National participation levels in the 2017-2018 Australian thoroughbred racing season

INTRODUCTION

The social licence of the Australian thoroughbred (TB) industry relies on the general public's perception of how they manage the animal in their care.

METHOD

This study examines the horse, race and activity records for the 37,704 horses racing and training in Australia from 1 August 2017 to 31 July 2018. Three-quarters (75%, n = 28,184) of TBs started in one of the 180, 933 race starts that occurred during the 2017-2018 Australian racing season.

RESULTS

Horses participating in the 2017-2018 Australian racing season had a median age of 4 years, with geldings more likely to be aged 5 years and older. The majority of the TB racehorse population were geldings (51%, n = 19,210), with 44% (n = 16,617) females and only 5% (n = 1877) entire males. Horses aged 2 years were three times more likely to not start in a race in that year compared with older horses. At the end of the 2017-2018 racing season, 34% of the population had an inactive status recorded. Horses aged 2 years (median two starts) and 3 years (median five starts) had fewer starts than older horses (median seven starts). Eighty-eight percent (n = 158,339) of race starts were over distances of 1700 metres or less. Race starts by horses aged 2 years (46%, 3264 of 7100) were more likely to have occurred at a metropolitan meeting compared with starts by older horses.

CONCLUSION

This study provides a national overview of the racing and training activities and TBs participating in the 2017-2018 Australian racing season.

Health Promoting Lifestyle during Covid-19 Pandemic among Residents of Gandaki Province, Nepal

Background Lifestyle is an important factor to individual's health and quality of life. Although, the emergence of Corona virus disease 2019 (COVID-19) has forced billions of people to change their lifestyle overnight. Objective To identify health promoting lifestyle during COVID-19 pandemic among the residents of Gandaki Province, Nepal. Method Descriptive cross sectional web based study was conducted among 386 respondents from Gandaki Province. Adults from 18 years and above, who could fill the form online were included using purposive and snowball sampling technique. Data were collected using Health Promoting Lifestyle Profile II (HPLP II) scale and analysed using descriptive (frequency, percentage, median) and inferential statistics (Mann Whitney U test and Kruskal Wallis test). Result Only 18.7% of the respondents had an excellent health promoting lifestyle followed by good health promoting lifestyle among 60.4%. Highest median score was observed in spiritual 27(10-36), and interpersonal relationship subscale 27(9-36). Whereas, the lowest was observed in physical activity 21(8-32) followed by stress management 24(10-32). Statistically significant difference was observed in age and perception of own health status with spirituality; gender, chronic illness and perception of own health status with interpersonal subscale and age, gender, marital status, occupation and perception of own health status with physical subscale. Conclusion The study concludes the need of health education and awareness to promote healthy lifestyle behaviours with a particular emphasis on indoor physical activities and stress management skills with specific consideration to female and elderly.

Large magnetoresistance and quantum oscillations in Sn0.05Pb0.95Te

We have synthesized high-quality single crystals of Sn_xPb_1-xTe and carried out detailed studies of the magnetotransport properties of one of the samples, Sn_0.05Pb_0.95Te. Longitudinal magnetoresistance increases almost linearly with increasing applied field (H) and reaches ∼310% atH= 13 T. At higher fields, both longitudinal and Hall resistance show clear Shubnikov de Haas oscillations. The oscillations are smooth and periodic, and there exists only one frequency,f_α∼ 57 T. However, an additional frequency,f_β∼ 69 T, appears as the angle between the field direction and the normal to the sample surface (θ) is increased. Bothf_αandf_βexhibitθ-dependence;f_αdecreases whereasf_βincreases gradually with increasingθ. The presence of two frequencies in Sn_0.05Pb_0.95Te indicates that there exist two Fermi surface pockets (αandβpockets). We have constructed the Landau-level fan plot and determined the Berry phase (δ) for theαpocket to beδ∼ 0.1. Thisδvalue is very close to the expected value of 0 for a topologically trivial system.

Mothers' Perception of Their Children's Play in Dhulikhel Hospital, Nepal

Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children's play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different subscales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child's choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative playamong mothers.

Correlation of Fasting and Postprandial Glucose Levels with Glycosylated Hemoglobin in Diagnosis of Diabetes

Introduction: Diabetes Mellitus describes a group of metabolic disorders characterized by hyperglycemia. Uncontrolled glycemic state often leads to micro and macro vascular complications. Diabetes is the foremost cause of new blindness in adults. Constant screening of the diabetic profile through blood tests of the affected people and prompt actions to control them can help to improve the quality of life of these patients. The study was done to evaluate the correlation between fasting and postprandial plasma glucose levels with glycosylated hemoglobin for diagnosis of diabetes and to determine the prevalence of diabetes in different age groups with sex predilection. Methods: A descriptive cross sectional study was conducted and the data collection was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine, Biratnagar Eye Hospital. Ethical approval was obtained from Institutional Review Committee of this hospital. All 275 patients who attended the laboratory from January 2019 to June 2019 for fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin values estimation were included in this study. The data obtained were computed and analyzed using Statistical Package for the Social Sciences version 20.0 Results: A significant correlation between fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin was observed in this study (p value <0.001). The correlation coefficient between fasting plasma glucose and glycosylated hemoglobin (r= 0.728) is stronger than the correlation coefficient between postprandial plasma glucose and glycosylated hemoglobin (r= 0.709). Conclusions: Fasting plasma glucose correlated better than postprandial plasma glucose with glycosylated hemoglobin.    

