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Background Chronic Spontaneous Urticaria is considered to be an autoimmune phenomenon in half of the total cases. Autologous serum skin test is a simple screening test for the presence of auto-antibodies in chronic urticaria. Significant impairment in quality of life have been observed in autologous serum skin test positive cases. There are limited literatures on chronic spontaneous urticaria, autologous serum skin test and associated Dermatology Life Quality Index in Nepal till date. Objective To find the proportion of autologous serum skin test positive cases in chronic urticaria and impairment in quality of life in such patients. Method This was a retrospective review of outpatient records of patients diagnosed with chronic spontaneous urticaria, from January 2018 to December 2019, from a tertiary care hospital in Kathmandu, Nepal. Details of the patients, autologous serum skin test and dermatology life quality index scores were analyzed and presented. Result Among the total 114 cases positive autologous serum skin test was seen in 48.2% of cases. The mean total Dermatology Life Quality Index score was 8.06±6.64. A significantly higher quality of life impairment was observed in in patients with positive autologous serum skin test as compared to the negative ones. The odds of finding a positive autologous serum skin test in patients with angioedema was 2.1, however the difference was not statistically significant. Conclusion Chronic spontaneous urticaria was more common in females as compared to males. A positive autologous serum skin test was present in half of the patients which was in turn associated with a greater impairment of quality of life.

In this work, dust properties around the White Dwarf PG 1225-079 located at RA (J2000): 12h 27m 47.35s, DEC(J2000): -08° 14’ 37.97” is studied extensively using the publicly available data from Improved Reprocessing of IRAS Survey (IRIS), AKARI infrared survey and Wide field Infrared Survey Explorer (WISE). The bipolar dust structure hardly resolved in IRIS (60 μm and 100 μm) is clearly resolved in AKARI (90 μm and 140 μm) and WISE (12 μm and 22 μm) images. The dust color temperature and dust mass are calculated from the infrared flux density. The average value of dust color temperature in isolated dust structure is 27.57 K for IRIS (I1). For isolated upper and lower dust clouds the average temperatures are; 22.64 K and 22.63 K for AKARI (A1 and A2), 295.34 K and 296.85 K in WISE (W1 and W2) data. A wide range of temperatures suggests the bipolar dust structure is dynamically active. The mass of dust is found to be 3.44 × 1025 kg in IRIS (I1), 1.82 × 1026 kg and 5.89×1026 kg in two bipolar regions in AKARI (A1 and A2) and 1.12 ×1026 kg and 1.14×1026 kg in WISE (W1 and W2). A good relation is found between the infrared flux in all survey data with r2 value 0.83 in IRIS (I1) and more than 0.90 in AKARI (A1, A2) and WISE (W1, W2) data. SIMBAD database explore some sources including Supernova Remnants nearby the dust which might be the progenitor of dust as well as the contributor of energetic radiation. The Gaussian modeling of temperature is found to be deviated from normal shape. The contour plot of dust color temperature and dust mass shows non uniform variation among the IRIS, AKARI and WISE survey. The relation between infrared flux, dust color temperature and dust mass within the dust clouds are presented.

