bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Outcome of Intra-articular Fractures of Distal Radius: ORIF with Locking Plate vs CRPP
Authors: Shrestha Bhola , Sapkota K , Kandel IS , Dhakal RM , Bista K 
Published: March 2019

Background: Distal radius fractures are common, costly, and increasing in incidence. Closed reduction and percutaneous K wires fixation and ORIF with locking plate fixation are two of the mostly used surgical treatments for dorsally displaced distal radius fractures. However, there is uncertainty which of these treatments is superior.
Methods: This is a prospective study on 40 patients. Twenty patients had closed reduction and percutaneous pinning (CRPP) with K wires (Group A) and 20 patients had open reduction and internal fixation (ORIF) with locking plate and screws (Group B). Evaluation were done in the means of DASH scores and ROM of operated wrist on 1.5 months, three months and six months follow up period.
Results: Though the overall functional outcome is comparatively better with Group B, the significant difference for most variables like DASH Scores, extension, supination and ulnar deviation were found at early part of treatment only. The flexion and radial deviation bear no significant outcomes at all intervals of evaluations. Superficial wound infection was more common in patients treated with K-wires but otherwise no difference in complication rates was noted.
Conclusion: Locking plate fixation provided lower DASH scores and reduced total postoperative complications compared to CRPP group over six months follow-up period. However, these differences were significant in early part of treatment. Further research is required to better delineate the confirmation.
Decreased Level of Vitamin D is Associated with Rheumatoid Arthritis Patients from Western Region of Nepal
Authors: Tamrakar Basant Kumar , Karki D , Nagila A 
Published: March 2019

Background: Rheumatoid Arthritis (RA) is a progressive, chronic type of autoimmune disease and the role of vitamin D in the pathogenesis of RA is under investigation.
Objective: The objective of this study was to determine the vitamin D deficiency in patients with RA as compared to healthy controls and to assess the relationship between serum vitamin D and anti-cyclic citrullinated peptide (anti-CCP) antibody levels in patients with newly diagnosed rheumatoid arthritis.
Methods: The study was conducted between January 2017 to February 2018 at Fishtail Hospital and Research centre. A total of 63 patients with early RA diagnosed and a control group of 56 healthy participants, not on vitamin D supplements were recruited from Department of Internal Medicine. Five ml of blood samples were drawn from cubital veins. Blood glucose, creatinine, uric acid, calcium, RA factor, 25-hydroxy vitamin D, anti-CCP antibody, and erythrocyte sedimentation rates were measured in a centralized laboratory of Fishtail Hospital and Research centre.
Results: The level of serum 25-hydroxy vitamin D were significantly lower in RA group (20.03 ±9.97 ng/mL) in comparison to the control group (24.46 ±8.45 ng/mL) (p<0.003). Our result indicates the prevalence of vitamin D deficiency was more in RA group compared with control group (47.61% vs. 33.16%, p <0.002). The level of Anti-CCP is significantly high in RA group than control group. In RA patients serum 25-hydroxy vitamin D levels were negatively correlated to anti-CCP antibody levels (rs = 0.72, p <0.001), and erythrocyte sedimentation rate (rs = 3.95, p <0.005).
Conclusion: In RA patient vitamin D deficiency is quite common and serum 25-hydroxy vitamin D level was negatively correlated to anti-CCP antibody level. Our results suggest that vitamin D level is a motivation factor rather than a consequence of RA activity.
Is Routine Histopathological Examination of Appendix Mandatory?
Authors: Acharya A , Basnet RB , Singh RR , Bastakoti R , Paudel SR 
Published: March 2019

