Sai Krishna Medical College & Hospital

Abstract Nanotechnology is rapidly becoming more and more important in today's technological world as the need for industry increases with human well-being. In this study, we synthesized SnO 2 nanoparticles (NPs) using an environmentally friendly method or green method from Croton macrostachyus leaf extract, leading to the transformation of UV absorbance to visible absorbance by reducing the band gap energy. The products underwent UV, FTIR, XRD, SEM, EDX, XPS, BET, and DLS for characterization. Characterization via UV–Vis spectroscopy confirmed the shift in absorbance towards the visible spectrum, indicating the potential for enhanced photocatalytic activity under visible light irradiation. The energy band gap for as-synthesized nanoparticles was 3.03 eV, 2.71 eV, 2.61 eV, and 2.41 eV for the 1:1, 1:2, 1:3, and 1:4 sample ratios, respectively. The average crystal size of 32.18 nm and very fine flakes with tiny agglomerate structures of nanoparticles was obtained. The photocatalytic activity of the green-synthesized SnO 2 nanoparticles was explored under visible light irradiation for the degradation of rhodamine B (RhB) and methylene blue (MB), which were widespread fabric pollutants. It was finally confirmed that the prepared NPs were actively used for photocatalytic degradation. Our results suggest the promising application of these green-synthesized SnO 2 NPs as efficient photocatalysts for environmental remediation with low energy consumption compared to other light-driven processes. The radical scavenging experiment proved that hydroxyl radicals ( _ OH) are the predominant species in the reaction kinetics of both pollutant dyes under visible light degradation.

Geopolymer is an environment friendly construction material that could be synthesized using either the natural source or the industrial byproducts such as flyash and GGBS. The characteristics of the Geopolymer rely on the proportion of the flyash and GGBS and the concentration of the activator solution used. In this research work, the effect of partial replacement of flyash with GGBS in proportions such as 0, 10, 20, 30 and 40% is investigated. Also Molarity of NaOH are tested from 8 to 14 M and both the parameters are optimized. In this optimized Geopolymer concrete, the utilization of iron slag as a partial substitute for river sand in various proportions such as 10, 15, 20, 25, 30 35, 40 and 45% are investigated. The optimized Geopolymer concrete with iron slag is investigated for its performance as a paver block with incorporation of banana fiber in proportions such as 0, 0.5, 1 and 1.5 and is compared with conventional cement concrete paver block. The results show that there is a significant enhancement in the properties of Geopolymer concrete with the different levels of optimization and the utilization of natural banana fiber. The developed sustainable paver block was found to with stand medium traffic conditions as per IS 15658:2006. Further this study employed random forest (RF) algorithm for the prediction of compressive strength of geopolymer concrete specimens for the variable parameters such as molarity of alkaline solution, Flyash/GGBS ratio and partial replacement of river sand with iron slag. The performance evaluation parameters represented high accuracy of developed RF model. This research work unleashes a heft potential of Geopolymer concrete to develop economical eco-friendly sustainable paver blocks to the society through mitigation of environmental strain on the ecosystem.

In recent times, the number of malware on Android mobile phones has been growing, and a new kind of malware is Android ransomware. This research aims to address the emerging concerns about Android ransomware in the mobile sector. Previous studies highlight that the number of new Android ransomware is increasing annually, which poses a huge threat to the privacy of mobile phone users for sensitive data. Various existing techniques are active to detect ransomware and secure the data in the mobile cloud. However, these approaches lack accuracy and detection performance with insecure storage. To resolve this and enhance the security level, the proposed model is presented. This manuscript provides both recognition algorithms based on the deep learning model and secured storage of detected data in the cloud with a secret key to safeguard sensitive user information using the hybrid cryptographic model. Initially, the input APK files and data are preprocessed to extract features. The collection of optimal features is carried out using the Squirrel search optimization process. After that, the Deep Learning-based model, adaptive deep saliency The AlexNet classifier is presented to detect and classify data as malicious or normal. The detected data, which is not malicious, is stored on a cloud server. For secured storage of data in the cloud, a hybrid cryptographic model such as hybrid homomorphic Elliptic Curve Cryptography and Blowfish is employed, which includes key computation and key generation processes. The cryptographic scheme includes encryption and decryption of data, after which the application response is found to attain a decrypted result upon user request. The performance is carried out for both the Deep Learning-based model and the hybrid cryptography-based security model, and the results obtained are 99.89% accuracy in detecting malware compared with traditional models. The effectiveness of the proposed system over other models such as GNN is 94.76%, CNN is 95.76%, and Random Forest is 96%.

