Acute pancreatitis and severe hyperbilirubinemia as initial presentation of Gilbert syndrome

Gilbert syndrome (GS) is benign, often familial condition characterized by recurrent but asymptomatic mild unconjugated hyperbilirubinemia in the absence of hemolysis or underlying liver disease. The coexistence of GS with other more clinically significant conditions could interfere with their diagnoses. The genetic variation described as GS may affect drug glucuronidation and could potentially precipitate. Gallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, congenital causes prevail, commonest of which is Gilbert’ Syndrome. Here we report a case of 21-year old male who presented to our hospital with complaint of pain abdomen and was diagnosed as gall stone induced pancreatitis which was further diagnosed as GS after genetic testing for UGT1A1 gene polymorphism

Projected distribution of the westernmost subpopulation of Assamese macaques (Macaca assamensis pelops) under climate change: conservation implications of a threatened population

Anthropogenic climate change can have a negative impact on the distribution of habitat specialist species with narrow distributional ranges. Among the many areas around the world affected by climate change, the Himalayan region in particular is experiencing marked effects of global warming on its climatic patterns and life forms. This study assessed the current distribution of Assamese macaques (Macaca assamensis) in western Nepal, and projected their likely distribution (via habitat suitability modeling) for the years 2050 and 2070 under the two most plausible greenhouse gas emission scenarios (RCP4.5 and RCP6.0). We recorded a total of 159 Assamese macaques belonging to 10 groups (nine of them residing outside of protected area networks) between 684m and 2550m asl in western Nepal. Climatic niche modeling predicted that 37.03% (25,114 km2) of the total area of western Nepal (67,813 km2) represented suitable habitat of the species, the majority of which ranged between 1000 m and 2000 m asl. Future projections of the current climatic niche of the Assamese macaques revealed a consistent decrease in the suitable habitat for 2050 and 2070 in both of the greenhouse emission scenarios tested. With the RCP6.0 scenario, almost 57% of the current highly suitable habitat would be lost by 2070 with remaining suitable habitat shifted towards higher elevations. The loss of habitat directly affects the species survival and the range shift towards higher elevation exposes them to new areas for conflict with humans. Therefore, the Assamese macaque population in western Nepal requires a high conservation priority with the establishment of new protected areas

Synchronous dual malignancy: a rare case report of carcinoma breast with carcinoma gall bladder

Incidence of multiple primary cancers is reported to be between 0.18% to 17.2% in various studies. Occurrence of breast and gall bladder malignancy as synchronous malignancy is very rare. We are reporting one of such rare case. Our patient, a 64 years old lady had a unique presentation. She underwent laparoscopic cholecystectomy for a clinical diagnosis of cholelithiasis. Histopathology turned out to be adenocarcinoma of the gall bladder (Stage II A). A clinical examination done at the time of presentation to our institute revealed suspicious thickening of the skin of the left breast and a subsequent tru-cut biopsy revealed infiltrating ductal carcinoma. Hormone receptor immunohistochemistry revealed oestrogen receptor (ER) negative progesterone receptor (PR) negative and Her2neu negative tumour. Further evaluation revealed a widespread metastatic disease. She was treated with palliative radiotherapy, chemotherapy and zolendronate. She had an aggressive clinical course and succumbed to her illness within four months after diagnosis of dual malignancy. There is a high incidence of gall bladder carcinoma along the Gangetic belt of Northern India. Presence of dual malignancy with gall bladder carcinoma as one primary in these geographic location needs to be further explored for sporadic environmental factors or other genetic alterations as possible causative factors

ANALGESIC ACTIVITY OF BARK AND LEAVES OF FICUS RELIGIOSA L. FROM NEPAL

Objective: Because of adverse side effects, caused by NSAIDs, tolerance, and dependence induced by opiates, the use of these analgesic agents has not been successful in all cases. Therefore, alternative analgesic drugs from plant sources are the new target now days. The objective of this study was to evaluate the analgesic activity of ethanolic extracts of stem barks and leaves of Ficus religiosa. Methods: The analgesic activity of ethanolic extract of stem barks and leaves was evaluated in the Swiss albino mice model using acetic acid-induced writing response and Eddy’s hot plate method. Analgesic activity was demonstrated with the percentage inhibition of acetic acid induced writings and the percentage increased in latency time of paw licking. The potency of test extracts was compared with standard drug, Diclofenac. Results: Ethanolic extract of leaves and bark of F. religiosa showed potential analgesic activity from both methods. From Eddy’s hot plate model, it was observed that the percentage of increased latency time at 90 min by ethanolic extract of leaves and stem bark was found to be 70.81 % (8.54 min) and 70.78 % (8.53 min) respectively at a dose of 400 mg/kg. Both of these results are statistically significant (p<0.05) as compared to the test group. Furthermore, both of these extracts showed the dose-dependent and time-dependent increased in latency time and these results are compared to that of standard drug Diclofenac. Similarly, ethanolic extract of leaves and stem at 400 mg/kg significantly inhibited the number of writhings induced by acetic acid. The percentage inhibition of writhings by ethanolic extract of leaves at a dose of 400 mg/kg was 68.47 % which was similar to that of standard drug Diclofenac (68.47 %). However, ethanolic extract of bark showed relatively lower percentage inhibition (60.79 %) as compared to leaf extract and standard, but the result was significant as compared to that of the test group (p<0.05). Conclusion: Ethanolic extracts of F. religiosa stem bark and leaf possess both central and peripheral analgesic properties and these effects may be beneficial for the management of pain

