bluuebunny/crossref_metadata_2025 huggingface dataset:
The roles of JAK/STATs and transcription factors in the framework of host immunological pathways
Authors: Hu Wan-Chung
Published: June 2021

Transcription factors, especially STATs proteins, play vital roles in the host immunological pathways. These STATs proteins compete each other and drive different immunological pathways in reaction to different pathogens. Here, I summarize the JAK-STAT signaling for each immunological pathway. In addition, specific important transcription factors for specific immune response are also given. Tfh is related to STAT5 and BCL6. Treg is related to STAT5a, STAT5b, and FOXP3. TH1 immunity is related to STAT1a, STAT4, and T-bet. TH2a immunity is related to STAT6, STAT1a, GATA1, and GATA3. TH2b immunity is related to STAT6, STAT3, GATA2, and GATA3. TH22 immunity is related to STAT3 and AHR. THab immunity is related to STAT1a, STAT1b, STAT2, STAT3b, and ISGF. TH1-like immunity is related to STAT1a, STAT4, STAT5a, and STAT5b. TH9 immunity is related to STAT6, STAT5a, STAT5b, and PU.1. TH17 immunity is related to STAT3a, STAT5a, STAT5b and RORG. TH3 immunity is related to STAT1a, STAT1b, STAT2, STAT3b, STAT5a, STAT5b, and ISGF.
Những người kiến tạo không gian và văn hóa khoa học Phenikaa
Authors: Huyen Nguyen Thanh Thanh
Published: June 2021

Những người kiến tạo không gian và văn hóa khoa học Phenikaa
Hak Asasi Manusia di Indonesia: Menuju Democratic Governances
Authors: phoenix
Published: June 2021

Democratic governance requires the existence of good governance, human rights, and democracy. Obtaining the standard of democratic governance is needed by Indonesia to be internationally accepted. Nonetheless, Indonesia’s record on human rights leads to the understanding that this country has to pay high attention to human rights. Five elements can be contested to evaluate the position of Indonesia in achieving democratic governance. Democracy, in general, is often called from the people by the people and for the people, the people as the majority have a voice in determining the process of formulating government policies through available channels. Several elements must be considered in democratic governance, namely, people's sovereignty, majority power, government based on the approval of those who are ordered, equality before the law, and no less important is the guarantee of human rights to realize a democratic government.
KONSEP DASAR ILMU GIZI
Authors: nurain salsabila
Published: June 2021

gizi adalah Ilmu gizi (Nutrition Science) : Ilmu yg mempelajari segala sesuatu tentang makanan dlm hubungannya dg kesehatan optimal.
Value Proposition Design
Authors: Clarence Richard
Published: June 2021

Value Proposition Design
The Recovery of MSMEs and Efforts to Digitize
Authors: Liang Nicole Doelitzsch
Published: June 2021

Companies that are disrupting new media technology, especially during this Covid 19 era must have a new business platform. However, there are many incumbent companies that are less able to keep up. This study used a qualitative method, a case study approach. The analysis focuses on efforts to raise Medium, Small and Medium Enterprises (MSMEs) that contribute to improving the Indonesian economy. The findings show that their position in small and medium enterprises doesn’t get strengthen by credit, training and mentoring programs. But to accelerate income distribution in Indonesia, They are still working to increase the literacy index and financial inclusion.
Medium, Small and Medium Enterprises and Digital Platforms
Authors: imkotta Distin Findly
Published: June 2021

A new business platform is a must for companies that are disrupting new media technology, especially during the Covid 19 era. However, many incumbent companies are less able to keep up with changing business trends. Anticipate all changes in the competitive sclimate in the digital era in carrying out the company transformation program along with the implementation of good corporate governance values to avoid oral hazards and a greater risk of failure. The qualitative method used in this research is a case study approach. The analysis focuses on efforts to raise Medium, Small and Medium Enterprises (MSMEs) that contribute to improving the Indonesian economy. The findings show that credit, training, and mentoring programs have not been able to strengthen their position in small and medium enterprises but they are still working to increase the literacy index and financial inclusion to accelerate income distribution in Indonesia.
KEBIJAKAN KEIMIGRASIAN DI MASA PANDEMI COVID-19
Authors: Elmin Anggisa Ayu
Published: June 2021