Permcath - A Vascular Access for Hemodialysis, Our Experience in Last Two Years

Background The double lumen tunneled catheter (Permcath) is mostly used as an alternative access, not as a temporary access in End Stage Renal Disease patients requiring hemodialysis. If there is no possibility of other access modalities, failed or unable to create native arteriovenous fistula (AVF), Permcath can be a very good alternative. Objective To find the indications, complications and results of Permcath insertion. Method We reviewed the results of 92 Permcath inserted under ultrasound guidance in two different hospitals, 45 in Sahid Dharma Bhakta National Transplant Center (SDNTC), Bhaktapur and 47 in Nidan Hospital Pvt. Ltd., Lalitpur from April 2016 to April 2018 retrospectively. Result We had inserted 55 Permcath (59.78%) in right internal jugular vein (IJV), 25 (27.17%) in left internal jugular vein and 12(13.04%) in femoral vein. In terms of major complications, two (2.17%) patients had profound hypotension, bradycardia and cardiac arrest due to left internal jugular vein tear. Three patients (3.26%) died within a week due to septicemia and 23 patients (25%) died with multiple causes within one year. Of the cases, till now in 39 cases (42.39%) Permcath has been removed. Major reasons of removal of Permcath are post renal transplant in 18 cases (19.57%), Arterio Venous Fistula maturation in 13 cases (14.13%), Infection in six patients (6.52%) and non functioning Permcath in two patients (2.17%). Conclusion Permcath remains a reliable method for short term vascular access, hence can be used as a bridge to renal transplant or arteriovenous fistula maturation.

Health Related Quality of Life of Diabetic Patients

Background Diabetes mellitus is a common and serious global health problem. In Nepal, it is a major expanding non communicable disease that has a number of chronic effects, accompanied by marked reduction in the health related quality of life (HRQOL). Assessment of health related quality of life mainly focuses on the effect of illness and impact of treatment on health. Objective The objective of this study was to identify the health related quality of life of diabetic patients. Method A descriptive cross sectional study was conducted among 116 diabetic patients attending Diabetes, Thyroid and Endocrinology Care Center, Pokhara. Non probability purposive sampling technique was used. Data was collected using World Health Organization Quality Of Life - BREF tool and analysed using descriptive and inferential statistics such as frequency, percentage, mean, standard deviation, median, interquartile range, Mann Whitney U test, Kruskal Wallis test and Spearman's correlation coefficient test. Result The median score of HRQOL was 244 (225-275). Statistically significant difference was observed in age (p< 0.001), sex (p=0.043), living status (p=0.012), education (p=0.001), duration of illness (p=0.038) and co-morbidity (p< 0.001) with overall health related quality of life. Physical domain had strongest correlation (p< 0.000) with overall quality of life. Conclusion Diabetic patients have higher health related quality of life in the physical and social domain. Young adults, male, literate, living with spouse, duration of diabetes for less than 10 years and those without comorbidity have higher health related quality of life. Integration of routine counselling programme will be helpful in promoting health related quality of life of diabetic patients.

Combination of thermal and electric properties' measurement techniques in a single setup suitable for radioactive materials in controlled environments and based on the 3ω approach

We have designed and developed a new experimental setup, based on the 3ω method, to measure thermal conductivity, heat capacity, and electrical resistivity of a variety of samples in a broad temperature range (2-550 K) and under magnetic fields up to 9 T. The validity of this method is tested by measuring various types of metallic (copper, platinum, and constantan) and insulating (SiO₂) materials, which have a wide range of thermal conductivity values (1-400 W m^-1 K^-1). We have successfully employed this technique for measuring the thermal conductivity of two actinide single crystals: uranium dioxide and uranium nitride. This new experimental approach for studying nuclear materials will help us to advance reactor fuel development and understanding. We have also shown that this experimental setup can be adapted to the Physical Property Measurement System (Quantum Design) environment and/or other cryocooler systems.

Anaesthesia for Cleft Lip and Palate Surgery: Study from a Hospital of Eastern Nepal

IntroductionCleft lip and palate deformity is the most common congenital birth defect caused by complex genetic and environmental factors. Pre-operative management of these patients is always challenging and anesthesia has a great role for the surgery.ObjectiveThe aim of this study is to evaluate the outcomes including pre-operative election of cases, intra-operative and  post-operative complications in pediatric patients.MethodologyThis is retrospective study conducted on cleft lip and palate repair patients between the ages of 3 months to 12 years, operated under general anesthesia during last six years at Morang Co-operative Hospital, Biratnagar, Nepal. Total 570 patients were assessed with preoperative, intra-operative and post-operative parameters, complications and managements. The MS Excel office and SPSS software was used to analyze the data.ResultsAmong 570 patients about one third came from the high mountain and hilly region and the rest from the Tarai. The maximum travel _me to reach the hospital was 2 days. The percentage of cancellation was 22.13% and was mainly due to the respiratory problems. Among 570 patients 352(61.75%) were males. While classifying the cases, 202 cases were presented with only cleft lip, 325 cleft lip and palate combined and 43 patients with isolated cleft palate. Narcotics were not used for analgesia and analgesia maintained with other measures. There was no intra and post-operative death and none of the patient received intra-operative blood transfusion.ConclusionCleft lip and palate surgery in pediatric patients is possible in any hospitals when trained man power and proper operating and post-operative setup is available. Anesthesia for cleft lip and palate is challenging associated with several complications requiring continuous and vigilant anesthetic supervision and management for the better outcome.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 127-133

