Publications by authors named "Santosh Shrestha"

28 Publications

  • Page 1 of 1

Factors affecting anaemia among women of reproductive age in Nepal: a multilevel and spatial analysis.

BMJ Open 2021 03 29;11(3):e041982. Epub 2021 Mar 29.

Department of Community Medicine, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.

Objective: The main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis.

Design: This cross-sectional study analysed data from the 2016 Nepal Demographic and Health Survey. Spatial analysis was performed using ArcGIS software V.10.8 to identify the hot and cold spots of anaemia among WRA (15-49 years). Data were analysed using multilevel mixed-effect logistic regression analysis.

Setting: Nepal.

Participants: A total of 6414 WRA were included in the analysis.

Main Outcome Measure: Anaemia defined by WHO as haemoglobin level less than 120 g/L in non-pregnant women and less than 110 g/L in pregnant women.

Results: The spatial analysis showed that statistically significant hotspots of anaemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5 and one district in Sudurpaschim province) of Nepal. At the individual level, women who underwent female sterilisation (adjusted OR, aOR: 3.61, 95% CI 1.10 to 11.84), with no education (aOR: 1.99, 95% CI: 1.17 to 3.39), and from middle socioeconomic class families (aOR: 1.65, 95% CI: 1.02 to 2.68) were more likely to be anaemic, whereas, older women (35 years) (aOR: 0.51, 95% CI: 0.26 to 0.97) and those women who were using hormonal contraceptives (aOR: 0.63, 95% CI: 0.43 to 0.90) were less likely to be anaemic. At the community level, women from province 2 (aOR=2.97, 95% CI: 1.52 to 5.82) had higher odds of being anaemic.

Conclusion: WRA had higher odds of developing anaemia, and it varied by the geographical regions. Nutrition-specific and nutrition-sensitive interventions can be tailored based on the factors identified in this study to curb the high burden of anaemia.
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http://dx.doi.org/10.1136/bmjopen-2020-041982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009228PMC
March 2021

Detection of live larvae in cocoons of Bathyplectes curculionis (Hymenoptera: Ichneumonidae) using visible/near-infrared multispectral imaging.

Pest Manag Sci 2018 Mar 15. Epub 2018 Mar 15.

Department of Agroecology, Science and Technology, Aarhus University, Slagelse, Denmark.

Background: The multispectral (MS) imaging system is a non-destructive method with potential to reduce the labour and time required for quality control in the production of beneficial arthropods such as the parasitoid Bathyplectes curculionis. In Denmark, a project is being undertaken that focuses on the possible use of B. curculionis in augmentative control of Hypera weevil pests in white clover seed production where cocoons of the parasitoid remain as a by-product of seed processing. Only a fraction of the by-product contains live parasitoid larvae and an effective method is required detect live cocoons for later augmentative control of the pest. Therefore, this study aims to identify live larval cocoons of B. curculionis using the MS imaging system.

Results: Live and dead cocoons were identified using the canonical discriminant analysis (CDA) model with an accuracy of 91% and 80% (error rate 14%) in the training set, and a predicted accuracy of 89% and 81% (error rate 15%) in the test set. Reflectance from the near-infrared region was valuable in identifying live cocoons compared with that from the visible region.

Conclusion: The MS imaging system is a rapid method for the separation of live and dead cocoons of B. curculionis. This study shows the potential of developing an MS imaging system to facilitate sorting of live and dead cocoons and optimize augmentative control of Hypera weevil pests. © 2018 Society of Chemical Industry.
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http://dx.doi.org/10.1002/ps.4915DOI Listing
March 2018

Free charges versus excitons: photoluminescence investigation of InGaN/GaN multiple quantum well nanorods and their planar counterparts.

Nanoscale 2018 Mar;10(11):5358-5365

Australian Centre for Advanced Photovoltaics, School of Photovoltaic and Renewable Energy Engineering, UNSW Sydney, Sydney 2052, Australia.

InGaN/GaN multiple quantum well (MQW) nanorods have demonstrated significantly improved optical and electronic properties compared to their planar counterparts. However, the exact nature of the processes whereby nanorod structures impact the optical properties of quantum wells is not well understood, even though a variety of mechanisms have been proposed. We performed nanoscale spatially resolved, steady-state, and time-resolved photoluminescence (PL) experiments confirming that photoexcited electrons and holes are strongly bound by Coulomb interactions (i.e., excitons) in planar MQWs due to the large exciton binding energy in InGaN quantum wells. In contrast, free electron-hole recombination becomes the dominant mechanism in nanorods, which is ascribed to efficient exciton dissociation. The nanorod sidewall provides an effective pathway for exciton dissociation that significantly improves the optical performance of InGaN/GaN MQWs. We also confirm that surface treatment of nanorod sidewalls has an impact on exciton dissociation. Our results provide new insights into excitonic and charge carrier dynamics of quantum confined materials as well as the influence of surface states.
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http://dx.doi.org/10.1039/c7nr07567gDOI Listing
March 2018

Difference in hot carrier cooling rate between Langmuir-Blodgett and drop cast PbS QD films due to strong electron-phonon coupling.

Nanoscale 2017 Nov;9(43):17133-17142

School of Photovoltaic and Renewable Energy Engineering, UNSW Sydney, Sydney, NSW 2052, Australia.