Covid Disease 2019 (Covid-19) showed up toward the finish of 2019 in Wuhan, Hubei Province, China. The infection spread to different nations, including Indonesia. To forestall Covid-19 from spreading in Indonesia, the public authority, through the Directorate General of Immigration, given a few approaches while as yet maintaining basic freedoms. This examination will answer two issues. First is the means by which far types of movement strategy identified with Covid-19 from the viewpoint of basic liberties, second what are the deterrents confronted while executing the approach. The examination strategy utilized is subjective and with deductive reasoning rationale. This examination infers that the public authority sets two approaches during Covid-19. They are limitations for outsiders to Indonesian region and identification administrations limitations. On a basic level, the two approaches don't contain components of common liberties infringement. Other than of that, there is no critical obstruction during the time spent carrying out the approach so everything went on while as yet maintaining basic freedoms.
Software-based cognitive therapy intervention targeting core symptoms in Autism: A single case study
Authors: Awasthi Bhuvanesh
Published: June 2021

This study demonstrates the use and effectiveness of an online digital cognitive therapy platform to target core symptoms of Autism. A single case study of a nine-year-old subject is presented who underwent a 15-week cognitive and reading therapy intervention using software-based gameplays. Pre- and Post-intervention assessments show marked improvement in word reading, handwriting, sentence reading fluency and comprehension skills. In addition, the Parent observed positive behavioural changes in social engagement, self-control, improved motor skills, improved tolerance of sensory load, reduction in irritability, hyperactivity and aggressiveness. The study indicates that a short, digital, game-based cognitive therapy and reading training of letter-sound correspondences and word-level reading can boost the reading development of struggling readers in Autism. Such an option is beneficial for effective and meaningful engagement-based remote learning for neurodiverse populations. This case study is the first step in developing a community-based program for engaging parents in providing intervention to their children using simple to using online digital cognitive therapy.
A time-varying diffusion model analysis of age differences in value-based decisions: sooner processing but lesser weighting of reward probabilities in older adults
Authors: Chen Hsiang-Yu , Lombardi Gaia , Li Shu-Chen , Hare Todd
Published: June 2021

Empirical evidence has shown that visually enhancing the saliency of reward probability information can ease the cognitive demands of value comparisons and improve value-based decision-making in old age. In the present study, we used a time-varying DDM that includes starting time parameters (henceforth starting time DDM, stDDM) to better understand how increasing the saliency of probability may affect the dynamics of value-based decision-making. We enhanced the saliency of reward probability by using a color-coding scheme as a decision-aid in a mixed lottery choice task, with which the decisions of younger and older adults were assessed. Older adults’ evidence accumulation processes were less sensitive to information about outcome probability and magnitude than those of younger adults. The decision-aid enhanced the weighting of probability and magnitude information in both age groups, as well as the starting time advantage for probability information relative to magnitude information. Older adults who had a lower baseline value sensitivity, as reflected in the parameters from non-aid trials, benefited more from increasing information saliency in improving decisions. Furthermore, in older adults, this aid-induced effect was related to individual’s spontaneous eye-blink rate, a potential proxy of dopamine functioning. Taken together, analyzing the behavioral data using the stDDM revealed new evidence for adult age differences during value-based decisions: not do only older adults weigh the outcome probability and magnitude less than younger adults, they also do not process information about probability sooner than magnitude. Visually enhancing the saliency of probability information can benefit older decision makers in shifting their decision dynamics to be more similar to younger adults.
Are commonly used proxy measures of food value and motivation predictive of self-reported real-world snacking? An ecological momentary assessment study
Authors: Masterton Sarah , Hardman Charlotte , Boyland Emma , Robinson Eric , Makin Harriet , Jones Andrew
Published: June 2021

While the assessment of actual food intake is essential in the evaluation of behaviour change interventions for weight-loss, it may not always be feasible to collect this information within traditional experimental paradigms. For this reason, proxy measures of food intake (such as measures of food value and choice) are often used as more accessible alternatives. However, the predictive validity of these measures (in relation to subsequent food consumption) has not yet been studied. Using an Ecological Momentary Assessment design, our aim was to investigate the extent to which three commonly used proxy measures of snack food intake (explicit food value, unhealthy food choice and implicit preference) predicted self-reported real-world snacking occasions over a 7-day study period. Our findings demonstrated that none of the proxy measures significantly predicted self-reported healthy or unhealthy snacking occasions, or the number of unhealthy portions consumed by participants. These findings raise questions in relation to the association between proxy measures and self-reported real-world snack food consumption. Future research should further evaluate the predictive and construct validity of proxy measures in relation to food behaviours and explore the development of alternative assessment methods within eating behaviour research.
Medical Education Videos as a Tool for Rehearsal: Efficiency and the Cases of Background Music and Difficulty
Authors: Meyerhoff Hauke S. , Merkt Martin , Schröpel Carla , Meder Adrian
Published: June 2021

