Gender Bias and Organ Transplantation in Nepal

Women in Nepal are less likely to receive proper, high quality medical care than their male relatives. Live-donor kidney transplantation provides a compelling example of such disparities, as 84% of recipients are male, 75% of donors are female and most kidneys are transferred from mother to son and from wife to husband. In the case of transplantation, women are not just denied healthcare, they are also responsible for the health of their male kin. Based on semi-structured ethnographic interviews with transplant patients, organ donors, dialysis patients and relatives, this paper elaborates on the social and economic factors that have created an extreme gender bias in transplantation. We argue that women, whose livelihoods largely depend on their husbands, donate kidneys out of self-protection and a sense of duty. Conversely, men receive kidneys but rarely donate them to women, because the health of men is a more productive economic investment than the health of women. We reject the notion that wives are directly coerced or pressured into donating kidneys to their husbands. Rather, we argue that female kidney donors make thoughtful, independent decisions that serve their best interests, and allow them to assert some control over their lives. It is, however, Nepal’s patriarchal society that both necessitates and limits such assertions of power

Fast Transients in Non-Volatile Resistive Memories (RRAM) Using Tantalum Pentoxide as Solid Electrolyte

The semiconductor electronics industry has followed Moore\u27s law austerely since 1965 fueling the microelectronics revolution and major technological advancements. Over the recent decades, the semiconductor industry has proven to be very successful, particularly by scaling the geometry of devices ever smaller. The device scaling has been very effective in boosting productivity yielding astonishing integration levels while simultaneously dramatically dropping the price per bit. However, the future of device scaling remains unclear. It is certain that device scaling will face severe reliability, cost and energy issues in the future. Therefore, there is a need to identify alternative technology platforms. Reconfigurable devices are considered as one of the key alternatives. However, the widespread aggressive acceptance of reconfigurable devices in the semiconductor industry faces many different challenges. One of the major challenges is the size of the switching matrix. One solution to overcome this challenge is to replace the present SRAM (Static Random Access Memory) switch with a non-volatile resistive memory switch. Some of the advantages of these switches are low cost, CMOS compatibility and simple structure. Given such advantages, it is essential to elucidate the working principle as well as the reliability issues. Since these non-volatile resistive switch devices are new to the semiconductor electronics industry, it is crucially important to explore novel structures for improved device architectures and to develop adequate measurement techniques to inspect and characterize these novel resistive switch devices. In this thesis, novel structures of RRAM devices with constricted electrode area close to the size of a single conducting filament of around 10 nm have been explored to improve device performance. Also, new measurement setups have been developed and proprietary test circuits have been designed, built and tested in order to acquire accurate and reliable data to investigate device performance. Some of the notable achievements of the developed measurement setups are measurement capability of switching transient with accuracy of 4 ns, high resistance measurements up to 1.6 GΩ, accurate endurance test within 1 ms/cycle and limiting current during SET to \u3c 20 μA without noticeable overshoot within 500 ps

Estimating Energy Cost of Physical Activities from Video Using 3D-CNN Networks

This research proposes a machine learning model that can estimate the energy cost of physical activities from video input. Currently, wearable sensors are commonly used for this purpose, but they have limitations in terms of practicality and accuracy. A deep learning model using three dimensional convolutional neural network (3D-CNN) architecture was used to process the video data and predict the energy cost in terms of metabolic equivalents (METs). The proposed model was evaluated on a dataset of physical activity videos and achieved an average accuracy of 71% on energy category prediction task and an root mean squared error (RMSE) of 1.14 on energy cost prediction task. The findings suggest that this approach has the potential for practical applications in physical activity surveillance, health interventions, and at-home activity monitoring

Variations of Nutrient Foramen of Femur and its Clinical Implications

Introduction: Nutrient foramen is the largest opening on the shaft of the femur that conveys nutrient artery into the marrow cavity. Knowledge on locations of nutrient foramina is essential during surgical procedures as well as to rule out if the fracture line passes through the foramina. The purpose of the study was to determine the number and position of nutrient foramina in relation to length and topography of the femur. Methods: The study model was descriptive, cross-sectional study that included 151 femurs (71 right and 80 left side). The total number, location, and direction of nutrient foramina were investigated. Total length of femur and distance of foramen from the proximal end was measured with the 500mm 20" Digital Vernier Nib Jaw Caliper Metric/ Imperial Machine-DRO and finally Foraminal Index was calculated. Results: The analysis revealed 119(78.81%) of the femurs with single nutrient foramen, 31(20.52%) with double and 1(0.67%) with triple nutrient foramina. Foraminal Index II was found in 74(86.05%) on right side and 90(91.84%) on left side. The most common location of nutrient foramen was the medial lip of linea aspera (n= 77, 41.85%). All of the foramina were directed towards the proximal end. Conclusion: The present study has reported the majority of nutrient foramina located in the middle third of femur along the linea aspera. Thus, linea aspera should not be stripped off during surgical procedures to avoid damage to the nutrient arteries

The red hearing: swollen ear in a patient with ulcerative colitis

Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here, we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition

Immunoglobulin G4 Sclerosing Cholangitis: An Unusual Cause of Obstructive Jaundice-Case Report and Literature Review.

