Molecular characterization of human papillomavirus in head and neck tumors.

Head and neck cancers (HNCs) are common causes of cancer-related deaths worldwide. An increasing incidence of subsets of HNCs is due to human papillomavirus (HPV). Other subsets are associated with tobacco and alcohol use. Determination of differential biomarkers and molecular mechanisms distinguishing HPV-associated and unassociated HNCs should improve diagnostic and therapeutic strategies. This study was designed to identify potential biomarkers for HPV detection, and to evaluate viral and host genetic and epigenetic mechanisms involved in HPV-associated HNCs. Overexpression of a cellular protein, p16INK4a, which is widely used as a surrogate marker for HPV-positive HNC, is non-specific because some HPV-negative cancers can overexpress p16INK4a. I found “mitosoid cells” and “HPV E7 serology”, respectively, as histologic and serum biomarkers, which would improve diagnosis of HPV-positive head and neck (HN) tumors. Mitosoid cells were not only observed in HPV-positive benign epithelial hyperplasias but also abundantly present in subsets of pre-malignant tumors (high-grade oral epithelial dysplasia, hgOED). P16INK4a could be used as an HPV-surrogate marker only in Group 1 hgOED (containing diffuse mitosoid cells), but not in Group 2 (with focal mitosoid cells) and Group 3 (lacking these cells). My study revealed that E7 seropositivity complements p16INK4a overexpression in HNCs and a decrease in E7 serology potentially predicts patients’ response to treatment. To evaluate genetic and epigenetic changes in HPV-induced malignancy, I assessed viral DNA- integration and -methylation, and viral-induced methylation of host tumor vii suppressor genes (TSGs). Since viral DNA integration predicts malignancy, my data showing integrated HPV in Group 1 and malignant tumors, suggest greater malignant transforming potential of Group 1 than the other groups. Although viral methylation is another regulatory mechanism for malignancy, the HPV epigenome was mostly unmethylated in both premalignant and malignant HN tumors. Screening 38 host TSGs identified EREG as a candidate gene, which may be epigenetically regulated, specifically in HPV-positive HNC. Overall, the present study found that mitosoid cells and E7 serology in combination with p16INK4a overexpression are significant markers for HPV-associated head and neck malignancy. HPV DNA integration and host EREG gene methylation, but not viral DNA methylation, may play roles in HPV-associated head and neck carcinogenesis

Breakage of stylet inside endotracheal tube following intubation

A 52-year-old lady was scheduled for hemithyroidectomy for right colloid goitre. After the preanesthetic check-up, she was classified as an American society of anesthesiologists (ASA) physical status I.1 Her baseline vitals parameters were within normal limits. After receiving premedication, she was induced and intubated with a 7.0 mm ID flexometallic endotracheal tube (ETT) preloaded with a malleable aluminium stylet. Shortly afterwards, while fixing the ETT, the size of the stylet was noticed to be shorter than initial length. Immediately, ETT was removed and replaced with a new one. The broken piece of stylet was found inside the removed ETT. Keywords: endotracheal tube; hemithyroidectomy, style

Study Kekuatan Bending Dan Struktur Mikro Komposit Polyethylene Yang Diperkuat Oleh Hybrid Serat Sisal Dan Karung Goni

The purpose of this study is to investigate and study the mechanical properties of polyethylene strukrur micro hybrid composites reinforced by fibers sisal and jute sacks. Preparation of composites by hand lay-up method with a ratio of fiber volume fraction of sisal and jute sacks 30%: 0%, 20%: 10%, 15%: 15%, 10%: 20%, 0%: 30%. With unidirectional sisal fiber orientation and fiber length random burlap gunny sack fibers 2 cm. Specimen testing is performed with a standard bending test ASTM D790, and microstructure. Test results obtained from the average bending strength of composites with high fiber volume ratio fraksin 30%: 0% is 74.43 Mpa. While the lowest average for bending strength found in composites with fiber volume fraction of 0%: 30%, the bending strength of 32.21 MPa. Therefore we can conclude the increasing volume fraction of sisal fiber with unidirectional fiber orientation, the higher the bending strength of its appeal and reverse the growing volume of burlap fibers with random orientation of the fibers feeding the lower the bending strength and the strength

Proses Pack Carburizing dengan Media Carburizer Alternatif Serbuk Arang Tongkol Jagung dan Serbuk Cangkang Kerang Mutiara

Tujuan dari penelitian ini adalah untuk mengetahui pengaruh penggunaan arang tongkol jagung dan serbuk cangkang kerang mutiara sebagai media carburizer pada proses pack carburizing terhadap sifa (struktur mikro) dan mekanis (uji kekerasan) baja karbon rendah. Bahan yang digunakan dalam penelitian ini adalah baja karbon rendah yang berbentuk selinder. Proses pembuatan spesimen dilakukan dengan pemotongan menjadi beberapa bagian, pemotongan dilakukan untuk memudahkan di dalam meletakan spesimen di dalam kotak karburisasi,kemudian serbuk arang kayu dan serbuk cangkang ditimbang sesuai dengan komposisi yang diinginkan dengan pencampuran serbuk cangkang kerang mutiara 5, 10 , 20 dan 25 (% berat). Spesimen dilakukan perlakuan panas pada temperature 9100C, 9300C, 9500C dengan penahanan waktu selama 90, dan 150 menit. Kemudian dilakukan Uji kekerasan Vickers, pengujian foto struktur mikro dan uji komposisi. Dari penelitian ini dapat disimpulkan bahwa nilai kekerasan tertinggi rata-rata pada penambahan 20% serbuk cangkang di peroleh sebesar 262,47 kg/mm2 dan kekerasan material awal diperoleh sebesar 144,08 kg/mm2. Dari hasil pengamatan struktur mikro dan uji komposisi diketahui bahwa terjadi pengerasan permukaan karena difusi karbon kedalam baja karbon randah