The carrier dynamics of lead sulphide quantum dot (PbS QD) drop cast films and closely packed ordered Langmuir-Blodgett films are studied with ultra-fast femtosecond transient absorption spectroscopy. The photo-induced carrier temperature is extracted from transient absorption spectra and monitored as a function of time delay. The cooling dynamics of carriers in PbS QDs suggest a reduction of the carrier energy loss rate at longer time delays through the retardation of the longitudinal optical (LO) phonon decay due to partial heating of acoustic phonon modes. A slowed hot carrier cooling time up to 116 ps is observed in the drop cast film. A faster cooling rate was also observed in the highly compact Langmuir-Blodgett film due to the enhanced carrier-LO phonon coupling strength arising from the Coulombic interaction in neighboring QDs, which is verified by temperature dependent steady state PL measurements.
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http://dx.doi.org/10.1039/c7nr05247bDOI Listing
November 2017

Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia.

Am J Psychiatry 2017 Jul;174(7):620-622

From the Division of Medicine/Psychiatry, Department of Internal Medicine, and the Department of Psychiatry, Southern Illinois University School of Medicine, Springfield.

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http://dx.doi.org/10.1176/appi.ajp.2017.16111226DOI Listing
July 2017

Hepatic vena cava syndrome: New concept of pathogenesis.

Hepatol Res 2017 Jun 9;47(7):603-615. Epub 2017 May 9.

Center for Vein, Lymphatic and Vascular Malformation, George Washington University, Washington, USA.

Hepatic vena cava syndrome, also known as membranous obstruction of inferior vena cava (IVC), was considered a rare congenital disease and classified under Budd-Chiari syndrome. It is now recognized as a bacterial infection-induced disease related to poor hygiene. Localized thrombophlebitis of the IVC at the site close to hepatic vein outlets is the initial lesion which converts on resolution into stenosis or complete obstruction, the circulatory equilibrium being maintained by development of cavo-caval collateral anastomosis. These changes persist for the rest of the patient's life. The patient remains asymptomatic for a variable period until acute exacerbations occur, precipitated by bacterial infection, resulting in deposition of thrombi at the site of the lesion and endophlebitis in intrahepatic veins. Large thrombus close to hepatic vein outlets results in ascites from hepatic venous outflow obstruction, which is followed by development of venocentric cirrhosis. Endophlebitis of intrahepatic veins results in ischemic liver damage and development of segmental stenosis or membrane. Acute exacerbations are recognized clinically as intermittent jaundice and/or elevation of aminotransferase or ascites associated with neutrophil leukocytosis and elevation of C-reactive protein; sonologically, they are recognized as the presence of thrombi of different ages in IVC and thrombosis of intrahepatic veins. Development of liver cirrhosis and hepatocellular carcinoma is related to severity or frequency of acute exacerbations and not to duration or type of caval obstruction. Hepatic vena cava syndrome is a common co-morbid condition with other liver diseases in developing countries and it should be considered in differential diagnosis in patient with intermittent elevation serum bilirubin and or aminotransferase or development of ascites and cirrhosis.
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http://dx.doi.org/10.1111/hepr.12869DOI Listing
June 2017

Warty Carcinoma Penis: An Uncommon Variant.

Case Rep Pathol 2017 5;2017:2937592. Epub 2017 Jan 5.

Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal.

Penile carcinoma frequency varies widely in different parts of the world and comprises 1-10% of all the malignancies in males. Majority of the cases of penile carcinoma are squamous cell carcinoma of penis comprising 60% to 70% of all cases. Warty carcinoma of penis is an unusual neoplasm and a variant of penile squamous cell carcinoma comprising 5%-10% of all the variants. The other histological variants include basaloid, verrucous, papillary, sarcomatous, mixed, and adenosquamous carcinoma. The various histological entities with an exophytic papillary lesions including warty carcinoma are together referred to as the "verruciform" group of neoplasms. The warty carcinoma has to be differentiated from these lesions and is typically distinguished by histological features of hyperkeratosis, arborescent papillomatosis, acanthosis, and prominent koilocytosis with nuclear pleomorphism. We present a case of 65-year-old male with growth measuring 6 × 4 cm in the penis who underwent total penectomy and was diagnosed as warty carcinoma penis.
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http://dx.doi.org/10.1155/2017/2937592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244012PMC
January 2017

Acoustic-optical phonon up-conversion and hot-phonon bottleneck in lead-halide perovskites.

Nat Commun 2017 01 20;8:14120. Epub 2017 Jan 20.

Australian Centre for Advanced Photovoltaics, School of Photovoltaics and Renewable Energy Engineering, University of New South Wales, Sydney, New South Wales 2052, Australia.

The hot-phonon bottleneck effect in lead-halide perovskites (APbX) prolongs the cooling period of hot charge carriers, an effect that could be used in the next-generation photovoltaics devices. Using ultrafast optical characterization and first-principle calculations, four kinds of lead-halide perovskites (A=FA/MA/Cs, X=I/Br) are compared in this study to reveal the carrier-phonon dynamics within. Here we show a stronger phonon bottleneck effect in hybrid perovskites than in their inorganic counterparts. Compared with the caesium-based system, a 10 times slower carrier-phonon relaxation rate is observed in FAPbI. The up-conversion of low-energy phonons is proposed to be responsible for the bottleneck effect. The presence of organic cations introduces overlapping phonon branches and facilitates the up-transition of low-energy modes. The blocking of phonon propagation associated with an ultralow thermal conductivity of the material also increases the overall up-conversion efficiency. This result also suggests a new and general method for achieving long-lived hot carriers in materials.
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http://dx.doi.org/10.1038/ncomms14120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263885PMC
January 2017

Nanoscale Characterization of Carrier Dynamic and Surface Passivation in InGaN/GaN Multiple Quantum Wells on GaN Nanorods.