The COVID-19 pandemic has shifted the medical education to the virtual mode in most of the countries. Though online learning has been practiced for long and proved to be effective, its usefulness should be looked for in developing countries like Nepal. Methods: An online survey was conducted among undergraduate medical students with the help of a structured self-administered questionnaire consisting of demographic information, modalities of online classes they are taking and their opinion regarding the online classes. Results: Most of the students had access to the devices and internet facilities though some of the students responded that they have no internet facility at home. More than half of the students have answered that they are having some sort of visual problem after the online classes have started. Most of the students responded that the internet connectivity issue is a hindrance to online learning. More than half of the students strongly disagree that online class should be continued even after the pandemic is over. Conclusion: There are lots of obstacles in virtual learning in resource-limited countries like ours. The effectiveness of e-learning should be evaluated among the students and the shortcomings of virtual learning should be addressed by concerned authorities.

This study explores the impact of banana fiber-reinforced diatomaceous earth (DE) slurry treatment on recycled concrete aggregate (RCA) and recycled aggregate concrete (RAC) for structural applications. Six types of treated recycled aggregates were prepared by coating their surface with a slurry containing 5% DE, 0-7% banana fiber, and ordinary Portland cement. Various tests assessed the treatment's impact on aggregate and concrete properties. The treatment improved specific gravity, aggregate crushing resistance, impact resistance, and abrasion resistance for up to 5% of banana fiber in the slurry. The formation of additional calcium silicate hydrate (C-S-H) phases contributed to strengthening the microstructure by filling voids and enveloping the aggregate surface. Concrete prepared with treated recycled aggregate showed significant improvements in compressive strength (25.14%), tensile strength (36.58%), and flexural strength (72%) at an optimum 5% fiber content. Non-destructive testing confirmed better surface hardness and internal quality, while microstructural analyses revealed improved bonding and fiber reinforcement. These substantial improvements demonstrate the potential of banana fiber-reinforced DE slurry treatment for sustainable construction practices.

Background: Oral health habits are measures people learn and practice regularly in order to maintain good oral health or prevent oral diseases. The mouth is an integral part of the body, and there are oral manifestations of many systemic diseases that must be managed in both healthy and medically compromised people. Oral health knowledge is considered to be an essential requirement for health-related practices. A good quality of life is possible if students maintain their oral health and become free of oral disease. Dental caries are increasing in developing countries day by day where preventive programs have not been implemented properly. The level of information on oral health knowledge and practices among medical students is unidentified and worthy of investigation in Nepal, and this study aimed at assessing the level of knowledge, attitude and practices on dental caries and oral hygiene among medical students studying at Janaki Medical College Teaching Hospital, Janakpurdham. Methods:A standard structured closed-questionnaire was designed and distributed to medical students studying in MBBS programme to assess the knowledge, attitude and practice about dental caries and oral hygiene. Results: Out of 330 medical students, 145 were male and 185 were female, of which male had the highest knowledge regarding dental caries which was found to be statistically significant. Most of the students had attitude of visiting once in year for dental check up. The highest number of students had once per day brushing habit in early morning with fluoride containing tooth paste. Conclusions: The present study concluded that the knowledge and practice status of oral hygiene and dental caries among medical students was found to be satisfactory. More oral health education programs must be conducted for the control of oral diseases.

