bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Non Invasive Ventilation in Patients with Respiratory Failure in Nepal
Authors: Pandey R , Chokhani R , K C N B 
Published: June 2012

Background Non-invasive ventilation (NIV) has become an integral tool in the management of acute and chronic respiratory failure. Studies have shown that use of NIV decreases the length of hospital stay, improves symptoms and also reduces the need for invasive mechanical ventilation in patients with respiratory failure. However, NIV is not used sufficiently in our country. Objective To find out the outcome of Non Invasive Ventilation in Respiratory failure in Nepal. Methods Retrospective analysis of data of 28 patients in between June 2010- November 2010 was done. All the patients selected had respiratory failure. Records were analysed for documentation of clinical diagnosis. Arterial blood gases were assessed prior to, after starting and after discontinuation of NIV. The outcome of NIV and the need for domiciliary oxygen was evaluated at discharge. Results Thirty four patients received NIV out of which 6 were excluded from the study due to insufficient documentation. Out of these 28 patients, 27 received bi-level and one patient received Continuous Positive Airway Pressure. Mean age of patients was 66.5 years and ranged from 42-87 years. Majority (19, 79%) were from age group 60-80 years. Most common cause for the use of bi-level ventilation was chronic obstructive pulmonary disease with type 2 respiratory failure in 19 patients (67.8%). Others included obesity hypoventilation syndrome two, acute interstitial pneumonia two, cardiogenic pulmonary oedema two, Interstitial lung disease one, bronchogenic carcinoma one, and bronchiectasis one. Arterial blood gas analysis was done on admission and 12 hours or earlier after the onset of bi-level ventilation. At the time of admission, 89.3% of the patients had type 2 respiratory failure, of which 60.6% had respiratory acidosis and 67.9% of patients had pCO2 above 60 mm Hg. Arterial blood pH prior to admission ranged from 7.19 to 7.50. Twelve hours after bi-level ventilation, only 21.3% had pH <7.35 and 42.8% had pCO2 above 60 mm Hg. Non invasive ventilation was successful in 27 patients (96.4%). All patients were advised domiciliary oxygen and all patients had respiratory follow up arranged. Conclusions COPD patients with type 2 respiratory failure were seen to benefit most with NIV. It is a very cost effective and safe method of treatment and should be used first in patients with COPD with type 2 respiratory failure.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6340 Kathmandu Univ Med J 2011;9(4):256-59
Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants
Authors: K C N P , Basnett I , Sharma S K , Bhusal C L , Parajuli R R , Anderson K L 
Published: June 2012

Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6341 Kathmandu Univ Med J 2011;9(4):260-66
Study on Curvatures of Clavicle With Its Clinical Importance
Authors: Haque M K , Mansur D I , Sharma K 
Published: June 2012

Background The clavicle is the most frequently fractured bone of the human skeleton. 70–80% of fractures occur at the middle third of the shaft of the bone. Anatomical variations in the clavicle of relevance to form intramedullary fixation. Objectives The purpose of this study was attempted to know about comparative differences between curvatures of the right and left clavicles, from certain metrical parameters. Methods The materials for the present study consisted of 257 (135 right and 122 left) adult clavicles, which were collected from the Department of Anatomy and from the students of the first year M.B.B.S during the period 2010 - 2011, Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The deepest points of the curvatures of the clavicle, where the convexities were the maximum. These angles were measured with the help of a protractor. The sum of the two angles constituted the total curvature of the bone. Results The average medial angle, lateral angle and sum of the two angles of right side were 150.97º ±6.16 SD, 139.76º ±7.55 SD and 290.73º ±11.14 respectively and that of the left side were 151.50º ±5.67SD, 141.73º ±8.44 SD and 293.23º ±11.69SD respectively. The present study revealed that the medial and lateral angles of the left clavicle were greater than that of the right clavicle and medial curvature was more than the lateral curvature of the same clavicle. Conclusions It is important to recognize anatomical variations in the curvatures of clavicle when considering intramedullary nailing techniques. It also helps Anthropologists in their study of evolution.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6344 Kathmandu Univ Med J 2011;9(4):279-82
Microbiological Analysis of the Urine Isolates in Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
Authors: Raza S , Pandey S , Bhatt C P 
Published: June 2012