Factors Influencing Brain Drain among Nepalese Nurses

Background Brain drain means migration of technically skilled people from one country to another country. Migration of health workers including nurses are the result of interplay of many push and pull factors. Push factors are those conditions that influence the nurses' decision to leave their own country. Conversely, pull factors are those conditions in a given country that attract nurses, influencing their movement to that country. Objective The objective of this study was to identify push and pull factors of brain drain among the Nepalese nurses. Method Descriptive cross sectional study was done among 228 Nepalese nurses working in five different countries in 2016 by using quota sampling technique. A self administered questionnaire consisting of structured four-point Likert scale was designed to collect information on push and pull factors of brain drain. Descriptive and inferential statistics were computed using SPSS version 16. Result Many of brain drained nurses had ranked very important push factor was personal ambition (72.8%) and very important pull factor was better job and career opportunity (77.2%). Majority of nurses working in Nepal had ranked very important push factor was lack of job and career opportunity (86.0%) and pull factor was better job and career opportunity (85.1%). All push and pull factors were significantly associated with brain drain. Conclusion Most of the Nepalese nurses were forced to go abroad due to personal ambition, followed by low salary, and lack of job and career opportunity. Nurse migration out of Nepal is likely to persist and even increase if underlying factors aren't properly resolved.

Thyroid hormone profile in patients with chronic kidney disease: a single centre study

BACKGROUND

Chronic kidney disease (CKD) is a global burden and now recognized as a major public health problem worldwide. Patients with CKD have alteration in thyroid hormone metabolism. This study aims to evaluate the status of thyroid hormone profile in different stages of CKD.

METHODS

The cross-sectional study included 103 CKD patients attending Nephrology and Dialysis unit of KIST Medical College Teaching Hospital, Lalitpur, Nepal. Serum creatinine, free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) were measured. Risk factors, duration of illness and physical examination of patients were recorded along with their written informed consent. Patients with history of any thyroid function abnormalities, on medication for hypothyroidism and pregnancy were excluded.

RESULTS

Out of 103 CKD patients, 59 (57.28%) were males and 44 (42.71%) were females. Thirty five (33.98%) CKD patients had low fT3 and 19 (18.44%) had low fT4 with normal TSH. Six (5.82%) CKD patients had increased TSH concentrations with normal fT3 and fT4. The median value of creatinine, fT3 and fT4 were significantly altered at different stages of CKD. Among the risk factors for CKD, diabetic nephropathy (44.66%) was found to be the lead primary cause followed by chronic glomerulonephritis (26.21%) and hypertension (23.30%).

CONCLUSIONS

In our study thyroid hormone profile was altered in CKD patients, mainly in the stage 5 CKD. Most common thyroid dysfunction was low fT3 and low fT4 with normal TSH levels.

Food practices among postnatal mothers in a hilly township in Northeastern Nepal

A descriptive study on food practice among postnatal mothers in a hilly township in northeastern Nepal was carried out with 50 mothers (aged 20-39 years) of different ethnic groups (Adibasi-Janajati: 46.0%, Bahun/ Chhetri: 34.0% and Dalit 20.0%). Findings show that this township was representative of a rural area in northeastern Nepal in terms of demographic characteristics like mixed ethnic composition, high illiteracy rate (especially among women), joint family structure in majority of the households (80% of the total participants) and agriculture as the more common occupation (44% of the total participants). It was seen that various factors are responsible for affecting food practices of mothers during the postnatal period in this region. Socio-cultural beliefs are contributory to the food practices followed, like the frequency of meals/day eaten by the mothers. Other factors that affected were: Lower economic status of the family (33% of Dalit women and 50% of women who work as laborers were only eating meals two times a day); Support from the family (75% of women living in joint families were eating meals four times a day while 80% of the women living in nuclear families were eating meals three times a day); It also showed more attention and care was given to younger, first-time mothers (younger mothers who were mostly first-time mothers were eating meals four times a day while experienced and older mothers were eating meals three times a day). The study also showed that there are food taboos surrounding specific food items, which were not consumed from 11 days to six months after delivery based on various socio-cultural beliefs and practices.

Gatifloxacin versus ofloxacin for the treatment of uncomplicated enteric fever in Nepal: an open-label, randomized, controlled trial

Background

Fluoroquinolones are the most commonly used group of antimicrobials for the treatment of enteric fever, but no direct comparison between two fluoroquinolones has been performed in a large randomised trial. An open-label randomized trial was conducted to investigate whether gatifloxacin is more effective than ofloxacin in the treatment of uncomplicated enteric fever caused by nalidixic acid-resistant Salmonella enterica serovars Typhi and Paratyphi A.

Methodology and Principal Findings

Adults and children clinically diagnosed with uncomplicated enteric fever were enrolled in the study to receive gatifloxacin (10 mg/kg/day) in a single dose or ofloxacin (20 mg/kg/day) in two divided doses for 7 days. Patients were followed for six months. The primary outcome was treatment failure in patients infected with nalidixic acid resistant isolates. 627 patients with a median age of 17 (IQR 9–23) years were randomised. Of the 218 patients with culture confirmed enteric fever, 170 patients were infected with nalidixic acid-resistant isolates. In the ofloxacin group, 6 out of 83 patients had treatment failure compared to 5 out of 87 in the gatifloxacin group (hazard ratio [HR] of time to failure 0.81, 95% CI 0.25 to 2.65, p = 0.73). The median time to fever clearance was 4.70 days (IQR 2.98–5.90) in the ofloxacin group versus 3.31 days (IQR 2.29–4.75) in the gatifloxacin group (HR = 1.59, 95% CI 1.16 to 2.18, p = 0.004). The results in all blood culture-confirmed patients and all randomized patients were comparable.