The household heating and cooling system often use the capillary device. The use of the helical capillary eliminates the need for lightweight refrigeration devices in the system. Capillary pressure is noticeably affected by the capillary geometric parameters, such as length, mean diameter, and pitch. This paper is concerned with the effects of the capillary length on the performance of the system. Three separate length capillary tubes were used in the experiment. The data on R152a were studied under various conditions to assess the impact of varying the length. Maximum COP is obtained at an evaporator temperature of - 12 °C and capillary length of 3.65 m. The result is drawn that the system performance enhances when the capillary length is improved to 3.65 m when compared to 3.35 m and 3.96 m. As a result, as the capillary length increases up to a specific amount, the system's performance improves. The findings from the experiment were compared with those from the computational fluid dynamics (CFD) analysis.

By Shiva Raj Mishra, Bishal Joshi & 2 more. Global health enterprises need to revitalize local epistemic enterprises to undo the historical epistemic injustices imposed on them in various forms, by liaising with governmental, and non-governmental stakeholders

Container-based sanitation (CBS) services operate in a number of low-income urban settlements across the globe, providing sanitation services where other on-site and off-site sanitation systems face logistical and environmental restrictions. The viability of each CBS service is influenced by a number of location-specific factors. Drawing on an initial review of existing CBS services, this paper identifies and evaluates these factors in relation to establishing CBS in a new service location. By applying a weighted scoring matrix to these factors, the potential viability of CBS services has been assessed for urban informal settlements in Kathmandu Valley, Nepal. The viability of CBS services in these settlements was found to be most influenced by the current availability of basic sanitation facilities, the unfamiliarity with paying for sanitation services, and the universally adopted practice of anal cleansing with water. The process and scoring matrix developed and subsequently applied in Nepal are recommended as part of the pre-feasibility stage assessment where a CBS service is being considered as a sanitation option in new locations.

The incorporation of various reinforcements in aluminium composites markedly improves their thermal, mechanical, and wear characteristics when compared to composites with a single reinforcement. Nevertheless, heightened hardness presents challenges in machining, rendering traditional methods less efficient for obtaining high-quality cuts. This study explores the application of Abrasive Water Jet Machining (AWJM) on aluminium alloy LM26 hybrid composites that are reinforced with graphite and fly ash, which were manufactured through stir casting. AWJM is assessed as a viable machining technique to tackle the challenges presented by these advanced composites. The analysis focuses on key process parameters, including transverse speed, stand-off distance, and abrasive flow rate, to evaluate their impact on essential output responses such as surface roughness, material removal rate (MRR), and overcut error. A systematic experimental design utilizing an L27 orthogonal array is implemented to thoroughly examine the influences of various parameters. Response Surface Methodology (RSM) serves as a vital tool for statistical analysis and optimization, facilitating an in-depth exploration of parameter interactions and their influence on machining performance. The results offer important perspectives on enhancing AWJM parameters for hybrid aluminium composites, leading to better machining precision and efficiency. The ideal machining parameters were determined to be an abrasive flow rate of 440 g/min, a traverse speed of 300 mm/min, and a stand-off distance of 1.50 mm, leading to a peak MRR of 1.201 g/sec and a minimum surface roughness (Ra) of 2.018 µm. The investigation highlights AWJM's proficiency in processing high-hardness materials while preserving favorable surface qualities. The findings enhance manufacturing methods for reinforced aluminium composites, facilitating their wider use in aerospace, automotive, and other high-performance sectors.

Aim: The study aimed to access the knowledge, practice, and compliance related to COVID-19 among people residing in Province 2, Nepal. Materials and methods: A descriptive cross-sectional study was conducted from October 2020 to March 2021. A total of 457 participants of eight districts of Province 2 were enrolled after obtaining consent. Data were collected by face-to-face interviews with participants. A total of 31 validated pre-structured questionnaires were asked to participants in which 11 questions were for knowledge, 12 questions were for practices, and 8 questions were for compliance related to COVID-19. For tool validation, pre-testing was done in 10.0% of individuals of the targeted study population of Mahottari district. Results: < 0.05). District-wise association with knowledge, practice and compliance was found to be significant (p < 0.05). Conclusion: The findings suggest that participants have a good level of knowledge; however, the practice and compliances are considerably low related to COVID-19.

