Spinal Cord Injury Rehabilitation in Nepal

Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life. Keywords: rehabilitation; spinal injury

Histopathological Study of Endoscopic Biopsies

Introduction: Diseases of upper gastrointestinal tract are responsible for a great deal of morbidity and mortality. The histopathological study of endoscopic biopsies permits exact diagnosis for further management.The aim of this study is to find out the histopathological pattern of endoscopic biopsy. Methods: A descriptive study was conducted in consecutive endoscopic gastric biopsies in a Hospital over a period of one year. The patient of all ages and both sexes who underwent gastric biopsy during the study period was included. Results: Endoscopic biopsies were studied on patients of age ranging from 20 years female to 84 years male. The histopathology revealed non-neoplastic lesions 54 (67.5%) and neoplastic lesions 26 (32.5%). Most common non-neoplastic lesion noted was mild chronic gastritis 22(27.5%) followed by chronic active gastritis 15 (18.75%) while H. pylori was present in 13 (16.25%) and absent in 2 (2.5%). Conclusions: Mild chronic gastritis was the commonest lesion noted in non-neoplastic lesions and adenocarcinoma was the commonest neoplastic lesion in the endoscopic gastric biopsies. ______________________________________________________________________________________ Keywords: biopsy; endoscopy; gastritis; histopathological

Spinal Cord Injury Rehabilitation in Nepal

Spinal cord injury is a major trauma, with its short and long term effects and consequences to the patient, his friends and family. Spinal cord injury is addressed in the developed countries with standard trauma care system commencing immediately after injury and continuing to the specialized rehabilitation units. Rehabilitation is important to those with spinal injury for both functional and psychosocial reintegration. It has been an emerging concept in Nepal, which has been evident with the establishment of the various hospitals with rehabilitation units, rehabilitation centres and physical therapy units in different institutions. However, the spinal cord injury rehabilitation setting and scenario is different in Nepal from those in the developed countries since spinal cord injury rehabilitation care has not been adequately incorporated into the health care delivery system nor its importance has been realized within the medical community of Nepal. To name few, lack of human resource for the rehabilitation care, awareness among the medical personnel and general population, adequate scientific research evidence regarding situation of spinal injury and exorbitant health care policy are the important hurdles that has led to the current situation. Hence, it is our responsibility to address these apparent barriers to successful implementation and functioning of rehabilitation so that those with spinal injury would benefit from enhanced quality of life. Keywords: rehabilitation; spinal injury

Antibiotic resistance patterns of Staphylococcus aureus, Escherichia coli, Salmonella, Shigella and Vibrio isolated from chicken, pork, buffalo and goat meat in eastern Nepal

Abstract Objective Food-borne pathogens are a major cause of illnesses, death and expenses. Their occurrence in meat and other food is considered a global health problem. The burden of food-borne disease is increasing due to antimicrobial resistance which represents a greater risk of treatment failure. However, very little is known about the antibiotic resistance profile of food-borne pathogens in Nepal. This study was conducted to examine the antibiotic resistance profile of common food-borne bacterial pathogens isolated from raw meat sold in Nepal. A total of 83 meat samples were collected from the market and analyzed. Results The prevalence of Staphylococcus aureus, Escherichia coli, Salmonella, Shigella, and Vibrio were 68%, 53%, 35%, 6%, and 6% respectively. The resistance of Salmonella was most frequently observed to amoxicillin (100%), tetracycline (24%), chloramphenicol (11%), and nalidixic acid (11%). S. aureus was resistant to amoxicillin (100%) followed by tetracycline (63%), nalidixic acid (17%), and cefotaxime (13%) respectively. Vibrio isolates resisted amoxicillin (100%), tetracycline (40%) and chloramphenicol (20%). Shigella expressed the highest resistance to amoxicillin (100%), followed by chloramphenicol (80%), tetracycline (60%) and nalidixic acid (20%). E. coli exhibited the highest resistance to amoxicillin (100%), followed by tetracycline (93%), nalidixic acid (25%) and cefotaxime (19%). </jats:sec