During the asymptotic giant branch (AGB) phase, a major fraction of mass is spread by the stars (0.6 - 10 M⊙) in the interstellar medium (ISM) in the form of dust. In the left phase of the post-main sequence evolution in the Hertzsprung-Russell (HR) diagram, these dust are found to be surrounding the white dwarfs (WD). Some small fraction of dust is also formed in the circumstellar shells and cavities around WD which is usually a source of infrared (IR) excess. The formation and evolution of such IR dust structures are the results of high-pressure events such as the Helium shell flash (thermal pulse) and stellar winds, and such structures are crucial in the study of interaction phenomena in ISM. This research project is focused on the study of an isolated dust structure near the white dwarf WD0011-399 located at R.A. (J2000) 00h 13m 47.48s and Dec. (J2000) -39° 370 24.2800 using Improved Reprocessing of the IRAS (IRIS), AKARI and Wide-field Infrared Survey Explorer (WISE) surveys from SkyView Virtual Observatory along with SIMBAD Astronomical Database and Gaia Archive of ESA. The size of the cavity under study is 7.43 pc×2.90 pc, 2.99pc×0.99pc, and 1.26×0.53pc with an inclination angle of 71.12°, 75.73°, and 68.48° respectively in IRIS, AKARI and WISE data suggesting the cavity is neither a face-on nor an edge-on. The relative flux density of the region has been studied through pixel extraction of Far-Infrared (FIR) images and dust color temperature along with dust mass has been calculated. Using IRIS data, the temperature of the isolated region is found between a maximum value of 36.82±4.30 K to a minimum of 22.59±2.32 K with an offset of 14.23 K. The average temperature of the region is 28.22±0.18 K. Following similar procedures for AKARI data, the temperature is found between a maximum of 26.37±3.56 K and a minimum of 16.32±1.47 K with an offset of 10.06K. The average temperature is 19.25±0.15 K. Similarly, using WISE data, the temperature is found between a maximum of 353.72±18.54 K and a minimum of 307.24±4.69 K with an offset of 46.48K. The average temperature is 316.62±0.81 K. High value of offset temperature suggests that the cavity might be evolving with disruptions from background radiative sources. Approximately Gaussian distribution of the temperature in all the surveys implies that the region might be tending towards local thermodynamic equilibrium. The total mass of the structure is estimated to be around 0.03±1.5×10−6M⊙, 1.6×10−3±1.4×10−5 M⊙, and 10−7±3×10−10 M⊙ using IRIS, AKARI, and WISE data respectively. The Jean’s mass of the structure is calculated assuming the structure is a non-degenerate gas, which is estimated around 2001.93M⊙, 178.44M⊙, and 121.47M⊙ respectively using IRIS, AKARI, and WISE data. Since Jean’s mass is much greater than the mass of the structure there seems no possibility of star formation within the region of interest. The color maps illustrate identical distribution for all wavelengths, however, no significant relation is observed between dust color temperature and dust mass.

A huge dust structure of size 3° ×3° consisting of many sub−structures of dust nebulae and dust cavities is discovered around the WD 0307+077, located at RA (ICRS): 47.59° , DEC (ICRS): +7.84° , in far−infrared image of IRIS survey. Infrared flux density at 60 µm and 100 µm are used to calculate dust color temperature and dust mass in dust structure and all sub−structures. The contour plot is used to visualize the variation of infrared flux, dust color temperature and dust mass within all sub−structures. The inclination angle of isolated region of sub−structures is calculated to know the shape of the dust cloud. It is found that the dust color temperature of all the nebulae and cavities lies between the 20 K to 24 K, with range not more than 3 K. This range of temperature suggests that the sub−structures are moving towards the thermal stability. The dust mass shows the similar mass composition within all sub−structures, with variation of just one order magnitude. The linear regression shows a very good linear relation between between the infrared flux at 60 µm and 100 µm wavelength with regression coefficient more than 0.90 in five sub−structures and more than 0.78 in remaining two. The inclination angle of shows the all sub−structures are clearly edge−on in shape having inclination angle i > 45° . The Gaussian distribution of dust color temperature in all sub−structures shows more or less deviation from Normal distribution, the background sources observed in the SIMBAD database are suspected for this deviation.

The lungs of patients with acute respiratory distress syndrome (ARDS) have hyperpermeable capillaries that must undergo repair in an acidic microenvironment. Pulmonary microvascular endothelial cells (PMVECs) have an acid-resistant phenotype, in part due to carbonic anhydrase IX (CA IX). CA IX also facilitates PMVEC repair by promoting aerobic glycolysis, migration, and network formation. Molecular mechanisms of how CA IX performs such a wide range of functions are unknown. CA IX is composed of four domains known as the proteoglycan-like (PG), catalytic (CA), transmembrane (TM), and intracellular (IC) domains. We hypothesized that the PG and CA domains mediate PMVEC pH homeostasis and repair, and the IC domain regulates aerobic glycolysis and PI3k/Akt signaling. The functions of each CA IX domain were investigated using PMVEC cell lines that express either a full-length CA IX protein or a CA IX protein harboring a domain deletion. We found that the PG domain promotes intracellular pH homeostasis, migration, and network formation. The CA and IC domains mediate Akt activation but negatively regulate aerobic glycolysis. The IC domain also supports migration while inhibiting network formation. Finally, we show that exposure to acidosis suppresses aerobic glycolysis and migration, even though intracellular pH is maintained in PMVECs. Thus, we report that 1) the PG and IC domains mediate PMVEC migration and network formation, 2) the CA and IC domains support PI3K/Akt signaling, and 3) acidosis impairs PMVEC metabolism and migration independent of intracellular pH homeostasis.