Conclusion

Gatifloxacin was not superior to ofloxacin in preventing failure, but use of gatifloxacin did result in more prompt fever clearance time compared to ofloxacin. Trial registration: ISRCTN 63006567 (www.controlled-trials.com).

Enteric fever, which comprises of typhoid and paratyphoid fevers, is common in many developing countries. It is also sometimes seen in the Western world in returning travellers. This present study of uncomplicated enteric fever in an outpatient setting in a hospital in Kathmandu, Nepal compared the newer gatifloxacin with the widely-used ofloxacin (two drugs of the fluroquinolone class) in the treatment of this illness. Although fluroquinolones are commonly considered the main group of drugs in the treatment of enteric fever, there have not been comparisons of efficacy between two drugs in this same class in the treatment of enteric fever. Furthermore, certain strains of enteric fever organism called nalidixic-acid resistant strains are proving very difficult to treat in both the local population and the Western travellers. The study focused primarily on the efficacy of the 2 drugs against these particular strains. The results revealed that both drugs were effective but gatifloxacin decreased the patient's fever more rapidly than ofloxacin. Dysglycemia was noted in a 35-year-old woman taking gatifloxacin who did not disclose a pre-existing diagnosis of diabetes at time of enrollment, but not in any other healthy child or young adult.

Community attitudes towards leprosy affected persons in Pokhara municipality of western Nepal

BACKGROUND

Stigma is a social process of interpretation of an attribute. Leprosy has been seen as the epitome of stigmatization. The psychosocial impact a person has to bear in a society after the diagnosis weighs heavier than the physical afflictions it causes, which does not get cured with the mere medical treatment. There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among community people living in ward 15, Pokhara municipality.

METHODS

Cross-sectional descriptive study among 281 community people above the age of 18 years was conducted. Two sets of questionnaire form with additional Explanatory Model Interview Catalogue (EMIC) for each individual were used.

RESULTS

Among 281 community people, the median score of perceived stigma was 12 while it ranged from 0-30. Ethnic groups, Brahmins, Dalits and minorities had highest perceived stigma score of 15 and above compared to the rest (p=0.001), community people living at the distance more than 2 km had highest perceived stigma score of 15 compared to those living closer to the hospital (p=0.019) and nuclear family had highest perceived stigma score of 15 compared to the joint family (p=0.014). People who lacked information on leprosy had higher score of perceived stigma compared to those who had information on leprosy (p=0.002).Similarly, those who perceived leprosy to be difficult to treat (p<0.001) and a severe disease (p<0.001) had highest score of perceived stigma.

CONCLUSIONS

Stigma in leprosy was found highly associated with the lack of information about leprosy and their perception in treatment and disease severity. Stigma reduction strategies should focus on health education, targeting to alleviate their perception about the disease with their active participation.

Breast cancer knowledge and screening practice among women visited to KIST medical college

Breast cancer is one of the most common cancers among female worldwide. Global statistics show the annual incidence of breast cancer is increasing and this is occurring more rapidly in countries with a low incidence rate of breast cancer. In Nepal it is second most common cancer after cervical cancer. Studies shows the mortality rate of breast cancer can be reduced by early detection and Screening program. According to the latest WHO data published in April 2011 breast cancer death in Nepal has reached 1,248 (0.84%) of total death. The age adjusted death rate is 12.92 per 1000,000 of population and the rank has been reached in number 142 in the world. This study was aims to assess the knowledge and screening practice for breast cancer among women. A cross- sectional descriptive study was conducted among 110 women age range from 20 to 60 years at KIST Medical College, Imadol, Lalitpur. Purposive sampling technique was adopted. Structured questionnaire were used for data collection. Verbal informed concent was taken from each respondents. Descriptive analysis and simple statistical methods were used. Findings revealed that respondents who had heard about breast cancer were 33 (30%) and not even heard were 77 (70%), out of them 26 respondents were doing regular screening which was breast self- examination by 19 (73%) mammography 3 (11-5) and USG- 4 (15.4%). Their common source of information were Radio/TV. 90 (81%) married women were 90 in numbers. Knowledge on risk factors of breast cancer was very low. Result of this study shows low knowledge on breast cancer, risk factors and screening practice among women groups of this study. Thus it is important to educate women about importance of early detection through screening methods for breast cancer to reduce mortality.

Isolation and screening of thermophilic cellulolytic bacteria from compost piles

Cellulose, a major polysaccharide found in agricultural residues and industrial and municipal wastes. In the present study thermophilic cellulolytic microorganisms were isolated. The isolates were tested for their cellulytic activity. The enzyme production from potent isolates was optimised using cellulose basal broth medium. Activity of partially purified enzyme was determined. The most potent thermophilic cellulolytic isolates were identified as Bacillus subtilis. The crude cellulase enzyme concentrated at 80-85% ammonium sulfate produced highest zone of hydrolysis. The enzymatic degradation of cellulose waste has been suggested as a feasible alternative for the conversion of lignocelluloses substrate into fermentable sugars and application for biofuel production. Scientific World, Vol. 10, No. 10, July 2012 p43-46 DOI: http://dx.doi.org/10.3126/sw.v10i10.6861

Psychological impact after mastectomy among Nepalese women: a qualitative study

Breast cancer is one of the leading causes of death in women. Cancer epidemiologists have stated that breast cancer is the most common cancer in women in developed countries, Nepal is not an exception. Breast cancer is the second most common cancer in women of Nepal after cervical cancer. A Qualitative phenomenological study was done to explore the psychological impact of women with mastectomy after diagnosis of breast cancer. In-depth study was done with ten women age ranging from 36 to 50 years. Ten women were interviewed which was recorded, and verbatim were transcribed before taking next interview. The interviews were analyzed in three stages as stated by Miles and Hubermans. Findings revealed that respondents expressed the fear of death, emotional impact of the loss of breast disfigurement, loss of femininity, fear of recurrence of disease, and concern about their family. Breast cancer and mastectomy have impact on women psychosocial state. They develop stress due to loss of body part, loss of femininity, fear of recurrence of disease, fear of cost and prolong treatment protocol.

