bluuebunny/crossref_metadata_2025 huggingface dataset:
Potentiation of the uterus‐relaxing effects of β‐adrenergic agonists with nifedipine: studies on rats and the human myometrium
Authors: Hajagos‐Tóth Judit , Kormányos Zsolt , Falkay George , Pál Attila , Gáspár Róbert
Published: September 2010

Objective. We investigated how progesterone and salmeterol modify the effect of nifedipine in an in vivo preterm birth model in rats, and how terbutaline and nifedipine modify the contractions of the isolated human myometrium. Design. Experimental animal and human myometrial studies. Sample. Twenty‐four female Sprague–Dawley rats and 13 human uterine tissues sampled from cesarean section. Methods. Preterm birth was induced in Sprague–Dawley rats with a combination of mifepristone and prostaglandin‐E2. The animals were treated with nifedipine or its combination with salmeterol and progesterone. Additionally, isolated human myometrial strips from cesarean sections were stimulated with oxytocin, and the inhibitory effects of nifedipine and terbutaline were studied. Results. Nifedipine delayed the preterm delivery in the rats, but its effect was tripled by the addition of β2‐mimetics, or abolished after progesterone pretreatment. Synergism was observed in the relaxing effects of nifedipine and terbutaline on the isolated human myometrium. Conclusion. The action of nifedipine in delaying labor is impeded by progesterone. A combination of nifedipine and β2‐agonists should be considered for the treatment or prevention of preterm birth.
Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden
Authors: Östensson Ellinor , Fröberg Maria , Hjerpe Anders , Zethraeus Niklas , Andersson Sonia
Published: September 2010

Objective. To assess the cost‐effectiveness of using human papillomavirus testing (HPV triage) in the management of women with minor cytological abnormalities in Sweden. Design. An economic analysis based on a clinical trial, complemented with data from published meta‐analyses on accuracy of HPV triage. The study takes perspective of the Swedish healthcare system. Setting. The Swedish population‐based cervical cancer screening program. Methods. A decision analytic model was constructed to evaluate cost‐effectiveness of HPV triage compared to repeat cytology and immediate colposcopy with biopsy, stratifying by index cytology (ASCUS = atypical squamous cells of undetermined significance, and LSIL = low‐grade squamous intraepithelial lesion) and age (23–60 years, <30 years and ≥30 years). Main outcome measures. Costs, incremental cost, incremental effectiveness and incremental cost per additional high‐grade lesion (CIN2+) detected. Results. For women with ASCUS ≥30 years, HPV triage is the least costly alternative, whereas immediate colposcopy with biopsy provides the most effective option at an incremental cost‐effectiveness ratio (ICER) of SEK 2,056 per additional case of CIN2+ detected. For LSIL (all age groups) and ASCUS (23–60 years and <30 years), HPV triage is dominated by immediate colposcopy and biopsy. Model results were sensitive to HPV test cost changes. Conclusion. With improved HPV testing techniques at lower costs, HPV triage can become a cost‐effective alternative for follow‐up of minor cytological abnormalities. Today, immediate colposcopy with biopsy is a cost‐effective alternative compared to HPV triage and repeat cytology.
Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study
Authors: Van Calsteren Kristel , Verbesselt René , Ottevanger Nelleke , Halaska Michael , Heyns Liesbeth , Van Bree Rieta , de Bruijn Ernst , Chai Daniel , Delforge Michel , Noens Lucien , Renard Vincent , Witteveen Els , Rob Lukas , de Hoon Jan , Amant Frédéric
Published: September 2010