Background Urinary tract infections (UTIs) are the common cause of bacterial infection. Recently UTI become more complicated and difficult to treat because of appearance of pathogen with increasing resistance to antimicrobial agents. Objective To determine the etiology of the urinary tract infections and their susceptibility to antimicrobial agents. Methods This study was carried out in Kathmandu Medical College, at department of microbiology. Total 3,460 urine samples were tested microbiologically by standard procedure. Antibiotic susceptibility test was performed for all the isolates by Kirby Bauer disc diffusion method and result was interpreted according to National Committee for Clinical Laboratory Standards (NCCLS) guide line. Results Out of 3,460 urine samples 680 (19.7%) showed the significant bacteriuria. The most common pathogens isolated were Escherichia coli 75.7% followed by Klebsiella pneumoniae 10.7%, Acinetobacter spp 5.5%, Proteus spp 3.5% and Pseudomonas aeruginosa 1.2%. Most susceptible antibiotic was Amikacin, Ceftriaxone and Ciprofloxacin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin 96.1%, Nitrofurantoin 91.3% and Gentamicin 77.7% followed by Ceftriaxone 65.8% and Ciprofloxacin 64.1%. ConclusionRegular surveillance of the resistance rate among uro-pathogens is needed to ensure the appropriate therapy of UTI.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6348 Kathmandu Univ Med J 2011;9(4):295-7
The Demographics of Molar Pregnancies in BPKIHS
Authors: Koirala A , Khatiwada P , Giri A , Kandel P , Regmi M , Upreti D 
Published: June 2012

This is an analysis of the incidence of molar pregnancies and those of complete and partial molar pregnancies across the reproductive age range for BP Koirala Institute of Health Sciences (BPKIHS) in the period 2010-2011. Patients with molar pregnancies registered with BPKIHS from January 2008 to January 2010 were identified. The overall number of molar pregnancies registered was compared to the number of maternities (live births and still births) and total viable conceptions for this year. A retrospective study of 64 cases of molar pregnancies recorded at BPKIHS during the two year time was done. Medical records were reviewed. Incidence, clinical presentation and methods of diagnosis were studied. During the study period, there were 37 complete moles, 23 partial moles, 1 persistent gestational trophoblastic tumor, 1 choriocarcinoma, and 2 invasive moles. The incidence of molarpregnancy was 3.94 per 1000 deliveries. Median distribution was at 22 years of age, and majority (67%) presented during early second trimester. Twenty one (32.8%) women were of blood group A positive and ten (15.6%) presented with severe form of anemia. This study provides detailed data regarding the incidence of partial and complete molar pregnancies with increasing maternal age. It confirms the relation of molar pregnancy with age, and blood group. Complete mole had the highest incidence, affecting mostly younger age group, and usually in the first half of their pregnancy.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6349 Kathmandu Univ Med J 2011;9(4):298-300
Negative Pressure Pulmonary Edema- Case Series and Review of Literature
Authors: Bhattarai B , Shrestha S 
Published: June 2012

Post obstructive pulmonary edema (POPE) also known as Negative pressure pulmonary edema (NPPE)is potentially life threatening complication. It occurs in about 0.1% of anesthetics and is related to upper airway obstruction. Two types have been described in literature. Different etiology has been attributed to development of Negative pressure pulmonary edema. Early identification and treatment of predisposing factor along with proper monitoring of this complication early treatment should be instituted because resolution is also fast and in most cases without residual effects. DOI: http://dx.doi.org/10.3126/kumj.v9i4.6352 Kathmandu Univ Med J 2011;9(4):310-4
Autophagy: An Emerging Immunological Paradigm
Authors: Deretic Vojo 
Published: June 2012

Abstract
Autophagy is a fundamental eukaryotic process with multiple cytoplasmic homeostatic roles, recently expanded to include unique stand-alone immunological functions and interactions with nearly all parts of the immune system. In this article, we review this growing repertoire of autophagy roles in innate and adaptive immunity and inflammation. Its unique functions include cell-autonomous elimination of intracellular microbes facilitated by specific receptors. Other intersections of autophagy with immune processes encompass effects on inflammasome activation and secretion of its substrates, including IL-1β, effector and regulatory interactions with TLRs and Nod-like receptors, Ag presentation, naive T cell repertoire selection, and mature T cell development and homeostasis. Genome-wide association studies in human populations strongly implicate autophagy in chronic inflammatory disease and autoimmune disorders. Collectively, the unique features of autophagy as an immunological process and its contributions to other arms of the immune system represent a new immunological paradigm.
Phenotypic and Functional Characterization of NK Cells in Human Immune Response against the Dimorphic Fungus Paracoccidioides brasiliensis
Authors: Longhi Larissa N. A. , da Silva Rosiane M. , Fornazim Márcia C. , Spago Maria C. , de Oliveira Rômulo T. D. , Nowill Alexandre E. , Blotta Maria H. S. L. , Mamoni Ronei L. 
Published: June 2012