Gatifloxacin versus chloramphenicol for uncomplicated enteric fever: an open-label, randomised, controlled trial

BACKGROUND

We aimed to investigate whether gatifloxacin, a new generation and affordable fluoroquinolone, is better than chloramphenicol for the treatment of uncomplicated enteric fever in children and adults.

METHODS

We did an open-label randomised superiority trial at Patan Hospital, Kathmandu, Nepal, to investigate whether gatifloxacin is more effective than chloramphenicol for treating uncomplicated enteric fever. Children and adults clinically diagnosed with enteric fever received either gatifloxacin (10 mg/kg) once a day for 7 days, or chloramphenicol (75 mg/kg per day) in four divided doses for 14 days. Patients were randomly allocated treatment (1:1) in blocks of 50, without stratification. Allocations were placed in sealed envelopes opened by the study physician once a patient was enrolled into the trial. Masking was not possible because of the different formulations and ways of giving the two drugs. The primary outcome measure was treatment failure, which consisted of at least one of the following: persistent fever at day 10, need for rescue treatment, microbiological failure, relapse until day 31, and enteric-fever-related complications. The primary outcome was assessed in all patients randomly allocated treatment and reported separately for culture-positive patients and for all patients. Secondary outcome measures were fever clearance time, late relapse, and faecal carriage. The trial is registered on controlled-trials.com, number ISRCTN 53258327.

FINDINGS

844 patients with a median age of 16 (IQR 9-22) years were enrolled in the trial and randomly allocated a treatment. 352 patients had blood-culture-confirmed enteric fever: 175 were treated with chloramphenicol and 177 with gatifloxacin. 14 patients had treatment failure in the chloramphenicol group, compared with 12 in the gatifloxacin group (hazard ratio [HR] of time to failure 0·86, 95% CI 0·40-1·86, p=0·70). The median time to fever clearance was 3·95 days (95% CI 3·68-4·68) in the chloramphenicol group and 3·90 days (3·58-4·27) in the gatifloxacin group (HR 1·06, 0·86-1·32, p=0·59). At 1 month only, three of 148 patients were stool-culture positive in the chloramphenicol group and none in the gatifloxacin group. At the end of 3 months only one person had a positive stool culture in the chloramphenicol group. There were no other positive stool cultures even at the end of 6 months. Late relapses were noted in three of 175 patients in the culture-confirmed chloramphenicol group and two of 177 in the gatifloxacin group. There were no culture-positive relapses after day 62. 99 patients (24%) experienced 168 adverse events in the chloramphenicol group and 59 (14%) experienced 73 events in the gatifloxacin group.

INTERPRETATION

Although no more efficacious than chloramphenicol, gatifloxacin should be the preferred treatment for enteric fever in developing countries because of its shorter treatment duration and fewer adverse events.

FUNDING

Wellcome Trust.

Evolving experience in the management of empyema thoracis

BACKGROUND

Empyema thoracis a disease of significant morbidity and mortality, especially in the developing world. However, the optimal management of empyema thoracis remains controversial.

OBJECTIVE

To analyse evolving experience in clinical presentation, management, outcome and factors contributing to adverse morbidity in empyema thoracis.

METHODS

This is hospital based retrospective study of patients who were diagnosed with empyema thoracis in cardiothoracic and vascular surgery (CTVS) unit, Bir Hospital, Kathmandu, Nepal over a period of one year (July 2009 to June 2010). A total of forty-six adult cases were categorized into two treatment groups: (i) thoracotomy for decortication (ii) segmentectomy, lobectomy and redo-thoracotomy for pneumonectomy. The median duration of illness prior to hospital admission was compared. The presence of loculated pleural fluid determined the need for thoracotomy.

RESULTS

Out of forty-six cases, twenty- nine (63.04%) who had early thoracotomy (less than 22 days) had prompt symptomatic recovery. Fourteen out of seventeen (82.35%) of the patients who were initially treated with thoracocentesis or tube thoracostomy eventually needed thoracotomy. There was a positive shift in management towards early thoracotomy resulting in prompt symptomatic recovery. Significant complications were noted in eight patients who had delayed thoracotomy. Complications included recurrent empyema with lung abscess (n = 3), restrictive lung disease (n = 3), bronchopleural fistula (n = 1) and scoliosis (n=1).

CONCLUSION

Early thoracotomy and decortication was found to be an excellent surgical procedure with good functional results and high patient satisfaction rate.

Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

INTRODUCTION: Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP. METHODS: The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study. RESULTS: There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision. CONCLUSIONS: Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision. Keywords: antibiotic, infection, prophylaxis, surgery.

Need of improvement in timing of prophylactic antibiotic in elective surgery

INTRODUCTION

Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP.

METHODS

The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study.

RESULTS

There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision.

CONCLUSIONS

Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision.