Introduction: No age is immune for appendicitis and appendicectomy. Appendicectomy is one of the most common operations done all over the world. Emergency surgeries are more common than elective. Histopathological examination of every excised tissue is strongly recommended but trained manpower and laboratory for histopathological examination is not available in every hospital in our country.
Methods: It is a prospective observational study of appendectomy performed at Bir Hospital, Kathmandu, Nepal country over a period of three years. Histopathological examination reports and preoperative findings were collected. Histopathological examination was performed by postgraduate pathologist at different hospitals and laboratory centres. Peroperatively appendices were categorized as non malignant looking appendix and suspicious malignant looking appendix by operating surgeons at different hospitals. Histopathological examination reports were compared with peroperative categorization.
Results: Eight hundred and fifty five appendectomies performed during the study period were analysed. Eight hundred thirteen (95.1%) cases had non-malignant looking appendix and 42 (4.9%) cases had malignant looking appendix peroperatively. Seven (0.8%) cases were found malignant and 848 (99.2%) cases were found non-malignant on histopathology report. All seven (16.67%) malignant cases were from 42 suspicious malignant looking cases.
Conclusion: Routine histopathology examination is mandatory for only peroperative suspicious malignant looking appendix.
Mindfulness based interventions for depression and anxiety in Asian Population: A systematic review
Authors: Thapaliya S. , Upadhyaya K.D. , Borschmann R. , Kuppili P.P. 
Published: March 2019

Introduction: Mindfulness based interventions (MBIs) have emerged as effective interventions for various psychiatric conditions including depression and anxiety. Asia being home to Buddhist tradition, it will be interesting to explore the trend and efficacy of MBIs in Asian population in Asian settings. The aim of this study is to perform a systematic review of mindfulness based interventions (MBIs) for management of depression and anxiety (disorders or symptoms) in Asian population.
Material And Method: Two researchers independently searched for literature published between January 2007 to December 2018 in Medline, Google Scholar, PsychInfo and Cochrane library using the search terms - ‘Mindfulness/Vipassana’ combined with ‘meditation’, ‘intervention’ ‘therapy’, ‘depression', ‘anxiety’ ‘Asia’ etc. Further, publications were also identified from the references recited in the retrieved articles. After screening 185 articles and applying the eligibility criteria, 40 articles were finally selected for the systematic review.
Results: Out of 40 selected articles, 33 articles were controlled trials and 7 had a pre-post test design without any control group. Most of the published studies have evaluated MBCT and MBSR for depressive and anxiety symptoms in different settings. Some of the studies have tested traditional Buddhist meditation and modified models. Overall, MBCT and MBSR seem to be efficacious over ‘routine treatment’ or ‘no treatment’ control for reducing depressive and anxiety symptoms at the end of the treatment. Studies which have modified MBIs based on MBCT/MBSR models have also demonstrated their feasibility and short term efficacy in specific populations like medical professionals with evidence for short term efficacy.
Conclusion: Overall, there is emerging evidence of MBIs for depression and anxiety across diverse settings in Asia. Future research should address methodological limitations of current research to strengthen the evidence.
Maternal Stress of Hospitalized Children in A Hospital of Rupandehi, Nepal
Authors: Dhungana M. , Kachapati A. 
Published: March 2019

Introduction: Illness and hospitalization are often critical events that a child is faced with and the stress of it can affect all family members. Maternal stress and anxiety can also affect the child in two ways, transferring stress to the child and interfering with the mother’s ability of childcare. Researcher sought to find out the maternal stressors of hospitalized children in a hospital of Nepal.
Material and Method: A descriptive cross-sectional study was conducted to find out the maternal stressors of hospitalized children among one hundred and five mothers selected through non probability purposive method. The data was collected by using semi-structured interview schedule and data was analyzed by using descriptive and inferential statistics with SPSS software version 16.
Results: The findings of the study revealed that more than half of the mothers 62.8%, 58.1%, 63.8%, 90.4%, 88.6%, 78%, 83.8% and 87.7% had very high stress related to child factors; child appears lethargic, weak and pale, prolongation of hospitalization, uncertain try about future of child’s medical condition, fear of relapse, child irritability and crying, in concern about IV fluids and tubes connected, child’s pain, and about laboratory and imaging respectively. Majority of mothers had stress related to social and economic aspects, 59% for failure to provide comfort to other children due to child illness, 82.8% had stress regarding being away from work and living place. Regarding stressors related to environmental factors, Majority 54.2% mothers had very high stress from equipments, 84.7% mothers had very high stress on unfamiliar environment, 68.5% had very high stress for lack of adequate sanitation and air pollution, 59% had very high stress that no room to rest for visitor. Regarding stressors related to hospital staffs, 78% mothers had very high stress for giving the responsibility for monitoring IV fluids, 74.2% had very high stress for turning over responsibility for collecting samples to mothers by nursing staffs, 60.9% mothers had very high stress on lack of attention from nursing staffs about mother’s problem and 68.5% had very high stress on lack of proper nutrition for hospitalized children.
Conclusion: Based on the study findings, it is concluded that mothers were passionate in taking care of their child. Most mothers had recognized that illness and hospitalization of their children had an overwhelming psychological and emotional impact on their own behavior and they did not have enough control over their reactions. Therefore, special attention should be given to identify the stressors in nursing care, planning and parents’ education, moving stressors and treatment in the same direction and the factors that can reduce the mother’s ability to provide childcare and delay in treatment progress.
Attribution and health seeking behavior of family members towards Conversion (Dissociative) Disorders
Authors: Sawant S. , Karki U. 
Published: March 2019

