Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

Objective: To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design: Observational cohort study. Setting: Medical college registry, with internet, phone, and personal follow-up of graduates. Participants: 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures: Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results: 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions: A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school

Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal

Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low- and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal.Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy.Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score, respectively.Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the disease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes

Isolation of Polyhydroxybutyrate (PHB) Producing Bacteria, Optimization of Culture Conditions for PHB production, Extraction and Characterization of PHB

Polyhydroxybutyrates (PHBs) are energy reserves synthesized by different micro-organisms such as Alcaligenes, Pseudomonas, Staphylococcus, Algae, in excess of carbon and limitation of nutrients like nitrogen. These biopolymers are suitable alternate to synthetic carbon-based polymers. However, the high production cost limits their commercialization. The aim of this study was thus, focused on optimization of culture condition for maximum PHB production in an attempt to reduce the production cost. The micro-organisms for this purpose were isolated from 4 different soil samples and screened for PHB production. Culture conditions for these organisms were optimized by changing the parameters, viz., incubation time, pH, carbon source and NaCl concentration. Thus, optimized culture condition was used to culture the isolates for extraction of PHB and its analysis. The extracted compounds on FTIR-analysis gave characteristic C=O peak of PHB, thus, confirming the seven isolates to be PHB producers. Results for optimized parameters for the isolated PHB positive species showed that synthesis of PHB was maximum at 48 hours i.e. during the early stages of stationary phase. However, different isolates favored different culture conditions. Highest PHB accumulation and growth of isolates were seen at pH 7 and 9. Similarly, it was observed that glucose was favored by 4 isolates and sucrose was favored by 3 isolates. Interestingly, NaCl concentration did not cause significant effect on neither the bacterial growth nor the PHB production. During the extraction of PHB from the optimized culture conditions, extraction of PHB from broth gave significant yield than that from agar. A good PHB yield from broth amounting to 36.41% and 34.59% was observed for Bacillus pasteurii and Micrococcus luteus respectively, showing a potential for their exploitation in industrial PHB production. At optimized conditions, 7 isolates exhibited significant PHB yields, thus showing a potential for further exploitation

Severity of Stress in Acne Patients Attending Dermatology Outpatient Department of Tertiary Hospital in Kathmandu

Introduction: Stress persists when a person is unable to cope with the situations of the past, present or future. Stress may be associated with physical and psychological abnormalities. Acne vulgaris is a chronic inflammatory disease of the pilo-sebaceous units with prevalence of more than 85% in adolescent age group. Materials and Methods: Three hundred one patients were recruited in the study. Inclusion criteria included new acne patients of age 16 years and above as well as those who were using but not improving with topical or oral acne therapies. Exclusion criteria included patients receiving sedatives, antidepressants, or glucocorticoids, patient suffering from chronic illnesses like diabetes, hypothyroidism, chronic kidney disease, migraine and other diseases. This questionnaire included biodata of the patients, clinical history and their perceived stress scale. Global Acne Grading System (GAGS) was used to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). Results: The results indicated an increase in stress severity positively correlated with an increase in acne severity, which was statistically significant (p<0.01). Most of the patients were students. Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS. Conclusions: The results showed that there is a positive correlation between severity of stress and grade of acne. Stress management should be a part of acne management

Work Safe Ergonomics Training Modules for Office Workers

The capstone project focused on developing ergonomics training modules and wellness handouts for office workers to increase their knowledge and understanding of ergonomics and musculoskeletal disorders. The project aimed to train and educate office workers in identifying common ergonomic issues, early symptoms of musculoskeletal disorders, risk factors, and preventive strategies, leading to workplace safety and better health and well-being. The office workers were also equipped with wellness resources such as handouts including stress management techniques, exercises and stretching guides, office wellness tips, and daily well-being checklists to foster a safe workplace culture.Agama Consulting Grou