We present a detailed morphology and spectroscopic study of a merging dwarf galaxy PGC 030133. Using the publicly available fiber spectroscopic data from the Sloan Digital Sky Survey (SDSS), we analyzed nine-strong emission lines of wavelength range 4336 Å to 6739 Å. We find that the strongest emission line is OIII5007, with an intensity of 146.32 × 10-17 erg/s/cm2 /Å. The observed emission lines are well fitted with a Gaussian profile with a coefficient of regression greater than 96%, and the derived full-width half maximum (FWHM) is less than 4.2Å. The Balmer decrement, characterized by the line ratio between Hα and Hβ is 3.07, suggesting a presence of dust at the center of PGC 030133. We derived the star-formation rate and emission line metallicity of PGC 030133 using extinction corrected emission line fluxes. SFR derived from Hα emission line flux is 0.0033 Mʘyear-1 and emission line metallicity derived from flux ratio between NII and Hα is 8.13 dex. Using the SDSS, g, and z-band imaging data, we derived morphological parameters. PGC 030133 has a half-light radius of 3.38 arc second and 3.05 arc second in g-band and z-band respectively and observed one-dimensional light profile is well fitted with a Sersic function with near exponential Sersic index ~ 0.9.

Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78°, the sacral slope was 34.38±6.79°, the pelvic tilt was 15.97±5.31°, and the lumbar lordosis was 46.76±6.78°. In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79°, the sacral slope was 40.40±6.91°, the pelvic tilt was 20.63±7.51°, and the lumbar lordosis was 57.31±7.11°. The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p < 0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52°, II =62° and III 72.5°). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip.

We report that we estimated the mean proper motion, the full space velocity of five Globular clusters, Pal 1, Pal2, NGC 1815, NGC 7089, and NGC 7099, using Gaia Early Data Release 3 (Gaia EDR3). We focus on these five clusters to measure proper motion, internal dispersion, and dynamical properties. Also, we have integrated the orbits using the potential of MWPotential2014 for five backyards Gyr. We have derived energy, angular momentum, and orbital properties for each cluster. In addition, we find that there are four metal-poor GCs with metallicity less than -1.1 dex and only one metal-rich GCs with metallicity greater than -1.0 dex. We estimate the distance modulus of these five globular clusters and examine isochrone fitting to the color-magnitude diagram from the PAdova and TRieste Stellar Evolution Code (PARSEC). Among five globular clusters, we have found that the NGC 7099 is the oldest globular cluster age of ∼ 13 Gyr with metallicity ([Fe/H]) of 2.19, whereas the youngest globular cluster we find in our sample is Pal 1 with metallicity ([Fe/H]) of -0.65 and age of ∼ 8 Gyr.

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

Background Spondylolisthesis is one of the major causes of low back pain. The anterior shift of the vertebra is mostly at L4 and L5 levels. Several types have been described, most common being the isthmic type. Pelvic parameters are said to be associated with development and progression of listhesis, and should be evaluated while treating it. Objective To study the correlation of Pelvic parameters with isthmic spondylolisthesis. Method It was a cross sectional case control study. In 68 cases with Isthmic Spondylolisthesis and of 34 cases with low back pain without listhesis (control), the spinopelvic parameters like lumbar lordosis, pelvic incidence, pelvic tilt and sacral slopes were measured together with degree of slip with lateral radiographs. Findings were analyzed and compared with control group. Result In control group, the pelvic incidence was 50.44±4.78o , the sacral slope was 34.38±6.79o , the pelvic tilt was 15.97±5.31o , and the lumbar lordosis was 46.76±6.78o . In Isthmic Spondylolisthesis group, the pelvic incidence was 60.85±6.79o , the sacral slope was 40.40±6.91o , the pelvic tilt was 20.63±7.51o , and the lumbar lordosis was 57.31±7.11o . The difference in spinopelvic parameters amongst control and Isthmic Spondylolisthesis group was statistically significant (p0.001). The degree of slip was directly proportional to the pelvic incidence angle (grade I=52o , II =62o and III 72.5o ). Conclusion Spino-pelvic parameters are higher in isthmic spondylolisthesis group and is significantly associated with severity of the slip.