ACS Appl Mater Interfaces 2016 Nov 9;8(46):31887-31893. Epub 2016 Nov 9.

Australian Centre for Advanced Photovoltaics, School of Photovoltaic and Renewable Energy Engineering, UNSW Australia , Sydney 2052, Australia.

Using advanced two-photon excitation confocal microscopy, associated with time-resolved spectroscopy, we characterize InGaN/GaN multiple quantum wells on nanorod heterostructures and demonstrate the passivation effect of a KOH treatment. High-quality InGaN/GaN nanorods were fabricated using nanosphere lithography as a candidate material for light-emitting diode devices. The depth- and time-resolved characterization at the nanoscale provides detailed carrier dynamic analysis helpful for understanding the optical properties. The nanoscale spatially resolved images of InGaN quantum well and defects were acquired simultaneously. We demonstrate that nanorod etching improves light extraction efficiency, and a proper KOH treatment has been found to reduce the surface defects efficiently and enhance the luminescence. The optical characterization techniques provide depth-resolved and time-resolved carrier dynamics with nanoscale spatially resolved mapping, which is crucial for a comprehensive and thorough understanding of nanostructured materials and provides novel insight into the improvement of materials fabrication and applications.
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http://dx.doi.org/10.1021/acsami.6b11675DOI Listing
November 2016

Metabolic disturbances: role of the circadian timing system and sleep.

Diabetol Int 2017 Mar 19;8(1):14-22. Epub 2016 Jul 19.

1Department of Endocrinology, Zhongnan Hospital, Wuhan University, Wuhan, 430071 China.

The incidence of metabolic disorders such as obesity and diabetes is on the rise, and food quality is not alone to blame. Sleep disturbances, altered feeding time and circadian disruption are linked to metabolic disturbances in many clinical research studies and cross-sectional analyses. This review tried to summarize the role of the circadian timing system and sleep on energy and metabolic homeostasis. We also tried to explain the molecular and endocrine mechanisms behind circadian misalignment and sleep disorders that lead to metabolic disorders.
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http://dx.doi.org/10.1007/s13340-016-0279-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224937PMC
March 2017

Tunability Limit of Photoluminescence in Colloidal Silicon Nanocrystals.

Sci Rep 2015 Jul 22;5:12469. Epub 2015 Jul 22.

Australian Centre for Advanced Photovoltaics, University of New South Wales, Sydney 2052, Australia.

Luminescent silicon nanocrystals (Si NCs) have attracted tremendous research interest. Their size dependent photoluminescence (PL) shows great promise in various optoelectronic and biomedical applications and devices. However, it remains unclear why the exciton emission is limited to energy below 2.1 eV, no matter how small the nanocrystal is. Here we interpret a nanosecond transient yellow emission band at 590 nm (2.1 eV) as a critical limit of the wavelength tunability in colloidal silicon nanocrystals. In the "large size" regime (d > ~3 nm), quantum confinement dominantly determines the PL wavelength and thus the PL peak blue shifts upon decreasing the Si NC size. In the "small size" regime (d < ~2 nm) the effect of the yellow band overwhelms the effect of quantum confinement with distinctly increased nonradiative trapping. As a consequence, the photoluminescence peak does not exhibit any additional blue shift and the quantum yield drops abruptly with further decreasing the size of the Si NCs. This finding confirms that the PL originating from the quantum confined core states can only exist in the red/near infrared with energy below 2.1 eV; while the blue/green PL originates from surface related states and exhibits nanosecond transition.
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http://dx.doi.org/10.1038/srep12469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510486PMC
July 2015

Extensive regeneration of the stomach using bioabsorbable polymer sheets.

Surgery 2015 Nov 9;158(5):1283-90. Epub 2015 May 9.

Division of Life Science, Nara Medical University, Nara, Japan.

Background: The growing prevalence of endoscopic surgery in recent years has led to the minimization of postoperative scarring. However, this procedure does not allow for the regeneration of the resected digestive tract, which compromises the postoperative maintenance of digestive function. In this preliminary study, we developed an artificial gastric wall (AGW) using bioabsorbable polymer (BAP), and evaluated the ability of this BAP patch to repair and regenerate a widely defective gastric wall in an animal model.

Methods: Pigs were laparotomized under general anesthesia. An 8 × 8-cm, round portion of the anterior gastric wall was excised and replaced by an AGW. The AGW was composed of a copolymer comprising 50% lactic acid and 50% caprolactone. The animals were relaparotomized 4, 8, or 12 weeks after implantation, after which they underwent resection of the entire stomach for gross and histologic evaluation of the graft sites.

Results: All recipient pigs survived until killing. By 4-8 weeks, the graft site revealed progressively fewer mucosal defect after each day. Moreover, the grafted area was indistinguishable from the native stomach 12 weeks after AGW implantation. The structures of the regenerated mucous membrane and muscle layers were identical to those of the native stomach. Furthermore, proton pumps were found in the regenerated tissue.

