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Introduction: Fine needle aspiration cytology is a simple, rapid, cost-effective method in diagnosis of head and neck swelling with minimal risk of complications. Head and neck swellings include a broad spectrum of diseases with different management for each. Fine needle aspiration cytology is a suitable and useful method for assessment of these swelling. This study was done with the objective to study the frequency and distribution of various head and neck lesions detected by fine needle aspiration cytology., Methods: A descriptive cross-sectional study was conducted at the Department of Pathology in a tertiary care center from February 1 to July 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference number: IRC-PA-191/2078-79). All the patients presenting with head and neck swelling during the study period were included in this study. Total sampling was done. Fine needle aspiration was done and cytological diagnosis was made. Descriptive analysis was done where frequency and percentage were calculated., Results: Out of 112 cases included in the study, 43 (38.40%) were of lymph nodes, 36 (32.14%) of thyroid, 22 (19.64%) of skin and soft tissue and 11 (9.82%) of salivary glands. Among the lymph nodes cases, there were 11 (25.57%) metastases. In thyroid lesions, beingn lesions were seen in 24 (66.68%)., Conclusions: This study found that lymph nodes were the most common site for head and neck swellings, frequently involving metastatic lesions.

Introduction and Importance: Fat embolism syndrome (FES) arises from the systemic effects of fat emboli in microcirculation. While sepsis is characterized by pathological, physiological, and metabolic abnormalities caused by infection. Septic shock is identified by elevated blood lactate (>2 mmol/l) and the need for vasopressors to maintain a mean arterial pressure of 65 mmHg or higher in the absence of hypovolemia., Case Presentation: This case report discusses the clinical course and treatment of a 50-year-old male involved in a road traffic accident resulting in polytrauma. The patient presented with multiple fractures, hemopneumothorax, lung contusions, and rib fractures. He was then stabilized following which fractures were reduced and managed operatively. Postoperatively, the patient developed FES with septic shock, manifested by altered consciousness, petechial rashes, and respiratory distress. He was managed with intubation, chest drainage, and a combination of antibiotics, anticoagulants, and vasoactive agents. A tracheostomy was performed due to respiratory insufficiency. Following 29 days in the SICU, the patient's condition was stabilized and shifted to the general ward for further management. He was discharged after 48 days, with a complete recovery and a 2-week follow-up. This case report depicts the challenges in the management of FES with septic shock following polytrauma., Conclusion: This case report is a comprehensive overview of FES complicated with septic shock. It highlights the importance of supportive care as the primary treatment modality, incorporating various medical interventions. The successful outcome and complete recovery of the patient underline the significance of prolonged monitoring, wound care, and physiotherapy., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Intimate partner violence (IPV) is a significant public health concern in Nepal and its prevalence has increased during the COVID-19 pandemic. This study aimed to assess the prevalence of IPV among married women of reproductive age in Nepal during the pandemic., Methods: A web-based survey was conducted with 420 participants using a validated questionnaire adopted from the World Health Organization. Descriptive and inferential statistical analyses were performed., Results: Our study found that 52.62% of participants experienced IPV during the COVID-19 pandemic with economic violence being the most prevalent type (38.81%) and followed by behavioral control (37.14%), emotional violence (26.20%), physical violence (21.43%), and sexual violence (14.05%). Despite the high level of IPV, only 14% of participants sought help and only 6% reported the violence to the police. Univariate analyses showed that factors such as the husband's level of education and occupation, number of children, property ownership, husband's alcohol use, relationship and quarrels with the husband, fear of the husband, and participation in decision-making were associated with an increased risk of IPV. Multivariate analysis revealed that women involved in decision-making faced a 2.52 times higher risk of violence, that women who reported daily quarrels had a risk 5.47 times that of women who did not endorse fights, and that women who were afraid of their husbands had a risk 16 times that of women who did not report fear., Conclusion: This study reveals a concerning prevalence of IPV among married women in Nepal during the COVID-19 pandemic. Our findings emphasize the low reporting rates and help-seeking behavior among IPV victims. They also highlight the significant influence of factors such as participation in decision-making, frequent quarrels, and fear. These findings underscore the urgent need to establish support systems for IPV victims and develop targeted interventions tailored to the local context. Furthermore, conducting comprehensive research and understanding the interplay of contributing factors can guide the formulation of effective strategies to combat this pervasive societal problem., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Upon cooling, semicrystalline polymers experience crystallization and form alternatively stacked layers consisting of thin crystal lamellae and amorphous ones. The unique morphology, crystallinity, and crystallization kinetics highly depend on the molecular weight. Therefore, it is deduced that entanglement impacts crystallization kinetics, as well as hierarchically crystalline structures. However, the impact of entanglement on folded crystalline chains has not been well understood due to experimental difficulties. In this work, chain-folding structures for seven 13 C CH 3 labeled poly(l-lactic acid)s with various molecular weights ( M w s) were investigated by 13 C- 13 C double quantum NMR spectroscopy. As a result, chain-folding events were categorized into three different M w regimes: (i) The lowest M w sample (2K g/mol) adopts an extended chain conformation (folding number, n = 0) (regime I); (ii) Intermediate M w ones possess mixtures of non- and once-folded structures, and the once-folded fraction suddenly increases above the entanglement length ( M e ), up to M w = 45K g/mol (regime II); (iii) The high M w ones ( M w > 45K g/mol) adopt the highest chance for an adjacent re-entry structure with n = 1.0 in the well-developed entangled network (regime III). It was suggested that entanglement induces folding of the semicrystalline polymer.