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

In this work, we have studied the far-infrared images of the dust cavity around the White Dwarf WD 0352-049 available in Infrared Astronomical Satellite Map from Sky View Observatory. The size of the cavity is 24.48 pc × 8.10 pc. We have studied the relative infrared flux density and calculated the dust color temperature and dust mass. The temperature of the whole cavity structure lies between a maximum value 24.09 ± 0.50 K to a minimum 21.87 ± 0.61K with fluctuation of 2.22 K and an average value of 23.09 ± 1.11 K. The small fluctuation of dust color temperature suggests that the dust in cavity structure is evolving independently and less disturbed from background radiation sources. The color map shows the identical distribution of flux at 60 μm and 100 μm and the inverse distribution of dust color temperature and dust mass. There is a Gaussian-like distribution of relative flux density, dust color temperature and dust mass. The Gaussian distribution of temperature suggests that the dusts in cavity are in local thermodynamic equilibrium. The study of relative flux density and dust color temperature along the major and minor axis shows there is a sinusoidal fluctuation of flux and temperature, which might be due to the wind generated by White Dwarf located nearby the center of the cavity structure. The total dust mass of the dust is found to be 0.07 Mʘ and that of gas is 13.66 Mʘ. The Jeans mass of the structure is less than the total mass of gas in the structure, suggesting the possibility of star formation activity by gravitational collapse in the future. Also, the study of inclination angle suggests that the three-dimensional shape of the structure is uniform and regularly shaped.

Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p

Primary extradural mesenchymal chondrosarcoma (MCS) is a very rare intraspinal tumor. Proper clinical evaluation with magnetic resonance imaging (MRI) followed by biopsy of the mass can confirm the diagnosis. Since MCS has a high tendency of recurrence and metastasis, the prognosis is guarded. We report a 52 years old male with primary extradural MCS in the lumbosacral region (L5-S3). Subtotal excision and biopsy were performed which confirmed the diagnosis. The patient received post excisional radiotherapy but expired after four months. Though rare, this tumor should be kept in differentials which helps in early diagnosis and thus can be treated with radical excision of the mass along with postoperative radiotherapy.

Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community.

Rare disease like primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities., Rare diseases like primary spinal epidural diffuse large B‐cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities.

Quantitative assessment of cellular forces and motion advanced considerably over the last four decades. These advancements provided the framework to examine insightful mechanical signaling processes in cell culture systems. However, the field currently faces three problems: lack of quality standardization of the acquired data, technical errors in data analysis and visualization, and perhaps most importantly, the technology remains largely out of reach for common cell biology laboratories. To overcome these limitations, we developed a new experimental platform - Integrative Toolkit to Analyze Cellular Signals (iTACS). iTACS consists of two components: Acquisition and Training Module (AcTrM) and Analysis and Visualization Module (AnViM). AcTrM is based on µManager - an NIH-ImageJ-based microscope control software - and facilitates user self-training and automation of common image acquisition protocols. AnViM is based on NIH-ImageJ and facilitates user-friendly automation of data analysis and insightful visualization of results. These experiments involve culturing adherent cells on hydrogels, imaging fiducial markers embedded in the hydrogel, and finally extracting from these images a comprehensive mechanical characterization of the cells. Currently, iTACS enables the user to analyze and track a wide array of properties, including morphology, motion, cytoskeletal forces, and fluorescence of individual cells and their neighboring region. The quality standardization issue was addressed in AcTrM with, a reference image-guided refocusing technique. The technical issues in data analysis were addressed in AnViM with a multi-pronged image segmentation procedure, a user-friendly approach to identify boundary conditions, and a novel cellular property-based data visualization. AcTrM is designed to facilitate the straightforward transformation of basic fluorescence microscopes into experimental cell mechanics rigs, and AnViM is equipped to enable users to measure cellular mechanical signals without requiring an engineering background. iTACS will be available to the research community as an open-source suite with community-driven development capabilities.