Conclusion: The BAP sheets helped to restore extensive gastric defects without causing any deformation. The use of BAP sheets may become a new therapeutic method that prevents alterations of gastric volume after extensive gastrectomy for stomach cancer and other diseases.
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http://dx.doi.org/10.1016/j.surg.2015.04.003DOI Listing
November 2015

Liver cirrhosis in hepatic vena cava syndrome (or membranous obstruction of inferior vena cava).

World J Hepatol 2015 Apr;7(6):874-84

Santosh Man Shrestha, Liver Foundation Nepal, Sitapaela Height, Kathmandu, Nepal.

Hepatic vena cava syndrome (HVCS) also known as membranous obstruction of inferior vena cava reported mainly from Asia and Africa is an important cause of hepatic venous outflow obstruction (HVOO) that is complicated by high incidence of liver cirrhosis (LC) and moderate to high incidence of hepatocellular carcinoma (HCC). In the past the disease was considered congenital and was included under Budd-Chiari syndrome (BCS). HVCS is a chronic disease common in developing countries, the onset of which is related to poor hygienic living condition. The initial lesion in the disease is a bacterial infection induced localized thrombophlebitis in hepatic portion of inferior vena cava at the site where hepatic veins open which on resolution transforms into stenosis, membrane or thick obstruction, and is followed by development of cavo-caval collateral anastomosis. The disease is characterized by long asymptomatic period and recurrent acute exacerbations (AE) precipitated by clinical or subclinical bacterial infection. AE is managed with prolonged oral antibiotic. Development of LC and HCC in HVCS is related to the severity and frequency of AEs and not to the duration of the disease or the type or severity of the caval obstruction. HVOO that develops during severe acute stage or AE is a pre-cirrhotic condition. Primary BCS on the other hand is a rare disease related to prothrombotic disorders reported mainly among Caucasians that clinically manifest as acute, subacute disease or as fulminant hepatic failure; and is managed with life-long anticoagulation, porto-systemic shunt/endovascular angioplasty and stent or liver transplantation. As epidemiology, etiology and natural history of HVCS are different from classical BCS, it is here, recognized as a separate disease entity, a third primary cause of HVOO after sinusoidal obstruction syndrome and BCS. Understanding of the natural history has made early diagnosis of HVCS possible. This paper describes epidemiology, natural history and diagnosis of HVCS and discusses the pathogenesis of LC in the disease and mentions distinctive clinical features of HVCS related LC.
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http://dx.doi.org/10.4254/wjh.v7.i6.874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411529PMC
April 2015

Viability prediction of Ricinus cummunis L. seeds using multispectral imaging.

Sensors (Basel) 2015 Feb 17;15(2):4592-604. Epub 2015 Feb 17.

Department of Agroecology, Science and Technology, Aarhus University, Slagelse 4200, Denmark.

The purpose of this study was to highlight the use of multispectral imaging in seed quality testing of castor seeds. Visually, 120 seeds were divided into three classes: yellow, grey and black seeds. Thereafter, images at 19 different wavelengths ranging from 375-970 nm were captured of all the seeds. Mean intensity for each single seed was extracted from the images, and a significant difference between the three colour classes was observed, with the best separation in the near-infrared wavelengths. A specified feature (RegionMSI mean) based on normalized canonical discriminant analysis, were employed and viable seeds were distinguished from dead seeds with 92% accuracy. The same model was tested on a validation set of seeds. These seeds were divided into two groups depending on germination ability, 241 were predicted as viable and expected to germinate and 59 were predicted as dead or non-germinated seeds. This validation of the model resulted in 96% correct classification of the seeds. The results illustrate how multispectral imaging technology can be employed for prediction of viable castor seeds, based on seed coat colour.
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http://dx.doi.org/10.3390/s150204592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367427PMC
February 2015

Use of multispectral imaging in varietal identification of tomato.

Sensors (Basel) 2015 Feb 16;15(2):4496-512. Epub 2015 Feb 16.

Department of Agroecology, Faculty of Science and Technology, Aarhus University, Slagelse 4200, Denmark.

Multispectral imaging is an emerging non-destructive technology. In this work its potential for varietal discrimination and identification of tomato cultivars of Nepal was investigated. Two sample sets were used for the study, one with two parents and their crosses and other with eleven cultivars to study parents and offspring relationship and varietal identification respectively. Normalized canonical discriminant analysis (nCDA) and principal component analysis (PCA) were used to analyze and compare the results for parents and offspring study. Both the results showed clear discrimination of parents and offspring. nCDA was also used for pairwise discrimination of the eleven cultivars, which correctly discriminated upto 100% and only few pairs below 85%. Partial least square discriminant analysis (PLS-DA) was further used to classify all the cultivars. The model displayed an overall classification accuracy of 82%, which was further improved to 96% and 86% with stepwise PLS-DA models on high (seven) and poor (four) sensitivity cultivars, respectively. The stepwise PLS-DA models had satisfactory classification errors for cross-validation and prediction 7% and 7%, respectively. The results obtained provide an opportunity of using multispectral imaging technology as a primary tool in a scientific community for identification/discrimination of plant varieties in regard to genetic purity and plant variety protection/registration.
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http://dx.doi.org/10.3390/s150204496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367422PMC
February 2015

Applications of atomic layer deposition in solar cells.

