Search results for: Niranjan Koirala

Authors: Niranjan Koirala, Sumangala Darsandhari, Hye Jin Jung, Jae Kyung Sohng

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Sakuranetin, an antifungal agent and genkwanin, an anti-inflammatory agent, are flavonoids with several potential pharmaceutical applications. To produce such valuable flavonoids in large quantity, an Escherichia coli cell factory has been created. E. coli harboring O-methyltransferase (SaOMT2) derived from Streptomyces avermitilis was employed for regiospecific methylation of naringenin and apigenin. In order to increase the production via biotransformation, metK gene was overexpressed and the conditions were optimized. The maximum yield of sakuranetin and genkwanin under optimized conditions was 197 µM and 170 µM respectively when 200 µM of naringenin and apigenin were supplemented in the separate cultures. Furthermore, sakuranetin was purified in large scale and used as a substrate for in vitro glycosylation by YjiC to produce glucose and galactose derivatives of sakuranetin for improved solubility. We also found that unlike naringenin, sakuranetin effectively inhibits α-melanocyte stimulating hormone (α-MSH)-stimulated melanogenesis in B16F10 melanoma cells. In addition, genkwanin more potently inhibited angiogenesis than apigenin. Based on our findings, we speculate that these compounds warrant further investigation in vivo as potential new therapeutic anti-carcinogenic, anti-melanogenic and anti-angiogenic agents.

Keywords: anti-carcinogenic, anti-melanogenic, glycosylation, methylation

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Authors: Ram Sharan Mehta, Sanjeev Sharma

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Introduction: Haemodialysis (HD) is a mechanical process of removing waste products from the blood and replacing essential substances in patients with renal failure. First artificial kidney developed in Netherlands in 1943 AD First successful treatment of CRF reported in 1960AD, life-saving treatment begins for CRF in 1972 AD. In 1973 AD Medicare took over financial responsibility for many clients and after that method become popular. BP Koirala institute of health science is the only center outside the Kathmandu, where HD service is available. In BPKIHS PD started in Jan.1998, HD started in August 2002 till September 2003 about 278 patients received HD. Day by day the number of HD patients is increasing in BPKIHS as with institutional growth. No such type of study was conducted in past hence there is lack of valid & reliable baseline data. Hence, the investigators were interested to conduct the study on " Profile of the Renal Failure patients under Haemodialysis at B.P. Koirala Institute of Health Sciences Nepal". Objectives: The objectives of the study were: to find out the Socio-demographic characteristics of the patients, to explore the knowledge of the patients regarding disease process and Haemodialysis and to identify the problems encountered by the patients. Methods: It is a hospital-based exploratory study. The population of the study was the clients under HD and the sampling method was purposive. Fifty-four patients undergone HD during the period of 17 July 2012 to 16 July 2013 of complete one year were included in the study. Structured interview schedule was used for collect data after obtaining validity and reliability. Results: Total 54 subjects had undergone for HD, having age range of 5-75 years and majority of them were male (74%) and Hindu (93 %). Thirty-one percent illiterate, 28% had agriculture their occupation, 80% of them were from very poor community, and about 30% subjects were unaware about the disease they suffering. Majority of subjects reported that they had no complications during dialysis (61%), where as 20% reported nausea and vomiting, 9% Hypotension, 4% headache and 2%chest pain during dialysis. Conclusions: CRF leading to HD is a long battle for patients, required to make major and continuous adjustment, both physiologically and psychologically. The study suggests that non-compliance with HD regimen were common. The socio-demographic and knowledge profile will help in the management and early prevention of disease and evaluate aspects that will influence care and patients can select mode of treatment themselves properly.

Keywords: profile, haemodialysis, Nepal, patients, treatment

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: Rosy Chaudhary, Pushpa Parajuli

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Background and Objectives: Informational support to family members has a significant potential for reducing this distress related to hospitalization of their patient into the critical care unit, enabling them to cope better and support the patient. The objective of the study is to assess family members’ perception of informational support, anxiety, satisfaction with care and to reveal the association with selected socio-demographic variables and to investigate the correlation between informational support, anxiety and satisfaction with care. Materials and Methods: A descriptive cross-sectional study was conducted in 39 family caregivers of patients admitted in critical care unit of BPKIHS(B.P. Koirala Institute of Health Sciences). Consecutive sampling technique was used wherein data was collected over duration of one month using interview schedule. Descriptive and inferential statistics were used. Results: The mean age of the respondents was 34.97 ± 10.64 and two third (66.70%) were male. Mean score for informational support was 25.72(SD = 5.66; theoretical range of 10 - 40). Mean anxiety was 10.41 (SD = 5.02; theoretical range of 7 - 21). Mean score for satisfaction with care was 40.77 (SD = 6.77; theoretical range of 14 - 64). A moderate positive correlation was found between informational support and satisfaction with care (r = 0.551, p < .001) and a moderate negative correlation was found between anxiety and satisfaction with care (r = -0.590; p = 0.000). No relationship was noted between informational support and anxiety. Conclusion: The informational support and satisfaction of the family caregivers with the care provided to their patients was satisfactory. More than three fourth of the family caregivers had anxiety; the factors associated being educational status of the caregivers, the family income and duration of visiting hours. There was positive correlation between informational support and satisfaction with care provided justifying the need for comprehensive information to the family caregivers by the health personnel. There was negative correlation between anxiety and satisfaction with care.