Introduction: Patients with Conversion (Dissociative) disorders are frequently seen in different communities and hospitals of Nepal. How people attribute illness determines what treatment will be received. Hence this study was conducted to identify attributions and health seeking behavior towards Conversion (Dissociative) disorder.
Material and Method: This is a hospital based cross-sectional and exploratory study. Purposive sampling method was used. Duration of study was 6 months from 1st January 2017 to 30th June 2017. Total number of participants was 57. Diagnosis was made using ICD 10 criteria. Self developed questionnaire was used which assessed knowledge and help seeking behavior.
Results: The findings showed that the percentage of trance and possession (33.3%) and dissociative convulsions (29.8%) compared to other groups were higher. Illiterate participants were high followed by high school level and intermediate respectively. Among total participants, 47.4% took more than 2 weeks to visit a mental health professional, 31.6% took 48 hours to 2 weeks, and 21.1% visited within 48 hours. Participant’s response to conversion disorder as neither mental illness nor physical illness and response to conversion disorder as mental illness was 43.85%. However response to conversion disorder as a physical illness was 38.6%. Participant’s response to the treatment of conversion disorder for faith healing was higher (52.63%) than to medical and psychosocial treatment (33.33%).
Conclusion: Communities in Nepal are still grounded to ethnic practices and faith healing. Conducting awareness program and working in collaboration with faith healers is crucial.
Reconstituting Canada: The enfranchisement and disenfranchisement of ‘Indians,’ circa 1837–1900
Authors: Kirkby Coel 
Published: March 2019

The constitutional history of Canada and First Nations is often told as the promise fulfilled of Aboriginal rights and treaties. I will challenge this story by recovering the story of the enfranchisement and disenfranchisement of ‘Indian’ subjects in the first three decades of Canadian Confederation. Far from forgotten actors in a foretold play, ‘Indian’ voters were crucial to determining the outcome of three closely contested federal elections and challenging settler ideas of the nascent Canadian nation. The question of the ‘Indian’ franchise was always embedded in competing constitutional visions for Confederation. The Canadian dream of transforming and assimilating Indigenous peoples would give way to a cynical idea of segregation under the permanent regime of the Indian Act. If the ‘Indian’ franchise was the apotheosis of assimilation, its revocation marked the start of racial segregation. I juxtapose these Canadian constitutional visions with two alternative possibilities. The Anishinaabe-dominated Grand General Council accepted the franchise as part of its vision of reconciling membership in both their treaty-recognized nations and the Canadian state. The Confederacy Council of the Six Nations, in contrast, rejected the franchise as an existential threat to Haudenosaunee self-rule mediated by a treaty relationship with the Canadian and imperial governments. Recovering the constitutional contests driving ‘Indian’ enfranchisement and disenfranchisement shows us how the successful imposition of a single vision of a white democracy silenced alternative visions of multinational coexistence. It also reminds us of the multiplicity of constitutional possibilities for a common future.
PROTAGONISMO DE LUTA INDIGENISTA E A CONSTRUÇÃO DOS DIREITOS HUMANOS DOS POVOS INDÍGENAS
Authors: Oliveira Odete Maria de , Braun Helenice da Aparecida Dambrós , Giachin Isadora e Sá 
Published: March 2019