Nanotechnology 2015 Feb 21;26(6):064001. Epub 2015 Jan 21.

School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore.

Atomic layer deposition (ALD) provides a unique tool for the growth of thin films with excellent conformity and thickness control down to atomic levels. The application of ALD in energy research has received increasing attention in recent years. In this review, the versatility of ALD in solar cells will be discussed. This is specifically focused on the fabrication of nanostructured photoelectrodes, surface passivation, surface sensitization, and band-structure engineering of solar cell materials. Challenges and future directions of ALD in the applications of solar cells are also discussed.
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http://dx.doi.org/10.1088/0957-4484/26/6/064001DOI Listing
February 2015

Hepatic vena cava syndrome: a common cause of liver cirrhosis in children in Nepal.

Trop Gastroenterol 2014 Apr-Jun;35(2):85-95

Background: Disease of hepatic portion of the inferior vena cava (IVC) now renamed hepatic vena cava syndrome (HVCS) is an insidious onset chronic disease characterized by recurrent acute exacerbations and development of cavo-caval collaterals. In adults it is complicated by high incidence of liver cirrhosis. Aim of this study was to assess the incidence of liver cirrhosis in children with HVCS and discuss its pathogenesis.

Method: One hundred and seventy eight children with HVCS were followed up with ultrasonography (USG), routine hematology and liver tests. During acute exacerbations, cultures of blood and ascitic fluid for aerobic microorganisms were also done. Diagnosis of liver cirrhosis was based on transformation of the liver parenchymal echo-texture from normal to uniformly coarse with rounded edges in follow-up USG It was confirmed by direct inspection of the liver or by biopsy in six. The duration from disease onset to detection of liver cirrhosis was also assessed.

Results: HVCS was seen in children from poor socio-economic background. Forty nine patients (27.5%) developed liver cirrhosis within a few months to a few years of onset of the disease. Development of cirrhosis was related to frequency or severity of acute exacerbations and not to duration of illness or severity of the caval lesion.

Conclusion: The cause of cirrhosis in HVCS was the ischemic injury of the hepatocytes and sinusoids following thrombosis of the IVC and/or intra-hepatic veins during severe acute episodes or exacerbations precipitated by bacterial infection. Since such acute exacerbations are amenable to medical treatment, HVCS may be a cause of preventable liver cirrhosis in developing countries.
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http://dx.doi.org/10.7869/tg.186DOI Listing
December 2014

Intestinal anisakiasis treated successfully with conservative therapy: importance of clinical diagnosis.

World J Gastroenterol 2014 Jan;20(2):598-602

Santosh Shrestha, Akiko Kisino, Makoto Watanabe, Hiroshi Itsukaichi, Kazumitsu Hamasuna, Giichiro Ohno, Atsushi Tsugu, Department of Gastro-Intestinal Surgery, Tokatsu Hospital, Chiba 270-0174, Japan.

Intestinal anisakiasis is not only a rare parasitic disease, but is also difficult to diagnose. The symptoms are not specific and are often very severe and abrupt, and the findings of clinical imaging are very remarkable. Therefore, intestinal anisakiasis is often misdiagnosed as acute abdomen or intestinal obstruction and is treated surgically. However, if intestinal anisakiasis could be diagnosed correctly, it is well treated conservatively. We experienced three cases of intestinal anisakiasis, which were diagnosed correctly and treated successfully with conservative therapy. A correct clinical history and imaging interpretation helped us diagnose intestinal anisakiasis correctly and thus treat the patients successfully with conservative therapy.
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http://dx.doi.org/10.3748/wjg.v20.i2.598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923037PMC
January 2014

Chronic hepatitis B in Nepal: an Asian country with low prevalence of HBV infection.

Trop Gastroenterol 2012 Apr-Jun;33(2):95-101

Liver Foundation Nepal Sitapaela Height Kathmandu, Nepal.

Sandwiched between China, a country with high prevalence of hepatitis B surface antigen (HBsAg) and 30% of the world's HBsAg carriers, and India which has intermediate HBsAg prevalence and 10% of the world's carriers, Nepal has the lowest prevalence of hepatitis B virus (HBV) infection in Asia, with an HBsAg carrier rate of 0.9%. This treatise discusses the probable causes of this low prevalence based on published literature on the subject. The HBsAg prevalence among pregnant women in Nepal is low (0.5%) and none of those examined were HBeAg positive. The highest prevalence of HBsAg was found in the 6-15 years age group. The low prevalence of this infection in the country was due to an absence of significant vertical transmission and its predominant spread by horizontal transmission among the adolescent age group.
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http://dx.doi.org/10.7869/tg.2012.24DOI Listing
October 2012

Comparison of ondansetron and combination of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery.

J Emerg Trauma Shock 2011 Apr;4(2):168-72

Department of Anesthesiology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel; Kavre, Nepal.

Background: Laparoscopic surgeries are the second most common cause of postoperative nausea and vomiting (PONV), which would cause unexpected delay in hospital discharge. This study intends to compare the efficacy and safety of the combination of ondansetron and dexamethasone with ondansetron alone given as prophylaxis for PONV in adults undergoing elective laparoscopic surgery.