Parietal Epidural Dermoid Mimicking a Scalp Abscess in an Infant: Case Report

Scalp masses that involve the scalp or the cranium especially over the parietal bone are uncommon presentation in infants. We report a case of an 8-week old female child who presented with a left parietal scalp mass which had been progressively increasing since birth. CT scan revealed the mass extending into the cranium with underlying bone defect over the parietal area, with medial extension till the sagittal suture. Intraoperatively there was presence of thick white infected flaky material with small tufts of hair which was removed completely till the bone edges and from the epidural space. There was no recurrence postoperatively and the baby was discharged after a week of antibiotics. This case provides an example that simple looking scalp masses in infants and children should be managed with caution to prevent further morbidity. Key words: Dermoid, Scalp abscess   doi: 10.3126/jnps.v29i2.2048 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.98-100

Are we really in safe hands? How safe is safe?

doi: 10.3126/kumj.v6i3.1702 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 298-300

Mortality due to dapsone hypersensitivity syndrome complicating multi-drug therapy for leprosy in Nepal

Dapsone is a component of multi-drug therapy (MDT) for the treatment of all types of leprosy. It is known that dapsone hypersensitivity syndrome (DHS) complicates the treatment in a proportion of patients. We performed a retrospective study of patients commenced on MDT between 1990 and 2006; 2% developed DHS and 0.25% died due to DHS.

An antiproliferative norditerpene dilactone, Nagilactone C, from Podocarpus neriifolius

An ethanolic extract of Podocarpus neriifolius D. Don (Podocarpaceae) showed antiproliferative activity against two major tumor cell lines, viz. human HT-1080 fibrosarcoma and murine color 26-L5 carcinoma. Bioassay guided fractionation showed the highest antiproliferative activity in chloroform-soluble fraction. Nagilactone C, the major constituent of this fraction was isolated and characterized by using NMR, IR and FAB-MS spectroscopic methods. Nagilactone C possessed potent antiproliferative activity against human fibrosarcoma and murine colon carcinoma tumor cell lines exhibiting ED50 values of 2.3 and 1.2 microg/ml, respectively. Hence, nagilactone C could be the active constituent present in this plant.

Evidence for paclitaxel from three new endophytic fungi of Himalayan yew of Nepal

Taxus wallichiana, collected from the Himalayan region of Nepal, yielded, among others, three different endophytic fungi including Sporormia minima, Trichothecium sp., and an unidentified dimorphic fungus. Each was shown to produce paclitaxel in a culture medium. Each of these fungi represents a new report as a paclitaxel producer. The production of paclitaxel was confirmed by an immunoassay that utilized monoclonal antibodies, TLC chromatography as well as high performance liquid chromatography combined with on-line mass spectrometry.

Occurrence of Fusarium species and mycotoxins in nepalese maize and wheat and the effect of traditional processing methods on mycotoxin levels

Maize (Zea mays) and wheat (Triticum aestivum) collected in the foothills of the Nepal Himalaya Mountains were analyzed for Fusarium species and mycotoxins: fumonisins, nivalenol (NIV), and deoxynivalenol (DON). Predominant species were Gibberella fujikuroi mating population A (F. moniliforme) in maize and F. graminearum in maize and wheat; G. fujikuroi mating population D (F. proliferatum), F. acuminatum, F. avenaceum, F. chlamydosporum, F. equiseti, F. oxysporum, F. semitectum, and F. torulosum were also present. Strains of G. fujikuroi mating population A produced fumonisins, and strains of F. graminearum produced NIV or DON. By immunoassay or high-performance liquid chromatography, fumonisins were >1000 ng/g in 22% of 74 maize samples. By immunoassay or fluorometry, NIV and DON were >1000 ng/g in 16% of maize samples but were not detected in wheat. Fumonisins and DON were not eliminated by traditional fermentation for producing maize beer, but Nepalese rural and urban women were able to detoxify contaminated maize by hand-sorting visibly diseased kernels.

First Report of A1 and A2 Mating Types of Phytophthora infestans on Potato and Tomato in Nepal

Late blight caused by Phytophthora infestans (Mont.) de Bary is an important disease of potato and tomato that occurs annually in the hills and occasionally in the terai (plain) of Nepal. In 1996 and 1997, each year, 50 samples of late blight-infected potato and tomato leaves were collected from the hill and terai areas. The pathogen was cultured on Rye A agar. Each isolate was paired on clear V8 agar with reference isolates DN111 (A1 mating type) and DN107 (A2 mating type) received from Hokkaido University, Japan, and examined for oospore formation after 10 to 15 days of incubation at 20°C. The proportion of A2 isolates was 6% in 1996 and 42% in 1997. The A2 isolates were mainly from the high hills (2,000 to 2,500 m) where local and Andean types of potatoes are grown. Analysis of genotypes of isolates at the glucosephosphate isomerase (GPI-1), malic enzyme (ME), and peptidase (PEP-1) (1,2) isozyme loci revealed genetic diversity between A1 and A2 isolates. A1 isolates from potato were either homozygous (100/100) or heterozygous (86/100) for GPI-1, whereas all A1 isolates from tomato were heterozygous (86/100). All A1 isolates were homozygous (100/100) at the ME locus and heterozygous (92/100) at the PEP-1 locus. A2 isolates were homozygous (100/100) at all isozyme loci. The results show that both A1 and A2 mating types of P. infestans are present in Nepal, and that they display different isozyme genotypes. It is speculated that the A1 type may have migrated with potatoes from Europe while the A2 type may have been introduced with Andean potatoes from Latin America more recently. The simultaneous occurrence of both mating types may allow the fungus to increase its pathogenic diversity and to survive by means of oospores. References: (1) A. A. Mosa et al. Plant Pathol. 42:26, 1993. (2) P. W. Tooley et al. J. Hered. 76:431, 1985.

