Manipal Teaching Hospital

Abstract Background: Persistent high-risk human papillomavirus is responsible for 95% of all cases of cervical cancer worldwide. Screening for high-risk genotypes has been acknowledged as the gold standard for the elimination of cervical cancer. However, most low- and middle-income countries have limited access to this screening method because ofa lack of adequate sustainable resources. Objective: This study aimed to compare the diagnostic accuracy of the rapid high-risk human papillomavirus 16/18 oncoprotein E6/E7 antigen test to that of the polymerase chain reaction (PCR) deoxyribonucleic acid test among women who presented to family planning and dysplasia clinics at Moi Teaching and Referral Hospital. Methods: This was a cross-sectional study performed between February and July 2024 to compare the diagnostic accuracy of the rapid high-risk human papillomavirus 16/18 oncoprotein E6/E7 antigen test to that of the polymerase chain reaction deoxyribonucleic acid test among women who underwent cervical cancer screening at Moi Teaching and Referral Hospital. Two hundred and fifty-seven (257) women aged 30 years and older were randomly selected for this study. A cervical swab was obtained from all participants for human papillomavirus polymerase chain reaction deoxyribonucleic acid testing, followed by cervical sample collection using the Delphi vaginal self-sampler for the rapid human papillomavirus oncoprotein E6/E7 antigen test. To achieve the objective of the study, sensitivity, specificity, positive predictive value, and negative predictive value were measured. Data on sociodemographicand clinical characteristics were collected and analysed. The significance of the data was set at a two-tailed p<0.05. The chi-squaretest was used to compare categorical variables. Fisher’s exact test or the Monte Carlo correction was used for the chi-square analysis when more than 20% of the cells had an expected count <5. Results: The sensitivity of the rapid oncoprotein E6 and E7 test was 99.33%, and the specificity was 99.07%. In addition, the positive predictive value and negative predictive value were 99.33% and 99.07%, respectively. Furthermore, the accuracy of the rapid oncoprotein E6/E7 test was 99.22%. These findings were statistically significant (p <0.001, 95% CI=0.98–1.00), and the AUC for the rapid oncoprotein E6/E7 test was 0.992. Conclusion: The accuracy of the rapid high-risk human papillomavirus mRNA oncoprotein E6/E7 antigen test is as good as that of the polymerase chain reaction deoxyribonucleic acid test for cervical cancer screening in low-resource settings.

ABSTRACTBackgroundCerebrospinal fluid (CSF) collection is routinely performed in dogs with neurological disorders. Little is known about the rate of major complications associated with CSF collection.ObjectivesDetermine the number of dogs experiencing a major complication secondary to CSF collection in a single referral hospital.AnimalsEleven dogs.MethodsSingle‐center, retrospective description of the number and nature of major complications encountered during or after CSF collection in dogs.ResultsFrom 7545 CSF collections performed between 1998 and 2024, 11 dogs (0.15%) experienced a major complication. Eight of these dogs had abnormal mentation on presentation. The most common neuroanatomical localization was multifocal (5/11). Nine dogs underwent magnetic resonance imaging (MRI) of the head and one dog had radiographs of the cervical vertebral column before CSF collection. The most common MRI findings included effacement of the cerebral sulci (7/9) and dilatation of the ventricular system (5/9). Cerebrospinal fluid collection was performed in 11 dogs, of which 3 were unsuccessful. Analysis of CSF aided in the diagnosis of meningoencephalitis of unknown origin (3/8), cryptococcosis (1/8), lymphoma (1/8), and results were normal in one and non‐specific in two dogs. Eight dogs were euthanized after failure to recover spontaneous ventilation (6), cardiopulmonary arrest (1) or severe neurological deterioration (1). One dog died during cardiopulmonary resuscitation. Repeat MRI after CSF collection identified caudal transtentorial and foramen magnum herniation in one dog. Two dogs survived to hospital discharge but with permanent neurological deficits.ConclusionThe frequency of major complications following CSF collection was low, but the associated mortality was high. Abnormal mentation and MRI evidence of cerebral cortical swelling were commonly detected before CSF collection in dogs experiencing complications.