The Majorana Demonstrator neutrinoless double-beta decay experiment comprises a 44 kg (30 kg enriched in ^{76}Ge) array of p-type, point-contact germanium detectors. With its unprecedented energy resolution and ultralow backgrounds, Majorana also searches for rare event signatures from beyond standard model physics in the low energy region below 100 keV. In this Letter, we test the continuous spontaneous localization (CSL) model, one of the mathematically well-motivated wave function collapse models aimed at solving the long-standing unresolved quantum mechanical measurement problem. While the CSL predicts the existence of a detectable radiation signature in the x-ray domain, we find no evidence of such radiation in the 19-100 keV range in a 37.5 kg-y enriched germanium exposure collected between December 31, 2015, and November 27, 2019, with the Demonstrator. We explored both the non-mass-proportional (n-m-p) and the mass-proportional (m-p) versions of the CSL with two different assumptions: that only the quasifree electrons can emit the x-ray radiation and that the nucleus can coherently emit an amplified radiation. In all cases, we set the most stringent upper limit to date for the white CSL model on the collapse rate, λ, providing a factor of 40-100 improvement in sensitivity over comparable searches. Our limit is the most stringent for large parts of the allowed parameter space. If the result is interpreted in terms of the Diòsi-Penrose gravitational wave function collapse model, the lower bound with a 95% confidence level is almost an order of magnitude improvement over the previous best limit.

Introduction Patients with inflammatory bowel diseases (IBDs) frequently develop colon cancer. Previous studies have identified the association between IBD and colon cancer. In this study, we explored the characteristics and outcomes of IBD patients with colon cancer admitted to the hospitals of the United States. Methods Patients who were hospitalized patients with diagnoses of IBD and colon cancer were compared with patients with IBD without colon cancer. The data were extracted from the Nationwide Inpatient Sample (NIS) from January 2016 to December 2017. Comparisons were made with regards to mortality, complications, in-hospital stay, and cost of treatment between the two groups. Results We identified 1,82,025 hospitalizations from January 2016 to December 2017 admitted with a diagnosis of IBD. Of these, 181,560 patients had IBD without colon cancer, and 465 patients had IBD with colon cancer. No statistically significant difference was observed with regards to the in-hospital mortality between the two groups. There were higher odds of acute kidney injury (AKI) (OR 1.54, 95% CI 6.6-9.8; p=0.00), colectomy (OR 1.2, 95% CI 1.3-2.5; p=0.0) and lower gastrointestinal bleeding (LGIB) (OR 1.6, 95% CI 1.8-3.7; p=0.04) in patients with IBD and colon cancer. A longer length of stay (7.1±6.9 vs.5.0±5.6, p=0.00) and higher mean total charge ($20,283 vs. $12,166, p=0.00) were observed in patients with IBD with colon cancer. Conclusions Patients with IBD-associated colon cancer appear to have higher complication rates, higher costs, and more extended hospital stays. Therefore, early identification and management of complications related to IBD among patients with colon cancer are particularly crucial to reduce morbidity as well as the cost of hospitalization and treatment.

Introduction: Mental health problems raise many human rights issues. People with mental illness are exposed to human rights violation within and outside the health care context. Because of lack of awareness, people with mental illness and their families do not exercise their rights. Psychiatric patients are most vulnerable groups in community. Incidence of violation of rights of mentally ill patients can be avoided if the community people become aware of them. Objective: To assess knowledge regarding human rights and myth of mental illness among community people. Method: A descriptive crosssectional study was conducted among 140 community people of Ritthepani-27, Kaski, Nepal. Non probability convenient sampling technique was adopted to collect the data. Inclusion criteria included head of the family of the selected community who were willing to participate in the study. Data was collected through face to face interview using a structured questionnaire. Results: In the present study, it was found that 46.40% of the community people had inadequate knowledge regarding human rights of mentally ill patients. There was no significant association between demographic variables and knowledge score of the respondents. The study found that more than half of the respondents (51%) had belief that mental illness is not related to physical health. Likewise 36.4% believed mental illness is caused by supernatural power and evil and 30% believed that marriage can cure mental illness. Conclusion: Based on findings, it is concluded that the level of knowledge regarding rights of mentally ill patient is inadequate and there is a high prevalence of myths and misconceptions related to mental illness among the adult population. So, there is need to conduct awareness raising activities in the community.

