The impact of COVID-19 outbreak and perceptions of people towards household waste management chain in Nepal.

The spread of COVID-19 is posing significant challenges to the household (HH) waste management sectors putting waste personnel and concerned bodies under massive pressure. The chain of collection, segregation, recycling, and disposal of household generated wastes is interrupted. This study aimed to assess how the household waste management chain was disrupted by novel coronavirus in Nepal and find the perception of the people towards the existing household waste management system (HHWMS). A descriptive online survey was carried out among 512 people using a cross-sectional research design and data was collected through a self-administered questionnaire method. Both descriptive, as well as inferential tests, were conducted using SPSS software. The finding of this study showed that 62.3% of respondents were not satisfied with the present HHWMS. Furthermore, there was a significant association of the satisfaction level of household waste management during coronavirus outbreak with gender, waste volume change in lockdown, PPE for waste collectors, and education on waste handling techniques provided by the government sector at 5% level of significance (p < 0.05). Proper HH waste management has become a challenge, and to address this some innovative works such as awareness programs for people, health and hygiene related support to waste workers, and effective policy formulation and implementation should be done by the Government of Nepal.

Pharmacologic activities of phytosteroids in inflammatory diseases: Mechanism of action and therapeutic potentials.

Natural products and their derivatives are known to be useful for treating numerous diseases since ancient times. Because of their high therapeutic potentials, the use of different medicinal plants is possible to treat varied inflammation-mediated chronic diseases. Among natural products, phytosteroids have emerged as promising compounds mostly because they have diverse pharmacological activities. Currently, available medications exert numerous systemic toxicities, including hypertension, immune suppression, osteoporosis, and metabolic abnormalities. Thus, further research on phytosteroids to subside these complications is of significant importance. In this study, the information on phytosteroids, their types, and actions against inflammation, and allergic complications was collected by a systematic survey of literature on several scientific search engines. The literature review suggested that phytosteroids exhibit antiinflammatory action via different modes through transrepression or selective COX-2 enzymes. Also, in silico ADMET analysis was carried out on available phytosteroids to uncover their pharmacokinetic properties. Our analysis has shown that eight compounds: withaferin A, stigmasterol, ß-sitosterol, guggulsterone, diosgenin, sarsasapogenin, physalin A, and dioscin, -isolated from medicinal plants show similar pharmacokinetic properties as compared to dexamethasone, commercially available glucocorticoid. These phytosteroids could be useful for the treatment of inflammatory diseases, such as rheumatoid arthritis, inflammatory bowel diseases, multiple sclerosis, asthma, and cardiovascular diseases. Thus, systematic research is required to explore potent phytosteroids with lesser side effects, which might substitute the current medications.

Visualization in arthroscopic meniscectomy- portal-site injection versus tourniquet inflation: A prospective, double-blinded, randomised controlled study.

OBJECTIVES: Alternatives to tourniquets include portal-site epinephrine injections. This prospective, randomised-controlled, double-blinded study compared intraoperative visibility and safety of portal-site injections with tourniquets in arthroscopic meniscectomies. METHODS: Sixty eligible adults [16-55ys, excluding vascular/neuromuscular/systemic illnesses] were randomly/equally divided across 3 groups A (controls)-local portal injections; B-local injections with tourniquet; C-local and 1:200,000epinephrine injections. A single surgeon operated blinded to patient group. Intraoperative visibility, surgeon visual analogue score (VAS)and other details were recorded. RESULTS: Superior visibility [p = 0.003,p = 0.027] and VAS [p = 0.010,p = 0.042] were reported in groups B, C versus A, Visibility [p = 0.705; p = 0.805] and operating times [p = 0.05] were comparable between B and C. CONCLUSIONS: Portal-site epinephrine injections emerged as tenable surrogates for tourniquets for clear visualization in arthroscopy.

Rare Presentation of Schwannoma in the Ankle: A Case Report.

Schwannomas are benign slow-growing tumors that constitute 8% of all soft-tissue tumors. The clinical signs and symptoms are often misinterpreted because of the low incidence, and these tumors are often misdiagnosed. A 39-year-old male patient presented with non-traumatic solitary swelling in the posteromedial aspect of the right ankle that gradually increased in size and was associated with pain. Clinically, the swelling was firm, non-fluctuant, and was not associated with sensorimotor impairment. Surgical excision of the swelling was performed without damaging the surrounding vessels and nerves. The histopathological examination of the excised tumor revealed a schwannoma.

Rare Presentation of Schwannoma in the Ankle: A Case Report / Apresentação rara de schwannoma no tornozelo: Um relato de caso

Abstract Schwannomas are benign slow-growing tumors that constitute 8% of all soft-tissue tumors. The clinical signs and symptoms are often misinterpreted because of the low incidence, and these tumors are often misdiagnosed. A 39-year-old male patient presented with non-traumatic solitary swelling in the posteromedial aspect of the right ankle that gradually increased in size and was associated with pain. Clinically, the swelling was firm, non-fluctuant, and was not associated with sensorimotor impairment. Surgical excision of the swelling was performed without damaging the surrounding vessels and nerves. The histopathological examination of the excised tumor revealed a schwannoma.

