effect was significant (p < 0.05). Interval mapping identified a single large effect QTL distally on the short arm of chromosome 7D for all environment-trait combinations. This locus was identified on a chromosome where no other Hessian fly resistance/tolerance QTL has been previously identified. This novel Hessian fly partial-resistance QTL is termed QHft.nc-7D. Fine mapping must be conducted in this region to narrow down the causal agents responsible for this trait, and investigation into the mode of action is highly suggested.

Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study

INTRODUCTION

Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients.

METHODS

This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS.

RESULTS

On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8-13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1-19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001).

CONCLUSION

There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.

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.

Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study

Background Thrombocytopenia is a common haematological abnormality noted in clinical practice, however, it can be missed in cases where specific investigations are not asked for. Acute Febrile Illness with thrombocytopenia is a diagnostic and therapeutic challenge, as thrombocytopenia has an inverse relation to mortality and morbidity in various febrile illnesses. Vector-borne and zoonotic diseases (like malaria, dengue, scrub typhus, and leptospirosis), infections and sepsis are some of the common causes of fever with thrombocytopenia. Objective To identify the causes of fever with thrombocytopenia, assess the clinical complications associated with febrile thrombocytopenia, and overall study the clinical profile of thrombocytopenia in a tertiary care hospital Method Medical records of all adult patients, admitted to a tertiary level hospital, with fever and thrombocytopenia (platelet count < 1,00,000 /mm3 ) were assessed (from October 2009 to March 2011). Detailed case history, general physical examination findings, routine and specific examinations were recorded according to a pre-decided format. Data were analysed using SPSS 16.0 Result Acute febrile illness with thrombocytopenia was most commonly seen in Dengue patients. Headache and arthralgia were more commonly encountered in scrub typhus. Platelet transfusions were necessitated in a large number of patients, especially in scrub typhus. Malaria patients had the highest mortality rate. Conclusion Acute Febrile Illnesses (AFI) are of varied origins, and proper diagnosis is imperative. The degree of thrombocytopenia in infections has a prognostic value. It can also help in differential diagnosis and clear identification of aetiology of acute febrile illnesses. Timely identification and management of thrombocytopenia in acute febrile illness can positively impact the overall patient outcome.

Probing the solute-drag effect and its role in stabilizing the orthorhombic phase in bulk La-doped HfO2 by X-ray and gamma ray spectroscopy

The recent observation of ferroelectricity in ultra thin films of hafnium oxide (HfO2) has been attributed to the orthorhombic (o) phase of HfO2 with space group Pca21. Although this oxide is polymorphic in nature, this polar o-phase is known to be stabilized in the doped thin film oxide. The objective of the present experiment is to stabilize the o-phases in La doped bulk polycrystalline HfO2 and investigate their evolution with the doping concentration through Time Differential Perturbed Angular Correlation (TDPAC), X-ray Absorption Near Edge Structure (XANES) and Extended X-ray Absorption Fine Structure (EXAFS) measurements. The present work reports the presence of both the polar Pca21 phase and the antipolar Pbca phase at different La-concentrations. Two o-phases of HfO2 with space groups Pca21 and Pbca, difficult to distinguish by other complimentary methods, could be unambiguously identified by utilizing the atomic scale sensitivity of the electric field gradient (EFG) embedded in TDPAC spectroscopy. The determination of the oxidation state and the local environment of La-atoms by XANES and EXAFS measurements illuminates the microscopic role of the dopant in stabilizing the o-phase. The "solute drag model" proposes a critical crystallite size for the nucleation of the o-phase in bulk HfO2 and explains the role of the La-dopant in stabilizing the o-phase. Thus the present study shows the possibility of stabilizing the polar o-phase and hence attaining ferroelectricity in bulk HfO2 to augment the scope of future application for this ferroelectric device.

Adrenal Ganglioneuroma

Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facililate the diagnosis of adrenal ganglioneuroma.

Measuring gender norms about relationships in early adolescence: Results from the global early adolescent study

Introduction

Gender norms are increasingly recognized as drivers of health and wellbeing. While early adolescence constitutes a critical window of development, there is limited understanding about how adolescents perceive gender relations across different cultural settings. This study used a mixed-method approach, grounded in the voices of young people around the world, to construct and test a cross-cultural scale assessing the perceptions of gender norms regulating romantic relationships between boys and girls in early adolescence.

Methods

The study draws on the Global Early Adolescent study (GEAS), a study focusing on gender norms and health related outcomes over the course of adolescence in urban poor settings worldwide. In-depth interviews were first conducted among approximately 200 adolescents between 10–14 years in seven sites across 4 continents to identify common scripts guiding romantic relations in early adolescence. These scripts were then transformed into a multidimensional scale. The scale was tested among 120 adolescents in each of 14 GEAS sites, followed by a second pilot among 75 adolescents in six sites. We evaluated the psychometric criteria of each sub-scale using principal component analysis, and parallel analysis, followed by exploratory factor analysis to guide the selection of a more parsimonious set of items.