Objective. To determine the impact of physiologic changes of pregnancy on pharmacokinetics of chemotherapeutic agents. Design. A preclinical and a clinical case–control trial. Setting. Institute of Primate Research Nairobi and collaborating hospitals in Belgium, the Netherlands and Czech Republic. Population. Pregnant and nonpregnant women and baboons receiving chemotherapy. Methods. Chemotherapy pharmacokinetics was compared between the pregnant and nonpregnant state. Standard‐dosed chemotherapy regimens were administered in pregnant and nonpregnant baboons/women, followed by serial blood samplings. Drug plasma levels were determined using high performance liquid chromatography and atomic absorption spectrometry. Main outcome measures. Area under the curve (AUC), maximal plasma concentration, terminal elimination half‐life, clearance and distribution volume of each drug in pregnant and nonpregnant state. Results. Intraindividual comparative pharmacokinetic data were obtained for doxorubicin and paclitaxel/platinum in three and two baboons, respectively. In the clinical trial, two patients were exposed to doxorubicin and one patient was exposed to paclitaxel/platinum during and after pregnancy. Furthermore, a pooled analysis was performed based on 16 cycles of pregnant and 11 cycles of nonpregnant women. Numbers of pregnant/nonpregnant patients were 5/2, 7/5, 4/4 and 2/2 for paclitaxel, doxorubicin, epirubicin and platinum, respectively. For all drugs tested in the preclinical and clinical study, a decreased AUC and maximal plasma concentration and an increased distribution volume and clearance were observed in pregnancy. Conclusions. Although numbers were too small for statistical significance, pregnancy‐associated physiologic alterations appear to lead to a decrease in plasma exposure of chemotherapeutic drugs. The importance of long‐term follow‐up of women treated with chemotherapy during pregnancy is underscored.
Relation between umbilical cord blood pH, base deficit, lactate, 5‐minute Apgar score and development of hypoxic ischemic encephalopathy
Authors: Wiberg Nana , Källén Karin , Herbst Andreas , Olofsson Per
Published: September 2010

Objective. Umbilical cord acid–base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5‐minute Apgar score and hypoxic ischemic encephalopathy (HIE) stage 2–3 was assessed, and new gestational age‐adjusted reference standards were compared with traditional stationary reference values. Design and sample. A total of 13,735 pH‐validated routine cord acid–base values from singleton deliveries were tested with stationary and gestational age‐adjusted reference values using receiver operating characteristic curves and calculation of area under curve. Setting. University hospital. Main outcome measures. Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5‐minute Apgar score < 7 or < 4 or HIE. Results. Gestational age‐adjusted values were for all parameters significantly better than crude values to indicate Apgar score < 7. For Apgar score < 4, the differences were not significant. The frequency of HIE was 0.046%, making statistical analyses pointless. Gestational age‐adjusted lactate had the overall best accuracy and among combinations; a low age‐adjusted pH plus high age‐adjusted lactate was slightly better than a low age‐adjusted pH plus high age‐adjusted base deficit. The sensitivity and positive predictive value were low for all parameters. Conclusions. Lactate in cord arterial blood at birth is at least as good as base deficit to reflect an impaired condition at birth, and best when gestational age‐adjusted values are used. Due to methodological confounding involved in calculation of base deficit, lactate may replace base deficit as an acid–base outcome parameter at birth.
Pattern and determinants of ocular complications in leprosy patients in eastern Nepal
Authors: Javvadhi S , Das H , Agrawal S
Published: September 2010

Background: Ocular complications of leprosy can lead to blindness. Objective: To report the pattern and determinants of ocular complications in patients with leprosy from eastern Nepal. Methods: A cross-sectional study was carried out analyzing one hundred and eighty six patients of leprosy presenting between Jan 2002-Nov 2004. All the patients were categorized using WHO and Ridley and Jopling classification. After determining bacillary indices in all of them, a detailed ocular examination was carried out. Independent risk factors were determined for ocular involvement. Results: Ocular complications were found in 30.65 % of the leprosy patients; lagophthalmos (17.74%) was the most frequent followed by uveitis (8.60%). Most of the patients having visual loss had it due to corneal complications and none of the patients with uveitis had vision <6/18. The patients released from treatment (83.33%) and those currently on treatment (31.63%) had higher occurrence of complications. Risk factors for ocular involvement were higher bacillary index, longer disease duration (p=0.031, RR=1.109, 95% CI=1.009-01.218) and decreased corneal sensation (p=0.001, RR=3.564; 95% CI =2.014-6.306). Higher Schirmer values (p=0.012, RR=0.935, 95% CI=0.888-0.985) were found to be protective for ocular complications. Statistics: SPSS ver 10.0 was used for data analysis. The P value of <0.05 was considered as significant. Conclusions: The prevalence of complications is high in patients released from treatment for leprosy. Cornea-related complications are the most important cause of visual disability and blindness. Risk factors for ocular complications are higher bacillary index, longer disease duration and decreased corneal sensation. Key words: leprosy; Nepal; ocular complications; risk factors DOI: 10.3126/nepjoph.v1i1.3666 Nep J Oph 2009;1(1):2-8
Pattern of ocular tumors in the eastern region of Nepal
Authors: Lavaju P , Arya SK , Sinha A , Pandey S , Adhikari S , Shrestha BG , Chetan S , T Lidunka Agarwal
Published: September 2010