Keywords: anxiety, caregivers, critical care unit, informational support, family

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Authors: M. Ramesh, Manish K. Niranjan

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The electronic, structural and thermoelectric properties of Mg₂SiSn (110) surface are investigated within the framework of first principle density functional theory and semi classical Boltzmann approach. In particular, directional dependent thermoelectric properties such as electrical conductivity, thermal conductivity, Seebeck coefficient and figure of merit are explored. The (110)-oriented Mg₂SiSn surface exhibits narrow indirect band gap of ~0.17 eV. The thermoelectric properties are found to be significant along the y-axis at 300 K and along x-axis at 500 K. The figure of merit (ZT) for hole carrier concentration is found to be significantly large having magnitude 0.83 (along x-axis) at 500 K and 0.26 (y-axis) at 300 K. Our results suggest that Mg₂SiSn (110) surface is promising for various thermoelectric applications due to its overall good thermoelectric properties.

Keywords: thermoelectric, surface science, semiconducting silicide, first principles calculations

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Authors: Pankaj Kumar Das, Niranjan Kumar, Prasun Chakraborti

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Temperature dependent tribologiocal properties of nuclear grade turbostatic graphite were studied using 100Cr6 steel counterbody. High value of friction coefficient (0.25) and high wear loss was observed at room temperature and this value decreased to 0.1 at 150oC. Consequently, wear loss is also decreased. Such behavior is explained by oxidation/vaporization of graphite and water molecules. At room temperature, the adsorbed water in graphite does not decompose and effect of passivation mechanism does not work. However, at 150oC, the water decomposed into OH, atomic hydrogen and oxygen which efficiently passivates the carbon dangling bonds. This effect is known to decrease the energy of the contact and protect against abrasive wear.

Keywords: high temperature tribology, oxidation, turbostratic graphite, wear

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Authors: Indra Bahadur Bhandari, Narayan Panthi, Ishwar Koirala, Devendra Adhikari

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We have used a theoretical model based on the assumption of compound formation in binary alloys to study the thermodynamic, microscopic, and surface properties of Bi-Pb and In-Pb liquid alloys. A review of the phase diagrams for these alloys shows that one of the stable complexes for Bi-Pb liquid alloy is BiPb3; also, that InPb is a stable phase in liquid In-Pb alloys. Using the same interaction parameters that are fitted for the free energy of mixing, we have been able to compute the bulk and thermodynamic properties of the alloys. From our observations, we are able to show that the Bi-Pb liquid alloy exhibits compound formation over the whole concentration range and the In-Pb alloys undergo phase separation. With regards to surface properties, Pb segregates more to the surface in In-Pb alloys than in Bi-Pb alloys. The viscosity isotherms have a positive deviation from ideality for both Bi-Pb and In-Pb alloys.

Keywords: asymmetry, Bi-Pb, deviation, In-Pb, interaction parameters

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Authors: Koirala Abarodh, Maghaiya Ujjwal, Guragain Phani Raj

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This analysis focuses on defining the spectrum evaluation model for telecom operators in terms of total cost of ownership (TCO). A quantitative approach for specific case analysis research methodology was used for identifying the results. Specific input parameters like target User experience, year on year traffic growth, capacity site limit per year, target additional spectrum type, bandwidth, spectrum efficiency, UE penetration have been used for the spectrum evaluation process and desired outputs in terms of the number of sites, capex in USD and required spectrum bandwidth have been calculated. Furthermore, this study gives a comparison of capex investment for target growth with and without addition spectrum. As a result, the combination of additional spectrum bands of 700 and 2600 MHz has a better evaluation in terms of TCO and performance. It is our recommendation to use these bands for expansion rather than expansion in the current 1800 and 2100 bands.

Keywords: spectrum, capex planning, case study methodology, TCO

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Authors: Ram Sharan Mehta

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Continuing changes in health and social care policy and practice have affected and changed the way in which nursing is practiced. One of the greatest challenges facing nursing today is to build on the essence of nursing as a caring profession whilst incorporating new technologies, ideas and approaches to future healthcare. The objective of this study was to find out the socio-demographic characteristics of the M.Sc. Nursing students and calculate the association between specialty subjects, caste, age group, and residence with SLC division, BN/BSN division, entrance score, and total nursing experience. Descriptive cross-sectional study design was used to conduct the study among all the 25 M.Sc. Nursing students studying at BPKIHS in 2012. Most of the students (56%) were of age group of 25-30 years, completed his academic courses with first division and succeeded in entrance test in first attempt (96%). Based on the results, it can conclude that most of the subjects were of young age, having high score achievers in SLC, I.Sc., CN, BN/BSN and Entrance test. The demographic characteristics do not influence in the academic scores of the students.