Two isolated far infrared dust structures (∼2.61pc × 1.57pc and ∼82.99pc × 39.99pc) at galactic coordinates: (353.01°, 16.98°) and (18.42°, 1.98°), were selected. We adopted the distance of the first structure to be about 139 pc and that of the second structure to be 2.6 kpc. In this present work we have studied the flux density variation and calculated dust color temperature and mass profile of the dust and Jeans mass of the structures using the data reduction software ALADIN v9. Our aim was to test whether this region is star forming or not. We also calculated the size and inclination angle of our structures. The dust color temperature is found to lie in the range 20.75 K to 35.90 K for the first region and 22.52 K to 45.63 K for the second region. The total mass of gas for the first structure is found to be about 20.99 M☉ and Jeans mass is found to be 180.9 M☉, which is significantly greater than the total mass of the structure, suggesting no possibility of star formation activity for the first region. For the second region, the total mass of gas and the Jeans mass are found to be 5621.61 M☉ and 6005.04 M☉ respectively. The mass of the region is still significantly lesser than the Jeans mass. Thus, we conclude that this region is also probably not a star forming region. Also the study of inclination angle suggests that the three-dimensional shape of structures is non uniform and regularly shaped.

Tomato (Lycopersicon esculentum) is highly perishable and has potential for processing industries in bumper producing seasons in Nepal. The study on judicious use of nitrogen and potassium levels was aimed to explore the quality attributes along with the shelf life of tomato fruits. Three levels of nitrogen comprising 0 kg/ha (N0), 100 kg/ha (N100), 200 kg/ha (N200) and four levels of potassium 0 K2O kg/ha (K0), 80 K2O kg/ha (K80), 160 K2O kg/ha (K160), 240 K2O kg /ha (K240) were used as treatments in randomized complete block design with three replications at Chitwan (Inner Terai) Nepal. Tomatoes at breaker stage were harvested from the field and 10 fruits from each treatment per replication were kept for physiological weight loss, color rating and shelf life in ambient condition (17.5±3 0C and 80.5±6.5 % RH). Fruit quality with respect to physicochemical properties like firmness, TSS, TA, pH and Vitamin C was assessed at the end of shelf life. Higher potassium levels hasten color development and increased TSS, firmness and vitamin C content. Physiological weight loss was greatly reduced and extended shelf life was achieved with 100 kg N/ha and 240 kg K2O/ha.

There are only limited policy levers that governments can use to facilitate sustainable development within remote rural communities. Often marginalised communities are almost uniquely dependent on the exploitation of local natural resources to generate livelihoods. We examine how formal education, both of household heads and more broadly across households, influences perceived opportunities for the conception, management and utilisation of community forests in the mid-hills of Nepal. As societies transition, more sophisticated economies will require education to facilitate effective natural resource management. New challenges are emerging for community forestry as a result. The quantitative socio-ecological data analysis suggests that while the roles of community forests are evolving, education is key to household participation in commercial opportunities. Formal education in the household is shown to be associated with a greater recognition of the importance of the commercialisation of forest timber and food products, and the desire to participate in further commercial forest activities. Education in the household also provides respondents with a more sophisticated understanding of new opportunities, ecosystem services and risks associated with the forest, and the abilities to actively manage the forest and influence planning. Formal education empowers people to become local experts in forest management and participate in new opportunities that forests provide. Any failure to examine household education levels may be neglecting key sociological data on the importance of education for sustainable development outcomes. In the rural margins of the mid-hills of Nepal there are opportunities for further aligning formal education with forestry policy.

Introduction Gastrointestinal (GI) varices are abnormally dilated submucosal veins in the digestive tract caused due to portal hypertension. Esophagus and stomach are common locations of varices induced by portal hypertension. Their presence correlates with the severity of the liver disease. Endoscopic variceal band ligation is one of the preferred methods for bleeding and nonbleeding large varices to decrease bleeding risk. Tissue adhesives such as N-butyl-2-cyanoacrylate have been used for gastric variceal obturation. Methods This descriptive study was conducted in the Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal, from March 2014 to January 2020. The endoscopic detection of esophageal and gastric varices was observed. Endoscopic variceal ligation (EVL) was done for esophageal varices and injection of N-butyl 2-cyanoacrylate for gastric varices. Results Esopahageal varices were detected in 1266 patients (8%) and gastric varices were in 36 patients (0.2%) among 15,657 patients undergoing upper gastrointestinal (UGI) endoscopy. Nine hundred seven (71.6%) were male. Large esophageal varices were endoscopically detected in 54.8% patients, small varices in 31.4% and both (large and small varices) in 13.4%. EVL was done in 30.7% and EVL with cyanoacrylate glue injection in 35 patients (2.7%). Conclusion Esophageal and gastric varices are seen commonly in patients with chronic liver disease. This study was conducted to describe the different types of GI varices in patients undergoing UGI endoscopy. Variceal band ligation for esophageal varices and glue injection for gastric varices are viable options of management.