This study reports a field experiment investigating how instructional videos with and without background music contribute to the learning of examination techniques within a formal curriculum of medical teaching. Following a classroom teaching unit on the techniques for examining the knee and the shoulder joint, our participants (N = 175) rehearsed the studied techniques for either the knee or the shoulder joint with an instructional video with or without background music. As dependent measures, we collected a general questionnaire, a judgement of learning, as well as performance on an exam-like knowledge test covering both joints. For both videos, the participants who had watched a particular video during rehearsal were more accurate in answering the corresponding questions than the participants who had seen the other video, signaling that instructional videos provide a useful tool for rehearsal. For the knee video (less difficult), we observed a detrimental effect of the background music, whereas we observed no such effect for the shoulder video (more difficult). Further explorations revealed that background music might be detrimental for learning, as it reduces the perceived demand characteristics. Because the impact of the demand characteristics might be more pronounced in less difficult instructional videos, we discuss video difficulty as a potential moderating factor. Overall, our study provides evidence that instructional videos could be usefully implemented in formal teaching curricula and that such instructional videos probably should be designed without background music.
Singers show enhanced performance and neural representation of vocal imitation.
Authors: Waters Sheena , Kanber Elise , Lavan Nadine , Belyk Michel , Carey Daniel , Cartei Valentina , Lally Clare , Miquel Marc , McGettigan Carolyn
Published: June 2021

Humans have a remarkable capacity to finely control the muscles of the larynx, via distinct patterns of cortical topography and innervation that may underpin our sophisticated vocal capabilities compared with non-human primates. Here, we investigated the behavioural and neural correlates of laryngeal control, and their relationship to vocal expertise, using an imitation task that required adjustments of larynx musculature during speech. Highly-trained human singers and non-singer control participants modulated voice pitch and vocal tract length (VTL) to mimic auditory speech targets, while undergoing real-time anatomical scans of the vocal tract and functional scans of brain activity. Multivariate analyses of speech acoustics, larynx movements and brain activation data were used to quantify vocal modulation behaviour, and to search for neural representations of the two modulated vocal parameters during the preparation and execution of speech. We found that singers showed more accurate task-relevant modulations of speech pitch and VTL (i.e. larynx height, as measured with vocal tract MRI) during speech imitation; this was accompanied by stronger representation of VTL within a region of right dorsal somatosensory cortex. Our findings suggest a common neural basis for enhanced vocal control in speech and song.
Book Review: Generation Z & Industrial Revolution 4.0 (Generasi Z & Revolusi Industri 4.0)
Authors: Hayati Sab Fitri Nur , Pandin Moses Glorino Rumambo
Published: June 2021

The purpose of writing this review is to find out information from the book's contents and assess the weaknesses and strengths of the book. The author did this review because he saw the development of the generation in Indonesia and their ability to face the era of the industrial revolution 4.0. Therefore, it is necessary to provide knowledge in relevant formal, non-formal, and informal education.The book entitled Generation Z & Industrial Revolution 4.0 was written by Hadion Wijoyo, one of the permanent lecturers at STMIK Dharmapala Riau. The purpose of writing books is because the millennial generation contributed a lot to drive the industrial revolution. The millennial generation can take advantage of increasingly developing technology. The millennial generation needs to be provided with knowledge in relevant formal, non-formal, and informal education.This book is intended for the millennial generation in Indonesia. The opportunity for the industrial revolution 4.0 to occur is tremendous if they can adapt well. So that the millennial generation is expected to make technology in Indonesia more advanced, as the millennial generation must be able to study all developments in the Industrial Revolution to bring the Indonesian nation forward. However, technological developments must also be by the Pancasila principles so that they do not conflict with the goals of the Indonesian government.The book Generation Z & the Industrial Revolution 4.0 provides information about the occurrence of the industrial revolution 4.0 in Indonesia. Industrial revolution 4.0 was implemented with the increase in machine technology, strategic policy frameworks, and others. Given the development of technology, the role of generation Z will also increase in achieving the benefits of the industrial revolution.The reader will interest in the book since it is fascinating. The book is interesting because it contains the role of the millennial generation in the industrial revolution. It is essential for the millennial generation so that they can keep up with existing technological developments. Therefore, this book by Hadion Wijoyo can be used as a guide in utilizing existing technology. The millennial generation must also have and practice the principles of Pancasila in everyday life so that they are not misguided when following technological developments.
Prevalence of Laryngopharyngeal Reflux in Patients with Gastroesophageal Reflux Disease Undergoing Upper Esophagogastroduodenoscopy
Authors: Regmi Chalise Sangita , Khadka Subash , Mukhia Rupesh , Thapa Abishek , Gautam Santosh , Sah Mukesh , Ranjan Rashmi
Published: June 2021