Quorum sensing in African Trypanosomes

Many microbial eukaryotes exhibit cell-cell communication to co-ordinate group behaviours as a strategy to exploit a changed environment, adapt to adverse conditions or regulate developmental responses. Although best characterised in bacteria, eukaryotic microbes have also been revealed to cooperate to optimise their survival or dissemination. An excellent model for these processes are African trypanosomes, protozoa responsible for important human and animal disease in sub Saharan Africa. These unicellular parasites use density sensing in their mammalian host to prepare for transmission. Recently, the signal and signal transduction pathway underlying this activity have been elucidated, revealing that the parasite exploits oligopeptide signals generated by released peptidases to monitor cell density and so generate transmission stages. Here we review the evidence for this elegant quorum sensing mechanism and its parallels with similar mechanisms in other microbial systems. We also discuss its implications for disease spread in the context of coinfections involving different trypanosome species

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study

BackgroundThe Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal.MethodsWe conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers.ResultsA total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies.ConclusionGovernment stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Theoretical studies of the structure-property relationships of hole- and electron-transport materials for organic photovoltaic applications

Donor-acceptor and thiophene based π-conjugated molecules and polymers, along with fullerene derivatives, are extensively used active components in the photoactive layer of organic photovoltaic devices. In this dissertation, we make use of several computational methodologies to investigate structure-property relationships of these organic systems in their molecular forms. We begin with an overview of the field of organic photovoltaics and some of the important problems in organic solar cells that are currently being investigated. This is then followed by a brief review of the electronic-structure methods (e.g. Hartree-Fock theory, Density Functional Theory, and Time-dependent Density Functional Theory) that are employed. We then present the main results of the dissertation. Chapter 3 provides a broad overview on how changes to the donor-acceptor copolymer chemical structure impacts its intrinsic geometric, electronic, and optical properties. Chapter 4 focuses on the characterization of the lowest excited-states and optical absorption spectra in donor-acceptor copolymers. In Chapter 5, we investigate the effects of alkyl side-chain placements in the π-conjugated backbone of oligothiophenes and how that impacts their intramolecular properties as well as the oligomer:fullerene interfacial interactions. Chapter 6 presents our investigation on the role of oligomer:fullerene configuration and reorganization energy on exciton-dissociation and charge-recombination processes. Finally, a synopsis of the work and further considerations are presented in Chapter 7.Ph.D

Correlates of avifaunal diversity along the elevational gradient of Mardi Himal in Annapurna Conservation Area, Central Nepal

Abstract Background Patterns of biological diversity and richness can vary along the elevational gradients among mountain systems making it difficult to conclude the general pattern. The drivers of such pattern are also poorly known in the southern flank of the Himalaya due to limited studies. Therefore, we assessed the species richness, seasonal patterns and drivers of avian diversity along an elevational gradient on Mardi Himal trekking trail, a newly open tourist route in Annapurna Conservation Area of the central Himalaya. Methods Two surveys (winter and summer seasons of 2019) were conducted from the bank of Seti-Gandaki River confluence (1030 m above sea level, asl) up to the Low Camp (3050 m asl) of the Mardi Himal. The point count method was employed in every 100 m rise in the elevation. Diversity indices were calculated and bird abundance data on species, sites, seasons and environmental variables were analyzed. Generalized linear model, polynomial regression and ordinary least square regression were performed to examine the importance of environmental factors in shaping the avian richness pattern. Results A total of 673 individuals of birds belonging to 112 species, of which 72 in winter and 80 in summer, were recorded. We observed a hump-shaped pattern of the overall species richness along the elevational gradient. The richness pattern remained consistent even when explored by season, for winter and summer separately. Diversity indices were found higher during the summer. Elevation and mean monthly temperature in both seasons showed non-linear relation with avian species richness. Precipitation exhibited positive association in summer whereas the same in winter was negatively correlated with avian species richness. Distance to the nearest water source and the nearest human settlement were negatively correlated with the richness of birds. Small-ranged and insectivorous birds were under the strong influence of gradients on climatic variables like temperature and precipitation. Conclusions We conclude that the combined effects of multiple factors such as area, gradients of climate (i.e. temperature and precipitation), resource availability and disturbance play an important role in bird diversity and richness pattern along an elevational gradient of a montane environment in Mardi Himal

Clinico-Pathological Assay Of The Severe Cases Of Diarrhoea & Vomiting Admitted In The Year 2018(1962) In Bir-Hospital

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