PI3K signaling and its role in cardiac morphogenesis

The formation of the heart tube in vertebrates involves the coordinated movement of bilateral myocardial precursors to the midline, where they merge in a process known as cardiac fusion to form the primitive heart tube. While external influences from the anterior endoderm and the endocardium are known to be essential for cardiac fusion, intrinsic myocardial mechanisms are less understood. Here, we identify an intrinsic PI3K-dependent mechanism directing myocardial cells toward the midline during cardiac fusion. We found that inhibiting the PI3K pathway throughout the embryo using chemical inhibitors and injection of dnPI3K mRNA results in cardiac fusion defects. PI3K-inhibited embryos display normal endoderm morphology and endocardial migration; however, they show a defective endocardial sheet. Previous studies show that embryos defective in the endocardium still form a cardiac ring, suggesting that the defective endocardium is unlikely to be the primary cause of myocardial movement defects in PI3K-inhibited embryos. Therefore, we explored if PI3K is required in the myocardium for proper cardiac fusion. Inhibiting the PI3K pathway specifically in the myocardium leads to cardiac fusion defects. Time-lapse studies show that PI3K-inhibited myocardial cells are misdirected and slower in their movement. Mosaic labeling reveals that wild-type myocardial cells extend membrane protrusions toward the midline, but these protrusions are unpolarized in PI3K-inhibited embryos. Additionally, PI3K activity depends on and genetically interacts with platelet-derived growth factor receptor alpha (Pdgfra). Our findings support a model where Pdgfra-PI3K signaling facilitates directed myocardial movement toward the midline. Cardiac fusion defects observed at 20 hours post fertilization (hpf) in Pdgfra mutants and PI3K-inhibited embryos can recover, forming a single heart tube by 48hpf. To understand this recovery mechanism, we investigated cardiac differentiation and morphogenetic events in PI3K-inhibited embryos post 20 hpf. Cardiomyocyte differentiation proceeded normally in PI3K-inhibited embryos. However, cardiac development deviates from the normal sequential process seen in wild-type embryos. Anterior fusion often occurs before posterior fusion and the heart extends even before forming a complete lumen. The myocardium continues with cardiac development despite initial fusion defects, indicating the resilience of the developing heart

Analyzing Urban Growth Pattern and Driving Factors Using Remote Sensing and GIS: A Case Study of Banepa Municipality, Nepal

Nepal is considered one of the rapidly urbanizing countries in south Asia. Most of the urbanization is dominated in large and medium cities i.e., metropolitan, sub-metropolitan, and municipalities. Remote Sensing and Geographic Information System (GIS) technologies in the sector of urban land governance are growing day by day due to their capability of mapping, analyzing, detecting changes, etc. The main aim of this paper is to analyze the urban growth pattern in Banepa Municipality during three decades (1992-2020) using freely available Landsat imageries and explore driving factors for change in the urban landscape using the AHP model. The Banepa municipality is taken as a study area as it is one of the growing urban municipalities in the context of Nepal. The supervised image classification was applied to classify the acquired satellite image data. The generated results from this study illustrate that urbanization is gradually increasing from 1992 to 2012 while, majority of the urban expansion happened during 2012-2020, and it is still growing rapidly along the major roads in a concentric pattern. This study also demonstrates the responsible driving factors for continuous urban growth during the study period. Analytical Hierarchy Process (AHP) was adopted to analyze the impact of drivers which reveals that, Internal migration (57%) is major drivers for change in urban dynamics whereas, commercialization (25%), population density (16%), and real estate business (5%) are other respective drivers for alteration of urban land inside the municipality. To prevent rapid urbanization in this municipality, the concerned authorities must take initiative for proper land use planning and its implementation on time. Recently, Nepal Government has endorsed Land Use Act 2019 for preventing the conversion of agricultural land into haphazard urban growth.</jats:p

Study of biofilm formation and antibiotic resistance pattern of gram-negative Bacilli among the clinical isolates at BPKIHS, Dharan

Abstract Objectives Gram-negative bacilli are the common causative agents for community-acquired, nosocomial and opportunistic infections. The recent upsurge of biofilm, as well as beta-lactamases producing strains, have synergistically led to the extensive dissemination of multi-drug resistant gram-negative bacilli. This study was carried out with an intention to detect the biofilm formation by gram-negative bacilli and determine their antibiogram along with the detection of extended-spectrum beta-lactamases (ESBLs) and metallo-beta-lactamases (MBLs) production. Results Among 314 isolates, Escherichia coli (38%) were the predominant isolates followed by Acinetobacter spp. (20%), Klebsiella spp. (16%), and Pseudomonas spp. (12%). Overall, 197 (62.73%) of isolates were biofilm positive. 84 (26.75%) and 51 (16.24%) were confirmed as ESBL and MBL producers respectively. The association between MBL production and biofilm formation was statistically significant (χ2 = 10.20, P value= 0.002) whereas it was insignificant between ESBL and biofilm production (χ2 = 0.006, P-value= 0.937). Most of the biofilm and MBL producing strains were multi-drug resistant

Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal

Abstract Background Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. Methods This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18–24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. Results Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. Conclusions E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency