Potential of X-ray imaging to detect citrus granulation in different cultivars with progress in harvesting time

Granulation, a physiological disorder of citrus is manifested by shriveled juice sacs and internal dryness. Extractable juice in granulated tissue is drastically reduced as a consequence of gelatinization and secondary epidermis formation. Since, the defect cannot be detected externally it leads to consumer dissatisfaction and poor returns to farmers. Processing industry also faces huge economic loss due to reduction in the juice recovery from granulated fruit. In this context, here, we studied the possibility of developing an image processing algorithm through MATLAB software to detect granulation with advancement of maturity via X-ray micrographs. Fruit of eight citrus cultivars comprising of granulation susceptible and tolerant varieties harvested at four different intervals were exposed to X-rays. Voltage of 46 kV and current of 6.5 mA given to fruit for an exposure time of 320 mAs gave the best X-ray image contrasts. The developed algorithm could effectively distinguish the healthy and granulated fruit with an accuracy of 90% as validated by subsequent destructive analysis when estimated for four different harvesting dates. The imaging technique can be employed by the processors to determine the severity of granulation and to sort out fruit online which will help in saving economic losses.

Knowledge about heart attack and hypertension among individuals attending a cardiac camp in Pokhara city.

OBJECTIVES: Previous studies in other countries had shown lacunae in patients' and general publics' understanding of cardiovascular diseases. Such studies are lacking in Nepal. Hence the present study was carried out to: a) note the respondent's knowledge regarding myocardial infarction and hypertension and b) note the association, if any, of the knowledge with demographic and personal characteristics. MATERIALS AND METHODS: Respondents attending a cardiac camp organized in the Manipal Teaching hospital during September 2002 were interviewed by previously briefed seventh semester students using a structured questionnaire. Basic demographic information and knowledge about myocardial infarction and hypertension was collected. The median score was calculated. Differences in scores among different subgroups of respondents were noted using appropriate statistical tests (p<0.05). RESULTS: Sixty-six respondents were interviewed; 44 were male. The knowledge scores for heart attack and hypertension were 6 (maximum score 8) and 11 (maximum score 14) respectively. The scores were significantly lower among respondents with a monthly family income below 2000 rupees and was higher among respondents/family members suffering from cardiovascular disease. CONCLUSION: The respondents were aware of the basic facts regarding myocardial infarction and hypertension. However, lacunae in knowledge were noted. Further studies are required.

Prescribing patterns in the orthopaedics outpatient department in a teaching hospital in Pokhara, western Nepal.

OBJECTIVES: Information on the utilization patterns of drugs in the orthopaedics outpatient department (OPD) are lacking in hospitals in western Nepal. The present study was carried out to obtain demographic information about the respondents selected for analysis, information on the average number of drugs prescribed and the average cost of drugs per prescription. The prescriptions were critically analyzed using predetermined criteria. MATERIALS AND METHODS: The study was carried out over a four-month period (01.09.2002 to 31.12.2002) at the Manipal Teaching hospital, Pokhara, Nepal. The percentage of encounters with an injection or an antibiotic prescribed was noted. The percentage of drugs prescribed from the Essential drug list of Nepal and the mean cost of drugs per prescription was calculated. RESULTS: 1238 patients attended the orthopaedics OPD during the study period. 186 prescriptions were randomly selected for analysis. The mean number of drugs per prescription was 1.9. Low backache was the most common reason for attending the OPD. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most commonly prescribed drug group. Diclofenac and meloxicam were the most commonly prescribed drugs. Mean cost of drugs was 166.2 Nepalese rupees. Injections and antibiotics were prescribed in 16 (8.6%) and 7 (3.8%) encounters respectively. 51 prescriptions (27.4%) had various problems. Absence of diagnosis on the prescriptions and the duration of treatment were most commonly observed. CONCLUSIONS: Percentage of prescribing by generic name was low. Educational sessions for the doctors at different levels to encourage prescribing by generic names and on correct writing of prescriptions may be considered. Studies covering a larger number of patients and for a longer time period are required. A greater number of patients can be studied, seasonal variations can be overcome and drug utilization can be measured quantitatively.

Attitudes of first-year medical students towards the doctor patient relationship.

In recent years, medical schools all over the world have instituted a variety of curricula to teach communication skills, professional values and ethics to medical students. Studies on the student attitudes towards doctor-patient relationships are lacking in Nepal. The present study was carried out to obtain information on the sharing and caring dimensions of the doctor-patient relationship and note any association of the dimensions with the demographic characteristics of the respondents. The study was carried out among first year students of the Manipal College of Medical Sciences, Pokhara, Nepal in August 2003 using the patient-practitioner orientation scale. One hundred and sixty-five students participated. The mean +/- SD total, caring and sharing scores were 3.71 +/- 0.48, 3.51 +/- 0.55 and 3.91 +/- 0.62 respectively. Students whose first degree relative was a doctor had higher sharing score compared to those without doctor relatives. Female students had higher scores. Students had a positive attitude towards the doctor-patient relationship. Our scores were lower than those reported previously. Further studies are required and the results obtained will be helpful in designing a doctor-patient relationship course for Nepal.

