The Double Burden of COVID-19 and Dengue in Nepal: The challenges ahead.

Coronavirus disease 2019 (COVID-19) pandemic has caused significant impact on the health care system. As a consequence, diagnosis and treatment of vector borne diseases including dengue has been equally affected. Nepal is no exception to this, where COVID-19 cases is exponentially increased and all resources are concentrated on its prevention, control and management. Dengue, one of the major vector-borne diseases in Nepal, is apparently overlooked despite approaching the peak season of the disease. The aim of this paper is to describe the double burden of COVID-19 and dengue in Nepal, particularly highlighting the co-circulation and possible coinfections. This has posed higher risk of increased severity, more severe cases and deaths in Nepal. Moreover, potential misdiagnosis of these viral diseases may lead to delayed or, inappropriate treatment and poor allocation of resources.

Process optimization and kinetics for leaching of rare earth metals from the spent Ni-metal hydride batteries.

Nickel-metal hydride batteries (Ni-MH) contain not only the base metals, but valuable rare earth metals (REMs) viz. La, Sm, Nd, Pr and Ce as well. In view of the importance of resource recycling and assured supply of the contained metals in such wastes, the present study has focussed on the leaching of the rare earth metals from the spent Ni-MH batteries. The conditions for the leaching of REMs from the spent batteries were optimized as: 2M H2SO4, 348K temperature and 120min of time at a pulp density (PD) of 100g/L. Under this condition, the leaching of 98.1% Nd, 98.4% Sm, 95.5% Pr and 89.4% Ce was achieved. Besides the rare earth metals, more than 90% of base metals (Ni, Co, Mn and Zn) were also leached out in this condition. Kinetic data for the dissolution of all the rare earth metals showed the best fit to the chemical control shrinking core model. The leaching of metals followed the mechanism involving the chemical reaction proceeding on the surface of particles by the lixiviant, which was corroborated by the XRD phase analysis and SEM-EDS studies. The activation energy of 7.6, 6.3, 11.3 and 13.5kJ/mol was acquired for the leaching of neodymium, samarium, praseodymium and cerium, respectively in the temperature range 305-348K. From the leach liquor, the mixed rare earth metals were precipitated at pH∼1.8 and the precipitated REMs was analyzed by XRD and SEM studies to determine the phases and the morphological features.

Microbial Variants from Iron Ore Slimes: Mineral Specificity and pH Tolerance.

This paper describes the isolation of the native bacterial strains from the iron ore mines slime pond and its extremophilic characteristics. The two microbial isolates designated as CNIOS-1 and CNIOS-2 were grown in selective silicate broth at pH 7.0 and the organisms were tested for their selective adhesion on silicate and alumina minerals. The silicate bacteria with their exopolymers are very potent to grow over aluminosilicates. It was established that CNIOS-1 grew preferentially in the presence of silicate mineral compared to CNIOS-2 which grew in the presence of alumina. The organisms were tested for growth at various pH and trials were carried to define their efficacy for eventual applications to remove gangue minerals of silica and alumina from the raw material.

Recovery of valuable metals from cathodic active material of spent lithium ion batteries: Leaching and kinetic aspects.

This work is focussed on the processing of cathodic active material of spent lithium ion batteries (LIBs) to ensure resource recovery and minimize environmental degradation. The sulfuric acid leaching of metals was carried out for the recovery of all the valuable metals including nickel and manganese along with the frequently targeted metals like lithium and cobalt. The process parameters such as acid concentration, pulp density, time and temperature for the leaching of metals from the cathode powder containing 35.8% Co, 6.5% Li, 11.6% Mn and 10.06% Ni, were optimized. Results show the optimized leach recovery of 93.4% Li, 66.2% Co, 96.3% Ni and 50.2% Mn when the material was leached in 1M H2SO4 at 368 K and 50 g/L pulp density for 240 min. The need of a reductant for improved recovery of cobalt and manganese has been explained by the thermodynamic analysis (Eh-pH diagram) for these metals. Leaching of the valuable metals was found to follow the logarithmic rate law controlled by surface layer diffusion of the lixiviant reacting with the particles. The mode of leaching of the metals from the spent LIBs was further examined by chemical analysis of the samples at various stage of processing which was further corroborated by characterizing the untreated sample and the leach residues by XRD phase identification and the SEM-EDS studies.