Abstract In recent decades, friction stir welding has emerged as a significant transformative technique in advanced manufacturing. In this work, fabricating the friction stir welding of 5 mm thick similar titanium grade 4 plates with varying weight percentages of naturally derived biochar (0, 1, 2, and 3 wt%) to enhance the mechanical properties and wear behavior. According to the test analysis, the biochar-included FSW samples had better mechanical properties than the plain-welded titanium sample. The 2 wt% biochar-induced FSW sample gets the best tensile result of 395 MPa, impact strength of 32.02 J, and fatigue result of 183 MPa. Through field emission scanning electron microscopy analysis, biochar was well dispersed throughout the regions and contributing to the grain nucleation. The bookend surfaces of the tensile fractured specimen were examined by using scanning electron microscopy analysis. According to micro-hardness and wear resistance test analysis, a 3 wt% biochar sample plays a key role in enhancing the results and getting 107 HV and a specific wear rate of 0.052 mm³/Nm×10 − 3 and a co-efficient of friction of 0.25 µ. The worn surface analysis was accomplished by scanning electron microscope analysis, and the wear mechanisms were studied. The novel approach of the present research is to suggest the ideal biochar FSW titanium sample for aerospace components in critical wear applications. This technique is currently gaining popularity and is being used in a variety of applications, including aviation, shipbuilding, aircraft companies, defense sectors, and the automotive industry. These are implemented to mitigate the detrimental effects and the emergence of defects in the joining of similar alloys in comparison to fusion welding techniques because of their energy-efficient, versatile, and eco-friendly process.

BACKGROUND: In today's fast-paced healthcare environment, self-directed learning is essential for healthcare professionals to stay updated and provide optimal care. Game based learning has a potential of motivating students' engagement and creating fascinating self-directed learning environment for favorable outcome. This randomized controlled trial aims to investigate the impact of game-based learning as an innovative self-directed learning strategy compared to conventional self-directed learning strategy on knowledge acquisition, and self-directed learning abilities among nursing undergraduates based on Self-directed learning Instrument (SDLI) score. METHODS: This quantitative, randomized controlled trial will enroll and randomize 140 undergraduate nursing students in the experimental and control group using stratified random sampling and follow them for 12 weeks. Self-directed learning (SDL) orientation session will be conducted prior to the randomization for all the participants. After randomization, experimental group will undergo SDL with game-based learning and control group will undergo SDL with conventional learning for four weeks. Follow up sessions will be conducted once a week for a period of 4 weeks. Evaluation of impact of intervention will be assessed at four time points: preintervention, immediately postintervention, 4 weeks postintervention and 12 weeks postintervention using structured knowledge questionnaire, Self-Directed Learning Instrument (SDLI) and Cognitive, Affective and Psychomotor (CAP) perceived learning scale. ANOVA will be used to compare the variations in self-directed learning ability, perceived learning competency, and knowledge between two groups. Regression analysis will be conducted to explore the correlation between various independent variables and the dependent variables. Paired t-test will be used to analyze the variation between pre-test and post-test results, considering a p-value less than 0.05 to be statistically significant. DISCUSSION: This trial aims to determine whether game-based learning as an innovative self -directed learning strategy is superior to conventional self-directed learning strategy in improving knowledge level and self-directed learning abilities of nursing undergraduates. This trial is approved by the Datta Megha Institute of Higher Education & Research, Institutional ethics committee (DMIHER(DU)/IEC/2023/141C). We plan to disseminate study results in peer-reviewed journals and international conferences. TRIAL REGISTRATION: Trial Registered Prospectively [CTRI/2024/01/061599].