Learning styles of preclinical students in a medical college in western Nepal.

OBJECTIVES: Information on the learning styles of medical students are lacking in medical colleges in Nepal. Learning styles may be associated with student understanding and may predict success in examination. The present study was carried out to obtain information on learning styles and preferences for teaching of fourth semester medical students and note the association, if any, between respondents' personal characteristics and preferences for learning styles and types of teaching. The correlation between preferences for learning styles and types of teaching and performance in the second year university examination was also explored. METHODS: The study was carried out during October 2003 at the Manipal College of Medical Sciences, Pokhara, Nepal using the Approaches and Study Skills Inventory (ASSIST) instrument. Information on the respondents' personal characteristics was collected. Respondents had to indicate their degree of agreement with a set of statements using a modified Likert-type scale. The statements were grouped into three main learning styles and two types of teaching. The median scores among different subgroups of respondents were compared using appropriate non-parametric tests (p<0.05). RESULTS: Ninety-two students (92%) participated; fifty-six were male. Thirty-one respondents were Nepalese, 48 were Indians. Majority were educated in English medium schools. The median scores for deep and surface learning styles were 64 and 49 respectively (maximum score=80). The scores for strategic learning was 75.5 (maximum score=100). There was no clear preference for any particular type of teaching. Indian students used more surface apathetic learning strategies compared to others. There was a negative correlation between surface learning and marks obtained in the final examination. CONCLUSIONS: The students mainly used deep and strategic learning styles. Differences in preference for learning styles and types of teaching were noted according the respondents' personal characteristics. This was a preliminary study and further studies are required.

Safety monitoring of drugs--where do we stand?

Drug related complications, a major cause of hospitalizations, lead to huge economic burden and significant human suffering. New chemical entities enter the market without sufficient safety data on patient population making rare (Adverse Drug Reactions) ADRs undetected in the clinical trials. ADR monitoring helps in detecting the occurrence of rare and unknown ADRs and helps in prevention of further occurrence. Several methods are adopted for effective monitoring of ADRs. An effective ADR monitoring program requires adequate infrastructure and trained manpower. In developed countries, the ADR monitoring system is well established. In Nepal, the concept of ADR monitoring is in the infant stage. A simple approach for ADR monitoring may be helpful in starting an ADR monitoring program in hospital setups in Nepal. Though it is difficult to prevent ADRs, a systematic approach will definitely helps in minimizing the further occurrence of similar ADRs.

Intensive care unit drug utilization in a teaching hospital in Nepal.

OBJECTIVES: The intensive care unit (ICU) is a setting where a large number of drugs are administered to patients and the costs of hospitalization and drug treatment are high. Information on drug utilization in intensive care units (ICUs) are lacking in western Nepal. The present study was carried out to obtain information on the basic demographic pattern of the respondents, drug utilization during the study period, the antibiotic sensitivity patterns of isolated microorganisms and measure drug consumption in defined daily dose (DDD)/ 100 bed-days. METHODS: A retrospective analysis of patients admitted to the ICU of the Manipal Teaching hospital, Pokhara, Nepal during the time period from 01/02/2002 to 31/05/2002 was carried out. The ICU mortality rate, length of stay greater than 7 days and median length of stay were calculated. RESULTS: A total of 259 individuals were admitted. The ICU mortality rate was 15.4%; median length of stay was 4 days. E.coli, H.influenzae, K.pneumoniae, S.aureus and P.aeruginosa were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Mean +/- SD number of drugs and cost of drugs were 5.1 +/- 2.7 and 1958.5 +/- 1267.8 Nepalese rupees (25.1 +/- 16.2 US dollars). Total drug consumption was 356.4 DDD/100 bed-days. Consumption of intravenous fluids was 25.8 litres/100 bed-days. CONCLUSIONS: An antibiotic use policy should be framed. Formation of a multidisciplinary team to oversee drug use and periodically review microbial sensitivity patterns will be helpful. Longitudinal surveillance of ICU drug use should be carried out.

Emotional impact of cadaver dissection: a survey in a medical college in western Nepal.