Introduction: Severe COVID-19 patients experience elevated levels of serologic indicators of inflammation which can alter blood cell lineages and cause lymphopenia. The objective of this study was to find out the prevalence of severe COVID-19 among admitted COVID-19 patients in a tertiary care centre., Methods: A descriptive cross-sectional study was conducted in a tertiary care centre from 22 June 2021 to 30 September 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: IRC-PA-146/2077-78). Confirmed COVID-19 patients by reverse transcriptase polymerase chain reaction and admitted in the COVID block during the study period were included and those who were discharged on request or referred or unavailable blood tests were excluded. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated., Results: Among 72 admitted COVID-19 patients, 63 (87.5%) (79.86-95.14, 95% Confidence Interval) patients had severe disease. The mean neutrophil to lymphocyte ratio and mean lymphocyte to C-reactive protein ratio were 11.60±8.15 and 25.55±20.96 respectively., Conclusions: The prevalence of severe COVID-19 was higher than in other studies done in similar settings. We suggest clinical parameter-based early categorisation of COVID-19 cases to utilize limited resources during the pandemic., Keywords: COVID-19; c-reactive protein; lymphocytes; severe acute respiratory syndrome coronavirus.

An understanding of surfactant adsorption at solid-liquid interfaces is important for solving many technological problems. This work evaluates surfactant adsorption abilities of high surface area (200-600 m 2 /g), high porosity (>90%), hierarchically structured open pore polymer gels. Specifically, the interactions of a nonionic block copolymer surfactant, poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (PEO-PPO-PEO), with three polymer gels, namely, syndiotactic polystyrene (sPS), polyimide (PI), and polyurea (PUA) offering different surface energy values, are evaluated at surfactant concentrations below and well above the critical micelle concentration (CMC). Two distinct surfactant adsorption behaviors are identified from the surface tension and nuclear magnetic resonance data. At concentrations below CMC, the surfactant molecules adsorb as a monolayer on polymer strands, inferred from the Langmuir-type adsorption isotherm, with the adsorbed amount increasing with the specific surface area of the polymer gel. The study reports for the first time that the gels show a strong surfactant adsorption above CMC, with the effective surfactant concentration in the gel reaching several folds of the CMC values. The effective surfactant concentration in the gel is analyzed using surfactant micelle size, polymer surface energy, and pore size of the gel. The findings of this study may have strong implications in liquid-liquid separation problems and in the removal of small dye molecules, heavy metal ions, and living organisms from aqueous streams.

To fulfill the increasing needs of diagnostic support for researchers in plasma technology, a portable diagnostic package (PDP) equipped for both laser Thomson scattering (TS) and optical emission spectroscopy has been designed and constructed at Oak Ridge National Laboratory (ORNL), aiming to measure the temperature and number density of electrons and temperatures of ions in plasma devices. The PDP has been initially implemented on a high density and low temperature electrothermal arc source (ET-arc) at ORNL to test its TS capability. TS from the plasmas in the ET-arc has been obtained using the PDP. The electron temperature and number density were determined from TS spectra. These results were then compared to measurements from previous studies on the ET-arc. The TS diagnostic measured 0.8 ± 0.1, 1.3 ± 0.2, and 0.7 ± 0.1 eV and (4.4 ± 0.5) × 10 21 , (5.9 ± 0.7) × 10 21 , and (4.3 ± 0.5) x 10 21  m -3 , respectively, from three lines of sight that transect the plasma column.

