MOOCs for higher education in Nepal

The paper examines how massive open online courses (MOOCs) could be designed and developed by higher education institutions (HEIs) in Nepal to leverage the potential of MOOCs for greater access to education. A MOOC on “Fundamental Concepts of C Programming” was designed and developed as part of the sub-project. The report offers information about teachers’ and learners’ perceptions of MOOCs in the first MOOC offered by Kathmandu University in Nepal. It includes a breakdown of frequency of use of computer applications (browsers, Internet, facebook, YouTube etc.). Slow Internet access and lack of time are constraints to MOOC participation and course completion

Hemoperitoneum among Pediatric Abdominal Trauma Patients Visiting in Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional study

Introduction: Pediatric abdominal trauma presents a major challenge for first-line responders in the Emergency Department for assessment and management. The Focused assessment sonography for trauma is a readily available, easy-to-use, and affordable tool for detecting hemoperitoneum during the initial assessment of trauma in the Emergency Department for adult traumatic patients. The aim of this study was to find the prevalence of hemoperitoneum among pediatric abdominal trauma patients visiting the Emergency Department of tertiary care centre through Focused assessment with sonography for trauma examination technique. Methods: This was a descriptive cross-sectional study conducted in the Emergency Department of a tertiary care hospital from 7 April 2019 to 7 April 2020. Among 413 pediatric trauma patients, 93 children (1 to 17 years) admitted to the Emergency Department who underwent focused assessment with sonography for trauma examination were included in the study. Ethical approval was obtained from the Institutional Review Committee (Approval number: 111/19). Convenience sampling was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 93 children receiving focused assessment with sonography for trauma imaging in the Emergency Department with a history of blunt abdominal trauma, the prevalence of hemoperitoneum was 18 (19.34%) (12.61-26.09, 90% Confidence Interval). Conclusions: The prevalence of hemoperitoneum was similar to other studies conducted in a similar setting

The Journal of Microelectronic Research 2005

https://scholarworks.rit.edu/meec_archive/1014/thumbnail.jp

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Clinical profile and drug resistance patterns of typhoid fever in children: A prospective hospital-based study

Background: Salmonella typhi and Salmonella paratyphi are important causes of bacteremia in children, especially those from the developing world. The present study is undertaken to study the pattern of antimicrobial resistance of S. typhi in culture positive cases of enteric fever. Materials and Methods: This prospective non-randomized study was conducted in the Department of Pharmacology, J. N. Medical College, AMU, Aligarh, in association with the Department of Paediatrics and Department of Microbiology, J. N. Medical College, on pediatric patients attending the Outpatient/Inpatient Department of Paediatrics, over a period of 1 year and 11 months from September 2005 to August 2006. For all patients with suspected enteric fever, the following investigations were sent for complete hemogram, blood culture, and sensitivity test and Widal test. Results: About 114 randomly selected children having clinical features strongly suggestive of uncomplicated enteric fever with either culture positive or serology positive or both were entered in the study. Fever was the most common clinical presentation and was present in 94.7%. Only 25% of patients attended the hospital within the 1st week of illness, while maximum (54.6%) patients came to the hospital in the 2nd week of illness. Hepatomegaly was more common (43.8%) as compared to splenomegaly (27.1%). The characteristic rose spots of enteric fever were a rare finding in children. Conclusion: Burden of typhoid fever in endemic areas of India underscores the importance of evidence on disease burden in making policy decisions about interventions to control this disease. Our antimicrobial susceptibility data suggest that quinolones and third-generation cefalosporins should be used as first-line antimicrobials in enteric fever. A careful consideration should be given before deciding the antibiotic for treatment to prevent the emergence of antibiotic resistance. Key words: ,,,&nbsp

C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour

Introduction: Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour. Methods: Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program. Results: Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (p=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (p=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (p=0.344) or periodontitis (p=0.541). Conclusions: We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended. Keywords: body mass index; cardiovascular disease; c-reactive protein; periodontitis; smoking; systemic inflammation. [PubMed

Physical and Chemical Properties and Accelerated Aging Test of Bio-oil Produced from <i>in Situ</i> Catalytic Pyrolysis in a Bench-Scale Fluidized-Bed Reactor

<i>In situ</i> catalytic upgrading is a promising technique to improve the properties of bio-oil because the bio-oil produced from the conventional method has several negative attributes, such as low heating value and highly acidic nature, and is also unstable during storage. In this study, the catalytic effect of CaO, MgO, and ZSM-5 as <i>in situ</i> upgrading catalysts during biomass pyrolysis was studied in a fluidized-bed reactor. Southern pine sawdust was subjected to pyrolysis with inert bed material (quartz sand) and subsequently with the catalysts. The quality of bio-oil obtained was compared to the baseline values (i.e., with the use of sand as bed material without any catalyst) in terms of its chemical composition, heating value, viscosity, pH, total acid number (TAN), and oxygen and water contents. The use of CaO resulted in an improvement in pH (2.39–3.98) and TAN (88.9–46.6) of the bio-oil when compared to the results when using only sand. In comparison, MgO was a mild catalyst because it altered the bio-oil quality slightly, while ZSM-5 had no effect on the acid content in bio-oil, although it produced bio-oil with the least oxygen content at a significantly lower yield and higher water content (38.5%). In terms of chemical composition, the catalysts exhibited different behaviors to various groups of compounds. Anhydrosugars were reduced by all of the catalysts tested to different extents, but CaO significantly altered the quality of bio-oil by reducing organic acids, while CaO and ZSM-5 reduced the abundance of phenolic compounds with a higher oxygen content. An accelerated aging test was performed to compare the efficacy of these <i>in situ</i> catalysts on improving the stability of bio-oil, and it was observed that the bio-oil produced using CaO was the most stable when compared to the baseline and other catalytic bio-oils tested in this study