Abstract
Besides their role in fighting viral infection and tumor resistance, recent studies have shown that NK cells also participate in the immune response against other infectious diseases. The aim of this study was to characterize the possible role of NK cells in the immune response against Paracoccidioides brasiliensis. Purified NK cells from paracoccidioidomycosis patients and healthy individuals were incubated with P. brasiliensis yeast cells or P. brasiliensis-infected monocytes, with or without the addition of recombinant IL-15. We found that NK cells from paracoccidioidomycosis patients exhibit a lower cytotoxic response compared with healthy individuals. NK cells are able directly to recognize and kill P. brasiliensis yeast cells, and this activity seems to be granule-dependent but perforin-independent, whereas the cytotoxicity against P. brasiliensis-infected monocytes is perforin-dependent. These results indicate that NK cells participate actively in the immune response against the P. brasiliensis infection either by directly destroying yeast cells or by recognizing and killing infected cells. Granulysin is the possible mediator of the cytotoxic effect, as the reduced cytotoxic activity against the yeast cells detected in patients with paracoccidioidomycosis is accompanied by a significantly lower frequency of CD56+granulysin+ cells compared with that in healthy controls. Furthermore, we show that NK cells released granulysin in cultures after being stimulated by P. brasiliensis, and this molecule is able to kill the yeast cells in a dose-dependent manner. Another important finding is that stimulated NK cells are able to produce proinflammatory cytokines (IFN-γ and TNF-α) supporting their immunomodulatory role in the infection.
Cross-Species Transcriptional Network Analysis Defines Shared Inflammatory Responses in Murine and Human Lupus Nephritis
Authors: Berthier Celine C. , Bethunaickan Ramalingam , Gonzalez-Rivera Tania , Nair Viji , Ramanujam Meera , Zhang Weijia , Bottinger Erwin P. , Segerer Stephan , Lindenmeyer Maja , Cohen Clemens D. , Davidson Anne , Kretzler Matthias 
Published: June 2012

Abstract
Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus. Therapeutic studies in mouse LN models do not always predict outcomes of human therapeutic trials, raising concerns about the human relevance of these preclinical models. In this study, we used an unbiased transcriptional network approach to define, in molecular terms, similarities and differences among three lupus models and human LN. Genome-wide gene-expression networks were generated using natural language processing and automated promoter analysis and compared across species via suboptimal graph matching. The three murine models and human LN share both common and unique features. The 20 commonly shared network nodes reflect the key pathologic processes of immune cell infiltration/activation, endothelial cell activation/injury, and tissue remodeling/fibrosis, with macrophage/dendritic cell activation as a dominant cross-species shared transcriptional pathway. The unique nodes reflect differences in numbers and types of infiltrating cells and degree of remodeling among the three mouse strains. To define mononuclear phagocyte-derived pathways in human LN, gene sets activated in isolated NZB/W renal mononuclear cells were compared with human LN kidney profiles. A tissue compartment-specific macrophage-activation pattern was seen, with NF-κB1 and PPARγ as major regulatory nodes in the tubulointerstitial and glomerular networks, respectively. Our study defines which pathologic processes in murine models of LN recapitulate the key transcriptional processes active in human LN and suggests that there are functional differences between mononuclear phagocytes infiltrating different renal microenvironments.
Increased Frequency of Suppressive Regulatory T Cells and T Cell-Mediated Antigen Loss Results in Murine Melanoma Recurrence
Authors: Jensen Shawn M. , Twitty Christopher G. , Maston Levi D. , Antony Paul A. , Lim May , Hu Hong-Ming , Petrausch Ulf , Restifo Nicholas P. , Fox Bernard A. 
Published: June 2012

Abstract
Therapeutic treatment of large established tumors using immunotherapy has yielded few promising results. We investigated whether adoptive transfer of tumor-specific CD8+ T cells, together with tumor-specific CD4+ T cells, would mediate regression of large established B16BL6-D5 melanomas in lymphopenic Rag1−/− recipients devoid of regulatory T cells. The combined adoptive transfer of subtherapeutic doses of both TRP1-specific TCR transgenic Rag1−/− CD4+ T cells and gp100-specific TCR transgenic Rag1−/− CD8+ T cells into lymphopenic recipients, who received vaccination, led to regression of large (100–400 mm2) melanomas. The same treatment strategy was ineffective in lymphoreplete wild-type mice. Twenty-five percent of mice (15/59) had tumors recur (15–180 d postregression). Recurrent tumors were depigmented and had decreased expression of gp100, the epitope targeted by the CD8+ T cells. Mice with recurrent melanoma had increased CD4+Foxp3+ TRP1-specific T cells compared with mice that did not show evidence of disease. Importantly, splenocytes from mice with recurrent tumor were able to suppress the in vivo therapeutic efficacy of splenocytes from tumor-free mice. These data demonstrate that large established tumors can be treated by a combination of tumor-specific CD8+ and CD4+ T cells. Additionally, recurrent tumors exhibited decreased Ag expression, which was accompanied by conversion of the therapeutic tumor-specific CD4+ T cell population to a Foxp3+CD4+ regulatory T cell population.
IL-21 Promotes Lupus-like Disease in Chronic Graft-versus-Host Disease through Both CD4 T Cell- and B Cell-Intrinsic Mechanisms
Authors: Nguyen Vinh , Luzina Irina , Rus Horea , Tegla Cosmin , Chen Ching , Rus Violeta 
Published: June 2012