An Advanced Research Projects Agency-Energy funded diagnostic system has been deployed to the Princeton field-reversed configuration 2 (PFRC-2) device, located at Princeton Plasma Physics Laboratory. The Portable Diagnostic Package (PDP), designed at Oak Ridge National Laboratory, allows for the measurement of Thomson Scattering (TS) for electron density and temperature and Optical Emission Spectroscopy (OES) for ion temperature, impurity density, and ion velocity. A tunable spectrometer on the PDP with three gratings provides the flexibility to measure low (1 eV) and high (1000 eV) electron temperature ranges from TS. Additionally, using a second spectrometer, the OES diagnostic can survey light emission from various ion excitation levels for wide wavelength ranges. The electron density (<2 × 10 19  m -3 ) of plasmas generated in PFRC-2 has been below the PDP TS discrimination threshold, which has made TS signal detection challenging against a high-background of laser stray light. The laser stray light was iteratively reduced by making modifications to the entrance and exit geometry on PFRC-2. Rayleigh scattering experiments on PFRC have yielded the TS discrimination sensitivity to be >1 × 10 20  m -3 for the PDP. A recently implemented narrow-band notch spectral filter that masks the second harmonic 532 nm Nd:YAG laser wavelength has increased the system's TS light discrimination sensitivity 65 times compared to the instance when the notch filter was not implemented. The hardware implementation including design changes to the flight tubes and Brewster windows will be discussed, along with results from Rayleigh and rotational Raman scattering sensitivity analyses, which were used to establish a quantitative figure of merit on the system performance. The Raman scattering calibration with the notch filter has improved the PDP electron density threshold to 1 ± 0.5 × 10 18  m -3 .

Semicrystalline polymers are categorized as either mobile or fixed crystals, depending on chain mobility in the crystalline region. In this work, we investigate molecular dynamics and phase structure in the cocrystal consisting of fixed and mobile polymer crystals by solid-state (ss) nuclear magnetic resonance (NMR) spectroscopy. It is demonstrated that (i) the mobile component begins large amplitude motions associated with crystal-crystal transition, while fixed ones keep their rigidity in the cocrystal, and (ii) asymmetric molecular dynamics leads to nanosegregations into mobile- and fixed-rich domains in the cocrystal below the melting temperature ( T m ). The observed phase separation induced by asymmetric molecular dynamics is similar to the phase separation of the miscible amorphous polymer blend; however, it is limited to two dimensions due to the parallel packing of the stems inside the cocrystal, as well as chain connectivity at the crystalline-amorphous boundary.

There isn't any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students' achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pretest and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science.

Introduction: Pathway of psychiatric care is defined as the sequence of contacts with individuals and organizations initiated by the distressed person's efforts and his significant others to seek appropriate health care. This study aimed to find the prevalence of non-psychiatric referral as first encounter among patients attending the psychiatry outpatient department of a tertiary care hospital., Methods: A descriptive cross-sectional study was carried out from 29th March 2015 to 25th April 2015 in the outpatient department of the department of psychiatry of a tertiary via direct interview using the World Health Organization's encounter form. Ethical approval was taken from undergraduate medical research protocol review board (Reference number 105/071/072). Psychiatric diagnoses were made by respective consultants using the International Classification of Diseases-10 Clinical Descriptions and Diagnostic Guidelines criteria. Data was entered in the Microsoft Excel 2007 and analyzed by Stata version 15. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data., Results: Out of 50 patients, 26 (52%) (38.2-65.8 at 95% Confidence Interval) of new cases in the outpatient department had non-psychiatric referrals. Among them, 13 (26%) referred from faith healers, 7 (14%) from the general hospital and 6 (12%) from medical out patient department., Conclusions: The prevalence of non-psychiatric referral for the patients seen for the first time in the psychiatry outpatient department was similar to findings from studies done in different parts of South East Asia.

Climate change and variability affect virtually everyone and every region of the world but the effects are nowhere more prominent than in mountain regions and people living therein. The Hindu Kush Himalayan (HKH) region is a vast expanse encompassing 18% of the world's mountainous area. Sprawling over 4.3 million km 2 , the HKH region occupies areas of eight countries namely Nepal, Bhutan, Afghanistan, Bangladesh, China, India, Myanmar, and Pakistan. The HKH region is warming at a rate higher than the global average and precipitation has also increased significantly over the last 6 decades along with increased frequency and intensity of some extreme events. Changes in temperature and precipitation have affected and will like to affect the climate-dependent sectors such as hydrology, agriculture, biodiversity, and human health. This paper aims to document how climate change has impacted and will impact, health and well-being of the people in the HKH region and offers adaptation and mitigation measures to reduce the impacts of climate change on health and well-being of the people. In the HKH region, climate change boosts infectious diseases, non-communicable diseases (NCDs), malnutrition, and injuries. Hence, climate change adaptation and mitigation measures are needed urgently to safeguard vulnerable populations residing in the HKH region., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dhimal, Bhandari, Dhimal, Kafle, Pyakurel, Mahotra, Akhtar, Ismail, Dhiman, Groneberg, Shrestha and Müller.)