Liquid-liquid extraction of Cd(II) from pure and Ni/Cd acidic chloride media using Cyanex 921: a selective treatment of hazardous leachate of spent Ni-Cd batteries.

The present paper is focused on solvent extraction of hazardous Cd(II) from acidic chloride media by Cyanex 921, a new extractant mixed with 10% (v/v) TBP in xylene. The optimum conditions for extraction and stripping of Cd(II) were investigated with an aqueous feed of 0.1 mol/L Cd(II) in 2.0 mol/L HCl. McCabe-Thiele diagram was in good agreement with the simulation studies, showing the quantitative extraction (99.9%) of Cd(II) within two counter-current stages utilizing 0.30 mol/L Cyanex 921 at O/A ratio of 3/2 in 10 min. Stoichiometry of the complexes extracted was determined and confirmed by numerical treatment and graphical method, revealing the formation of HCdCl3 · 2L and HCdCl3 · 4L for Cyanex 921(L) concentration in the range 0.03-0.1 mol/L and 0.1-1.0 mol/L, respectively. The thermodynamic parameters for the extraction of cadmium were also determined. The stripping efficiency of cadmium from the loaded organic with 0.10 mol/L HCl was 99.6% in a three-stage counter-current process at an O/A ratio of 2/3. Cyanex 921 was successfully applied for the separation of Cd(II) from Ni(II) in the simulated leach liquor of spent Ni-Cd batteries. The study demonstrates the applicability of the present hydrometallurgical approach for the treatment of hazardous waste, the spent Ni-Cd batteries.

Understanding the burden of disease in Nepal: a call for local evidence.

The burden of disease, most commonly expressed in terms of Disability-Adjusted Life Years, has become a crucial component in decision making processes within the health sector. In Nepal, however, burden of disease estimates are scarce and lack representativeness. To improve our understanding of the burden of disease in Nepal and thereby increase the efficiency of health policies, there is an urgent need to strengthen the local evidence base. All relevant stakeholders should therefore collaborate to generate new data, improve existing data generation mechanisms, make generated data available, and optimize the use of available data.

Comparative study of microscopy and polymerase chain reaction for the diagnosis of suspected visceral leishmaniasis patients in Nepal.

BACKGROUND: Visceral leishmaniasis is potentially fatal protozoan diseases caused by Leishmania donovani. Nepal is an endemic region in which visceral leishmaniasis causes a major public health problem in the lowland areas that border the endemic areas of Bihar state in India. Accurate diagnosis to inform treatment is a first step in achieving the goal of visceral leishmaniasis elimination from South East Asian regions by 2020. OBJECTIVE: The objective of the present study was to compare between the Microcopy and polymerase chain reaction for diagnosis of visceral leishmaniasis. METHODS: In the present study, 236 bone marrow aspirations were collected from suspected visceral leishmaniasis patients in Janakpur Zonal Hospital, Dhanusa district, Terai region of Nepal in between 2003-2007. We evaluated bone marrow samples by microscopic examination with subsequent testing of the same sample by polymerase chain reaction and sequence analysis. RESULTS: Giemsa's solution stained bone marrow slides stored for over five years were used for polymerase chain reaction amplification. The result showed that 71% were polymerase chain reaction positive and 56% were microscopic positive. Out of 104 microscopic negative bone marrow samples, 15% of samples were positive by polymerase chain reaction. CONCLUSION: Polymerase chain reaction could make a very good option for diagnosis by using less or non-invasive material from visceral leishmaniasis patients in endemic areas of Nepal.

Characterizing toxic Cr(VI) contamination in chromite mine overburden dump and its bacterial remediation.

Cr(VI) generated due to natural oxidation of chromite mineral present in chromite mine overburden (COB) dumps of Sukinda, India, has been characterized by different physico-chemical methods. The Cr(VI) was found to be associated with goethite matrix at a contamination level of 500 mg Cr(VI)kg(-1) of COB. Bacillus sp. isolated from the overburden sample exhibiting high tolerance to the hexavalent chromium, was used for the remediation of Cr(VI) in the overburden. The process was optimized while varying the parameters such as pH (2-9), pulp density (10-60%) and temperature (25-40 °C). Optimal reduction of more than 98% of Cr(VI) in the COB sample was achieved in 16 h at pH∼7.0 and 60% pulp density with the Bacillus sp. (4.05 × 10(7)cells mL(-1)) in absence of media. The exponential rate equation yielded rate constant value of 2.14 × 10(-1)h(-1) at 60% pulp density. The mode of bio-reduction of Cr(VI) in the overburden sample was established by FT-IR, XRD, EPMA and SEM-EDS studies.