Percutaneous Fluoroscopy-guided Retrieval of a Fractured Pelvic Drain after Caesarean Section: A Case Report

Iatrogenic retention of surgical drains following drain entrapment and breakage is a never event and a preventable complication. The traditional approach for removing a fractured drain from the intra-peritoneal cavity involves exploratory laparotomy. However, over the last few decades, minimal access surgery has been a more popular retrieval method for retained surgical items from peritoneal and extraperitoneal cavities. We report a case of a 32-year-old woman with a fractured pelvic drain post-caesarean section. Postoperatively, the patient developed the signs of infection and features of bowel obstruction. The mechanical obstruction was ruled out by computed tomography scan. Multiple attempts were made to pull the pelvic drain out but the tube snapped, leaving about a quarter of its length. The drain remnant was retrieved using a non-invasive, inexpensive interventional radiology technique. We could not find any such report in the literature describing this innovative approach for retrieving a fractured pelvic drain

Food-borne bacterial pathogens in marketed raw meat of Dharan, eastern Nepal

Abstract Objectives This study aims to assess the bacteriological quality of marketed raw meat with a special emphasis on isolation of Escherichia coli, Salmonella spp., Shigella spp., Vibrio spp., Pseudomonas aeruginosa and Staphylococcus aureus in raw meat marketed in Dharan. Altogether 50 meat samples were collected from local markets of Dharan and transported to the microbiology laboratory at 4 °C. The meat samples were homogenized in a sterile glass homogenizer and the possible pathogens were isolated and identified by conventional microbiological techniques. Results The mean total viable count values were found having a mean count of 8.22 ± 0.14, 8.29 ± 0.17, 7.87 ± 0.18 and 7.92 ± 0.19 in terms of log10 CFU/g ± Standard Error for chicken, pork, buffalo, and goat meat respectively. Coliforms were found in 84% samples, S. aureus was found in 68% samples, Salmonella spp. in 34% samples, Shigella spp. in 6% samples, Vibrio spp. in only 3 samples and P. aeruginosa was isolated from 40% sample. Higher microbial load and presence of intestinal commensals E. coli, Salmonella spp., Shigella spp., Vibrio spp indicates that meat might be contaminated by the visceral content and consumers are at risk of getting a foodborne disease when eaten raw

Haemodynamic stability following adrenaline intracervical block for major haemorrhage during surgical management of late miscarriage: A case report

The risk of heavy bleeding after a miscarriage is higher in women undergoing medical management compared with surgical. According to the literature, oxytocin receptor mRNA expression in the myometrium is not well formed during early gestation. Adrenaline may be considered in miscarriage which remains refractory to uterotonics and where bleeding from the placental bed may contribute to haemorrhage, before proceeding to surgical intervention. It is used in various settings to control bleeding in gynaecological procedures. A 34-year-old woman in her third pregnancy presented at 15 + 1 weeks of gestation with an open cervical os and bulging membrane. Within three hours of admission, she passed the fetus but failed to deliver the placenta and continued to bleed. She was taken to theatre for surgical management of miscarriage. The bleeding persisted following suction evacuation and despite the standard dose of oxytocin, and misoprostol uterotonics were given. Because the source of bleeding could be the placental bed, potentially low lying at this stage, a 4.4 ml prefix combination of 12.5 μg/ml adrenaline (1:80,000) and lidocaine (20 mg/ml) was administered as an intracervical block equally at four quadrants at the level of the cervical isthmus. This arrested the bleeding immediately and controlled the bleeding until discharge. This technique has not been described previously, which we believe causes vasoconstriction of the placental bed

Microbiological Quality and Adulteration of Pasteurized and Raw Milk Marketed in Dharan, Nepal