Materials And Methods: One hundred adult patients undergoing elective laparoscopic surgeries were selected and were randomly divided into 2 groups of 50 each. Group I received 4 mg of ondansetron intravenously (i.v.), whereas Group II received ondansetron 4 mg and dexamethasone 4 mg i.v. just before induction of anesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting, and need for rescue antiemetic at intervals of 0-2, 3, 6, 12, and 24 h. Postoperative pain scores and time for the first analgesic dose were also noted.

Results: Results were analyzed statistically. Complete response defined as no nausea or emesis and no need for rescue antiemetic during first 24 h, was noted in 76% of patients who received ondansetron alone, while similar response was seen in 92% of patients in combination group. Rescue antiemetic requirement was less in combination group (8%) as compared with ondansetron group.

Conclusion: Combination of ondanserton and dexamethasone is more effective in preventing post operative nausea vomiting in patients undergoing laparoscopic surgery than ondansetron alone.
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http://dx.doi.org/10.4103/0974-2700.82200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132353PMC
April 2011

Liver cirrhosis and hepatocellular carcinoma in hepatic vena cava disease, a liver disease caused by obstruction of inferior vena cava.

Hepatol Int 2009 Jun 23;3(2):392-402. Epub 2009 Jan 23.

Liver Foundation Nepal, Sitapaela Height, P.O. Box 3439, Kathmandu, Nepal,

Purpose: Hepatic vena cava disease (HVD), a form of Budd-Chiari syndrome, is caused by the obstruction of hepatic portion of the inferior vena cava. It is a chronic disease characterized by the development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). As HVD occurred in areas with high incidence of hepatitis B virus (HBV) infection and some patients tested HBsAg positive, it was thought to be the cause of LC and HCC. To assess the pathogenesis of LC or HCC in HVD, a long-term follow-up study was done.

Method: Fifty-six patients with HVD diagnosed by ultrasound (US) and confirmed by cavography in 31 and liver biopsy in 34 were followed up for an average of 14.8 +/- 9 years. The occurrence of LC was diagnosed by US and/or liver biopsy and that of HCC by US, elevated level of alpha-fetoprotein, and liver biopsy or fine-needle aspiration cytology, or computed tomographic scan. Other risk factors for LC/HCC such as alcohol use and HBV and hepatitis C virus (HCV) infections were assayed.

Results: Forty-four (78.5%) and 6 (10.7%) patients developed cirrhosis and HCC, respectively. LC/HCC occurred more frequently among those who had severe or frequent acute exacerbations (P = 0.017), but it was not related to alcohol use or HBV and HCV infections.

Conclusion: HVD is independent risk factors for LC and HCC. Severe and/or recurrent loss of hepatocytes caused by hepatic venous outflow obstruction and/or thrombotic obstruction of small radicals of hepatic and portal veins that occurred during acute exacerbations was considered important in the pathogenesis of LC and HCC in HVD.
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http://dx.doi.org/10.1007/s12072-009-9122-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716770PMC
June 2009

High prevalence of hepatitis B virus infection and inferior vena cava obstruction among patients with liver cirrhosis or hepatocellular carcinoma in Nepal.

J Gastroenterol Hepatol 2007 Nov;22(11):1921-8

Liver Foundation Nepal, Sitapaela Height, Kathmandu, Nepal.

Background: Little is known about the prevalence of hepatitis B virus (HBV) DNA and the genotype distribution among patients with liver diseases in Nepal, where obstruction of the hepatic portion of the inferior vena cava (IVCO) is common. The aim of the present paper was to assess the roles of HBV infection and IVCO in liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in Nepal.

Methods: Serum samples from 121 patients (89 male, 32 female; age, 55.0 +/- 13.6 years) with or without IVCO consisting of 70 LC patients and 51 HCC patients in Nepal, were tested for HBV-DNA.

Results: The HBV-DNA was detected in 68 patients (56%) including 20 hepatitis B surface antigen (HBsAg)-negative patients: 33 LC patients (47%) and 35 HCC patients (69%) had detectable HBV-DNA (P = 0.0303). Among the 89 patients with IVCO, HBV-DNA was detected in HCC patients significantly more frequently than in LC patients (80%vs 43%, P = 0.0005). The frequency of HBV viremia was significantly higher among HCC patients with IVCO than those without (80%vs 44%, P = 0.0236), and that of HBV viremia with IVCO was significantly higher among HCC patients than among LC patients (55%vs 27%, P = 0.0153). The HBV genotypes A and D were predominant, and genotype A was significantly more frequent among HCC patients than among LC patients (22%vs 6%, P = 0.0090). Among HCC patients, those with genotype A HBV were significantly younger than those with genotype D (43 +/- 13 vs 57 +/- 12 years, P = 0.0252).

Conclusion: Hepatitis B virus alone (especially genotype A) or in concert with IVCO may be responsible for development of HCC in Nepal.
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http://dx.doi.org/10.1111/j.1440-1746.2006.04611.xDOI Listing
November 2007

Hepatic vena cava disease: Etiologic relation to bacterial infection.

Hepatol Res 2007 Mar;37(3):196-204

Liver Foundation Nepal, Kathmandu, Nepal.