Background: Ocular tumors are commonly encountered in ophthalmic practice. Objective: To study the clinical pattern of ocular tumors in the eastern region of Nepal. Materials and methods: The hospital records of patients with ocular tumors treated at B P Koirala Institute of Health Sciences in the eastern region of Nepal over a period of 5 years (April 2003 - March 2008) were studied retrospectively. Results: Of 115 consecutive patients with ocular tumors, 40 (34.75%) were below the age of 21 years, 41 (35.65%) were in the age group of 21-50 years and 34 (29.56%) of age above 50 years. There were 48 (41.73%) and 67 (58.26%) patients with benign and malignant tumors respectively. The common benign tumors were conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma. Among the malignant tumors, basal cell carcinoma was the commonest (22.38%). Retinoblastoma was the most common ocular malignant tumor in the pediatric age group (88.8%). Basal cell carcinoma was the commonest eyelid malignancy 53.57%. Conclusion: Conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma are common benign ocular tumors, whereas basal cell carcinoma and retinoblastoma are the commonest ocular malignancies in adults and children respectively. Key words: ocular malignancy; retinoblastoma; basal cell carcinoma DOI: 10.3126/nepjoph.v1i1.3667 Nep J Oph 2009;1(1):9-12
Efficacy of latanoprost in management of chronic angle closure glaucoma
Authors: Kumar S , Malik A , Singh M , Sood S
Published: September 2010

Background: Chronic angle closure glaucoma is often managed surgically. Aim: To study the effect of Latanoprost 0.005% on intraocular pressure in subjects diagnosed as having chronic angle closure glaucoma. Materials and methods: Forty patients participated in the study. Baseline examination included visual acuity, refraction, slit-lamp examination, intraocular pressure, anterior and posterior segment examination, gonioscopy and perimetry. Patients were treated with Latanoprost 0.005% once daily at bedtime. IOP was recorded at baseline, 2weeks, 4 weeks, 8 weeks and 12 weeks after starting the treatment. Results: The mean age of the study sample was 56.45 years (40-70 years). There were 18 males and 22 females in the study. Mean IOP at baseline was 24.55±3.63. Mean IOP decreased to 17.27±3.19 at 2 weeks, 15.27±3.07 at 4 weeks, 14.60±3.06 at 8 weeks and 14.47±2.66 at 12 weeks. There was a statistically significant reduction in mean IOP (41.03%) at 12 weeks as compared to those of the baseline IOP (p=0.000). There was no significant difference in IOP reduction in eyes with different degrees of angle closure by peripheral anterior synechiae. Conclusion: Latanoprost, a prostaglandin analogue, is effective in reducing IOP in chronic angle closure glaucoma patients and its efficacy is not affected by the degree of angle closure by peripheral anterior synechiae. Key words: latanoprost; chronic angle closure glaucoma; intraocular pressure; peripheral anterior synechiae DOI: 10.3126/nepjoph.v1i1.3671 Nep J Oph 2009;1(1):32-36
Efficacy of lid everting suture in the management of involutional lower eyelid entropion using 4-0 silk versus 4-0 chromic catgut
Authors: Singh SK , Das H , Lavaju P
Published: September 2010