Chemical and microbial remediation of hexavalent chromium from contaminated soil and mining/metallurgical solid waste: a review.

Chromium is a highly toxic non-essential metal for microorganisms and plants, and its occurrence is rare in nature. Lower to higher chromium containing effluents and solid wastes released by activities such as mining, metal plating, wood preservation, ink manufacture, dyes, pigments, glass and ceramics, tanning and textile industries, and corrosion inhibitors in cooling water, induce pollution and may cause major health hazards. Besides, natural processes (weathering and biochemical) also contribute to the mobility of chromium which enters in to the soil affecting the plant growth and metabolic functions of the living species. Generally, chemical processes are used for Cr- remediation. However, with the inference derived from the diverse Cr-resistance mechanism displayed by microorganisms and the plants including biosorption, diminished accumulation, precipitation, reduction of Cr(VI) to Cr(III), and chromate efflux, bioremediation is emerging as a potential tool to address the problem of Cr(VI) pollution. This review focuses on the chemistry of chromium, its use, and toxicity and mobility in soil, while assessing its concentration in effluents/wastes which becomes the source of pollution. In order to conserve the environment and resources, the chemical/biological remediation processes for Cr(VI) and their efficiency have been summarised in some detail. The interaction of chromium with various microbial/bacterial strains isolated and their reduction capacity towards Cr(VI) are also discussed.

Microbial processing of apatite rich low grade Indian uranium ore in bioreactor.

Bioreactor leaching using enriched culture of Acidithiobacillus ferrooxidans and Leptosprillium ferrooxidans was investigated for the apatite rich Indian (Narwapahar) uranium ore. Bioreactor leaching of Narwapahar ore of <45 µm size at pH 2.0 and 10% (w/v) PD using 10% (v/v) inoculum of the bacterium at 35 °C (A. ferrooxidans) and 40 °C (L. ferrooxidans), solubilised 57% and 63% uranium in 5 days, respectively; the E(SCE) values being 561 and 588 mV. Leaching kinetics improved so much so that ~83% uranium was recovered in just 10h with 10% inoculum of A. ferrooxidans containing biogenic Fe(3+); at 20% PD uranium recovery rose to 87%. Role of temperature (25-40 °C) was noticed with 90.3% uranium bioleaching in 10h at 40 °C with L. ferrooxidans as against 77% leaching with A. ferrooxidans at pH 2.0, 40 °C and 20% (w/v) PD.

Synthesis of zinc-based nanomaterials: a biological perspective.

Nanoparticles are the materials characterised by dimensions of the order of 100 nm or less. They exhibit a high surface/volume ratio leading to different properties very different from those of the bulk materials. The development of uniform nanoparticles has been intensively pursued because of their technological and fundamental scientific importance. A number of chemical methods are available and are extensively used, but these are often energy intensive and use toxic chemicals. An alternative approach for the synthesis of uniform nanoparticles is the biological route that occurs at ambient temperature, pressure and at neutral pH. The main aim of this review is to enlist and compare various methods of synthesis of zinc-based nanoparticles with emphasis on the biological method.

Dengue in western Terai region of Nepal.

BACKGROUND: Dengue Fever (DF) is an emerging mosquito-borne disease. It is a nagging public health problem in the low lands of Terai, expanding to new areas of Nepal in recent years. METHODS: A cross-sectional study was conducted to determine anti-Dengue IgM positive rate in Mahendranagar, Dhangadi and Dang between August 2008 and November 2009. Serum samples were collected from 283 patients visiting hospitals with history of fever, headache and suspected DF. The samples were examined by ELISA. RESULTS: The anti-Dengue IgM positivity was found to be 9.8 %. The positive rate was highest in Mahendranagar (13.3 %) followed by Dhangadi (9.8 %) (P<0.05). The Dengue positive cases were higher in female (10.9 %) than males (9.0 %). The positivity was higher in Ethnic group Brahman/Chherti (13.1%) as compared to Janajati (5.6 %). The highest positive cases (10.7 %) were from age group above 50 years. The highest numbers of Dengue positive cases were observed in occupation group of agriculture (18.2 %) (P>0.05). CONCLUSIONS: Dengue has substantial expansion in Western and Far Western Terai region of Nepal which was limited to the middle Terai region in the past and mostly infects older people.