The survival of dogs with pheochromocytoma (PCC) treated with adrenoreceptor antagonists has not been described or compared to surgically managed cases. The objective of this study is to evaluate the survival of medically and surgically managed dogs with PCC and investigate factors associated with survival. Two hundred fifty-five dogs with PCC, treated with alpha-adrenoreceptor antagonists (AA) without adrenalectomy (Group 1, n = 75), adrenalectomy +/- AA (Group 2, n = 128), or neither treatment (Group 3, n = 52). Retrospective, multicenter review of medical records. Median overall survival time (OST) for Groups 1 and 2 combined was calculated using Kaplan-Meier estimates, and then compared between Group 1 and Group 2 using Log-Rank testing. Cox proportional hazard analysis identified factors associated with survival in Groups 1 and 2 individually and combined. Median OST for all cases was 854 (95% CI: 572-1136) days. Median OST was lower in Group 1 (247 days, 95% CI: 76-418 days) than in Group 2 (927 days, 95% CI: 587-1267 days; p < 0.001). In Group 2, 88/92 dogs (97.8%) that received presurgical AA treatment survived to discharge compared to 23/27 (85.2%) that did not receive AA pretreatment (p = 0.03). Lack of clinical signs at presentation was associated with increased survival in both groups combined (HR 0.5; 95% CI 0.3-0.9; p = 0.02) and in Group 2 alone (HR 0.3; 95% CI 0.1-0.7; p = 0.01). Dogs with PCC treated with adrenalectomy have longer survival compared to those managed with AA without adrenalectomy.

This study provides a comprehensive descriptive analysis of service marketing and customer satisfaction within the tourism sector of Eastern Nepal. Utilizing a sample of 185 respondents, the research employed a structured questionnaire to gather data on key dimensions such as service quality, price competitiveness, convenience of locations, cultural experiences, brand image, and overall customer satisfaction. The results reveal that tourists generally perceive high levels of service quality, particularly regarding responsiveness and efficient service delivery, with mean scores indicating positive experiences across various metrics. Price competitiveness was rated favorably, suggesting that respondents find Nepal's tourism offerings provide good value for money. Accessibility of major attractions and the quality of cultural experiences were highlighted as significant contributors to overall satisfaction. Notably, respondents expressed strong intentions to revisit and recommend Nepal as a tourist destination, emphasizing the effectiveness of current marketing strategies the cultural richness of the region. The study underscores the importance of ongoing collaboration between government and local businesses to enhance service delivery and address challenges in the tourism industry, ultimately positioning Eastern Nepal as a premier destination for global travelers. These insights are essential for developing targeted strategies that further promote sustainable growth in the region's tourism sector.

Phytochemical study helps to identify bioactive compounds in medicinal plants, mainly alkaloids, flavonoids, tannins, terpenoids, and phenolics, which are known for their therapeutic potential. Traditional extraction methods such as maceration and Soxhlet remain useful, but modern green approaches like supercritical fluid extraction and ultrasound-assisted extraction offer higher efficiency and sustainability. For compound identification, classical methods including Thin Layer Chromatography (TLC), High Performance Liquid Chromatography (HPLC), Gas Chromatography-Mass Spectrometry (GC-MS), and Fourier Transform Infrared Spectroscopy (FTIR) remain reliable. Latest advance, such as Nuclear Magnetic Resonance (NMR), Liquid Chromatography–Tandem Mass Spectrometry (LC-MS/MS), metabolomics, and machine learning–assisted spectral analysis, have further enhanced accuracy in profile complex plant metabolites. Together, these integrated methods strengthen quality control, ensure standardization, and accelerate natural product–based drug discovery. Phytochemical analysis thus continues to bridge traditional plant knowledge with modern pharmaceutical applications.

Objective: The present study will help us in establishing local statistics in our population. Study Design: Descriptive study. Setting: Department of Orthopedic Surgery at Khyber Teaching Hospital in Peshawar. Period: June 2023 to December 2023. Methods: Seventy MRI of knee were collected. Knee MR images sagittal and coronal plane (T2-Weighted Images) were reviewed by radiologist and only knees with an intact cruciate ligament were included in the study. All the measurement (length and width) were made with electronic caliper. Results: Regarding radiological length of ACL on sagittal view on MRI, the minimum length was 28mm and maximum was 46mm and mean length was 34mm and standard deviation of 4.49, Regarding width of ACL on sagittal view it was found that the minimum length was 8mm and maximum was 16mm and its mean length was 10.4mm with standard deviation of 2.02. While the width of ACL on coronal plane was such that the minimum length was 6mm maximum was 16mm its mean was 11.34 and standard deviation of 2.48. By applying one sample T-Test and compare with Kowen parameter the p value was 0.00 for both length and width showing statistically highly significant. Conclusion: In conclusion in our population ACL is shorter and thicker then westerns population. Further studies should be done arthroscopically and on cadaveric to establish our local statistics of anthropometric measurements of anterior cruciate ligament.