 This study was aimed to evaluate the quality of raw and pasteurized milk marketed in Dharan. Milk may be contaminated with pathogenic microorganisms and a mixture of several adulterants and such milk pose a risk to consumers. The study was carried out from September 2019 to January 2020. Collected samples were tested for adulterants (starch, formalin, neutralizer and table sugar) as well as microbial quality (Total Coliform count, Total Viable Count, Thermoduric Count, Escherichia. coli and Staphylococcus aureus) as per standard guideline. The adulterants starch, formalin and neutralizer were not detected in both raw and pasteurized milk. However, table sugar was present in 45% (9 out of 20) raw milk and 90% (18 out of 20) pasteurized milk. The average Total Viable Count, Total Coliform Count and Thermoduric Count of raw milk were, 59×105 CFU/ml, 14×104 CFU/ml and 5×103 CFU/ml respectively. Similarly, the average Total Viable Count, Total Coliform Count and Thermoduric Count of pasteurized milk were found to be 15×104 CFU/ml, 14×103CFU/ml and 4×103 CFU/ml respectively. E. coli was detected in 30% pasteurized milk whereas S. aureus was isolated from only 20%. Likewise, E.coli and S. aureus were found in 55% and 45% of raw milk respectively. The results of the study indicated that routine monitoring of dairy industries and raw milk vendors, awareness campaign and good hygienic practice should be promoted to upgrade the quality of raw and pasteurized milk.</jats:p

Intestinal Parasitic Infections and Associated Risk Factors Among School-going Children of Age 1-5 years in Dharan, Eastern Nepal

Intestinal parasitic infections have been a major public health burden of developing countries, especially in children. Higher prevalence has been reported among school children, mostly in rural areas of Nepal where water, toilets, hygiene, and sanitation facilities are insufficient. This cross-sectional study was carried out from April to September 2019 to determine the prevalence of intestinal parasitic infections among school-going children1-5 years of Dharan, Nepal, and to assess the associated risk factors. Stool samples were collected in a clean, dry, screw-capped, and wide-mouthed plastic container, kept in an icebox, and transported to the laboratory. Data relating to different risk factors were collected from the parents of 116 participants using a structured questionnaire. The parasites were identified by using the direct wet mount method and formal-ether concentration method. Pearson’s chi-square test was carried out to establish associations between dependent and independent variables using SPSS version 20, and the test considered a greater than &lt; 0.05% as statistically significant with a 95% confidence level. Out of the 116 stool samples, 9 (7.75%) tested positive for the parasitic infections in which 5 (55.5%) were protozoa and 4 (44.45%) were helminths. The prevalent parasites, were Entamoeba histolytica (23%), Hyamenolepis nana (22%), Giardia lamblia (11%), Hookworm (11%), Entamoeba coli (11%), Ascaris lumbricoides (11%), and Intestinal parasitic infections had a significant association with drinking water, bowel syndrome, bathing habit, toilet facility, and washing hands after toilets (p&lt;0.05). Lack of toilets, poor hygiene, and unsafe drinking water were the main risk factors. Improved hygienic practices, safe drinking water, and the use of latrines could lower the rate of parasitic infections.</jats:p

Dust Structure Nearby G229-03

The Sky View Virtual Observatory was used for the systematic search of dust structures within the far-infrared loop G229-03. The source (object) responsible for the formation of the cavity of interest was detected by the Set of Identifications, Measurements, and Bibliography for Astronomical Data (SIMBAD) database. The total mass of the loop was 8.50031 × 1029 kg which is about 0.425 times the mass of the Sun at a distance of 1300 pc. The size of the cavity was 3.67° × 3.6°, whereas its core size was 0.531° × 0.255° located at R.A. (J2000) = 7h10m0.8s and Dec.(J2000) =15h55m30s. The minimum and maximum temperatures were between 20.24 ± 1.16 K and 18.63 ± 1.96 K respectively. In the core region, the average temperature was 19.53 K, approximately equal to Gaussian center 19.267 K with an offset temperature of 0.4 K showing that the core region of the cavity is dynamically stable. The Far-infrared loop was found to be located within a 1° radius around the high-velocity cloud HVC oriented by 45° to the plane of the sky. The inclination angle of the core of the loop was greater than 60° whereas the inclination angle for the larger structure was 13.71°. The Gaussian distribution of temperature was well fitted with the center of 19.267 K which shows that the cavity was in thermal equilibrium and the outer region with offset temperature of about 35 K suggesting that the loop was dynamically unstable possibly due to high-velocity cloud</jats:p