Prognostic value of rapid test for diagnosis of dengue in Nepalese patients during 2010 epidemic.

BACKGROUND: Dengue is an emerging vector borne disease in Nepal and rapid diagnostic test is important for early diagnosis of the disease. OBJECTIVES: The aim of the study was to evaluate the diagnostic accuracy of commonly used rapid immunochromatographic test kit in Nepal during 2010 dengue epidemic and to assess disease burden of dengue. METHODS: A total of 131 acute and nonacute serum samples were collected during recent epidemic of dengue in 2010 from clinically suspected Nepalese patients of different hospitals. Rapid immunochromatographic test kit was used for early diagnosis and enzyme immunosorbent was chosen as a reference assay. RESULTS: The sensitivity and specificity of rapid test was 70% and 76.54% respectively whereas the prevalence of the disease was 38.17%. The odds ratio for males was 1.8 however; the association with the disease was statistically not significant. CONCLUSION: The diagnostic accuracy of rapid immunochromatographic test for dengue diagnosis was low (k=0.46). So, it should be substituted by highly sensitive test device for prompt diagnosis and health personnel should consider appropriate timing of sample collection for better performance of rapid test.

Relapse of kala-azar after use of multiple drugs: a case report and brief review of literature.

We present a case of kala-azar infection that recurred in a patient after completion of the standard treatment course of miltefosine, amphotericin B-deoxycholate (short course), and amphotericin B lipid formulations. The patient was cured after continuous amphotericin B-deoxycholate administration for 4 weeks. This is a unique case of relapse following the use of three important drugs. Although amphotericin B-deoxycholate is a second line drug in Nepal, it has shown a satisfactory clinical response with continuous treatment for 4 weeks. Therefore, an extended course of amphotericin B-deoxycholate may be beneficial in patients with resistance to the standard short course and other anti-leishmania drugs.

Human rotavirus associated diarrhea and strain diversity in Nepal.

Two new rotavirus vaccines were recently introduced to the market and have shown a tremendous impact in reducing severe diarrhea due to rotavirus in children. Diarrheal disease is a common cause of morbidity and mortality among Nepalese children. In anticipation of a rotavirus vaccine in Nepal, we systematically reviewed published articles on rotavirus infection in Nepal. Literatures were searched in health related national and international databases. Fifteen rotavirus related articles between 1978 and 2010 were identified. Of these, information from five articles were extracted and analyzed in the present study. Of 3671 participants, 864 were positive for rotavirus infection by ELISA. The prevalence ofrotavirus infection ranged from 12 to 39%. G1P[8] (25%) was the most frequent combined G and P genotype, followed by G12P[6] (23%) and G2P[4] (16%) between 2003 and 2007. Nearly 9% of analyzed rotavirus positive samples (G and P genotype) were non-typable. The data demonstrated that rotavirus is the most identifiable cause of severe diarrhea in children less than 5 years old in Nepal. The wide variety of rotavirus strains circulating in Nepal; underscore the need for continued surveillance. This will be the key to understanding the epidemiological characteristics of rotavirus disease and the impact of vaccination after introduction.

The burden of dengue infection in some vulnerable regions of Nepal.

Dengue is an emerging mosquito borne disease of public health importance in Nepal. A descriptive cross sectional study was carried out to estimate sero-prevalence and distribution pattern of dengue in certain vulnerable regions of Nepal from June to September 2009. A total of 460 venous blood samples were collected from individuals experiencing a febrile illness clinically consistent with dengue infection visiting nearby hospitals of Kanchanpur, Kailali, Banke, Dang and Chitwan districts. The sero-prevalence of dengue virus specific IgM was determined by enzyme linked immunosorbent assay (ELISA) kit. The anti-dengue IgM positivity was found to be 12.17%. The higher frequency of positive cases (16.4%) were from age group 20-40 years followed by < 20 years age group with 9.7% and 5.3% from > 40 years age group. The association between dengue infection and age is found to be statistically significant (p < 0.05). The male:female ratio was determined as 1.3:1 in IgM positive population. Among sampling areas, Kanchanpur showed highest prevalence of dengue infection (15.5%) followed by Chitwan (11.7%), Kailai (11.1%), Banke (10.7%) and Dang (8.3%). Similarly, 94.6% of the positive cases were indigeneous and had no history of travel to other countries. Dengue is firmly established in terai region with increasing trends of infection and expansion into newer areas raising a public health threat. Regular epidemiological studies are suggested which could further reveal the contributing factors associated with dengue virus infection and help in formulating strategies in reducing the transmission rate and control of the infection.