Introduction Gastroesophageal reflux disease (GERD) has been defined as the retrograde flow of gastric contents into the esophagus. Laryngopharyngeal reflux (LPR) is one of the manifestations of GERD which can be diagnosed clinically by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The aim of this study was to find the prevalence of laryngopharyngeal reflux in patients with GERD undergoing upper esophagogastroduodenoscopy.

MethodsThis was a prospective cross sectional study and all the patients visiting author’s institute with GERD undergoing upper esophagogastroduodenoscopy were included. All the relevant data on history, examination, RSI scores, RFS scores and upper esophagogastroduodenoscopy findings were recorded in the standard proforma and data were analysed.

ResultsA total of 205 patients with GERD and undergoing upper esophagogastroduodenoscopy were included whose mean age was 46.1 years. The female to male ratio was 1.3:1. The most common presenting symptoms in our study was hoarseness (97%) followed by coughing (90.7%). The mean RSI score was 11.6. The symptom prevalence of LPR was 23.4%. The prevalence in between age groups and gender was not significantly different. The mean RFS score was 9.5. The prevalence of LPR by RFS assessment was 64.4%, which is significantly more than the prevalence assessed by RSI (23.4%).

ConclusionThe prevalence of LPR in patients with GERD by RSI was less than the prevalence by RFS. So both the tools need to be used simultaneously to make the diagnosis and not recommendable to use independently.
Profile and Outcome of Patients Admitted to Pediatric Intensive Care Unit at a General Referral Hospital
Authors: Sharma Arun K , Gurung Binay
Published: June 2021

Introduction Nepal has made substantial progress in child health primarily through preventive care. There is an increasing need for critical care services across the country which is highly resource-intensive. Periodic data of critical care admissions help plan the utilization of scarce resources in a low-income country like Nepal. This study aimed to analyze the epidemiologic patterns of critically ill pediatric patients admitted to the pediatric intensive care unit (PICU).

MethodsThis descriptive study of all children admitted to PICU at Tribhuvan University Teaching Hospital for 18 months between October 2017 and April 2019 was conducted by a retrospective review of hospital records. Demographic data, etiologies of PICU admissions and outcomes of children admitted to the PICU were analyzed.

ResultsPICU admitted 413 children during the study duration from all over the country. Children under the age of 2 years (36%) were admitted in the largest number and boys outnumbered girls (65.1%). Respiratory illnesses, neurosurgical and neurological problems, infectious disorders and airway foreign bodies were the most common etiologies for admission. The average length of ICU stay was around 4.4 days. Almost one-third of patients required circulatory and respiratory support. At the time of exit from PICU, 14.3% of patients died; 4.3% patients had opted for withdrawal of life support or decided to leave hospital against medical advice.

ConclusionPatients with diverse etiologies were admitted to ICU from all over the country. A similar analysis from PICUs across the country can serve as the basis for development of newer intensive care facilities in the country, developing dedicated protocols for critical care and redistributing the ICUs’ available resources for optimal efficiency.
Awareness Regarding Hypertension among Adults in a Community of Bhaktapur, Nepal
Authors: Pokhrel Sanju , KC Tulza
Published: June 2021

Introduction Hypertension is a common global health problem with significant morbidity and mortality. Various preventive life style practices play significant role in controlling it. The objective of this study was to identify awareness regarding hypertension among the adult people in a community of Bhaktapur, Nepal.

MethodsA descriptive cross-sectional study was conducted among 138 adults aged 20-59 residing in Bhaktapur, selected through non probability purposive sampling technique. The data was collected by face to face interview method through semi structured questionnaire. Data was analyzed by using descriptive and inferential statistics.