OBJECTIVES: Adverse physical and psychological effects to human dissection have been reported in many studies. In Nepal, the basic science subjects are taught in an integrated manner in the first four semesters of the MBBS course. Studies on the attitudes of medical students towards anatomy dissection are lacking in Nepal. The present study was carried out to obtain information on the present and initial perception of medical students on exposure to anatomy dissection and the association, if any, of the perception with demographic factors. METHODS: The study was carried out among the first, second and third semester students at the Manipal College of Medical Sciences, Pokhara using the appraisal of life events (ALE) scale in February 2005. Sixty-three first semester, 57 second and 65 third semester students successfully completed the questionnaire and their responses were taken up for analysis. Information on sex, age, nationality, religion, food habits, occupation of parents and selection procedures of respondents was collected. The parameters loss, challenge and threat were measured on first exposure to dissection and at the time of the study. The scores were compared among different categories of students (p< 0.05). RESULTS: 185 of the 225 students (82.2%) successfully completed the questionnaire. The median initial loss, challenge and threat scores were 2, 19 and 4 respectively. The median present loss, challenge and threat scores were 1, 20 and 0 respectively. The present threat score was higher among second semester students. The initial loss was higher among Indians and the present challenge score was higher among vegetarians. CONCLUSIONS: The loss and threat score were low compared to that reported in a previous study. The challenge scores were higher than those reported previously. Majority of students considered anatomy dissection as a significant life experience and one which was largely positive. Further studies with a larger student population and in other medical colleges are required.

Ginkgo biloba--an appraisal.

Ginkgo biloba has been used in traditional Chinese medicine for about 5000 years. A standardized preparation, EGb 761 has been recently prepared. The pharmacologically active constituents, flavonol glycosides and the terpene lactones are standardized. The terpene lactones comprise of ginkgolides A, B, C and bilobalides. The extract scavenges excess free radicals and pretreatment with EGb 761 reduces damage by free radicals in patients undergoing coronary bypass surgery. The action of platelet activating factor is antagonized and platelet aggregation is reduced. Blood flow is increased. Release of prostacyclines and nitric oxide was shown to be stimulated. Ginkgo biloba has been found to be useful in the treatment of Alzheimers disease and cognitive impairment. EGB 761 has shown beneficial effect in aging and mild cognitive impairment. Bilobalide has been shown to be protective against glutamate-induced excitotoxic neuronal death. Early studies indicate a potential role in age-related macular degeneration and some types of glaucoma. Anticancer action is related to antioxidant, anti-angiogenic and gene regulatory actions. Ginkgo biloba has shown overall improvement in about 65% of patients with cerebral impairment and a similar percentage suffering from peripheral vascular diseases. A recent study suggested that phytoestrogens in Ginkgo biloba may have a role as alternative hormone replacement therapy. Recent trials have not shown a beneficial effect of Ginkgo biloba in tinnitus and acute mountain sickness. Ginkgo biloba increased the bioavailability of diltiazem. The extract has been shown to protect against doxorubicin-induced cardiotoxicity and gentamicin-induced nephrotoxicity in animals. Ginkgo biloba inhibits microsomal enzymes and has a potential for drug interactions. Further studies to establish the efficacy of Ginkgo biloba are required.

Pathology of post meningitic hydrocephalus.

Meningitis of bacterial (including tubercular) or non bacterial origin is a common and lethal infection of central nervous system in children. Although, with the use of modern medical facilities including antibiotics, the mortality rates of meningitis have decreased, yet the number of patients surviving with complications such as hydrocephalus have greatly increased. In this article the etiopathogenesis of post meningitis hydrocephalus has been reviewed. Effective use of appropriate antibiotics and shunt procedures have improved the outcome of post meningitic hydrocephalus of bacterial origin but the same is not true with that of fungal origin, which still carries high mortality and morbidity.

Effect of IUCD on human uterine fluid protein concentration throughout the menstrual cycle.

Uterine fluid of 96 Women implanted with IUCD was collected and processed for protein estimation. The results obtained in women having IUCD were compared with those of parous/normal women. The trend of fluctuation in protein concentration was the same in both parous and women with IUCD. But comparatively the protein concentration in it was so much higher in women having IUCD throughout the menstrual cycle. The increased concentration may be responsible for making the fluid environment unfavourable for blastocyst as well as sperm metabolism.

Cyclic variation in rats's uterine fluid phosphatase level after administration of lyndral (17 alpha-ethinyl estradiol).

An oral administration of antifertility drug Lyndral (17 alpha-ethinyl estradiol) at doses 5 micrograms/rat/a week for 3 consecutive weeks altered the internal biochemical milieu of uterus, showing a cyclic variation in both acid and alkaline phosphatase of the uterine fluid with high levels being present at proestrus and estrus in control rats. In Lyndral treated rats acid phosphatase showed a tendency to increase in estrus and metestrus rats, whereas alkaline phosphatase increased significantly during proestrus and estrus stages of the cycle. All these altered phosphatase levels in uterine fluid, after Lyndral treatment, gives some insight into the hormonal sensitiveness of these enzymes.