Selective recovery of gold from waste mobile phone PCBs by hydrometallurgical process.

The leaching of gold from the scrap mobile phone PCBs by electro-generated chlorine as an oxidant and its recovery by ion exchange process was investigated. The leaching experiments were carried out by employing separate leaching reactor connected with the anode compartment of a Cl(2) gas generator. The leaching of gold increased with increase in temperature and initial concentration of chlorine, and was favorable even at low concentration of acid, whereas copper leaching increased with increase in concentration of acid and decrease in temperature. In a two-stage leaching process, copper was mostly dissolved (97%) in 165 min at 25°C during the 1st stage leaching in 2.0 mol/L HCl by electro-generated chlorine at a current density of 714A/m(2) along with a minor recovery of gold (5%). In the 2nd stage gold was mostly leached out (93% recovery, ∼67 mg/L) from the residue of the 1st stage by the electro-generated chlorine in 0.1 mol/L HCl. Gold recovery from the leach liquor by ion exchange using Amberlite XAD-7HP resin was found to be 95% with the maximum amount of gold adsorbed as 46.03 mg/g resin. A concentrated gold solution, 6034 mg/L with 99.9% purity was obtained in the ion exchange process.

Health status of married women residing five communities in Nepal: unexpectedly high prevalence of anemia in a well-off community of Kathmandu.

The high prevalence of anemia and underweight among reproductive age women is a serious health concern in Nepal. The objective of the present study was to describe anemia prevalence and nutritional status of married women in Nepal. Total of 278 women were included in the present analysis. The five communities included an urban commercial area (W) in Kathmandu, an agricultural village (K) in Lalitpur District, an agricultural village in Chitwan District (C) and one in Ilam District (I) with intensive cash cropping, and another rural village in Kaski District (P) with high number of international out-migration of males. The study procedure included anthropometric measurements, blood collection for hemoglobin measurement, and stool collection for examination of hookworm infection, and a structured interview on their reproductive history including contraceptive use. The altitude adjusted prevalence of anemia was 65%, 23%, 16%, 49% and 58% in communities C, I, K, P and W respectively. The hookworm prevalence of each community was not associated with the anemia prevalence. In the urban well-off community W, although 38% of the women had BMI > or = 25 and only 2% of women had BMI<18.5, 58% of the women were anemic. A logistic regression analysis on the anemia risk at the individual level showed no effect of helminth infection, but a significant negative effect of Depo-Provera (depot-medroxyprogesterone acetate) use. Causes of high anemia prevalence among the women resided in the urban well-off area should be investigated in future studies.

The occurrence of amino acid substitutions D96N and S242N in VP7 of emergent G2P[4] rotaviruses in Nepal in 2004-2005: a global and evolutionary perspective.

Rotavirus is the leading cause of severe diarrhea among children worldwide. Strains with G2P[4] have captured recent attention because of its abrupt increase or re-emergence in many locations in the world. In Nepal, G2P[4] strains were detected at a rate of 1% in 2003-2004, but increased to 33% in 2004-2005. Thus, the VP7 genes of 45 emergent G2 strains from Nepal were sequenced and analyzed together with a total of 339 G2VP7 sequences detected over the last 34 years that were compiled from the DNA database. We found that all Nepalese VP7 sequences had a substitution from aspartic acid to asparagine at residue 96 (D96N) that was the hallmark of the lineage termed sublineage IVa, which replaced virtually all globally circulating G2 strains during the last decade. Within sublineage IVa, further sublineages emerged, of which a sublineage termed IVa-3 was identified to have another amino acid substitution from serine to asparagine at 242 (S242N). This sublineage, to which all Nepalese sequences belonged, now became the most frequent G2 sequence globally. In conclusion, the G2VP7 gene evolved in a dynamic fashion such that new lineages emerged within the previously dominant lineage, one of which became subsequently dominant.