Keywords: profile, postgraduate nursing students, Nepal, influence

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Authors: Ram Sharan Mehta, Naveen Kumar Pandey, Binod Kumar Deo

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Quality of Life (QOL) is an important component in the evaluation of the well-being of People Living with AIDS (PLWA). This study assessed the effectiveness of education intervention programme in improving the QOL of PLWA on ART attaining the ART-clinics at B. P. Koirala Institute of Health Sciences (BPKIHS), Nepal. A pre-experimental research design was used to conduct the study among the PLWA on ART at BPKIHS from June to August 2013 involving 60 PLWA on pre-test randomly. The mean age of the respondents was 36.70 ± 9.92, and majority of them (80%) were of age group of 25-50 years and Male (56.7%). After education intervention programme there is significant change in the QOL in all the four domains i.e. Physical (p=0.008), Psychological (p=0.019), Social (p=0.046) and Environmental (p=0.032) using student t-test at 0.05 level of significance. There is significant (p= 0.016) difference in the mean QOL scores of pre-test and post-test. High QOL scores in post-test after education intervention programme may reflective of the effectiveness of planned education interventions programme.

Keywords: telephone, AIDS, health service, Nepal

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Authors: Bandana Koirala, Shivalal Sharma

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Introduction: Gingival enlargements are quite common and may be either inflammatory, non-inflammatory or a combination of both. Idiopathic gingival enlargement is a rare condition with a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. It is of undetermined etiology. Case Description: This case report addresses the diagnosis and treatment of a case of idiopathic gingival enlargement in a 9-year-old male patient. The patient presented with a generalized diffuse gingival enlargement involving the entire maxillary and the mandibular arch with extension on occlusal, buccal, lingual, and palatal surfaces with just parts of occlusal surfaces of few upper and lower molars visible resulting in open mouth, difficulty in mastication and speech. Biopsy report confirmed the diagnosis of fibromatosis gingivae. Gingivectomy was carried out in all four quadrants by using external bevel incision. Conclusion: Though total esthetics could not be restored due to unusual bony enlargement, the general appearance improved satisfactorily. Treatment after complete excision however, improved the masticatory competence to a great extent.

Keywords: idiopathic gingival fibromatosis, gingival enlargement, gingivectomy, medical and health sciences

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Authors: H. Niranjan, S. Sivasankaran, Zailan Siri

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This study investigates mixed convection heat transfer about a thin vertical plate in the presence of magnetohydrodynamic (MHD) and heat transfer effects in the porous medium. The fluid is assumed to be steady, laminar, incompressible and in two-dimensional flow. The nonlinear coupled parabolic partial differential equations governing the flow are transformed into the non-similar boundary layer equations, which are then solved numerically using the shooting method. The effects of the conjugate heat transfer parameter, the porous medium parameter, the permeability parameter, the mixed convection parameter, the magnetic parameter, and the thermal radiation on the velocity and temperature profiles as well as on the local skin friction and local heat transfer are presented and analyzed. The validity of the methodology and analysis is checked by comparing the results obtained for some specific cases with those available in the literature. The various parameters on local skin friction, heat and mass transfer rates are presented in tabular form.

Keywords: MHD, porous medium, soret/dufour, stagnation-point

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Authors: Satya S. N. Narayana, P. Parthiban, T. Niranjan, N. Kannan

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Enterprises adopt methodologies to increase their business performance and to stay competent in the volatile global market. Lean manufacturing is one such manufacturing paradigm which focuses on reduction of cost by elimination of wastes or non-value added activities. With increased awareness about social responsibility and the necessary to meet the terms of the environmental policy, green manufacturing is becoming increasingly important for industries. Large plants have more resources, have started implementing lean and green practices and they are getting good results. Small and medium scale enterprises (SMEs) are facing problems in implementing lean and green concept. This paper aims to identify the key issues for implementation of lean and green concept in Indian SMEs. The key factors identified based on literature review and expert opinions are grouped into different levels by Modified Interpretive Structural Modeling (MISM) to explore the importance among the factors to implement lean and green manufacturing. Finally, Fuzzy Analytic Network Process (FANP) method has been used to determine the extent to which the main principles of lean and green manufacturing have been carried out in the six Indian medium scale manufacturing industries.

Keywords: lean manufacturing, green manufacturing, MISM, FANP

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Authors: Niranjan Mukherjee, Burga Braun, Ulrich Szewzyk

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Recalcitrant pharmaceuticals are increasingly found in urban water systems forced by demographic changes. The groundwater-surface water interface, or the hyporheic zone, is known for its impressive self-purification capacity of water bodies. Redox gradients present in this zone provide a wide range of electron acceptors and harbour diverse microbial communities. Biotic transformations of pharmaceuticals in this zone have been demonstrated, but not much information is available on the kind of communities bringing about these transformations. Therefore, bioreactors using sediment from the hyporheic zone of a river in Berlin were set up and fed with iopromide, a recalcitrant iodinated X-ray contrast medium. Iopromide, who’s many oxic and anoxic transformation products have been characterized, was shown to be transformed in such a bioreactor as it passes along the gradient. Many deiodinated transformation products of iopromide could be identified at the outlet of the reactor. In our experiments, it was seen that at the same depths of the column, the transformation of iopromide increased over time. This could be an indication of the microbial communities in the sediment adapting to iopromide. The hyporheic zone, with its varying redox conditions, mainly due to the upwelling and downwelling of surface and groundwater levels, could potentially provide microorganisms with conditions for the complete transformation of recalcitrant pharmaceuticals.

Keywords: iopromide, hyporheic zone, recalcitrant pharmaceutical, redox gradients

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Authors: H. Niranjan, S. Sivasankaran

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Heat and mass transfer near a steady stagnation point boundary layer flow of viscous incompressible fluid through porous media investigates along a vertical plate is thoroughly studied under the presence of magneto hydrodynamic (MHD) effects. The fluid flow is steady, laminar, incompressible and in two-dimensional. The nonlinear differential coupled parabolic partial differential equations of continuity, momentum, energy and specie diffusion are converted into the non-similar boundary layer equations using similarity transformation, which are then solved numerically using the Runge-Kutta method along with shooting method. The effects of the conjugate heat transfer parameter, the porous medium parameter, the permeability parameter, the mixed convection parameter, the magnetic parameter, and the thermal radiation on the velocity and temperature profiles as well as on the local skin friction and local heat transfer are presented and analyzed. The validity of the methodology and analysis is checked by comparing the results obtained for some specific cases with those available in the literature. The various parameters on local skin friction, heat and mass transfer rates are presented in tabular form.

Keywords: MHD, porous medium, slip, convective boundary condition, stagnation point

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Authors: Masni Mat Yusoff, Michael H. Gordon, Keshavan Niranjan

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The study reports on the effect of aqueous enzymatic extraction (AEE) parameters on the Moringa oleifera (MO) oil yield and the formation of emulsion at the end of the process. A mixture of protease and cellulase enzymes was used at 3:1 (w/w) ratio. The highest oil yield of 19% (g oil/g sample) was recovered with the use of a mixture of pH 6, 1:4 material/moisture ratio, and incubation temperature, time, and shaking speed of 50 ⁰C, 12.5 hr, and 300 stroke/min, respectively. The use of pH 6 and 8 resulted in grain emulsions, while solid-intact emulsion was observed at pH 4. Upon fixing certain parameters, higher oil yield was extracted with the use of lower material/moisture ratio and higher shaking speed. Longer incubation time of 24 hr resulted in significantly (p < 0.05) similar oil yield with that of 12.5 hr, and an incubation temperature of 50 ⁰C resulted in significantly (p < 0.05) higher oil yield than that of 60 ⁰C. In overall, each AEE parameter showed significant effects on both the MO oil yields and the emulsions formed. One of the major disadvantages of an AEE process is the formation of emulsions which require further de-emulsification step for higher oil recovery. Therefore, critical studies on the effect of each AEE parameter may assist in minimizing the amount of emulsions formed whilst extracting highest total MO oil yield possible.

Keywords: enzyme, emulsion, Moringa oleifera, oil yield

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Authors: Jyoti Agrawal

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Introduction: Renal diseases in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. The pattern of renal disease in children is different from developing countries as compared to developed countries. Methods: This study was a hospital based prospective observational study carried from March, 2014 to February 2015 at BP Koirala institute of health sciences. Patients with renal disease, both inpatient and outpatient from birth to 14 years of age were enrolled in the study. The diagnosis of renal disease was be made on clinical and laboratory criteria. Results: Total of 120 patients were enrolled in our study which contributed to 3.74% % of total admission. The commonest feature of presentation was edema (75%), followed by fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%). Most common diagnosis was acute glomerulonephritis (40%) followed by Nephrotic syndrome (25%) and urinary tract infection (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependent nephrotic syndrome. 5% of our cases expired because of multiorgan dysfunction syndrome, sepsis and acute kidney injury. Conclusion: Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children.

Keywords: glomerulonephritis, nephrotic syndrome, renal disease, urinary tract infection

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Authors: Christina Roman, Deepak Koirala, Joseph A. Piccirilli

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Phage displaying synthetic Fab libraries have been used to obtain Fabs that bind to specific RNA targets with high affinity and specificity. These Fabs have been demonstrated to facilitate RNA crystallization. However, the antibody framework used in the construction of these phage display libraries contains numerous bulky, flexible, and charged residues, which facilitate solubility and hinder aggregation. These residues can interfere with crystallization due to the entropic cost associated with burying them within crystal contacts. To systematically reduce the surface entropy of the Fabs and improve their crystallization properties, a protein engineering strategy termed surface entropy reduction (SER) is being applied to the Fab framework. In this approach, high entropy residues are mutated to smaller ones such as alanine or serine. Focusing initially on Fab BL3-6, which binds an RNA AAACA pentaloop with 20nM affinity, the SER P server (http://services.mbi.ucla.edu/SER/) was used and analysis was performed on existing RNA-Fab BL3-6 co-crystal structures. From this analysis twelve surface entropy reduced mutants were designed. These SER mutants were expressed and are now being measured for their crystallization and diffraction performance with various RNA targets. So far, one mutant has generated 3.02 angstrom diffraction with the yjdF riboswitch RNA. Ultimately, the most productive mutations will be combined into a new Fab framework to be used in a optimized phage displayed Fab library.

Keywords: antibody fragment, crystallography, RNA, surface entropy reduction

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Authors: R. Kanmaniraja, R. Freshipali, J. Abdullah, K. Niranjan, K. Balasubramani, V. R. Sanal Kumar

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The present environmental issues have made aircraft jet noise reduction a crucial problem in aero-acoustics research. Acoustic studies reveal that addition of chevrons to the nozzle reduces the sound pressure level reasonably with acceptable reduction in performance. In this paper comprehensive numerical studies on acoustic characteristics of different types of chevron nozzles have been carried out with non-reacting flows for the shape optimization of chevrons in supersonic nozzles for aerospace applications. The numerical studies have been carried out using a validated steady 3D density based, k-ε turbulence model. In this paper chevron with sharp edge, flat edge, round edge and U-type edge are selected for the jet acoustic characterization of supersonic nozzles. We observed that compared to the base model a case with round-shaped chevron nozzle could reduce 4.13% acoustic level with 0.6% thrust loss. We concluded that the prudent selection of the chevron shape will enable an appreciable reduction of the aircraft jet noise without compromising its overall performance. It is evident from the present numerical simulations that k-ε model can predict reasonably well the acoustic level of chevron supersonic nozzles for its shape optimization.

Keywords: supersonic nozzle, Chevron, acoustic level, shape optimization of Chevron nozzles, jet noise suppression

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Authors: Anurag Niranjan, Michael Fitzpatrick, Yin Jin Janin, Jazeel Chukkan, Niall Smyth

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Fillet welds are used in joining longitudinal stiffeners in ship structures. Welding residual stresses in fillet welds are generally distributed in a non-uniform manner, as shown in previous research the residual stress redistribution occurs under the cyclic loading that is experienced by such joints during service, and the combination of the initial residual stress, local constraints, and loading can alter the stress field in ways that are extremely difficult to predict. As the residual stress influences the crack propagation originating from the toe of the fillet welds, full understanding of the residual stress field and how it evolves is very important for structural integrity calculations. Knowledge of the residual stress redistribution in the presence of a flaw is therefore required for better fatigue life prediction. Moreover, defect assessment procedures such as BS7910 offer very limited guidance for flaw acceptance and the associated residual stress redistribution in the assessment of fillet welds. Therefore the objective of this work is to study a surface-breaking flaw at the weld toe region in a fillet weld under cyclic load, in conjunction with residual stress measurement at pre-defined crack depths. This work will provide details of residual stress redistribution under cyclic load in the presence of a crack. The outcome of this project will inform integrity assessment with respect to the treatment of residual stress in fillet welds. Knowledge of the residual stress evolution for this weld geometry will be greatly beneficial for flaw tolerance assessments (BS 7910, API 591).

Keywords: fillet weld, fatigue, residual stress, structure integrity

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Authors: Nadama Kumar, P. Parthiban, T. Niranjan

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In the present paper, we propose an incorporated approach for 3PL supplier choice that suits the distinctive strategic needs of the outsourcing organization in southern part of India. Four fundamental criteria have been used in particular Performance, IT, Service and Intangible. These are additionally subdivided into fifteen sub-criteria. The proposed strategy coordinates Structural Equation Modeling (SEM) and Non-additive Fuzzy Integral strategies. The presentation of fluffiness manages the unclearness of human judgments. The SEM approach has been used to approve the determination criteria for the proposed show though the Non-additive Fuzzy Integral approach uses the SEM display contribution to assess a supplier choice score. The case organization has a exclusive vertically integrated assembly that comprises of several companies focusing on a slight array of the value chain. To confirm manufacturing and logistics proficiency, it significantly relies on 3PL suppliers to attain supply chain superiority. However, 3PL supplier selection is an intricate decision-making procedure relating multiple selection criteria. The goal of this work is to recognize the crucial 3PL selection criteria by using the non-additive fuzzy integral approach. Unlike the outmoded multi criterion decision-making (MCDM) methods which frequently undertake independence among criteria and additive importance weights, the nonadditive fuzzy integral is an effective method to resolve the dependency among criteria, vague information, and vital fuzziness of human judgment. In this work, we validate an empirical case that engages the nonadditive fuzzy integral to assess the importance weight of selection criteria and indicate the most suitable 3PL supplier.

Keywords: 3PL, non-additive fuzzy integral approach, SEM, fuzzy

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Authors: Rajendra N. Ghosh, Paramjeet Singh, Niranjan Khandelwal, Sameer Vyas, Pratibha Singhi, Naveen Sankhyan

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Background: Tuberculoma and neurocysticercosis (NCC) are two most common intracranial infections in developing country. They often simulate on neuroimaging and in absence of typical imaging features cause significant diagnostic dilemmas. Differentiation is extremely important to avoid empirical exposure to antitubercular medications or nonspecific treatment causing disease progression. Purpose: Better characterization and differentiation of CNS tuberculoma and NCC by using morphological and multiple advanced functional MRI. Material and Methods: Total fifty untreated patients (20 tuberculoma and 30 NCC) were evaluated by using conventional and advanced sequences like CISS, SWI, DWI, DTI, Magnetization transfer (MT), T2Relaxometry (T2R), Perfusion and Spectroscopy. rCBV,ADC,FA,T2R,MTR values and metabolite ratios were calculated from lesion and normal parenchyma. Diagnosis was confirmed by typical biochemical, histopathological and imaging features. Results: CISS was most useful sequence for scolex detection (90% on CISS vs 73% on routine sequences). SWI showed higher scolex detection ability. Mean values of ADC, FA,T2R from core and rCBV from wall of lesion were significantly different in tuberculoma and NCC (P < 0.05). Mean values of rCBV, ADC, T2R and FA for tuberculoma and NCC were (3.36 vs1.3), (1.09x10⁻³vs 1.4x10⁻³), (0.13 x10⁻³ vs 0.09 x10⁻³) and (88.65 ms vs 272.3 ms) respectively. Tuberculomas showed high lipid peak, more choline and lower creatinine with Ch/Cr ratio > 1. T2R value was most significant parameter for differentiation. Cut off values for each significant parameters have proposed. Conclusion: Quantitative MRI in combination with conventional sequences can better characterize and differentiate similar appearing tuberculoma and NCC and may be incorporated in routine protocol which may avoid brain biopsy and empirical therapy.

Keywords: advanced functional MRI, differentiation, neurcysticercosis, tuberculoma

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Authors: Manish Subedi, Bijay Bartaula, Ashok R. Pant, Purbesh Adhikari, Sanjib K. Sharma

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Background: The pattern of glomerular disease varies worldwide. In absence of kidney disease/Kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. Method: We retrospectively analyzed 175 cases of renal biopsies performed from dated September 2014 to August 2016 at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: The commonest indication for renal biopsy was nephrotic syndrome (34.9%), followed by Systemic lupus erythematosus with suspected renal involvement (22.3%). Majority of patients were in the 30-60 year bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. IgA nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and FSGS (14.6%). The commonest secondary glomerular disease was lupus nephritis. Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6% and perinephric hematoma in 4% cases. Conclusion: The commonest primary and secondary glomerular disease was IgA nephropathy and lupus nephritis respectively. The high prevalence of Systemic lupus erythematosus with lupus nephritis among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt towards documentation of glomerular diseases in the national context, this study should serve as a stepping stone towards the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.

Keywords: glomerular, Nepal, renal biopsy, systemic lupus erythematoses

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Authors: Deependra Prasad Sarraf, Gajendra Prasad Rauniar, Robin Maskey, Rajiv Maharjan, Ashish Shrestha, Ramayan Prasad Kushwaha

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Objectives: To assess the perception of faculties towards online teaching-learning activities conducted during the COVID-19 pandemic and to identify barriers and facilitators to conducting online teaching-learning activities in our context. Methods: A cross-sectional study was conducted among faculties at B. P. Koirala Institute of Health Sciences using a 26-item semi-structured questionnaire. A Google Form was prepared, and its link was sent to the faculties via email. Descriptive statistics were calculated, and findings were presented as tables and graphs. Results: Out of 158 faculties, the majority were male (66.46%), medical faculties (85.44%), and assistant professors (46.84%). Only 16 (10.13%) faculties had received formal training regarding preparing and/or delivering online teaching learning activities. Out of 158, 133 (84.18%) faculties faced technical and internet issues. The most common advantage and disadvantage of online teaching learning activities perceived by the faculties were ‘not limited to time or place’ (94.30%) and ‘lack of interaction with the students’ (82.28%), respectively. Majority (94.3%) of them had a positive perception towards online teaching-learning activities conducted during COVID-19 pandemic. Slow internet connection (91.77%) and frequent electricity interruption (82.91%) were the most common perceived barriers to online teaching-learning. Conclusions: Most of the faculties had a positive perception towards online teaching-learning activities. Academic leaders and stakeholders should provide uninterrupted internet and electricity connectivity, training on online teaching-learning platform, and timely technical support.

