Visualisation of Rouviere’s Sulcus during Laparoscopic Cholecystectomy

Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle. Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy.  Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury

Association of Preoperative mid-stream urine culture, Renal pelvic urine culture and Renal stone culture in the detection of Systemic inflammatory response syndrome/urosepsis post Percutaneous Nephrolithotomy

Introduction: Urosepsis post Percutaneous Nephrolithotomy (PCNL) is a dreaded complication with high mortality rate. Objective: To find the association of preoperative midstream urine culture (PMUC), renal pelvic urine culture (RPUC) and renal stone culture (RSC) in the post-operative development of Systemic Inflammatory Response Syndrome (SIRS) and urosepsis. Methods: It was a prospective cross-sectional observational study. The study included all symptomatic patients meeting the inclusion criteria who underwent Percutaneous Nephrolithotomy from 18th August, 2019 to 28th March, 2020. PMUC, RPUC and RSC were done and analyzed accordingly. Results: A total of 140 (73 males, 67 females) patients underwent PCNL. PMUC was positive in 15% (21/140) as compared to RPUC and RSC which were 7.9 % (11/140) and 4.3% (6/140) of total cases. None of the patients had simultaneous culture positivity in all the three types of specimens. Only two (1.42%) patients had simultaneous positivity in pelvic urine culture and stone culture. The organisms obtained in pelvic urine culture and stone culture were same i.e. Klebsiella and Escherichia coli respectively. Only two (1.42%) patients developed SIRS post PCNL, where in both the cases stone culture were positive but PMUC and RPUC were negative. Urosepsis was found in none of the patients. In the Fischer Exact test PMUC and RPUC were not statistically significant in the detection of SIRS post PCNL. Whereas only RSC showed statistical significance in the detection of SIRS. Conclusion: Stone culture has high prediction for SIRS and it might be considered for patients undergoing PCNL in order to prevent stone related infective complications

Transaminitis among Patients with Dengue Fever Visiting a Tertiary Care Centre

Introduction: Transaminitis is a condition where serum aspartate transaminase and alanine transaminase increase indicating liver dysfunction. One such disease where liver involvement might be observed is dengue, which is a mosquito-borne viral infection. The aim of the study was to find out the prevalence of transaminitis among patients with dengue fever in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre from 1 November 2022 to 31 March 2023 after obtaining ethical approval from the Institutional Review Committee. Informed written consent was taken before collecting the data. A rapid immunochromatography test was used to confirm dengue infection. Serum aspartate transaminase and alanine transaminase were measured through routine Reitman and Frankel’s enzymatic method. Dengue-confirmed patients from the medical outpatient department, fever clinic, and medical ward of the centre were included in the study. Patients with known prior liver diseases or any other chronic diseases, pregnancy, and patients in the hospice unit were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 442 dengue infected patients, the prevalence of transaminitis was 188 (42.53%) (37.92-47.13, 95% Confidence Interval). The highest frequency of dengue positive was observed among the 18-35 years age group, which was 97 (51.59%) with male predominance 134 (71.27%). Conclusions: The prevalence of transaminitis among patients with dengue fever in a tertiary care centre was found to be lower than other studies done in similar settings

A Study of Electrocardiographic Changes in patients with Newly Diagnosed Primary Hypothyroidism: A Cross-Sectional Study

Background: The thyroid hormones have an important role in the cardiovascular system; even minimal change in its level can cause significant alteration in the cardiac activity which can cause considerable electrocardiographic changes. We conducted this study to assess the electrocardiographic (ECG) changes in patients who were newly diagnosed with primary hypothyroidism. Methods: This study is a descriptive cross-sectional study conducted among 71 newly diagnosed subclinical and overt primary hypothyroidism patients visiting the out-patient department (OPD) of Universal College of Medical Sciences, Nepal from December 2018 to June 2020 after taking ethical clearance from the institutional review committee (UCMS/IRC/212/18). ECG was obtained for each patient at the time of diagnosis of primary hypothyroidism. The data were analyzed with SPSS Version 16. Results: The most common ECG changes were sinus bradycardia seen in 32.4%, followed by T wave inversion in 21.1%, low voltage QRS complex in 15.5%, and prolonged PR interval in 14.1%. ECG changes were seen in 62% of cases of newly diagnosed primary hypothyroidism. Among all patients, subclinical hypothyroidism accounted for 7%, while overt hypothyroidism accounted for 55% of the ECG findings. Conclusion: Our study found ECG changes like sinus bradycardia, T wave inversion, low QRS voltage, and prolonged PR interval in newly diagnosed primary hypothyroidism. We suggest that every newly diagnosed hypothyroid patient should be evaluated for ECG changes

Molecular mechanisms of drug resistance in natural Leishmania populations vary with genetic background