Aim: Hepatic vena cava disease is a primary obliterative disease of the hepatic portion of the inferior vena cava (IVC) that often causes liver cirrhosis and hepatocellular carcinoma. Its geographic prevalence is inversely related to the standard of community hygiene. The disease is endemic in Nepal and is commonly associated with bacterial infection. The cause of the disease is not known. It was previously thought to be congenital. Thrombosis due to hypercoagulable condition is suggested as a possible cause of the disease. This study looks at the relation of the disease to bacterial infection.

Methods: Ultrasonography is sensitive and specific for the diagnosis of acute and chronic lesions of hepatic vena cava disease. Patients attending the Liver Clinic with pyrexia with and without bacteremia were examined by ultrasonography for acute "thrombophlebitic" lesion of the IVC, and five patients with bacterial infection with acute lesion in the hepatic portion of the IVC were followed.

Results: Sixty eight percent of the patients with bacteremia had ultrasonographic evidence of acute lesion in the hepatic portion of the IVC, compared to 18% patients without bacteremia. A follow-up study of five patients showed transformation of the acute lesion into chronic obliterative lesion - stenosis or complete obstruction.

Conclusion: Bacterial infection is probably the cause of hepatic vena cava disease seen in developing countries.
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http://dx.doi.org/10.1111/j.1872-034X.2007.00012.xDOI Listing
March 2007

A case-control study for differences among hepatitis B virus infections of genotypes A (subtypes Aa and Ae) and D.

Hepatology 2004 Sep;40(3):747-55

Department of Clinical Molecular Informative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

There are two subtypes of hepatitis B virus genotype A (HBV/A) and they are provisionally designated Aa ("a" standing for Africa/Asia) and Ae ("e" for Europe). In a case-control study, 78 HBV/Aa, 78HBV/Ae, and 78HBV/D carriers from several countries were compared. The prevalence of HBe antigen (HBeAg) in serum was significantly lower in carriers of HBV/Aa than in carriers of HBV/Ae (31% vs. 49%; P = .033), with a difference more obvious in the carriers aged 30 years or younger (34% vs. 67%; P = .029). HBV DNA levels in the carriers of HBV/Aa (median, 3.46 log copies/mL; 95% CI, 2.93-3.95) were significantly lower than those of carriers of HBV/Ae (6.09 log copies/mL; 95% CI, 4.24-7.64) or of carriers of HBV/D (5.48 log copies/mL; 95% CI, 4.06-7.02), regardless of the HBeAg status (P < .001). The most specific and frequent substitutions in 54 HBV/Aa isolates were double substitutions for T1809 (100%) and T1812 (96%) immediately upstream of the precore initiation codon, which would interfere with the translation of HBeAg in HBV/Aa infections. They were not detected in 57 HBV/Ae or 61 HBV/D isolates examined. The double mutation in the core promoter (T1762/A1764) was more frequent in both HBV/Aa (50%) and HBV/Ae (44%) than in HBV/D isolates (25%; P < .01), whereas the precore mutation (A1896) occurred in HBV/D isolates only (48%; P < .0001). In conclusion, the clearance of HBeAg from serum may occur by different mechanisms in HBV/Aa, HBV/Ae, and HBV/D infections, which may influence clinical manifestations in the Western countries where both genotypes A and D are prevalent.
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http://dx.doi.org/10.1002/hep.20365DOI Listing
September 2004

Epidemiological and sequence differences between two subtypes (Ae and Aa) of hepatitis B virus genotype A.

J Gen Virol 2004 Apr;85(Pt 4):811-820

Departments of Clinical Molecular Informative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Complete nucleotide sequences of 19 hepatitis B virus (HBV) isolates of genotype A (HBV/A) were determined and analysed along with those of 20 previously reported HBV/A isolates. Of the 19 HBV/A isolates, six including three from Japan and three from the USA clustered with the 14 HBV/A isolates from Western countries. The remaining 13 isolates including four from The Philippines, two from India, three from Nepal and four from Bangladesh clustered with the six HBV/A isolates reported from The Philippines, South Africa and Malawi. Due to distinct epidemiological distributions, genotype A in the 20 HBV isolates was classified into subtype Ae (e for Europe), and that in the other 19 into subtype Aa (a for Asia and Africa) provisionally. The 19 HBV/Aa isolates had a sequence variation significantly greater than that of the 20 HBV/Ae isolates (2.5+/-0.3 % vs 1.1+/-0.6 %, P<0.0001); they differed by 5.0+/-0.4 % (4.1-6.4 %). The double mutation (T1762/A1764) in the core promoter was significantly more frequent in HBV/Aa isolates than in HBV/Ae isolates (11/19 or 58 % vs 5/20 or 25 %, P<0.01). In the pregenome encapsidation (epsilon) signal, a point mutation from G to A or T at nt 1862 was detected in 16 of the 19 (84 %) HBV/Aa isolates but not in any of the 20 HBV/Ae isolates, which may affect virus replication and translation of hepatitis B e antigen. Subtypes Aa and Ae of genotype A deserve evaluation for any clinical differences between them, with a special reference to hepatocellular carcinoma prevalent in Africa.
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http://dx.doi.org/10.1099/vir.0.79811-0DOI Listing
April 2004

Genetic changes in hepatitis E virus of subtype 1a in patients with sporadic acute hepatitis E in Kathmandu, Nepal, from 1997 to 2002.

J Gen Virol 2004 Jan;85(Pt 1):97-104

Division of Virology, Department of Infection and Immunity, Jichi Medical School, Tochigi-Ken 329-0498, Japan.

