Efficacy of morning-only dose compared with split-dose polyethylene glycol electrolyte solution in bowel cleansing for afternoon colonoscopy

Introduction: The efficacy of colonoscopy in detecting abnormalities within the colon is highly dependent on the adequacy of the bowel preparation. The objective of this study was to compare the efficacy and tolerability of morning only vs split-dose administration of polyethylene glycol (PEG) solution for colon cleansing in patients undergoing afternoon colonoscopy. Methods: This was a comparative study conducted in Department of Medicine, Patan Academy of Health Sciences (PAHS), Patan Hospital, Nepal from November 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee. Informed consent was taken from the patients. Patients aged >18 years undergoing elective colonoscopy were randomly assigned to one of the two bowel preparation regimens- morning only or split-dose of PEG. The adequacy of bowel preparation was assessed by the endoscopist using Boston Bowel Preparation scale. Preparation to colonoscopy interval, adverse events and risk factors for poor bowel preparations were noted. Results: In this study, 110 patients were included in the final analysis- 55 received morning only regimen and 55 received split-dose. Mean Boston bowel preparation scales of Morning only and Split-dose regimen were 7.60 and 7.09 respectively (p= 0.019). Split-dose group had significant sleep disturbances compared to Morning only regimen (p< 0.001), whereas nausea occurred significantly more often in Morning only regimen (p=0.012). Preparation to colonoscopy interval between 4-6 hours resulted in better bowel cleansing compared to PC interval of greater than 6 hours. Conclusion: Morning-only bowel preparation is more effective than Split-dose for achieving adequate colon cleansing for afternoon colonoscopy

Factors predicting early re-bleeding and in-hospital mortality after acute variceal hemorrhage in patients with cirrhosis

Introduction: Risk factors for early re-bleeding and in-hospital mortality following acute variceal hemorrhage (AVH) are incompletely understood. The aim of this study was to find out the risk factors for early re-bleeding within 5 days and in-hospital mortality after AVH in patients with cirrhosis. Methods: This was an analytical cross-sectional study conducted in Department of Medicine, Patan Academy of Health Sciences (PAHS), Patan Hospital, Nepal from July 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee. Informed consent was taken from the patients. Patients aged > 18 years with diagnosed case of liver cirrhosis and endoscopy confirmed variceal bleeding were enrolled. All cases of early re-bleeding within 5 days and in-hospital outcome were recorded. Results: In this study total 72 patients were enrolled. The mean age of our patients was 51.68 years. More than 91% of the patients improved, 4.16% had early re-bleeding and 6.9% died during the same hospital admission. Univariate analysis showed that early re-bleeding was significantly associated with the high PT/INR (p=<0.001) and high high Child-Turcotte Pugh (CTP) score (p=0.032), whereas in-hospital mortality of patients was significantly associated with low Protein (p=0.044), CTP score (p=0.041), high Model for End stage Liver Disease (MELD) score (p=0.002) and presence of gastric varices (p=0.008). Conclusion: High PT/INR and high CTP score were the predictors of early re-bleeding after AVH in cirrhotic patients. Low Protein, high CTP and MELD scores, and presence of gastric varices were the predictors of in-hospital mortality in these patients

A Study of Optical and Electronic Properties of a Semiconducting Polymer, Poly(o-methoxyaniline)

The optical properties of spin coated thin films of poly(o-methoxyaniline) (POMA) were investigated using spectroscopic ellipsometry (SE) complimented by optical absorption spectroscopy in the visible-near UV optical range and atomic force microscopy (AFM) for surface roughness. For these studies a custom built ellipsometer was constructed and interfaced with a computer and software was written in LABVIEW™ for automation. A Gaussian oscillator optical model was used to fit the data obtained from SE. roughness results were also evaluated in an optical model. The effect of different spin deposit conditions including spin rate, and concentration of solution and deposition ambient on the POMA film thickness, surface roughness, optical properties and optical anisotropy have been investigated. Small uniaxial anisotropy has been measured and annealing leads to some densification and surface smoothing. Organic thin film transistors (OTFT) were fabricated with POMA as the active semiconductor layer, silicon dioxide (SiO2) as the gate dielectric, heavily doped silicon as the substrate, and vacuum evaporated gold lines as the source and drain contacts. The electronic properties were characterized using a custom built probe station. The custom probe station was also automated with software program written in LabVIEW™. POMA yielded a P-channel device, and from transfer characteristic and turn-on plot, the charge mobility was calculated which was in the range of about 10-3 cm2 V-1 s-1. Various post fabrication processes were carried out to optimize the device performance. Controlled doping and moderate annealing have shown improvement in the device mobility by 10 folds and 2 folds respectively, yielding evidence for a hopping mechanism for charge transport in POMA. Two alternate gate dielectric layers for the OTFT were also considered; while a nonpolar low-K dielectric, polyethylene improved mobility; polar high-K dielectric, copolymer of vinylidene fluoride with trifluoroethylene had an adverse effect on mobility