Abstract
T cell-driven B cell hyperactivity plays an essential role in driving autoimmune disease development in systemic lupus erythematosus. IL-21 is a member of the type I cytokine family with pleiotropic activities. It regulates B cell differentiation and function, promotes T follicular helper (TFH) cell and Th17 cell differentiation, and downregulates the induction of T regulatory cells. Although IL-21 has been implicated in systemic lupus erythematosus, the relative importance of IL-21R signaling in CD4+ T cells versus B cells is not clear. To address this question, we took advantage of two induced models of lupus-like chronic graft-versus-host disease by using wild-type or IL-21R−/− mice as donors in the parent-into-F1 model and as hosts in the Bm12→B6 model. We show that IL-21R expression on donor CD4+ T cells is essential for sustaining TFH cell number and subsequent help for B cells, resulting in autoantibody production and more severe lupus-like renal disease, but it does not alter the balance of Th17 cells and regulatory T cells. In contrast, IL-21R signaling on B cells is critical for the induction and maintenance of germinal centers, plasma cell differentiation, autoantibody production, and the development of renal disease. These results demonstrate that IL-21 promotes autoimmunity in chronic graft-versus-host disease through both CD4+ T cell- and B cell-intrinsic mechanisms and suggest that IL-21 blockade may attenuate B cell hyperactivity, as well as the aberrant TFH cell pathway that contributes to lupus pathogenesis.
Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults
Authors: Xie Xuetao , Zhang Changqing , Jin Dongxu , Chen Shengbao , Gao Youshui 
Published: June 2012

Neglected femoral neck fractures in young adults pose a great challenge to orthopedic surgeons because of the high risks of nonunion and osteonecrosis. We attempted to determine whether free vascularised fibular grafting through an anterior approach could enhance bone union, improve hip function and reduce complications in the treatment of such fractures. Thirteen patients with neglected femoral neck fractures were treated with a free vascularised fibular graft through an anterior approach between 2004 and 2008. The mean age was 30.9 years (range, 17–47 years). The average delay between injury and operation was 6.7 months (range, 1.5–22 months). All 13 cases had ununited fractures but without osteonecrosis of the femoral head on plain radiographs before coming under our care. The average follow-up was 51.2 months (range, 36–75 months). All patients had fracture union within an average of 4.8 months (range, 3–9 months). Postoperatively, 9 patients had coxa vara of 10 to 20 degrees and leg discrepancy between 0.5 to 1.5 cm. One patient had coxa vara deformity of 25 degrees and 2-cm leg discrepancy. No patients developed osteonecrosis of the femoral head or donor-site morbidity. The mean Harris hip score improved from 55.5 points preoperatively to 84.8 points postoperatively (p<0.01). This procedure may be useful and safe in the treatment of neglected femoral neck fractures in young adults, but further studies with a large number of patients are needed.
Vascular Access Outcomes in HIV-Positive Patients
Authors: Mistry Hiren , Lifford Rhiannon , Stephenson Matthew A. , Valenti Domenico 
Published: June 2012

Purpose There is a limited source of information about vascular access outcomes in HIV-positive patients in the literature. Previous studies have shown autogenous arteriovenous fistulae (AVF) to have similar cumulative survival rates in HIV-positive and negative patients but functional patency has not been assessed. The primary aim of this study was to investigate functional patency of AVFs in HIV-positive patients. Methods A retrospective case-control study identifying 17 HIV-positive patients with AVFs under the care of renal services at Kings College Hospital, London was undertaken. Seventeen HIV-negative controls were matched for age, sex, ethnicity, and co-morbidities. Comparisons were made for pre-operative vein diameter, primary and functional patencies, and postoperative complications. Results No statistically significant difference was seen for functional patency between AVFs in the HIV-positive and control groups (P=.078). Complications were experienced by five HIV-positive patients (29.4%) and nine of the control group (52.9%). These included aneurysms and pseudoaneurysms for both groups. The difference in pre-operative vein diameter was not significant (P=.102), although only five of the HIV-positive patients had pre-operative vein diameters >=2.5 mm (45.5%) compared to twelve of the controls (75%). Conclusions This study reveals that there is no statistically significant difference between the functional patency of autogenous AVFs in HIV-positive patients compared to HIV-negative controls. With less than half of the HIV-positive patients having pre-operative vein diameters >=2.5 mm, this suggests that it is still worth creating AVFs in patients with sub-optimal veins considering the known poorer patency with non-autogenous fistulae.