Introduction Inflammatory bowel diseases (IBD) comprise ulcerative colitis (UC) and Crohn's disease (CD). These are diseases of the gastrointestinal tract without a clear etiology but have strong relationships with underlying factors like genetic susceptibility, environmental factors, and intestinal bacteria. In the east, inflammatory bowel diseases predominantly affect the younger population and have an almost equal gender distribution. With urbanization and the adoption of the western lifestyle, the incidence and prevalence of IBD are increasing in Asia. In this study, we describe the epidemiology of IBD in Nepal. Methods This was an observational study conducted in nine endoscopy centers within Nepal. Two years of data of colonoscopies in these centers were collected retrospectively. IBD was diagnosed by endoscopic examination. The incidence of IBD was calculated as the number of patients with IBD per 1000 colonoscopies per year. The demographic profiles of the patients were also collected. Results A total of 7526 colonoscopies were done in nine centers within the two years study period. IBD was seen in 479 patients (6.3%). The incidence of UC was 23.7 per 1000 colonoscopies per year and the incidence of CD was 1.6 per 1000 colonoscopies per year. UC (87%) was more common than CD (13%). Both UC and CD were mostly seen in the 30 to 40 years age group. In patients with UC, the rectum was the most commonly affected site. Discussion IBD in Nepal affects young males in their thirties. Younger age of affliction with a chronic disease and lack of awareness regarding the symptoms and diagnostic modalities of IBD may result in a delayed diagnosis. The target population must be made aware of the presenting symptoms of IBD and a need for colonoscopic examination for diagnosis. There is also a need for creating a national IBD registry for Nepal.

Background and objective The prevalence of non-alcoholic fatty liver disease (NAFLD) is 60% in patients with type 2 diabetes mellitus (T2DM). NAFLD can lead to non-alcoholic steatohepatitis (NASH), both of which are the leading causes of cirrhosis. This study was undertaken to evaluate whether empagliflozin, a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, reduces liver fat content in these patients after therapy. Methods After enrolling patients of T2DM with NAFLD, they were administered empagliflozin 10 mg once daily orally for six months without modifying existing oral hypoglycemic agents (OHA) if any. All demographic data were collected, and anthropometric measurements, as well as laboratory investigations, were performed, and controlled attenuation parameter (CAP) and liver stiffness (LS) were measured using FibroScan® (Echosens, Paris, France) at baseline, and six months of therapy. The adverse effects related to therapy were also taken into account. Results There was a significant decrease in mean CAP value from 282.07 ± 47.29 dB/m to 263.07 ± 49.93 dB/m and LS from 5.89 ± 4.23 kPa to 5.04 ± 1.49 kPa along with a significant decrease in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) among the patients. Compared to the baseline, there was a significant reduction in post-treatment weight, body mass index (BMI), and blood pressure (BP). The most commonly observed adverse effects of the therapy were urinary tract infection (UTI) (17.8%), nasopharyngitis (11.9%), and hypoglycemia (10.71%). Conclusion A reduction in hepatic fat content was seen in our prospective study cohort after six months of empagliflozin therapy. Empagliflozin also led to beneficial effects such as weight loss and reduction in transaminases and GGT. Given the absence of significant side effects of the therapy, empagliflozin could be used as an effective treatment modality for T2DM patients with NAFLD, which are two conditions commonly seen in combination.

Tuberculosis is a common infection caused by Mycobacterium tuberculosis. Tuberculosis can affect many organ systems of the human body including the gastrointestinal tract. Esophageal involvement of tuberculosis is however rare. A 60 years old male from Nepal with an occupational history suggestive of exposure to tuberculosis presented with dysphagia. He did not have any other complaints and his physical examination was unremarkable. An upper gastrointestinal endoscopic examination revealed an esophageal ulcer at 25 cm from incisors. Biopsy from the edge of the ulcer revealed granulomas with central caseous necrosis. A computed tomography scan of the chest and abdomen did not reveal additional lesions. Considering the higher prevalence of tuberculosis in the geographical area, he was started on an empirical antitubercular regimen. His dysphagia subsided within two weeks of starting therapy. A repeat upper gastrointestinal examination at six months of therapy revealed complete healing of the esophageal lesion. In this case report, we review the symptomatology, diagnosis, and treatment of esophageal tuberculosis.

Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community.

Lymphomas are malignant tumors arising from lymphoid tissues and can spread to other organs. Primary extra-nodal locations such as the spinal epidural space are less common. Primary spinal epidural lymphoma (PSEL), which can be either Hodgkin’s or non-Hodgkin’s type, is rare. There are different cell types of Non-Hodgkin’s PSEL, among which mantle cell lymphoma (MCL) is extremely rare. MCL can have an aggressive or indolent course. Indolent MCL in the epidural space is not yet reported. We report a case of 20-year-old male who presented with radiating low back pain for six weeks followed by a progressive neurological deficit in both lower limbs for nine days. Magnetic resonance imaging (MRI) revealed spinal epidural tumor extending from L2 to L3. Decompression and subtotal excision biopsy were performed. Histopathology and immunohistochemistry identified indolent MCL. His neurological status improved to normal postoperatively, and he was referred to an oncologist. He is under observation and planned for radiotherapy. At one-year follow-up, he is asymptomatic and doing his regular job abroad.

Author(s): Arnquist, IJ; Avignone, FT; Barabash, AS; Barton, CJ; Bertrand, FE; Blalock, E; Bos, B; Busch, M; Buuck, M; Caldwell, TS; Chan, YD; Christofferson, CD; Chu, PH; Clark, ML; Cuesta, C; Detwiler, JA; Drobizhev, A; Edwards, TR; Edwins, DW; Efremenko, Y; Ejiri, H; Elliott, SR; Gilliss, T; Giovanetti, GK; Green, MP; Gruszko, J; Guinn, IS; Guiseppe, VE; Haufe, CR; Henning, R; Hervas Aguilar, D; Hoppe, EW; Hostiuc, A; Kidd, MF; Kim, I; Kouzes, RT; Lopez, AM; Lopez-Castano, JM; Martin, EL; Martin, RD; Massarczyk, R; Meijer, SJ; Mertens, S; Myslik, J; Oli, TK; Othman, G; Paudel, LS; Pettus, W; Poon, AWP; Radford, DC; Reine, AL; Rielage, K; Ruof, NW; Saykl, B; Stortini, MJ; Tedeschi, D; Varner, RL; Vasilyev, S; Wilkerson, JF; Wiseman, C; Xu, W; Yu, CH; Zhu, BX | Abstract: The majorana demonstrator is a neutrinoless double-β decay search consisting of a low-background modular array of high-purity germanium detectors, ∼2/3 of which are enriched to 88% in Ge76. The experiment is also searching for double-beta decay of Ge76 to excited states (e.s.) in Se76. Ge76 can decay into three daughter states of Se76, with clear event signatures consisting of a ββ-decay followed by the prompt emission of one or two γ rays. This results with high probability in multi-detector coincidences. The granularity of the demonstrator detector array enables powerful discrimination of this event signature from backgrounds. Using 41.9 kg yr of isotopic exposure, the demonstrator has set world leading limits for each e.s. decay of Ge76, with 90% CL lower half-life limits in the range of (0.75-4.0)×1024 yr. In particular, for the 2ν transition to the first 0+ e.s. of Se76, a lower half-life limit of 7.5×1023 yr at 90% CL was achieved.

The total cross section for electron capture is being calculated in this paper for 2s state of hydrogen atom in proton-potassium collision. The energy range chosen for the calculation is 50 keV to 10,000 keV and we have used Coulomb projected Born (CPB) approximation method. Also the differential cross section at different scattering angle has been calculated. The result obtained are compared with available theoretical data and found it to be in good agreement.

DOI: https://doi.org/10.3126/jnprossoc.v1i2.23871 A surgical obturator prosthesis is commonly used as an effective means for rehabilitating patient with hemi-maxillectomy defect. The obturator supports the soft tissues after surgery and minimizes the contraction of scar and disfigurement thereby making a positive effect on patient’s overall function and psychology. The goal of prosthodontics to restore missing orofacial structures for improving facial esthetics and oral function for such patients. The inability to achieve adequate retention, stability, support and comfort due to the friability of healing tissues are the common problems associated with prosthetic treatment in the initial phase of treatment. This case report demonstrates a simple technique to overcome such difficulties by the use of soft lining materials in the delayed surgical obturator. Keywords: Hemimaxillectomy, Maxillofacial prosthesis, Soft liner, Surgical obturator

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Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding. Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score. Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.