Upper gastrointestinal endoscopy findings in patient presenting with dyspepsia

ntroductions: The objective of this study was to evaluate the upper gastrointestinal endoscopy findings in patients presenting with dyspepsia. Methods: This retrospective observational study was conducted in Department of internal medicine, Patan Hospital from April 2013 to March 2014. Adult patients who underwent upper gastrointestinal endoscopy for dyspepsia were included in the study. Results: There were 2141 endoscopies (out of total 3195) performed for dyspepsia, male 996 (46.52 %), female 1145 (53.48%), mean age 39.37 years (SD ±18.16). A single endoscopic diagnosis was made in 1991 (93%) and in rest combinations of lesions were seen. Gastritis 892 (41.66%), Oesophagitis 215 (10.04%), Duodenal Ulcer 100 (4.67%), Gastro-duodenitis 85 (3.97%), Hiatus hernia 82 (3.82%), Gastric Ulcer 46 (2.14%) and no lesions in 594 (27.74%) were seen. Conclusion: Gastritis followed by oesophagitis was seen half of the dyspeptic, while a quarter had functional dyspepsia with normal findings. Keywords: duodenal ulcer, gastritis, gastric ulcer, hiatus hernia, oesophagitis, upper gastrointestinal (UGI) endoscopyÂ

XPA: An Open Source IDE for XACML Policies

This paper presents XPA (XACML Policy Analyzer), an open source IDE (Integrated Development Environment) for testing, debugging, and mutating XACML 3.0 policies. XACML is an OASIS standard for specifying attributebased access control policies. XPA provides a variety of new techniques for generating test cases from policies, localizing bugs in faulty policies, and repairing faulty policy elements. XPA has been applied to numerous XACML policies from the literature and real-world applications. These policies have been used to quantitatively evaluate the effectiveness of various testing and debugging methods. For system developers and administrators, XPA is a practical IDE for developing dependable XACML policies. For access control researchers, XPA offers a versatile toolkit for studying and evaluating new testing, debugging, and verification techniques

Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population

Intravenous paracetamol vs tramadol for pain management in patients with acute pancreatitis

Introduction: Acute Pancreatitis causes severe and persistent pain, and thus, necessitates effective treatment. Opioids are widely used to relieve pain in acute pancreatitis due to their efficacy and effectiveness. Intravenous paracetamol has been documented to have comparable effectiveness as that of opioids, with lesser side effects. In this study, the analgesic efficacy of tramadol, an opioid was compared with paracetamol in acute pancreatitis.  Method: This was an open label comparative study conducted in a tertiary referral hospital of Nepal. Patients with Acute Pancreatitis were randomly assigned to receive 1 g of paracetamol or 50 mg of tramadol with 100 mL normal saline within 4-5 minute. Pain measurements of the patients were conducted at baseline and 24 hours after the treatment intervention. Changes in pain scores were calculated by subtracting the mean scores at baseline and 24 hours as pairs.  Result: In this study, 80 patients were enrolled and included in the final analysis. The study subjects had a mean age of 39.33 +/- 13.3 years and 62(77.5%) of them were male. Alcohol was the etiology for pancreatitis in 67.5% (n=54) of patients. Mean pain scores at baseline and 24 hours were similar in the two groups. Similarly, change of scores from baseline to 24 hours did not differ between the groups. Comparison of pain improvements failed to reveal any differences between groups.  Conclusion: Intravenous paracetamol is an effective alternative to tramadol in pain management of acute pancreatitis

Dynamic modelling reveals the separable contributions to achieving correct spindle orientation in a noisy system

The mechanisms by which the mammalian mitotic spindle is guided to a predefined orientation through microtubule-cortex interactions have recently received considerable interest, but there has been no dynamic model that describes spindle movements toward the preferred axis in human cells. Here, we develop a dynamic model based on stochastic activity of cues anisotropically positioned around the cortex of the mitotic cell and we show that the mitotic spindle does not reach equilibrium before chromosome segregation. Our model successfully captures the characteristic experimental behavior of noisy spindle rotation dynamics in human epithelial cells, including a weak underlying bias in the direction of rotation, suppression of motion close to the alignment axis, and the effect of the aspect ratio of the interphase cell shape in defining the final alignment axis. We predict that the force exerted per cue has a value that minimizes the deviation of the spindle from the predefined axis. The model has allowed us to systematically explore the parameter space around experimentally relevant configurations, and predict the mechanistic function of a number of established regulators of spindle orientation, highlighting how physical modeling of a noisy system can lead to functional biological understanding. We provide key insights into measurable parameters in live cells that can help distinguish between mechanisms of microtubule and cortical-cue interactions that jointly control the final orientation of the spindle.This work was supported by Cancer Research UKThis is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.bpj.2015.08.01

A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal – reappraising the role of instrument reprocessing in retaining their value [version 1; referees: 2 approved]

Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of “safe surgery saves lives” as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role

Assesment of electricity excess in an isolated hybrid energy system: A case study of a Dangiwada village in rural Nepal

The increasing demand of power can be fulfilled through different architectures and electricity supply models by utilizing the available local resources. But most of the isolated energy system suffers from high energy cost and unreliable energy supply. This study identifies different electricity supply models to fulfill the dynamic demand of power in a remote area, which is analyzed in terms of cost of energy and causes for the high cost of energy. Among different factors, the presence of unusable energy (Electricity Excess) produced by the energy system during fulfillment of the demand is found to be major one cause for the high cost of energy. Further, the importance of energy storage system in isolated energy system is discussed. In this case, up to 83.4 % of electricity excess is observed, which can be utilized in different manners to reduce the total energy cost. Electricity excess profile for different energy model, their impacts and possible techniques of the solution with open views are discussed