Comparative Antioxidant, Antimicrobial and Phytochemical Assesments of Leaves of Desmostachya bipinnata L. Stapf, Hordeum vulgare L. and Drepanostachyum falcatum (Nees) Keng f.

 Nepal is rich in varieties of religious plants. The locally used religious plants also carry medicinal importance. Desmostachya bipinnata L. Stapf, Hordeum vulgare L. and Drepanostachyum falcatum (Nees) Keng f. are three plants belonging to the family Poaceae having religious significance in different practices of Hinduism. They were also used as traditional medicines by our ancestors but nowadays they are underutilized. In this research, our core objective was to validate the traditional assumption of use of these plants in medicinal purposes by carrying out the assessments like antimicrobial assessment, antioxidative assessment and phytochemical assessment. Methanolic extracts produced from leaves of all three plants were examined for antimicrobial activities through agar well diffusion method. The same extracts were also assessed for determining their antioxidative potentials with the use of DPPH (1, 1-diphenyl-2-picryl hydrazyl) free radical scavenging assay followed by qualitative phytochemical analysis and GCMS (Gas Chromatography Mass Spectroscopy). Most promising antimicrobial activity was shown by Desmostachya bipinnata L. against Salmonella typhimurium and Staphylococcus aureus, Drepanostachyum falcatum (Nees) Keng f. against Salmonella typhimurium and Klebsiella pneumoniae and Hordeum vulgare L. against Salmonella typhmurium and Staphylococcus aureus. The antioxidant activity of the plant extracts were observed in descending order of Hordeum vulgare L.>Desmotachya bipinnata L. > Drepanostachyum falcatum (Nees) keng f. and phytochemical assessment of the extracts indicated the presence of alkaloids, glycosides, sterols, Triterpenes, Saponins, Flavonoids, Coumarins, Phlobatanin and reducing sugars. Through this project, we can clarify that the above mentioned plants have bioactive compounds which contributed for the presence of antimicrobial and antioxidative property in the plants

Isolation and Screening of Antibiotics Producing Streptomyces spp from the Soil Collected around the Root of Alnus nepalensis from Godawari

Actinomycetes are considered as the most invaluable prokaryotes whose genome mining show a great number of putative secondary metabolite biosynthesis pathways as well as gene clusters ranging from 20 to 50 per genome. The genus Streptomyces has been explored for its ability to produce 60% antibiotics worldwide. Alnus nepalensis (Alder) has been found to harbor diverse Eubacteria in its rhizosphere. To evaluate the antibiotic production potential from Actinomycetes, we collected soil samples from rhizosphere (5-7 cm deep) of Alder tree. Primary screening was done by cross-streak method against Multidrug Resistant (MDR) such as Methicillin resistant Staphylococcus auereus (MRSA), Vancomycin resistant Enterococcus feacalis (VRE), Imepenem resistant Acinetobacterbaumannii, Vancomycin resistant Klebsiella pneumonia and Imepenem resistant E. coli as well as Non-MDRs (E. coli, Bacillus subtilis, Klebsiella pneumoniae, S. aeureu and Enterococcus feacalis). Extraction of antibiotics was done using rota-vapour from extract obtained by solid-substrate fermentation technique followed by solvent extraction. Secondary screening was done using well diffusion assay against MDRs. Among total of 40 isolates of Actinomycetes recovered, 14 showed remarkable zone of inhibition (ZOI) to various MDRs. NASA 303 showed 26 mm of ZOI against VRE, NASA 101 had ZOI of 34 mm against MRSA, NASA 319 had 33.7 mm ZOI against Imepenem resistant E. coli, NASA 306 had 36 mm of ZOI against Vancomycin resistant Klebsiella pneumoniae, and NASA 108 showed ZOI of 29.6 mm against Imepenem resistant E. faecalis. This investigation revealed that the Actinomycetes found in Rhizosphere of Alder tree had MDR killing potent antibiotics, which needs to be further explored

Energy Devices for Clipless-Sutureless Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis on Utility and Safety