Health and Healthcare in Nepal: An Analysis of the Private And Public Sector

Through private and public efforts, there has been considerable improvement in the health and healthcare sector in Nepal. However, the healthcare system in Nepal faces challenges such as limited access and lack of quality healthcare. Although there have been recent efforts to introduce universal healthcare coverage, there is limited evidence on existing systems to properly formulate a policy. To provide a wholistic review of the Nepali health system, we assess both public and private sectors. In 2005, Nepal introduced a financial incentive, called the Safe Delivery Incentive Program, to increase the use of maternity care with the goal of reducing maternal and neonatal mortality. The program included a cash transfer to help with transportation costs, free delivery for mothers in certain districts and an incentive for healthcare providers to participate in the delivery. In the first paper, we use microdata from the Demographic and Health Surveys (2001 to 2008) and a difference-in-differences model to estimate the effect of free delivery, which was only implemented for mothers in 25 Nepali districts with the lowest Human Development Index. We measure five outcomes: neonatal mortality; prenatal care; prenatal care by doctor; prenatal care by nurse/midwife and immunization against neonatal tetanus. The sample consists of 5,317 live births between the years of 2001-2008. We find that women are more likely to get prenatal care from a doctor, nurse or midwife and immunization against neonatal tetanus if they reside in districts with free delivery care. Further, neonates born to mothers in the treatment district are more likely to survive, which may have occurred due to increased prenatal care and tetanus vaccines. We provide new evidence that the program did prenatal care, which is contingent on wealth quintile, ethnicity and education. In the second paper, we address the limited empirical evidence on the relationship between management and performance of private hospitals in Nepal, with emphasis on differences by performance indicator, patient type and analytical approach. We use de-identified inpatient data to assess the relationship between hospital management and performance. We estimate Pabon Lasso and regression models for native-born and foreign-born patients, and for the full sample of patients. Using a Pabon Lasso model, we assess relationship between hospital management and: bed occupancy rate; bed turnover rate; and average length of stay. To complement the Pabon Lasso model, we use a regression analysis to assess the relationship between hospital management and length of stay in a multivariate framework. Our results indicate that separation between the Chief Executive Officer (CEO) and board may promote better performance (except the Pabon Lasso model favors CEO duality for average length of stay among native-born patients). However, results vary by performance indicator, patient type and analytical approach. We provide new evidence on the relationship between management and performance of private hospitals in a developing context. However, when it comes to evaluating management strategies, there are important differences by outcome measure, patient type (i.e. native-born versus foreign-born) and analytical approach

Tegangan Maksimum Dan Faktor Keamanan Pada Poros Engkol Daihatsu Zebra Espass Berdasarkan Metode Numerik

The purpose of this study was to determine the maximum stress and safety factor on the crankshaft Daihatsu Zebra Espass based on numerical methods. Material is selected as the crankshaft material is AISI 1053 steel. This numerical method uses CATIA software program to determine the maximum stress based on Von Mises failure theory. Research procedure begins by measuring the dimensions of the crankshaft Daihatsu Zebra Espass, then draw and analyze. Results of analysis in the form of images that show the stress distribution that occurs in the elements of the crankshaft. From the analysis results can be concluded that the highest maximum stress occurred in the area of the crankshaft fillet into 4 at the position 360o angle of 86.5 MPa with the lowest safety factor of 4.22. Keywords: crank shaft, CATIA, maximum stress, safety factor

Intraoperative anaphylaxis

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully. She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully. Keywords: anaphylaxis, anesthetic agents, cardiac arres

Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery

Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups.  Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p<0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD. Keywords: catheter related bladder discomfort (CRBD), detrusor activity, tramado

Pemanfaatan Serbuk Tempurung Kelapa Pada Komposit Al2o3-epoxy

The purpose of this research is utilization of coconut shell powder on Al2O3-Epoxy composite so it can be used as an alternative material of brake linings that are enviromentlly friendly. In this research, coconut shell powder is used as a filler on Al2O3-Epoxy composites that are made using hand lay up method. Comparison volume fraction of coconut shell powder and Al2O3 was varied amount 0:40, 10:30, 20:20, 30:10 and 40:0 (%). Adhesive was used is epoxy resin namely amount 60%. Test conducted is wear test. The results showed that utilization of coconut shell powder on Al2O3-Epoxy can be decrease the wear so it can be used as an alternative material of brake linings that are environmentally friendl