Resumo Schwannomas são tumores benignos de crescimento lento, e constituem 8% de todos os tumores de tecido mole. Os sinais clínicos e sintomas são muitas vezes mal interpretados por causa da baixa incidência, e, muitas vezes, esses tumores são mal diagnosticados. Um paciente do sexo masculino de 39 anos apresentou um inchaço solitário não traumático sobre o aspecto posteromedial do tornozelo direito, que aumentou gradualmente de tamanho e estava associado a dor. O inchaço era clinicamente firme, não flutuante, e não associado a qualquer comprometimento sensório-motor. A excisão cirúrgica do inchaço foi feita sem danificar os vasos e os nervos circundantes. O exame histopatológico do tumor excisado revelou schwannoma.

Comparison of patellar tendon versus hamstrings autografts for anterior cruciate ligament reconstruction in Indian population: A randomised control trial study.

Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The best choice of graft for reconstruction remains undecided. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (QHT) grafts for ACL reconstruction over a 1-year follow-up interval in Indian population. METHODS: 42 consecutive patients with ACL injury were recruited, by pick and draw method and allotted into two groups with 21 patients in each group. Group A patients underwent arthroscopic ACL reconstruction using BPTB graft while QHT autograft was used for patients in Group B. All the patients underwent standard ipsilateral arthroscopic ACL reconstruction procedure using a single incision, antero-medial (AM) portal technique for BPTB or the QHT autograft by a same surgeon. Patients were followed up regularly for a minimum period of 1 year. RESULTS: After one year, the Cincinnati score was 91 ±â€¯4.117 in BPTB group and 89.29 ±â€¯5.371 in QHT group (P = 0.282). There was no significant difference between the two groups in the mean scores with respect to pain, overall activity level and running in the Cincinnati score. None of the patients complained of the knee giving way. Similarly, at 1 year, the Lysholm score was 92.84 ±â€¯2.630 and 90.55 ±â€¯2.395 in the two groups respectively (P = 0.842). There were no episodes of locking or instability and there was no significant difference in the mean Lysholm scores regarding pain and squatting. CONCLUSION: There was no significant functional difference between the two grafts in terms of Lysholm and the Cincinnati score, anterior knee laxity and altered sensation over proximal leg. The patients with QHT groups performed better than BPTB functionally at 6 month so early return to sport is possible even with QHT autograft.

Arthroscopic diagnosis and treatment of shoulder ochronotic arthropathy - A case report.

Alkaptonuria is a rare inherited metabolic disorder, caused by the deficiency of homogentisate 1,2 dioxygenase enzyme. The three major features of alkaptonuria are the presence of homogentisic acid in urine, ochronosis (bluish-black pigmentation in connective tissue) and arthritis of the spine and large joints. We present a 48 years old female presented with pain, restriction of movements of right shoulder. Arthroscopy was suggestive of ochronotic arthropathy. The definitive diagnosis of ochronosis was subsequently confirmed by laboratory and pathologic evaluation.

Bilateral Coracoid Avulsion Fractures with Unilateral Anterior Instability with Glenoid Bone Loss: Use of Avulsed Fragment for Reconstruction of Glenoid.

INTRODUCTION: Coracoid fractures are often missed since the fracture is not visualized in a routine anteroposterior view of the shoulder and special views are not ordered. Shoulder dislocation is common but it is rare to have a dislocation with a coracoid fracture. The purpose of this paper is to present the rare occurrence of bilateral coracoid fractures in a patient with unilateral anterior shoulder instability managed using the same fractured coracoid fragment by the latarjet procedure. CASE REPORT: We report a case of 48 -year -old male who presented to us with a history of recurrent dislocations of the left shoulder. He had frequent episodes of tonic-clonic seizures 5 years back. He was diagnosed to be suffering from neurocysticercosis of the brain for which he was successfully treated. He did not have any episode of seizure later, but he continued to have repeated episodes of dislocation on his left side only. On examination of his left shoulder, he had normal range of motion. He was found to be very apprehensive, even in the midrange. This made us to suspect glenoid bone loss and hence both magnetic resonance imaging and three -dimensional computed tomography (CT) scan of the left shoulder were ordered. The CT scan revealed bilateral coracoid fractures along with glenoid bone loss. An open bony procedure including iliac crest bone graft was planned after a diagnostic arthroscopy keeping in mind that the latarjet procedure may not be possible due to the coracoid fracture. During the operation, we found that the coracoid fragment was large enough to perform a latarjet procedure rather than doing an iliac crest bone graft. This itself provided stability of the shoulder on abduction and external rotation by providing a bony block not requiring any further procedure for the Hill -Sachs lesion. CONCLUSION: Epileptic patients should undergo CT scan evaluation for glenoid bone loss, large Hill -Sachs lesion and to rule out coracoid fractures to plan for bony stabilization procedure and since we have used the same fractured coracoids fragment for latarjet procedure and found to be successful, this add on the knowledge to the orthopedic community.