Delineation of partial melts and crustal heterogeneities within the crust beneath Kumaon Himalaya, India from Lg wave attenuation.

The crustal seismic attenuation or the Q structure is studied by using the Fourier spectra of Lg-wave along the Tanakpur- Dharchula- Dharma transect in the Kumaon Himalaya. The 1 Hz Lg Q (Q0) values are computed between different pairs of two stations and the observed values are later utilized to calculate the lateral variation in the Q0 values by following a back projection algorithm. This computation of Q0 values utilizes five regional distance earthquakes having moment magnitude (Mw) ≥ 4.0, which lie along the great circle path of the transect. Three of the five earthquakes occurred in the Tibetan plateau and the and the others occurred to the southwest on the Indian shield and are well recorded at all the 32 broadband seismographs operated between September 2018 and March 2022. The estimate Qo values range from 63 ± 2 and 203 ± 25, with the lowest value in the Lesser Himalaya and the highest across part of the Indo Gangetic Plain and Siwalik Himalaya. The Q0 model has low values ∼200 along the profile in the Indo Gangetic Plain and the Siwalik Himalaya, and are correlated with 2-5 km thick sedimentary layers below the Himalaya and the adjoining Indo-Gangetic Plain. We observe two distinctly different Q0 values to the northeast in the Lesser Himalaya tectonic unit. The region lying between the South Almora Thrust (SAT) and the Berinag Thrust (BT) shows extremely low Q0 values (∼60) but increases further north towards the Vaikrita Thrust (VT) to ∼200. The possible explanation for observing such huge variation of the Q0 values within a single tectonic unit may be the presence of fluid rich ramp structures, which introduces crustal heterogeneities and traps the aqueous fluids or partial melts lying within the crust. The Lg Q0 values decrease to the North and become ∼166 for station pairs in the Higher Himalaya and Tethys Himalaya tectonic units. The low Q0 values observed in this region may be correlated with low viscous partial melts in the form of Miocene leucogranite plutons, which resulted out of the Indo-Asian collision. The attenuation structure along the profile in the Kumaon Himalaya can be used to estimate ground motions of future earthquakes in the area and can contribute to seismic hazard assessment in the Himalaya and neighbouring regions.

Preclinical and Clinical Role of Coenzyme Q10 Supplementation in Various Pathological States.

Coenzyme Q10 (CoQ10) is an efficient antioxidant produced endogenously in a living organism. It acts as an important cofactor in the electron transport system of mitochondria and reported as a safe supplement in humans and animals with minimal adverse effect. CoQ10 is found naturally, as a trans configuration, chemical nomenclature of which is 2,3- dimethoxy-5- methyl-6-decaprenyle -1,4-benzoquinone. It is found in the body in two forms. In quinone form (oxidized form), it serves as an electron transporter that transfers the electrons in the electron transport chain between various complexes, and in ubiquinol form (reduced form), it serves as potent antioxidants by scavenging free radicals or by tocopherol regeneration in the living organism. Its primary roles include synthesis of adenosine triphosphate (ATP), stabilizes lipid membrane, antioxidant activity, cell growth stimulation, and cell death inhibition. CoQ10 has shown a variety of pharmacological and clinical effects including neuroprotective, hepatoprotective, anti-atherosclerotic, anticonvulsant, antidepressant, anti-inflammatory, antinociceptive, cardiovascular, antimicrobial, immunomodulatory, and various effects on the central nervous system. Present review has set about to bring updated information regarding to clinical and preclinical activities of CoQ10, which may be helpful to researchers to explore a new bioactive molecules for various therapeutic application.

Profile of Pediatric Scrub Typhus in Odisha, India.

OBJECTIVE: To investigate the distribution and clinical profile of scrub typhus infection among children with acute febrile illness in Odisha. METHODS: Children (<15 y) presenting with acute fever (>5 days) in 4 agro-climatic zones from June to November 2017 were evaluated. Patients were screened for malaria, leptospira, dengue, typhoid and scrub typhus. Scrub typhus was confirmed by IgM ELISA and PCR. RESULTS: Out of 413 cases examined, 48.7% were positive for scrub typhus, and 5.5% of them developed systemic complications. Eschar was found in 17.9% of cases. Five days treatment of Doxycycline and/or Azithromycin was clinically effective against scrub typhus. CONCLUSIONS: Our study highlights that scrub typhus is one of the causes of high morbidity in children during rainy months in Odisha.

Assessing maternal and neonatal near-miss reviews in rural Nepal: an implementation research study to inform scale-up.