ResultsThe study showed that 58.7% of adults had adequate awareness regarding hypertension. About 35.5% knew the range of value of high blood pressure and nearly half (47.8%) answered heart as the organ primarily related to hypertension. Stress was identified as a risk for hypertension by 96.4%, 92% specified headache as main symptom and only 31.9% knew about the asymptomatic nature of hypertension. Nearly 90% were aware that management of hypertension includes all: medicine, diet and exercise. Almost 99% of the respondents mentioned about restricting alcohol for BP control and 93.2% mentioned heart attack as the complication of hypertension.

ConclusionThe study concluded that only half of adults have adequate awareness regarding hypertension. It also showed that there is statistically significant association of awareness level with age, religion, educational status, occupation, economic status, family history and diagnosis of hypertension. Thus, it could be recommended that health personnel should provide education and information covering all aspects of hypertension to adults residing in community.
Case of HER2-Enriched Multifocal Breast Cancer Associated with Pregnancy
Authors: Khanal Suman , Singh Yogendra P , Shrivastav Shreya
Published: June 2021

Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome.
A Case Report of Recurrent Pyogenic Granuloma with Satellitosis
Authors: Parajuli Sudip , Das Anil K , Paudel Upama
Published: June 2021

Recurrent pyogenic granuloma with satellitosis is an uncommon condition with majority of cases resolving within one year after treatment. We report a case of recurrent pyogenic granuloma in a middle aged man who kept on relapsing at different point of time despite treatment with electrocoagulation, cryosurgery and oral methotrexate. The case highlights the unusual presentation of relatively common condition of pyogenic granuloma.
Fracture Nasal Bone: Causes, Presentation and Management in a Tertiary Care Center in Nepal
Authors: Mahaseth Rajeev K , Gurung Urmila , Thapa Narmaya , Pradhan Bibhu , Kharel Bijaya
Published: June 2021

Introduction Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center.

MethodsA retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital.

ResultsThirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days.

ConclusionNasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice.
Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal
Authors: Phuyal Suman , Rajbhandari Binod , Pradhanang Amit B , Sedain Gopal , Shilpakar Sushil K , Sharma Mohan R
Published: June 2021

Introduction Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aim of the study was to evaluate the outcome especially complications of shunt surgery at our center.

MethodsA single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications.

ResultsOut of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). The commonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shunt obstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%.

ConclusionThe shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.
Granular Cell Tumor of Breast: Rare Tumor Masquerading as Malignancy
Authors: Hirachan Suzita , Singh Yogendra P , Jha Anamika , Manandhar Usha
Published: June 2021

Granular cell tumor (GCT) is a rare soft tissue tumor that arises from the Schwann cells of peripheral nerves. It was first postulated by Abrikossoff in 1926 as Myoblastoma. About 5-15% of these tumors occur in the breast and less than 1% has the potential to be malignant. Here we present a case of 41 years old premenopausal woman with Benign GCT of the right breast, having clinically malignant features. The clinical and radiological features of GCT are similar to malignant lump. However, histology showing presence of sheets of polygonal cells with abundant granular eosinophilic cytoplasm with round nuclei and granules with Periodic acid–Schiff (PAS) positive, diastase resistant and S-100 antigen positive are confirmatory. Treatment of Granular cell tumor is wide local excision. There is apparently no role of chemotherapy and radiotherapy. The presence of GCT in the breast is quite rare and clinically as well as radiologically it may mimic malignancy, however with histopathology and appropriate immunohistochemistry, proper diagnosis can be made.
Adnexal Torsion in Ovarian Hyperstimulation Syndrome in Early Pregnancy: A Diagnostic Challenge
Authors: Regmi Pradeep R , Amatya Isha , Poudel Atit
Published: June 2021

Adnexal torsion in ovarian hyperstimulation syndrome (OHSS) is rare but serious complication in pregnancy. It is more common in assisted reproductive techniques. Delay in diagnosis and treatment results in functional loss of ovary as well as termination of pregnancy. In this report, we are presenting a case of 27 years female with subfertility who conceived after ovulation induction presented at 7 weeks 6 days period of gestation with ovarian hyperstimulation associated with adnexal torsion. Later, she was treated with laparoscopic salpingo-oophorectomy.
Palliative Toilet Mastectomy for Advanced Breast Cancer in a University Hospital of Nepal
Authors: Verma Rupesh , Hirachan Suzita , Singh Yogendra P
Published: June 2021

Introduction In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 18%, IIIB 22%), and stage IV (10%). Delayed presentations are due to lack of awareness, reluctancy and poor accessibility to health care services often leads to local complications like sloughing of fungating breast lesions, secondary infection and bleeding. The aim of this study was to analyze the advanced breast cancer (ABC) patients who underwent palliative toilet mastectomy.