Background and Objectives: While laparoscopic appendectomy is standardized, techniques for appendiceal stump closure and mesoappendix division remain variable. Novel vessel sealing techniques are increasingly utilized ubiquitously. We sought to systematically summarize all relevant data and to define the current evidence on the safety and utility of energy devices for clipless-sutureless laparoscopic appendectomy in this systematic review and meta-analysis. Materials and Methods: This review was conducted following the PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were systematically searched. Inclusion criteria included studies with laparoscopic appendectomy for appendicitis. The intervention included patients undergoing division of mesoappendix and/or securing of the appendicular base using diathermy (Monopolar or Bipolar or LigaSure Sealing Device) or Harmonic Scalpel (Group A) compared to patients undergoing division of mesoappendix and/or securing of the appendicular base using endoclip or Hem-o-lok or ligature (Group B). The methodological quality of the included studies was assessed using the Downs and Black scale. The outcomes of surgical site infection (SSI) or intra-abdominal collection, postoperative ileus, average operative duration, and length of hospital stay (LHS) were compared. Results: Six comparative studies were included; three were retrospective, two were prospective, and one was ambispective. Meta-analysis revealed a shorter operative duration in Group A with respect to appendicular base ligation (MD -12.34, 95% CI -16.57 to -8.11, p Conclusions: Clipless-sutureless laparoscopic appendectomy is safe and fast. Postoperative ileus seems less common with energy devices for mesoappendix division. However, the studies included have a moderate-to-high risk of bias. Further studies addressing the individual devices with surgeons of similar levels are needed.</p

Feasibility of store-and-forward teledermatology in out-patient care: A prospective study from rural India utilising specialist referral services through an instant messaging platform - "WhatsApp"

Objectives: The COVID-19 pandemic has placed unprecedented demands on the delivery of health care in rural areas of India. We examined the feasibility of store-and-forward mobile teledermatology for outpatient access to specialist dermatologic care in underserved areas in India. Methods: We conducted a prospective study using smartphone-based teledermatology, connecting six underserved clinics manned by primary care physicians (PCP) to three dermatologists, using the instant messaging platform WhatsApp. We assessed the concordance between PCPs and dermatologists (using Cohen’s kappa coefficient), consultation time, the spectrum of conditions, and the outcome. Results: Of the 730 dermatology patients screened in the clinics, (13%) (36 males and 59 females) required teleconsultation, among which 61.1% were non-infective, 34.7% were infective, and the diagnosis could not be ascertained in 4.2 %. The mean time takenwas 13.5 (± 18.4) minutes. Twenty per cent (n=19) required referral, and 80% (n=76) of consultations could be resolved at the clinic, of whom 36.8 % were cured, 38.2% had moderate, 4% had minimal improvement, 13% were lost to follow-up, and 8% refused treatment. Cure was observed in viral infections and eczema. The diagnostic concordance ranged from low values [0.38 (95% CI: 0-0.68)] in infective to moderate [0.66 (95% CI: 0.42-0.83), p=0.033] in non-infective disorders. Conclusion: Asynchronous mobile teledermatology, using specialist referral via instant messaging platforms, is a powerful modality for providing real-time dermatologic care, while offering a very promising alternative for decreasing healthcare disparities and continuity of services even in adverse situations like the Covid-19 pandemic

Data_Sheet_1_Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal

Questionnaire and feedback form produced for the study, "Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal"

Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal.

During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context

Pyeloplasty in children by lumbotomy approach using infant feeding tube as single stent

Background: The objective of this study was to assess the outcome in children who had undergone pyeloplasty by lumbotomy approach using infant feeding tube (IFT; 5 Fr) as a single stent. Materials and Methods: During January 2000 and December 2010, 134 pyeloplasty were performed by the lumbotomy approach. The procedure involves single layer anastomosis at pelvi-ureteric junction using vicryl 5-0/6-0 (reduction of pelvis if required). An IFT 5 Fr with multiple holes used as a single stent to serve as nephrostomy and as transanastomotic stent also. Results: There were 109 males and 25 females with M: F ratio of 4.3:1. Left-side pelvi-ureteric junction obstruction (PUJO) was seen in 117 (87.3%) while right side PUJO in 17 (12.7%). Mean age of presentation was 52.7 months (range 9-120 months). Postoperative complications included infection 2 (1.5%), urinoma formation 1 (0.7%), urine leak 3 (2.2%), non drainage 2 (1.5%), accidental removal of the stent 2 (1.5%). Follow-up scan done at 3 and 9 months showed improved drainage in 124 (92.5%), preserved renal function in 129 (96.2%) cases. Overall success rate 97.5%. Conclusion: Transanastomotic stent using IFT not only provide an effective drainage but also avoid the complications associated with double-J stents and nephrostomies, with the added benefit of being cheaper and availability