Background: Involutional lower eyelid entropion is a common ophthalmic condition requiring surgical correction. Objective: To compare the efficacy of lid everting sutures in the management of involutional lower lid entropion using 4-0 silk versus 4-0 chromic catgut. Materials and methods: Fifty eyes with involutional lower eyelid entropion were enrolled into the study and divided randomly into two groups, A and B. Group A underwent lid everting suture with 4-0 chromic catgut and group B with 4-0 silk. The parameters assessed were pre- and post-operative lower lid excursion (LLE) and horizontal lid laxity (HLL). Statistical analysis: Data were plotted in the excel spread sheet and analyzed using SPSS 11.0 software program. The difference between the two groups was compared using Chi square test and unpaired t test. Results: While comparing the pre-operative and post-operative changes of HLL within the two groups separately, there was 63% reduction of HLL in group A (p=0.001) and 68% reduction (p=0.001) in group B. In group A, there was 48.2% improvement in LLE and in group B 52% postoperatively (p=0.001). The success rate in each group was 92%. The cost of surgery in group A was higher than that in group B (p=0.003). Conclusion: Lid everting suture by 4-0 silk is as effective as 4-0 chromic catgut. The cost of lid everting suture by 4-0 catgut is higher than that of 4-0 silk. The silk suture can be recommended for correction of lower lid involutional entropion in a country with low socioeconomic status. Key words: involutional entropion; lid laxity; lid excursion; lid everting suture DOI: 10.3126/nepjoph.v1i1.3672 Nep J Oph 2009;1(1):37-42
Monitored anaesthesia care (MAC) and ophthalmic surgery
Authors: Bhattarai BK
Published: September 2010

The use of monitored anaesthesia care (MAC) is increasing with the discovery of newer, more effective and appropriate drugs and techniques. MAC is intended to achieve patient comfort with safety and optimal clinical outcome and is being extensively used worldwide for cataract and other ophthalmic surgeries. This article briefly reviews the conceptual basis of MAC, its use in ophthalmic surgeries, sedative-analgesic drugs commonly used during MAC in eye surgeries, monitoring during MAC in eye surgery and the role of anaesthesia practitioners during MAC. Key words: anaesthesia; cataract; eye; monitored anaesthesia care (MAC); sedation; surgery DOI: 10.3126/nepjoph.v1i1.3674 Nep J Oph 2009;1(1):60-65
Retinal vasculitis
Authors: Shrestha JK , Khadka D , Lamichhane G , Khanal S
Published: September 2010

Retinal vasculitis is an idiopathic inflammatory venous occlusion primarily affecting the peripheral retina of otherwise healthy young adults. Eales' disease is recognized as primary vasculitis of unknown etiology occurring in young adults. This article aims at the overall review of the etiopathogenesis, clinical presentations, pathology, management and prognosis of retinal vasculitis. Key words: Retinal vasculitis; Eales' disease DOI: 10.3126/nepjoph.v1i1.3675 Nep J Oph 2009;1(1):66-71
Management of glaucoma in a case of familial aniridia by trabeculectomy
Authors: Barthakur R , Shrestha SP , K S Bhat , Natarajan M
Published: September 2010

Aniridia is a rare developmental disorder. Glaucoma and complications associated with glaucoma surgery are a major cause of blindness in patients with aniridia. We describe here a case of a nine year old boy who presented with familial aniridia of both eyes along with glaucoma. He was treated by trabeculectomy of both eyes, which was successful in controlling the glaucoma. Key words: Aniridia; glaucoma; trabeculectomy DOI: 10.3126/nepjoph.v1i1.3677 Nep J Oph 2009;1(1):75-76
Phacoemulsification versus small incision cataract surgery (SICS): which one is a better surgical option for immature cataract in developing countries?
Authors: Singh SK , Winter I , Surin L
Published: September 2010