MethodsRetrospective review of all patients presenting with ABC who underwent palliative toilet mastectomy in the breast unit of Tribhuvan University Teaching Hospital Kathmandu, Nepal from January 2016 to December 2018, was done. The data included were demographic profile, histopathological and immunohistochemistry report, indication of surgery, adjuvant therapy, timing of surgery, and quality of life after surgery.

ResultsTotal number of breast carcinoma patients was 155 within the duration of 3 years. There were 7 (4.5%) cases of breast cancer treated with palliative toilet mastectomy with mean age of 57.9±12.7 years. The mean tumor size was 4.3±1.3cm. The indications of palliative mastectomy were fungation-2 (28.5%), bleeding-2 (28.5%), ulceration-1 (14.3%), malodorous discharge with secondary infection-1 (14.3%) and hemiplegic patient with infection in 1 (14.3%). Luminal A molecular subtype was seen in 1 out of 7 patients (14.3%) with basal like subtype in 6 out of 7 patients (85.7%). Lympho-vascular invasion were seen in 4 out of 7 (57.14%). One patient underwent bilateral palliative mastectomy for progressive disease and margins were positive for tumor and remaining six patients had tumor free margins.

ConclusionAdvanced breast cancers are treated with neoadjuvant therapy prior surgery but the delayed presentation of these with fungating, ulcerative, infective and bleeding lesions make the initial palliative toilet mastectomy a useful option.
Breast Cancer Surgery at a Cancer Center in Janakpurdham: An Initial Experience
Authors: Jha Pamesh , Thakur Anshu K , Gupta Sanjay , Mishra Richa , Singh Yogendra P
Published: June 2021

Introduction Breast cancer is the second commonest cancer in Nepalese women. In most of the low income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital.

MethodsSurgical service was started from April 2019 after establishing an equipped operating room and post-operative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done.

ResultSix female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disease. Two patients received neo-adjuvant chemotherapy and two were subjected for upfront surgery. Modified radical mastectomy was done in four patients. For one patient with suspected hereditary localized breast cancer and one with Paget’s disease of the breast with non invasive ductal carcinoma, simple mastectomy was performed. Postoperative period was uneventful except one case with seroma formation. Other than one Paget’s disease of the breast, all were triple nipple breast cancer.

ConclusionBreast cancer surgery is one of the important modality of treatment even for locally advanced disease in resource limited settings.
Risk Factors Among Breast Cancer Patients Being Treated in Tertiary Level Hospital of Nepal: A Case Control Study
Authors: Rana Asmita , Ghimire Anup , Sah Ram B , Pyakurel Prajjwal , Shah Nirmal P
Published: June 2021

Introduction Breast cancer is the leading cause of cancer death among females worldwide. Its incidence is on the rise in Nepal. However, the risk factors have not been studied in context of Nepal. The aim of this study is to identify and quantify the association of various risk factors with breast cancer in Nepal.

MethodsHospital-based age-matched case-control study was conducted among 50 cases and 150 controls visiting BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Semi-structured questionnaire was used to collect information on demographic characters, socio-economic parameters, reproductive history, dietary and personal habits, family history, history of contraception and history of benign breast disease. Height, weight, hip circumference and waist circumference were measured.

ResultsMajority of the cases (52%) belonged to the age group of 46-55 years. The significant risk factors were ethnicity of Dalit/Madhesi (AOR 8.222, 95% CI 2.377-28.441, p-value 0.001), parity of 3 to 5 (AOR 5.614, 95% CI 1.140-27.639, p-value 0.03) and previous history of benign breast disease (OR 13.614, 95% CI 3.229-57.391, p-value 0.001). Hysterectomy was found to reduce the risk of breast cancer (OR 0.122, 95% CI 0.017-0.826, p-value 0.03). Knowledge of breast self-examination was significantly higher among cases than controls (AOR 36.29, 95% CI 5.788-227.555, p-value < 0.001). Knowledge of mammography was significantly lower among cases than control (AOR=0.133, 95% CI=0.028-0.647, p-value=0.01).