The evolution of drug-resistance in pathogens is a major global health threat. Elucidating the molecular basis of pathogen drug-resistance has been the focus of many studies but rarely is it known whether a drug-resistance mechanism identified is universal for the studied pathogen; it has seldom been clarified whether drug-resistance mechanisms vary with the pathogen's genotype. Nevertheless this is of critical importance in gaining an understanding of the complexity of this global threat and in underpinning epidemiological surveillance of pathogen drug resistance in the field. This study aimed to assess the molecular and phenotypic heterogeneity that emerges in natural parasite populations under drug treatment pressure. We studied lines of the protozoan parasite Leishmania (L.) donovani with differential susceptibility to antimonial drugs; the lines being derived from clinical isolates belonging to two distinct genetic populations that circulate in the leishmaniasis endemic region of Nepal. Parasite pathways known to be affected by antimonial drugs were characterised on five experimental levels in the lines of the two populations. Characterisation of DNA sequence, gene expression, protein expression and thiol levels revealed a number of molecular features that mark antimonial-resistant parasites in only one of the two populations studied. A final series of in vitro stress phenotyping experiments confirmed this heterogeneity amongst drug-resistant parasites from the two populations. These data provide evidence that the molecular changes associated with antimonial-resistance in natural Leishmania populations depend on the genetic background of the Leishmania population, which has resulted in a divergent set of resistance markers in the Leishmania populations. This heterogeneity of parasite adaptations provides severe challenges for the control of drug resistance in the field and the design of molecular surveillance tools for widespread applicability

Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study

<p>Abstract</p> <p>Background</p> <p>Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal.</p> <p>Methods</p> <p>Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated.</p> <p>Results</p> <p>The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness.</p> <p>Conclusion</p> <p>The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.</p

Crises and Tourism Development

The main objective of this Bachelor’s thesis is to study the situation of the tourism industry during different crises time and the affect it had on tourism development process. Further-more, it also focuses on the changes brought up to the travelling behavior of the people and how the travelers’ overcome the situation of crisis. To research the topic, an interview was carried out with the professionals from the hotel industry operating in Helsinki region, Fin-land. Moreover, a web-based survey was conducted among young travelers to know their per-spective towards the current situation of tourism industry. Both qualitative and quantitative research methods have been applied in this research. The interview held with the professionals supports the qualitative approach of the study, whereas for the quantitative study, the online questionnaire created with the help of tools in Google was sent to respondents through social networks and via e-mail. Previous researches from var-ious authors and students relating to crisis and the tourism sector were also reviewed. The questions for both the interview and the online survey were developed after reviewing the literature and considering the main objectives. For instance, various research works from other researchers related to the same field were also examined for study purposes. The study covered the latest events during the time of present research. The results from this research are presented in two different phases of study and later combined to produce a final conclusion to the research

Spectrum Sensing of Cognitive Radio Networks using Amplify and Forward Relay over Correlated Nakagami-m Fading Channel

In the last ten years, we have been witnessing the vast growth in wireless communications due to the popularity of many wireless devices, mobiles, smart phones etc. As a result, the demand for high data rates, bandwidth, and spectrum utilization has increased. From a survey, it has been shown that limited spectrum is a crucial factor to the continued growth in wireless services. To fulfill this demand, the designers are having many difficulties with radio spectrum, multipath fading, interference etc. To meet the problem, they introduce multiple-input multiple-output (MIMO), where multiple antennas are used in transceivers to increase the diversity and multiplexing gains over single antenna systems. But, it seems impractical to implement in wireless devices. Thus, to overcome this drawback, cooperative communications has been proposed for single antennas to gain same benefits from MIMO, which helps to maintain the spatial diversity gain. The concept of cooperative communication is to enhance the wireless network by adding a relay as a third terminal to assist the direct communication. The use of relay as an intermediate terminal helps to increase the probability of detection. In this report, we analyze the detection probability in cognitive radio networks (CRNs) over correlated Nakagami-m fading channel assisted by amplify-and-forward (AF) cooperative networks using orthogonal space-time block codes (OSTBCs). We evaluate the impact of correlation in channel on the spectrum sensing performance in CRNs. We calculate the closed-form expressions of the detection probability, false alarm probability and probability of miss detection in correlated non-identical Nakagami-m fading channels. Moreover, we present a set of complementary receiver operating characteristics (ROC) curves for different scenarios to describe the effect of antenna correlation on the spectrum sensing performance of CRNs

Spectrum Sensing of Cognitive Radio Networks using Amplify and Forward Relay over Correlated Nakagami-m Fading Channel

In the last ten years, we have been witnessing the vast growth in wireless communications due to the popularity of many wireless devices, mobiles, smart phones etc. As a result, the demand for high data rates, bandwidth, and spectrum utilization has increased. From a survey, it has been shown that limited spectrum is a crucial factor to the continued growth in wireless services. To fulfill this demand, the designers are having many difficulties with radio spectrum, multipath fading, interference etc. To meet the problem, they introduce multiple-input multiple-output (MIMO), where multiple antennas are used in transceivers to increase the diversity and multiplexing gains over single antenna systems. But, it seems impractical to implement in wireless devices. Thus, to overcome this drawback, cooperative communications has been proposed for single antennas to gain same benefits from MIMO, which helps to maintain the spatial diversity gain. The concept of cooperative communication is to enhance the wireless network by adding a relay as a third terminal to assist the direct communication. The use of relay as an intermediate terminal helps to increase the probability of detection. In this report, we analyze the detection probability in cognitive radio networks (CRNs) over correlated Nakagami-m fading channel assisted by amplify-and-forward (AF) cooperative networks using orthogonal space-time block codes (OSTBCs). We evaluate the impact of correlation in channel on the spectrum sensing performance in CRNs. We calculate the closed-form expressions of the detection probability, false alarm probability and probability of miss detection in correlated non-identical Nakagami-m fading channels. Moreover, we present a set of complementary receiver operating characteristics (ROC) curves for different scenarios to describe the effect of antenna correlation on the spectrum sensing performance of CRNs