Keywords: COVID-19 pandemic, faculties, medical education, perception

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Authors: Niranjan Devkota , Ram Kumar Phuya, Durga Lal Shreshta

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This paper estimates cost and benefit of adoption of climate change adaptation options available to the rural rice farmers of Nepal. Adoption of adaptation strategies, intensity of use of adaptation options, identification of labor and non-labor cost and finally per unit cost and benefit analysis of climate change adaptation were made. Multi-stage sampling technique was used to source respondents for the study and used structured questionnaire techniques to collect data from 773 households from seven districts; 3 from Terai and 4 from Hilly region of Nepal. The result revealed that there are 13 major adaptation options rice farmers practice in order to protect themselves from climatic risk. Among the given adaptation options, the first three popular adaptation options practiced by rice farmers are (i) increasing use of chemical fertilizer (60.93%) (ii) use of climate smart verities (49.29%) and (iii) change in nursery date (32.08%). Adaptation cost is obvious, based on that, the first three costly adaptation options are the alternative irrigation practice which incurred average cost of US $69.95 (US$ 1 = 102.84 Nepalese Rupees) followed by a denser plantation of local seeds ($ 20.69) and using climate smart varieties ($ 18.06). 88% farmers practiced more than one adaptation strategies on the same farm with the aim of reducing the effect of extreme climatic conditions. Total cost and revenue revealed that per unit total cost ranges from $28.34 to $32.79 whereas per unit total revenue ranges $33.4 to $49.02. Surprisingly, it is observed that farmers who do not adopt any adaptation options are able to receive highest income from per unit production. As Net Present Value (NPV) is positive and Benefit Cost Ration (BCR) is greater than one for every adaptation options that indicates the available adaptation options are profitable to the rice farmers.

Keywords: climate change, adaptation options, cost benefit analysis, rural rice farmers, Nepal

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Authors: Ghimire K., Mehta R. S., Parajuli P., Chettri R.

Abstract:

Background: Malnutrition is a common hallmark of Human Immuno Virus (HIV) disease. It plays a synergistic role in immunosuppression which is initiated by Human Immuno Virus itself, and malnutrition forms an independent risk factor for disease progression. Objectives: The objective of the study is to assess the nutritional status of the people living with Human Immuno Virus/Acquired Immune Deficiency Syndrome attending the Anti-Retro viral Treatment Clinic and find the association of nutritional status with different socio-demographic variables. Methods: A total of 101 people living with HIV/AIDS (PLWHA) were selected by convenient sampling technique. The study was conducted at the ART clinic of BPKIHS. A subjective global assessment tool was used for data collection. Descriptive and inferential statistics were used for data analysis. Results: The study demonstrated that the mean age of the respondents was 40.97+8.650 years. 65.3% were well-nourished, and 34.7% of the participants were mildly/moderately malnourished, whereas none of them were severely malnourished. BMI was statistically significant with education status, family income, and duration of illness of the participants, and nutritional status was statistically significant with gender, marital status, education status, and family history of HIV. Conclusion: On the basis of the result, it can be concluded that more than half of the respondents were well nourished. Gender, marital status, and education are associated with nutritional status.

Keywords: nutritional status, people living with HIV/AIDS, ART treatment, Nepal

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Authors: Niranjan Das

Abstract:

‘Geographical indication’ is a sign which is used on products that have a specific geographical origin and possess qualities or a reputation that are due to that origin. Geographical Indication is primarily granted to agricultural, natural, manufactured, handicrafts originating from a definite geographical territory. It is defined in Article 22(1) of the World Trade Organization's (WTO) 1995 Agreement on ‘Trade-Related Aspects of Intellectual Property Rights (TRIPS)’. Assam is literally a ‘Silk country’ where silk culture is rooted in the rural life and culture of Assamese people. This is the only state in India and the world where Muga silk (Antheraea assamensis) is grown. Out of the total production of India’s Muga silk, Assam has the credit of being the sole producer of this 100 percent output, and thus occupies a unique position in the sericulture map of the world. Muga production has been an effective means for generating gainful employment in rural Assam and it has enormous potential in the context of building the rural economy and generating livelihood of this region. Muga, the unique golden-yellow silk of Assam was granted the ‘Geographical Indication (GI)’ registration in 2007. It is the first item from the state of Assam to obtain the GI tag. Besides manufacturing of Muga Silk cloths, the industry is also giving employment to thousands of people, and the silk industry is playing a leading role in the economy of the state. As Brahmaputra Valley is also known for tourist destination, tourists are visiting the valley every year and now the Muga Silk has reached each corner of the country and also in the other parts of the world. This paper tries to emphasizes how the Geographical Indication tag is protecting the traditional right of the Muga Silk of Assam as it has been practised by the Assamese people since times immemorial.