A diagnostic system, which has a design goal of high-portability, has been designed at Oak Ridge National Laboratory (ORNL). This project aims at providing measurements of key plasma parameters (n e , T e , n i , T i ) for fusion-relevant devices, utilizing Thomson scattering (TS) and optical emission spectroscopy (OES). The innovative design employs mostly commercial off-the-shelf instrumentation and a traveling team of researchers to conduct measurements at various magnetic-confinement plasma devices. The TS diagnostic uses a Quantel Q-smart 1500 Nd:YAG laser with a 2ω harmonic generator to produce up to 850 mJ of 532 nm laser pulses at 10 Hz. Collection optics placed at the detection port consists of an 11 × 3 optical fiber bundle, where the TS diagnostic uses an 11 × 1 subset array of the fibers, the OES diagnostic uses another 11 fibers, and the remaining fibers are available to the host institution. The detection system is comprised of two separate IsoPlane-320 spectrometers with triple-grating turrets of various line spacing and two PI-MAX 4 intensified CCD detectors, used simultaneously to measure a broad range of ion, impurity, and electron parameters. The self-contained diagnostic package also includes a data processing and storage system. The design and initial implementation of the TS-OES diagnostic system are described. The experiments from the proof-of-principle operation of the portable package on a high density (∼2.5 × 10 22  m -3 ) and low-temperature (∼5 eV) electrothermal arc source at ORNL are also discussed.

The Thomson scattering (TS) diagnostic on the Prototype-Material Plasma Exposure eXperiment has been upgraded to measure electron temperature ( T e ) and density ( n e ) simultaneously at two axial locations. After the first pass through the vacuum vessel, the exiting laser beamline is re-collimated in the atmosphere and rerouted into the vacuum vessel for the second pass. The upgrade will help diagnose axial T e and n e gradients between the "central chamber" and the target region which are located 1 m and 2.5 m, respectively, downstream from the Helicon radio-frequency source. The TS measurements have given T e ≈ 4-15 eV and n e ≈ 2-4 × 10 19 m -3 at the central chamber and T e ≈ 1-2 eV and n e ≈ 1-2 × 10 19 m -3 at the target region. The upgrade also increases the number of sampling points at the target region from 3 fibers to 5 fibers, measuring 3 cm radially across the plasma column, and 25 fibers in the central chamber, radially spanning 8 cm. The intensified CCD camera is double triggered for each laser pulse in order to measure (1) the TS and laser stray light and (2) the plasma background light that contains nuisance emission lines and bremsstrahlung. Subtracting the background light from the TS photons improves the temperature and density measurements. Details of the diagnostic setup, axial and radial measurements, and areas for further optimization are discussed.

Introduction: Whipple's Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors. Our aim was to study the distribution and histopathologic features of these tumors and to examine local trends of periampullary neoplasms resected with a PD., Methods: A descriptive study was conducted in the department of Pathology, Kathmandu Medical College Teaching Hospital from July 2013 to June 2016., Results: Thirty five patients underwent Whipple's Pancreaticoduodenectomy procedure during a period of 36 months from July 2013 to June 2016. Malignant tumor was present in 31 (88.57%) cases where as four cases (11.43%) harboured benign lesions. Periampullary mixed carcinoma was the predominant tumor (34.28%) followed by periampullary duodenal (20%), ampullary (14.28%), pancreatic adenocarcinoma (11.42%) and distal cholangiocarcinoma (5.71%). There was no significant difference in tumor size among periampullary, ampullary, pancreatic and biliary carcinomas. Ampullary carcinomas were predominantly well differentiated (80%) where as the other tumors were mostly moderately differentiated. Lymphovascular and perineural invasion varied in different tumor types. Four pancreatic adenocarcinomas showed lymphovascular and perineural invasion. Adequate surgical margin clearance was achieved in most of the cases except in one case each of periampullary duodenal carcinoma and distal cholangiocarcinoma and two cases of pancreatic adenocarcinoma.., Conclusions: Pancreaticoduodenectomy specimen requires thorough histopathological evaluation. Pathologists should also be aware of possibility of a benign diagnosis in PD specimens which have been resected presuming malignancy based on clinical judgement and radiological data.