ConclusionThis study showed a number of factors to be associated with the increased risk of breast cancer. It was observed that the mean age at diagnosis is a decade earlier than in Western countries. Genetic component was not significant in context of Nepal. It is hoped that the findings of this study will facilitate further exploration and evidenced-based preventive measures for Nepalese women.
Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal
Authors: Pradhan Bishwas , Bastola Priska , Basnet Madindra B , Shrestha Bibhush , Sigdel Shailendra , Gurung Arjun
Published: June 2021

Introduction European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients.

MethodsA retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve.

ResultsObserved mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power.

ConclusionMortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory.
Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal
Authors: Khanal Babita , Kafle Prakash , Singh Sandip K , Yadav Sunil K , Neupane Bishomber , Shakya Ipsa , Yadav Dipak K
Published: June 2021

Introduction Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal.

MethodsThis is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS).

ResultsThe study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome.

ConclusionThis study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome.
Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study
Authors: Sharma Lamsal Kamal , Neupane Keshab R , Acharya Niranjan , Lamsal Dinesh K , Karmacharya Niraj , Paudel Deepak , Paudel Rajan , Sharma Rabi P
Published: June 2021

Introduction Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. <40 years in a tertiary care hospital, Nepal.

MethodsThis is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of <40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver­age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0.

ResultsAmong 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level.

ConclusionA high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients <40 years of age.
Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal
Authors: Maharjan Narendra , Joshi Lakhey Paleswan , Ghimire Bikal , Kansakar Prasan BS , Bhandari Ramesh S
Published: June 2021

Introduction Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate.

MethodsThis is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019.

ResultsThere were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality.

ConclusionThe management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.
Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study
Authors: Gyawali Bigyan R , Pradhanaga Rabindra B , Rayamjhi Pabina , Dongol Kripa , Gupta Mudit , Shrestha Lava , Acharya Kunjan
Published: June 2021

Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population.

MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics.

ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin.

ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.
Multilevel Spinal Injury: Incidence, Distribution and Neurological Patterns
Authors: Khadka Yagya , Lakhey Rajesh B , Kafle Dinesh
Published: June 2021

Introduction Fractures and dislocation of spine are serious injuries that most commonly occur in young people. Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient.

MethodsThis was a prospective observational study carried out in Department of Orthopedics, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal from February 2012 to September 2013. Sixty cases of age group between 18 to 63 years of traumatic spinal injury were enrolled. Patients were examined clinically and radiographically.

ResultsOut of 60 patients, multilevel spinal injury occurred in 26 (43.3%) patients; 10 (16.67%) had contiguous spinal injury and 16 (26.67%) had non-contiguous spinal injury. There were 5 type A pattern spinal injury. Contiguous spinal injury most commonly occurred at level L1/L2 (n=4, 40%) and most had Frankel grade E neurology (n=6, 60%) followed by Frankel grade D (n=2, 20%). Non-contiguous lesions most commonly occurred at thoracic spine and had Frankel grade E neurology in most cases (n=10, 16.67%) followed by grade B and C (n= 2, 2.33% each).

ConclusionMultiple spinal injury was a common pattern of injury, which occurred in 26 (43.3%) patients out of 60 patients enrolled in our study. Multilevel spinal injury is common. We should be aware about its occurrence. We should evaluate for multilevel spinal injuries, so as not to miss them, especialy non-contiguous injuries, in the patients presenting with spinal injury.
Leigh Syndrome in an Adolescent Girl: A Case Report
Authors: Shrestha Merina , Bajracharya Luna , Basnet Sudha
Published: June 2021

Leigh syndrome (LS) is a disorder of infancy and rarely late childhood. It presents with regression of mental and motor skills. Here, we present LS in an adolescent girl who presented with generalized dystonia and cognitive decline. Her infective, metabolic, endocrinal and autoimmune work up was normal. The neuroimaging showed progressive symmetric involvement of basal ganglia with focal intensity over bilateral lentiform nucleus and thalamic region. The cerebrospinal fluid (CSF) lactate level was elevated. Genetic test could not be performed; however the history of neuro-regression with extrapyramidal involvement with CSF and neuroimaging finding led to the diagnosis of Leigh’s syndrome.