Keywords: Geographical Indication, environment, Muga silk, traditional right and livelihood

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Authors: Ram Sharan Mehta, Dina Khanal, Pushpa Parajuli, Gayanand Mandal, Bijaya Bartuala

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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Adequate awareness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients.This study aims to assess the awareness on risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of BPKIHS and to find the association between awareness with their selected socio demographic variables. Methods and Material: A descriptive cross sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling technique was used for data collection over duration of one month using interview schedule by HDFQ II tool. Data were analyzed by using descriptive and inferential statistics. (Chi square). Results: The mean age of respondents was 55.4±12.13 years. That mean HDFQ score was 14.31± 5.08. Only 33% of the respondents had adequate level of awareness whereas majority of the respondents (67%) had inadequate level of awareness. Majority of the respondent (83.9%) were aware about smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware of high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with (p=0.043) educational status, (p=0.025) monthly income, (p=0.05) residence, (p=0.006) CVD information received and (p=0.022) co morbid condition as a heart disease. Conclusion: The findings of this study concluded most of the respondents had an inadequate level of awareness on risk factors of CVD. So Effective education and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.

Keywords: cardiovascular disease, awareness, diabetes patients, risk

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Authors: Hritik Bhattarai, Vivek Dumre, Ananya Neupane, Poonam Koirala, Anjali Singh

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The availability of clean and reliable groundwater is essential for the sustainment of human and environmental health. Groundwater is a crucial resource that contributes significantly to the total annual supply. However, over-exploitation has depleted groundwater availability considerably and led to some land subsidence. Determining the potential zone of groundwater is vital for protecting water quality and managing groundwater systems. Groundwater potential zones are marked with the assistance of Geographic Information System techniques. During the study, a standard methodology was proposed to determine groundwater potential using an integration of GIS and AHP techniques. When choosing the prospective groundwater zone, accurate information was generated to get parameters such as geology, slope, soil, temperature, rainfall, drainage density, and lineament density. However, identifying and mapping potential groundwater zones remains challenging due to aquifer systems' complex and dynamic nature. Then, ArcGIS was incorporated with a weighted overlay, and appropriate ranks were assigned to each parameter group. Through data analysis, MCDA was applied to weigh and prioritize the different parameters based on their relative impact on groundwater potential. There were three probable groundwater zones: low potential, moderate potential, and high potential. Our analysis showed that the central and lower parts of the Bagmati River Basin have the highest potential, i.e., 7.20% of the total area. In contrast, the northern and eastern parts have lower potential. The identified potential zones can be used to guide future groundwater exploration and management strategies in the region.

Keywords: groundwater, geographic information system, analytic hierarchy processes, multi-criteria decision analysis, Bagmati

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Authors: Ram Sharan Mehta, Gayanandra Malla, Anita Gurung, Anu Aryal, Divya Labh, Hricha Neupane

Abstract:

Objectives: Lack of resuscitation skills of nurses and doctors in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. The objective of this study was to examine retention of life support measures (BLS/ALS) knowledge and skills of nurses following education intervention programme. Materials and Methods: Pre-experimental research design was used to conduct the study among the nurses working in medical units of B.P Koirala Institute of Health Sciences, where CPR is very commonly performed. Using convenient sampling technique total of 20 nurses agreed to participate and give consent were included in the study. The theoretical, demonstration and re-demonstration were arranged involving the trained doctors and nurses during the three hours educational session. Post-test was carried out after two week of education intervention programme. The 2010 BLS & ALS guidelines were used as guide for the study contents. The collected data were analyzed using SPSS-15 software. Results: It was found that there is significant increase in knowledge after education intervention in the components of life support measures (BLS/ALS) i.e. ratio of chest compression to ventilation in BLS (P=0.001), correct sequence of CPR (p <0.001), rate of chest compression in ALS (P=0.001), the depth of chest compression in adult CPR (p<0.001), and position of chest compression in CPR (P=0.016). Nurses were well appreciated the programme and request to continue in future for all the nurses. Conclusions: At recent BLS/ALS courses (2010), a significant number of nurses remain without any such training. Action is needed to ensure all nurses receive BLS training and practice this skill regularly in order to retain their knowledge.

Keywords: pre-experimental, basic and advance life support, nurses, sampling technique

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