Results

Results suggested a two-factor structure, consisting of an “adolescent romantic expectations” subscale and a “Sexual Double Standard” subscale. Both subscales yielded high internal validity in each site, with polychoric Cronbach alpha values above 0.70 with the exception of Kinshasa for the adolescent romantic expectations scale (0.64) and Hanoi for the sexual double standard scale (0.61).

Conclusion

This study reveals common perceptions of gendered norms about romantic engagement in early adolescence, normative for both sexes, but socially valued for boys while devaluated for girls. The findings illustrate that social hierarchies of power in romantic relationships form early in adolescence, regardless of cultural setting.

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Gender norms about romantic relationships prevail across diverse cultures.

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New cross-cultural scales measure early adolescents’ perceptions of gender norms;

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Adolescent romantic relations are viewed as normative but damaging for girls;

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Even before sexual activity, adolescents understand societal expectations about relationships;

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Social hierarchies of power in relationships form in early adolescence.

Optimization of lithium content in LiFePO4 for superior electrochemical performance: the role of impurities

Carbon coated Li_xFePO₄ samples with systematically varying Li-content (x = 1, 1.02, 1.05, 1.10) have been synthesized via a sol–gel route. The Li : Fe ratios for the as-synthesized samples is found to vary from ∼0.96 : 1 to 1.16 : 1 as determined by the proton induced gamma emission (PIGE) technique (for Li) and ICP-OES (for Fe). According to Mössbauer spectroscopy, sample Li_1.05FePO₄ has the highest content (i.e., ∼91.5%) of the actual electroactive phase (viz., crystalline LiFePO₄), followed by samples Li_1.02FePO₄, Li_1.1FePO₄ and LiFePO₄; with the remaining content being primarily Fe-containing impurities, including a conducting FeP phase in samples Li_1.02FePO₄ and Li_1.05FePO₄. Electrodes based on sample Li_1.05FePO₄ show the best electrochemical performance in all aspects, retaining ∼150 mA h g⁻¹ after 100 charge/discharge cycles at C/2, followed by sample Li_1.02FePO₄ (∼140 mA h g⁻¹), LiFePO₄ (∼120 mA h g⁻¹) and Li_1.10FePO₄ (∼115 mA h g⁻¹). Furthermore, the electrodes based on sample Li_1.05FePO₄ retain ∼107 mA h g⁻¹ even at a high current density of 5C. Impedance spectra indicate that electrodes based on sample Li_1.05FePO₄ possess the least charge transfer resistance, plausibly having influence from the compositional aspects. This low charge transfer resistance is partially responsible for the superior electrochemical behavior of that specific composition.

Extensive information regarding the Li : Fe stoichiometry in the LiFePO₄ cathode and the formation of concomitant impurities and their impact on the various electrochemical performances have been reported.

Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal

Background As the evidence based practice (EBP) movement expands, there is a need for health leaders and educators in each country to assess the extent to which health professional students and practitioners are prepared to locate, evaluate, and apply evidence to guide their practice. Objective The study objective was to explore nurses' and nursing students' perceptions and attitudes towards EBP. Method This was a descriptive cross-sectional survey administered to all 273 nurses and nursing students from Nepal who attended an EBP conference. The survey instrument that was used by Majid in Singapore was adapted for use in this study with permission from the author. Result In total, 121 nurses participated in the study. The majority (93%) of respondents reported that they had no previous training in EBP. The respondents' perceptions of their EBP knowledge and skills were variable, but most of them demonstrated positive attitudes toward EBP. Respondents identified a number of barriers that limit the implementation of EBP in Nepal. The greatest barriers were lack of time and resources, difficulty understanding research articles and translating the findings to practice, and limited autonomy to change practice based on evidence. Conclusion Although respondents had positive attitudes towards EBP, their knowledge and skills were limited and barriers to implementation existed. Nursing faculty can use the findings to guide implementation of EBP into curricula, and nursing administrators and clinicians can use the findings to guide practice to promote EBP.

Incidence of Post Operative Wound Infection Following the Use of Antibiotics in Clean Contaminated Head and Neck Surgery in a Tertiary Care Centre in Eastern Nepal

Introduction Post operative wound infection continues to be the major concern even after the appropriate antibiotic coverage.Objective To find out the incidence of post operative wound infection following the use of antibiotics in clean contaminated head and neck surgery in a tertiary care centre in Eastern Nepal.Methodology It is a prospective study conducted at Department of Otorhinolaryngology and Head and Neck Surgery, Nobel Medical  College Teaching Hospital, Biratnagar from 14th April 2013 to 12th April 2015. Patient who underwent clean contaminated head and neck surgery were followed up on 1st, 3rd and 6th post–operative day (POD) and wounds were inspected for any signs of wound infection.Results A total of 144 patients undergoing various clean contaminated head and neck surgeries were included in this study. Tonsillectomy was the commonest surgery performed (40.27%). An overall wound infection rate was 11.80%. Serous discharge rd from the surgical site observed on 3rd post operative day was the most common presentation of wound infection (29.41%). Parotidectomy was the surgery presenting with highest rate of wound infection (31.25%).Conclusion This study concludes that even the best technique and appropriate antibiotic has not completely eliminated the problem of wound infection in clean contaminated head and neck surgery.Birat Journal of Health Sciences 2016 1(1): 51-55