To investigate the genetic changes in hepatitis E virus (HEV) strains in the Kathmandu valley of Nepal, we compared the 412 nt sequence within open reading frame 2 of HEV among HEV isolates recovered from 16 patients in 1999, 14 patients in 2000 and 38 patients in 2002, and additional isolates recovered from 48 patients in 1997 whose nucleotide sequences have been previously published. All 116 HEV-viraemic samples were genotyped as 1 and subtyped further as 1a (n=85, 73 %), 1c (n=29, 25 %) and mixed infection of 1a and 1c (n=2, 2 %): subtype 1c was detected only in 1997. Among the 1a isolates, nucleotide sequence identity with the representative 1a isolate of Ne131-1997 was 96.4+/-2.4 % (mean+/-SD) in 1997, 93.9+/-1.7 % in 1999, 92.2+/-1.0 % in 2000 and 91.7+/-0.5 % in 2002, indicating gradual diversification of HEV sequences. When phylogenetic analysis of the 87 subtype 1a isolates was performed, they further segregated into five clusters, with two predominant clusters of 1a-2 and 1a-3: the annual frequency of cluster 1a-2 isolates decreased from 63 % in 1997, to 50 % in 1999, to 7 % in 2000 and no cases in 2002; cluster 1a-3 isolates were observed in all four years and its annual frequency increased from 5 % in 1997 to 95 % in 2002. Of the remaining three clusters, cluster 1a-1 was detectable only in 1997 and clusters 1a-4 and 1a-5 emerged in 2000 and 2002, respectively. These results indicate that genetic changes and take over of HEV strains may contribute to the genetic variability of HEV in the community.
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http://dx.doi.org/10.1099/vir.0.19571-0DOI Listing
January 2004

Molecular investigation of hepatitis E virus infection in patients with acute hepatitis in Kathmandu, Nepal.

J Med Virol 2003 Feb;69(2):207-14

Liver Foundation Nepal, Tripureswor, Kathmandu, Nepal.

One hundred fifty-four consecutive patients with sporadic acute hepatitis, who were seen at a city hospital in the Kathmandu valley of Nepal in 1997, were studied. IgM antibodies to hepatitis A virus were detected in four patients (3%), IgM antibodies to hepatitis B core in four patients (3%), hepatitis B surface antigen in 20 (13%), and hepatitis C virus RNA in four patients (3%). IgM antibodies to hepatitis E virus (HEV) (anti-HEV IgM) and HEV RNA were detected in 77 (50%) and 48 (31%), respectively. Consequently, 86 patients (56%) including nine HEV-viremic patients without anti-HEV IgM, were diagnosed with hepatitis E. The cause of hepatitis was not known in 53 patients (34%). All 48 HEV RNA-positive samples were genotyped as 1, and subtyped further as 1a in 17 (35%), 1c in 29 (60%), and mixed infection of 1a and 1c in 2 (4%). A seasonal difference in the prevalence of HEV subtypes was recognized. Before the rainy season (January to July), both 1a and 1c isolates were found: the intrasubtypic difference was up to 9.0% and 1.7%, respectively, in the 412-nucleotide sequence of open reading frame 2. During the rainy season (August), only 1c isolates (n = 17) with 99.5-100% identity were found; 13 of 17 isolates had the same sequence, being identical to the 3 isolates that emerged at the end of July. These results suggest that a particular HEV 1c strain spread widely during the rainy season and was implicated in a small epidemic in the Kathmandu valley in August 1997.
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http://dx.doi.org/10.1002/jmv.10276DOI Listing
February 2003

Bacterial peritonitis in hepatic inferior vena cava disease: a hypothesis to explain the cause of infection in high protein ascites.

Hepatol Res 2002 Sep;24(1):42

Liver Foundation Nepal, PO Box 3439 Tripureswor, Kathmandu, Nepal

Hepatic IVC disease (HVD), a disease caused by complete obstruction or stenosis of inferior vena cava (IVC) near cava-atrial junction is endemic in Nepal. It is a chronic disease characterized by upper abdominal pain, hepatomegaly, splenomegaly and dilated superficial veins in the body trunk. Ascites commonly, with high protein content is a feature of acute and subacute stages and during acute exacerbation of the chronic disease. We assessed the occurrence of bacterial peritonitis among patients of HVD with ascites. One hundred and sixty seven consecutive patients with ascites, which included 91 patients with HVD were examined for the presence of bacterial peritonitis. The ascitic fluids were examined for total and differential WBC count. The fluid and the blood were cultured for aerobic microorganisms by bedside inoculation in blood culture bottles. HVD is a common cause of non-cirrhotic high protein content ascites in Nepal. It was uniquely associated with high incidence of bacteremia (61%) and high incidence of mono-bacterial peritonitis (67%) from Gram-negative enteric bacteria (58.5%) and Staphylococcus aureus (42.5%). Ascites and bacterial peritonitis generally occurred almost simultaneously in these patients. It is postulated that when bacteremia occurred the defective portion of IVC near the cava-atrial junction become infected resulting in hepatic venous outflow obstruction and formation of ascites with high protein content. And spread of infection from the infected IVC to the peritoneum resulted in bacterial peritonitis.
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http://dx.doi.org/10.1016/s1386-6346(02)00018-9DOI Listing
September 2002