Isolation and characterization of a cDNA clone showing C-myc binding-activity

A cDNA clone encoding a novel c-myc promoter binding protein (MBP-2) was isolated from a HeLa cell expression library. MBP-2 showed binding to the sequence from -46 to -64, relative to the P2 transcription start site of the human c-myc oncogene. This important regulatory sequence is necessary for optimal transcription from the P2 promoter of the c-myc oncogene. A single base substitution prevented binding of the recombinant MBP-2 to its target sequence. The MBP-2 cDNA hybridized to a 1.7 kb transcript from several human tissues. Mouse antisera to the recombinant MBP-2 showed binding to an approximately 80 kd protein from the HeLa and NIH3T3 cell lines by Western blot analysis. Nucleotide sequence analysis suggested that MBP-2 is a unique DNA binding protein and may play an important role in the regulation of c-myc transcription.

A unique c-myc-targeted triplex-forming oligonucleotide inhibits the growth of ovarian and cervical carcinomas in vitro

A 27-base pair triplex forming oligonucleotide (G27-oligonucleotide) targeted to the "puf" regulatory protein-binding domain of the human c-myc oncogene has been conjugated with the DNA-binding molecule acridine (G27-conjugate) in order to obtain a drug with high binding affinity as well as high sequence specificity. Both the triplex-forming oligonucleotide and its acridine conjugate are shown to form triple-stranded DNA at the site of the target sequence by DNase 1 footprinting. When the cervical carcinoma cell line HeLa was exposed to 4 microM concentrations of the G27-oligonucleotide the viable cell count fell to 89, 56, and 49% of control at 25, 50, and 72 hr. After exposure to 1 microM G27-conjugate the viable cell count fell to 87, 50, and 33% of control. Nonspecific reductions in cell number were found for the control oligonucleotides to 79 and 82% of control. When SKOV-3 cells were exposed to the same concentrations of oligonucleotides, viable cell count in relation to control fell to 43, 50, and 67% with the G27-oligonucleotide and 57, 52, and 53% with the G27-conjugate at 24, 48, and 72 hr. The control oligonucleotides again caused a small nonspecific drop in the viable cell number.

Triple helix formation by purine-rich oligonucleotides targeted to the human dihydrofolate reductase promoter

The ability of oligodeoxynucleotides to form specific triple helical structures with critical regulatory sequences in the human dihydrofolate reductase (DHFR) promoter was investigated. A battery of purine-rich oligonucleotides targeted to the two purine.pyrimidine strand biased regions near the DHFR transcription initiation site was developed. The stable triple helical structures formed by binding of the oligonucleotides to the native promoter double helix were dominated by G*G.C triplets, with interspersed C*C.G and A*A.T alignments. Mismatches between the oligonucleotide and the purine-rich strand of the target significantly destabilized third strand binding, and a G*A.T alignment was particularly unfavorable. Formation of a pur.pur.pyr triple helical structure results in a localized limitation of access to the native double helical DNA and produces sequence dependent conformational alterations extending several nucleotides beyond the triplex-duplex boundary. Although they differ only by the insertion of two A.T base pairs, the distal and proximal purine.pyrimidine regions can be targeted individually due to the high degree of sequence specificity of triple helical alignment. Triplex formation overlapping any of three consensus transcriptional regulatory elements and collectively covering 50% of the DHFR core promoter is now possible with this set of oligonucleotides.

Oncogenes, malignant transformation, and modern medicine

During the past decade there have been remarkable strides in the understanding of the basic mechanism of cancer. It is now clear that there is a set of genes, known as oncogenes, that can cause cells to become malignant if their expression is altered, either by mutation or overexpression. The products of these genes include growth factors, growth factor receptors, signal tranduction proteins, and DNA binding proteins. The normal cellular counterparts of these genes play very important roles in the regulation of growth and proliferation by normal cells. Another set of genes, anti-oncogenes, also play an important role in preventing abnormal cell proliferation. The remarkable explosion of understanding of the pathophysiology of malignancy has led to a common unifying concept of malignant transformation that applies to all tumors. It is likely that these new insights will lead to improved and more specific treatments for malignant disease in the next decade.

Characterization of 5B12.1, a monoclonal antibody specific for IL-6

A monoclonal antibody (MAb) specific for interleukin-6 (IL-6) was generated by fusing SP2/0 cells with spleen cells from a mouse immunized with rat spleen cell derived plasmacytoma growth factor (rat PCT-GF). This MAb inhibited the growth of an IL-6-sensitive murine plasmacytoma clone, MD90, in the presence of the immunogen, rat PCT-GF. More interesting, however, this MAb demonstrated species cross-reactivity by neutralizing murine (recombinant and P388D1 cell line-derived) and human (recombinant) IL-6. IL-6 neutralization activity was also established in other IL-6 bioassays, such as the proliferation of spleen cells, plasmacytoma T1165, and a B-cell hybridoma 7TD1. IL-6 neutralization was overcome partially by increasing the concentration of PCT-GF. The MAb had no effect on PCT-GF-independent plasmacytoma KI81 proliferation. Plastic petri dish-bound MAb removed rmIL-6 activity. These results suggest that this MAb specifically binds IL-6 and neutralizes bioactivity of various PCT-GF, rmIL-6, and rhIL-6.