<p>A pesquisa ocupa-se com a proteção dos Povos Indígenas, esquecidos nos diferentes continentes do Planeta, durante séculos dizimados, violentados, excluídos pelos Estados e sociedades. O Direito Internacional e os direitos humanos buscaram o seu reconhecimento como sujeitos de direitos internacionais, mas com poucos resultados. O objeto desse estudo tenta refletir sobre essa abordagem, indagando: A variável de específicos direitos humanos indigenistas poderá resultar em uma eficiente medida? Usando o método hipotético-dedutivo e a pesquisa bibliografia, o texto estrutura-se em três partes: aborda a Declaração Universal dos Direitos Humanos, de 1948; primeiros instrumentos voltados aos direitos indígenas - Convenções de 1940, 1957, 1969 – e, finalmente, a trajetória da Declaração dos Direito dos Povos Indígenas adotada em 2007. Na conclusão são apresentadas considerações sobre a construção de autênticos Direitos Humanos Indigenistas como instrumentos de eficaz sustentabilidade. </p>
Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury
Authors: Lau Darryl , Dalle Ore Cecilia L. , Tarapore Phiroz E. , Huang Michael , Manley Geoffrey , Singh Vineeta , Mummaneni Praveen V. , Beattie Michael , Bresnahan Jacqueline , Ferguson Adam R. , Talbott Jason F. , Whetstone William , Dhall Sanjay S. 
Published: March 2019

OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes
Authors: Morrow Kevin D. , Podet Adam G. , Spinelli Casey P. , Lasseigne Lindsay M. , Crutcher Clifford L. , Wilson Jason D. , Tender Gabriel C. , DiGiorgio Anthony M. 
Published: March 2019

OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control.
Imaging characteristics of chronic spinal cord injury identified during screening for a cell transplantation clinical trial
Authors: Burks Joshua D. , Gant Katie L. , Guest James D. , Jamshidi Aria G. , Cox Efrem M. , Anderson Kim D. , Dietrich W. Dalton , Bunge Mary Bartlett , Green Barth A. , Khan Aisha , Pearse Damien D. , Saraf-Lavi Efrat , Levi Allan D. 
Published: March 2019

OBJECTIVEIn cell transplantation trials for spinal cord injury (SCI), quantifiable imaging criteria that serve as inclusion criteria are important in trial design. The authors’ institutional experience has demonstrated an overall high rate of screen failures. The authors examined the causes for trial exclusion in a phase I, open-lab clinical trial examining the role of autologous Schwann cell intramedullary transplantation. Specifically, they reviewed the imaging characteristics in people with chronic SCI that excluded applicants from the trial, as this was a common cause of screening failures in their study.METHODSThe authors reviewed MRI records from 152 people with chronic (> 1 year) SCI who volunteered for intralesional Schwann cell transplantation but were deemed ineligible by prospectively defined criteria. Rostral-caudal injury lesion length was measured along the long axis of the spinal cord in the sagittal plane on T2-weighted MRI. Other lesion characteristics, specifically those pertaining to lesion cavity structure resulting in trial exclusion, were recorded.RESULTSImaging records from 152 potential participants with chronic SCI were reviewed, 42 with thoracic-level SCI and 110 with cervical-level SCI. Twenty-three individuals (55%) with thoracic SCI and 70 (64%) with cervical SCI were not enrolled in the trial based on imaging characteristics. For potential participants with thoracic injuries who did not meet the screening criteria for enrollment, the average rostral-caudal sagittal lesion length was 50 mm (SD 41 mm). In applicants with cervical injuries who did not meet the screening criteria for enrollment, the average sagittal lesion length was 34 mm (SD 21 mm).CONCLUSIONSWhile screening people with SCI for participation in a cell transplantation clinical trial, lesion length or volume can exclude potential subjects who appear appropriate candidates based on neurological eligibility criteria. In planning future cell-based therapy trials, the limitations incurred by lesion size should be considered early due to the screening burden and impact on candidate selection.