Abstract The forward model design was employed in the Diffuse Optical Tomography (DOT) system to determine the optimal photonic flux in soft tissues like the brain and breast. Absorption coefficient (mua), reduced scattering coefficient (mus), and photonic flux (phi) were the parameters subjected to optimization. The Box–Behnken Design (BBD) method of the Response Surface Methodology (RSM) was applied to enhance the Diffuse Optical Tomography experimental system. The DC modulation voltages applied to different laser diodes of 850 nm and 780 nm wavelengths and spacing between the source and detector are the two factors operating on three optimization parameters that predicted the result through two-dimensional tissue image contours. The analysis of the Variance (ANOVA) model developed was substantial (R 2 = &gt; 0.954). The experimental results indicate that spacing and wavelength were more influential factors for rebuilding image contour. The position of the tumor in soft tissues is inspired by parameters like absorption coefficient and scattering coefficient, which depend on DC voltages applied to the Laser diode. This regression method predicted the values throughout the studied parameter space and was suitable for enhancement learning of diffuse optical tomography systems. The range of residual error percentage evaluated between experimental and predicted values for mua, mus, and phi was 0.301%, 0.287%, and 0.1%, respectively.

BACKGROUND: Counterfeit medicine is not only illegal, but it is also an insidious threat and poses serious public health and safety concern. Health professionals can play an important role in campaign against counterfeit drugs by staying vigilant, reporting suspicious products and preventing the distribution of counterfeit medicine. The present study aims to assess the awareness and attitude towards counterfeit medicine among health professionals and pharmacists in Nepal. METHODS: It was a cross-sectional study conducted among 264 health professionals and pharmacists of Saptari, Nepal. Samples were recruited by quota sampling technique and pretested, self-administered questionnaire were used for collecting data regarding socio-demographic, knowledge and attitude on counterfeit medicine. Descriptive & inferential statistics were used to analyze the data generated. RESULTS: This study found that mean knowledge score of respondent was 12.11±4.3 and only 31.7% (n=39) of the respondents had good knowledge on counterfeit medicine while 44.7% (n=55) showed moderate and 23.6% (n=29) had poor knowledge levels. Nurses, paramedics and pharmacists scored statistically lower than doctors, however there was no significant difference in knowledge between nurses and pharmacists (p< 0.001). Mean attitude score was 3.82 (±0.68) and majority of respondents (85.3%) showed favorable attitude towards counterfeit medicine. Respondents having poor knowledge level had statistically significant unfavorable attitude towards counterfeit medicine Conclusions: The study highlighted the need for counterfeit medicine awareness campaigns and training to enhance the role of health professionals and pharmacists to recognize and report suspicious medicine and prevent counterfeit medicines-associated harms.

Access to topical corticosteroids (TCs) globally includes over the counter (OTC) sale without proper guidelines, exacerbating treatment-resistant infections and complicating outcome of skin conditions. The main aim of the study was to evaluate the reasons behind OTC use of TCs among patients with skin conditions before attending a skin specialist clinic. This study was conducted from September 2021 to March 2022. The study included in-depth interviews (IDIs) and observations, among a total of thirty-one patients with specific skin conditions using TCs, at the Sarnath Skin Centre in Siddhartha Nagar (Bhairahawa), Nepal. All interviews were conducted in the Nepali language, audio-recorded, transcribed and translated into English and were coded and analyzed in NVivo. Among the 31 individuals diagnosed with Dermatophytosis, Melasma, Eczema, common treatments included use of Sonaderm (Clobetasol, Gentamycin and Miconazole), Derma-KT (Clobetasol, Gentamicin, Ketoconazole and Iodochlorhydroxyquinoline) and steroid-infused products from non-medical sources for prolonged periods of time, exposing patients to transient recovery and perpetuating a vicious cycle of OTC treatment seeking until patients failed to recover. OTC seeking was facilitated by participants' easy access to drug dispensers, suggestions from and practice of family and friends which often led to temporary relief for a few weeks/months. In addition, access factors (e.g., distance, cost, time), convenience factors (e.g., ease of presenting at the drug store compared to skin clinic) also influenced the choice for OTC. There was a lack of knowledge related to adverse effects of topical steroids, including proper guidance on the use of topical medications and limitations of home remedies. OTC use of topical medications poses significant challenges, often leading to complicated skin cases that present late at skin-specialist clinics. A multi-pronged public and community engagement approach is critical to curb the treatment seeking dynamics among patients developing skin conditions.