Dissociation of cellular proliferation and c-myc expression by buttercup extract

Buttercup extract (BE), an extract of the buttercup plant (Zanthoriza simplicissima), inhibits RNA and DNA synthesis by HL-60 promyelocytic leukemia cells. Exposure of these cells to 3% BE for 48 hours results in dramatic inhibition of RNA synthesis without loss of cell viability. The effect of BE is partially reversible over 12-24 hours with the level of RNA synthesis returning nearly to control levels during this time period. DNA synthesis is also reversibly inhibited by exposure to BE. Despite the inhibition of RNA synthesis in HL-60 cells, there is no decrease in the level of c-myc mRNA, even at high BE concentrations. The level of gene-specific mRNA for the c-Ha-ras, c-fms, and c-mos genes in these cells also remained constant during exposure to BE. Ribosomal RNA is not degraded during 24 hours of BE treatment in vitro, suggesting that BE does not maintain the relative mRNA level for these genes by selective degradation of other RNA species. The inhibition of RNA and DNA synthesis by BE without a corresponding alteration in the level of expression of the c-myc gene suggests that this agent dissociates c-myc expression and cellular proliferation in these cells.

Immunoregulation of murine plasmacytoma. II. Target selectivity of anomalous killer cells and role of immune T cells for the induction

Requirements for the induction of anomalous killer (AK) cells to syngeneic MOPC 104E-KI81 plasmacytoma, and their pattern of reaction were investigated. The AK cells are Thy-1.2 positive and were induced by cocultivation of normal BALB/c spleen cells for 5 days in vitro with mitomycin C-treated MOPC 104E-KI81 cells in RPMI 1640 medium supplemented with fetal calf serum and 2-mercaptoethanol. The pattern of reactivity was investigated by direct cytotoxicity and indirect cold target inhibition assays using a panel of target cells. The results from cold target inhibition show that anomalous killer cells react with various tumor targets in the same preferential order as the results shown in direct cytotoxicity assay, and indicates that the AK cell population may be detecting the same determinants expressed to different degrees on panels of target cells. Kinetic study showed that peak cytotoxic responses were observed on day 5 and day 4, for primary and secondary sensitizing cultures, respectively. Cytotoxicity was not generated when nude mouse spleen cells were used as responder cells, suggesting the essential role of T cells in the induction. Nylon wool-column-purified splenic T cells from mice primed in vivo with intraperitoneal injection of MMC-treated stimulator cells, but not from normal mice, were able to generate AK cells in vitro. These results indicate that generation of AK cells with NK-cell-like reactivity needs inductive factors provided by the immune reaction between sensitized T cells and stimulatory MOPC 104E-KI81 cells.

Immunoregulation of murine plasmacytoma. I. Generation of anomalous killer cells in vitro by cocultivation with MOPC 104E

Murine plasmacytoma MOPC 104E-K181 is a tissue culture cell line of MOPC 104E derived from BALB/c mice. MOPC 104E-K181 implanted subcutaneously in syngeneic normal mice regresses spontaneously after an initial growth of about 10 mm. Mice that regressed tumors or mice immunized intraperitoneally with mitomycin C-treated MOPC 104E-K181 myeloma could reject subsequent challenge of viable K181 myeloma cells. In contrast to euthymic mice, T-cell-deficient athymic nude mice developed subcutaneous tumors after challenge and died from progressive tumor growth, suggesting the critical role of T cells in tumor regression. In vitro induction of cytotoxic cells was used to define the immunologic mechanism by which the host can suppress tumor growth. Spleen cells from immune mice did not show cytolytic activity in 51Cr release cytotoxicity assay, but showed inhibitory action of tumor proliferation in vitro at an effector cell to target cell ratio of 500:1 in a [3H]thymidine incorporation assay. To determine if cytotoxicity could be induced against MOPC 104E-K181 cells, in vitro sensitizing cultures were studied. We have demonstrated that normal BALB/c spleen cells became cytotoxic against MOPC 104E-K181 cells after 5 days cultivation with mitomycin C-treated stimulator cells at an optimal responder to stimulator cell ratio of 5:1. Treatment of anti-Thy-1.2 serum plus complement abolished cytotoxic activity of effector cells. Cytotoxic cells lysed not only MOPC 104E-K181 cells used for stimulation but also H-2k osteosarcoma cells. It was concluded that Thy-1.2-positive cytotoxic cells with nonspecific anomalous reactivity could be induced in murine plasmacytoma-stimulating cultures.

Induction of the plateau phase and rescue of MOPC 104E by nonspecific immunization

The enhancement of MOPC 104E myeloma growth by nonspecific immunostimulation with C. parvum or immunization with sheep red blood cells and levan mixture was evaluated in BALB/c mice. We observed increased levels of serum MOPC 104E IgM and early mortality in the tumor-bearing mice following treatment with C. parvum or antigenic stimulation. The enhancement of tumor growth observed was due to the production of lymphokine mitogenic factors produced in response to the nonspecific immunostimulation.

Sexual jealousy in alcoholics

A hundred patients referred to an alcoholism service were assessed in terms of sexual jealousy by interview and with a Sexual Jealousy Questionnaire. The overall incidence of sexual jealousy was 35% in men and 31% in women as judged by the interview. Twenty-seven per cent of the men and 15% of the women had morbid jealousy. There was no relationship between sexual jealousy, as measured by the questionnaire, and sexual dysfunction. However, in the men there were inverse relationships between the scores for sexual jealousy and measures of sexual satisfaction and marital stability, and in the women sexual jealousy scores correlated negatively with duration of the marriage and positively with severity of alcohol dependence.