IgG4-related sclerosing cholangitis (IgG4-SC) is one of the most common extra-pancreatic manifestation of IgG4-related disease (IgG4-RD) and is clinically distinct from primary sclerosing cholangitis (PSC). IgG4-RD is an increasingly recognized immune-mediated fibroinflammatory systemic disease, mostly affecting middle-aged and older male populations that can affect multiple organs. The presence of extra-biliary clinical manifestations of IgG4-RD, such as parotid and lacrimal swelling, lymphadenopathy, autoimmune pancreatitis, and retroperitoneal fibrosis, if present could provide important clues to diagnosis. High serum IgG4 levels, characteristic radiological (e.g., sausage-shaped pancreas or periaortitis) or biopsy findings (high percentage of IgG4+ plasma cells, lymphoplasmacytic infiltrate, storiform fibrosis, or obliterative phlebitis) in the setting of these features is diagnostic of this disease process. However, isolated IgG4-SC might be a diagnostic challenge, and the distinction is important as management of this disorder is vastly different from other causes of cholangitis such as PSC. Systemic corticosteroid therapy is the mainstay of therapy

Primary thyroid MALToma- a rare diagnosis of an unassuming thyroid nodule.

Primary thyroid lymphoma, although a rare malignancy, can arise in common chronic inflammatory conditions such as Hashimoto\u27s thyroiditis. Incidental finding of a thyroid nodule with chronic thyroid inflammation warrants further investigation. Early detection of malignancy can play a vital role in improved outcomes. We report a case of a 60-year-old male who presented to the clinic for a routine visit. An enlarged, firm, non-tender thyroid gland was appreciated on exam with high thyroid stimulating hormone (TSH) level. Fine needle aspiration of the mass revealed nonspecific atypical lymphocytes. The pathology and immunohistochemical stains were consistent with histologic impression of extra nodal marginal B-cell lymphoma (mucosa-associated lymphoid tissue [MALT] lymphoma) and Hashimoto\u27s thyroiditis. Patient was treated with thyroxine after complete surgical excision of left thyroid lobe and remains in remission with close follow-up with his primary care provider. Primary thyroid MALT lymphoma follows an indolent process and remains asymptomatic in most patients. These are usually found to arise at sites of ongoing chronic inflammation with underlying autoimmune or infectious etiologies. Treatment modalities include surgical excision and/or radiation therapy for localized lesions, with both radiation and chemotherapy indicated for disseminated disease

Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies.

Background: Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention. Objective: A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy. Methods: Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010-June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase though IVIG and SCIG. Results: Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67-119.19 mg/dl, I2 = 45%, p = 0.05), favoring weekly SCIG. For every 100 mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p = 0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p = 0.67). Conclusion: In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship

Morphometric Study of Lumbar Intervertebral Spaces (discs) by Using MRI.

Introduction: The radiological space between two vertebrae is known as intervertebral space (height) which corresponds to the thickness of the intervertebral disc. Lumbar intervertebral disc is the most important structure which maintains the spinal function. An early diagnosis of pathological changes in disc has clinical significance. Hence the study aimed to determine normal height of the intervertebral disc space and effect of aging. Methods: It was a cross-sectional analytical study performed on 106 images of MRI scans of lumbar region. Dimensions of lumbar intervertebral spaces (discs) such as the anterior, middle, posterior intervertebral space height were measured in millimeter. Results: The mean anterior intervertebral space height was gradually increased from L1-L2 level (6.91 mm) to L5-S1 level (13.55 mm). The middle intervertebral space height increased from L1-L2 level (7.89 mm) to L4-L5 level (11.96 mm) whereas at L5-S1 level, there was a decrease (11.10 mm). Similarly, the posterior intervertebral space height showed an increment from L1-L2 level (5.52 mm) to L4-L5 level (8.09 mm) except at L5-S1 level, where it was decreased (6.94 mm). All mean values were found to be higher in males than in females except posterior intervertebral space height. The height of disc was increased up to third or fourth decade followed by a decrease. Conclusion: Knowing the normal lumbar intervertebral space height could be helpful for clinicians to diagnose and plan for proper treatment. It may also help to generate baseline data and to produce proper devices for Nepalese population

Comparative Antioxidant, Antimicrobial and Phytochemical Assesments of Leaves of Desmostachya bipinnata L. Stapf, Hordeum vulgare L. and Drepanostachyum falcatum (Nees) Keng f.

 Nepal is rich in varieties of religious plants. The locally used religious plants also carry medicinal importance. Desmostachya bipinnata L. Stapf, Hordeum vulgare L. and Drepanostachyum falcatum (Nees) Keng f. are three plants belonging to the family Poaceae having religious significance in different practices of Hinduism. They were also used as traditional medicines by our ancestors but nowadays they are underutilized. In this research, our core objective was to validate the traditional assumption of use of these plants in medicinal purposes by carrying out the assessments like antimicrobial assessment, antioxidative assessment and phytochemical assessment. Methanolic extracts produced from leaves of all three plants were examined for antimicrobial activities through agar well diffusion method. The same extracts were also assessed for determining their antioxidative potentials with the use of DPPH (1, 1-diphenyl-2-picryl hydrazyl) free radical scavenging assay followed by qualitative phytochemical analysis and GCMS (Gas Chromatography Mass Spectroscopy). Most promising antimicrobial activity was shown by Desmostachya bipinnata L. against Salmonella typhimurium and Staphylococcus aureus, Drepanostachyum falcatum (Nees) Keng f. against Salmonella typhimurium and Klebsiella pneumoniae and Hordeum vulgare L. against Salmonella typhmurium and Staphylococcus aureus. The antioxidant activity of the plant extracts were observed in descending order of Hordeum vulgare L.>Desmotachya bipinnata L. > Drepanostachyum falcatum (Nees) keng f. and phytochemical assessment of the extracts indicated the presence of alkaloids, glycosides, sterols, Triterpenes, Saponins, Flavonoids, Coumarins, Phlobatanin and reducing sugars. Through this project, we can clarify that the above mentioned plants have bioactive compounds which contributed for the presence of antimicrobial and antioxidative property in the plants