AIM: To understand how maternal and neonatal near-miss reviews could be implemented and scaled-up in rural communities through the existing district health system in Nepal. METHODS: Mixed methods with a modified time series evaluation design were used. The World Health Organization maternal and neonatal near-miss criteria used in multicountry surveys were adapted and used to define maternal and neonatal near-miss cases. RESULTS: The World Health Organization near-miss criteria were mainly applicable at the district hospital setting, but further adaptations were needed for community-level birthing centres, as organ dysfunction and critical intervention criteria were not found appropriate. In birthing centres, disease-based criteria were applicable for maternal near-miss review, and danger and clinical sign-based and condition at birth criteria were applicable for neonatal near-miss review. Primary barriers to implementation were attrition of trained staff due to the frequent transfer of healthcare providers, and time constraints of district hospital medical doctors for case-by-case reviews as they were often busy in hospital and in their private clinics. CONCLUSION: Adapted maternal and neonatal near-miss review process implementation in Nepal is feasible through the existing government health system.

Family planning knowledge and practice among people living with HIV in Nepal.

Unsafe sexual behavior is common among the HIV infected. This exposes them to the risks of unintended pregnancy, HIV transmission to uninfected partners and super-infection. Studies on the use of family planning measures among People Living with HIV (PLHIV) are scarce in Nepal. The aim of this study was to explore the knowledge and practice of family planning (FP) in PLHIV. A cross sectional survey was conducted during July-December 2012 in Kaski district of Nepal. A total of 120 PLHIVs were recruited using snowball sampling from three HIV clinics within the Pokhara sub-metropolitan city area. This study found that nine in ten PLHIV had heard about family planning. Two thirds of respondents were using at least one FP method. The majority (65.8%) used condoms and had received FP counseling (67.5%). Less than one percent used condoms in addition to another contraceptive. Being single, being female and having received the counselling sessions were associated with the use of FP. The individuals who received FP counseling were more likely [OR 4.522; 95% CI (1.410-14.504)] to use FP. Females were more likely [OR 4.808; 95% CI (1.396-16.556)] to use FP than males. The individuals who were single/de-facto widowed were more likely [OR 7.330; 95% CI (2.064-26.028)] to use FP than the married individuals. Our findings suggest that there is a need to focus on FP counseling if the HIV prevention program is to increase FP use among the PLHIV population. Use of dual contraceptives need to be promoted through counseling sessions and other health promotion programs focusing in HIV prevention.

Assessment of structured physical examination skills training using a retro-pre-questionnaire.

PURPOSE: The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. METHODS: KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. RESULTS: Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46×4=184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. CONCLUSION: The students perceived that their level of skills improved after the training. The retro-pre- instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.

Assessment of structured physical examination skills training using a retro-pre-questionnaire / 보건의료교육평가

PURPOSE: The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. METHODS: KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. RESULTS: Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46x4=184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. CONCLUSION: The students perceived that their level of skills improved after the training. The retro-pre- instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.

Treatment of inferior patellar pole avulsion fractures with pole resection and patellotibial cerclage wire.

The ideal treatment for avulsion fractures of the inferior pole of the patella has not yet been identified. The options include internal fixation of the pole fragment and resection of the avulsed fragment along with the repair of patellar ligament to the patella. The purpose of the present study was to evaluate the result of pole resection with repair of patellar ligament with augmentation by patellotibial cerclage. We retrospectively studied 13 of patients who had operative treatment of an avulsion fracture of the inferior patellar pole by pole resection with trans-osseous suture fixation of the tendon to the patella and reinforcement of ligament patella with patellotibial cerclage wire. Thirteen patients who had had pole resection were followed for an average of 3 years. The average patellofemoral score (maximum, 100 points) was 88.8 points. Normal patellar height was found in thirteen patients. In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by transosseous suture fixation of the tendon to the patella and patellotibial cerclage after pole resection. The present study indicates that patellotibial cerclage can provide better clinical results and avoid prolong postoperative immobilization.

Analytical study of the management of supracondylar fracture of children in our setup.

We performed a clinical-radiological audit of 142 children with consecutive upracondylar fractures of the humerus over a period of 5 years (1996-2001). The fractures were classified according to the Gartland system; 58 types I, 44 type II and 40 type III. And 87.0% were extension and 13.0% flexion types. These cases were managed by closed reduction and posterior cast application (n= 120) and open reduction with internal fixation (n=22). All the stable fractures irrespectable of types were managed by closed method and all the unstable or failed manipulation cases were operated upon. In total 38 required re manipulation in the cast group and twelve (n= 12) had a varus deformity (ten from closed group and two from operation group). Failure to follow the treatment according to the guidelines led to an unsatisfactory result in 12 patients. We have devised a protocol for the management of these difficult injuries in our setup for optimal outcome.