By Shiva Raj Mishra, Bishal Joshi & 2 more. Global health enterprises need to revitalize local epistemic enterprises to undo the historical epistemic injustices imposed on them in various forms, by liaising with governmental, and non-governmental stakeholders

BACKGROUND: Among all the abdominal cancers, pancreatic cancer is the second most common one. Majority of the patients present with an excruciating pain when they are diagnosed with the disease. Coeliac plexus neurolysis (CPN) is a procedure that can control the pain in pancreatic cancer while precluding further consumption of analgesics in higher doses and quantity. The procedure of neurolysis is performed by injecting phenol/alcohol into the coeliac plexus ganglionic neural network. There is a high proportion of pain relief with CPN in up to 80% of the patients. AIM: The aim of our study is to assess the pain relief after CPN, reduction in analgesics consumption and evaluation of patient satisfaction post procedure. METHODS: A cross sectional study was done and we collected the retrospective data from December 2016 to November 2017. A total of 35 patients of either gender (male and female) were included in this study. Neurolysis was done with transcrural approach using 6% phenol. Follow up of patients was done after 1 and 4 weeks of the procedure. The patients were evaluated for pain scores on numeric rating scale (NRS), reduction in analgesia and patient satisfaction regarding the procedure and pain relief. The analysis was based on mean values. RESULTS: Total numbers of patients were 35. The mean age was 54.11±12.51 (SD) years with a male to female percentage of 31.43% and 68.57%. Follow up was done after 1 week and 4 weeks. Patients reported decrease in mean pain score (1 from 9 in Males and 0 from 9 in Females), reduction in analgesics (81.8% among Males and 18.2% among Females) and over all patient's satisfaction was (72.7% Males and 27.3% Females). CONCLUSIONS: It has been observed from the results that CPN works effectively for pancreatic cancer patients. There is a strong recommendation of neurolysis in patients with pancreatic cancer pain as it improves the pain scores, significant reduction in analgesia consumption with good patient satisfaction.

Purpose: Shaukat Khanum Memorial Cancer Hospital and Research Cancer primarily deals with cancer patients and has various departments which provide best-integrated lifesaving care. However, when patients who have been given all possible medical and oncological treatment still progress their disease, they are then referred for best supportive care to palliative care department. The aim of this paper was to audit documented care for palliative patients before and after implementation of end of life care (ELC) pathway.Materials and Methods: We used a retrospective method to audit 45 terminally ill patients over a period of 3 months. Then, a re-audit was done over a period of 3 months and data were collected for patients who were started on SKM-ELC pathway.Results: Results show that the implementation of ELC pathway, 67% of the patients were not prescribed PRN medications for symptom control, 20% of the patients were not reviewed for the need of assisted nutrition and for 20% of the patient’s primary team were not even notified that the patient is dying. After the ELC pathway implementation, it was found that 100% of patients were reviewed for PRN medications and assisted nutrition. Oncologists were timely notified that the patient is dying.Conclusion: In summary, we can say that implantation of ELC pathway has significantly improved documented patients care in all aspects.Key words: Cancer, care for dying, end of life care, goals of care pathway

This work aims to provide a mathematical model that can be applied to prediction and defines this relationship. It helps economists understand how different factors influence economic indicators such as GDP, inflation, unemployment, and market trends. Forecasting using regression models provides valuable insights for policy-making, business strategies, and economic planning.