Background: Several studies have shown comparable visual outcomes of SICS and phacoemulsification (Gogate et al 2007, Ruit et al 2007). Objective: To compare the safety and efficacy of different types of surgical procedures (phacoemulsification versus SICS) for cataract surgery in immature cataract. Material and methods: A prospective randomized controlled trial was carried out involving 93 and 89 patients with immature senile cataract selected for phacoemulsification and SICS respectively. Statistics: Mean values with standard deviations were calculated. P value of less than 0.05 was considered significant. Results: There was no difference between the groups in terms of gender, age and pre-operative visual acuity (p = 0.09). In phacoemulsification group (n=93) more than two thirds and in SICS group (n=89) more than three quarters of the patients had good visual outcome (6/6-6/18) on first postoperative day (p=0.065). Poor outcome (<6/60) was recorded in 6% (phacoemulsification group) and 1% (small incision cataract surgery group). Mean visual acuity was 0.43 ± 0.27 in phacoemulsification group and 0.47 ± 0.24 in SICS group. Mean surgery time was significantly shorter in SICS group (p=0.0003). Statistics: Data were computed and analyzed using the SPSS software program vs 10. The p value of < 0.05 was considered significant. Conclusion: There was no significant difference in visual outcome on first post operative day in between phacoemulsification and SICS technique. However, performing SICS was significantly faster. Small incision cataract surgery with implantation of rigid PMMA lens is a suitable surgical technique to treat immature cataract in developing countries. Keywords: phacoemulsification; small incision cataract surgery (SICS) DOI: 10.3126/nepjoph.v1i2.3682 Nep J Oph 2009;1(2):95-100
Demographic pattern, clinical features and treatment outcome of patients with infective keratitis in the eastern region of Nepal
Authors: Lavaju P , Arya SK , Khanal B , Amatya R , Patel S
Published: September 2010

Background: Corneal ulcer is one of the major causes of monocular blindness in developing countries. Objective: To determine demographic pattern, risk factors, microbiological pattern and treatment outcome of infective keratitis. Materials and methods: A retrospective analysis of hospital records of 44 patients with clinically-diagnosed infective keratitis presenting to B.P. Koirala Institute of Health Sciences in the eastern region of Nepal was carried out. Outcome measures: The parameters studied were risk factors and organisms responsible for keratitis. Results: The infective keratitis was mostly prevalent among the males between 21-40 years of age (50%). 79.5 % of them were engaged in agricultural work. A history of corneal injury was found in 30 eyes (68.1%). Vegetative matter was the most common agent of trauma in 17 (56.6%). Culture positivity for microorganisms was observed in 20 (45.5%) samples. Of these, 8 (40%) patients had purely bacterial corneal ulcer. Purely fungal growth was seen in 4 (20%) and mixed in 8 (40%). Staphylococcus aureus was the most commonly isolated bacteria (70%). The other bacteria included Pseudomonas species, E. coli and Acinetobactor. Aspergillus species was the most common fungal organism isolated in 8 (40%) samples. 65.9 % of the patients improved with medical treatment alone. Perforation, endophthalmitis and panophthalmitis were the common complications encountered in 11.3%, 4.5% and 4.5% respectively. Conclusion: Corneal ulcer is prevalent in males, predominantly amongst the farmers. Ocular trauma with vegetative matter is the commonest predisposing factor. Staphylococcus aureus and Aspergillus species are the most commonly isolated organisms in corneal ulcers. Keywords: corneal ulcer; fungal keratitis; ocular trauma DOI: 10.3126/nepjoph.v1i2.3683 Nep J Oph 2009;1(2):101-106
Herpes simplex keratitis - an unusual clinical presentation
Authors: Arya SK , Malhotra C , Bhatia R , Sood S
Published: September 2010

A case of posterior corneal abscess with extension into the anterior chamber, in the presence of an intact corneal epithelium and clear anterior corneal stroma, occurring in a young patient is described. The patient responded to treatment with systemic and topical acyclovir. The diagnosis of presumed herpes simplex keratitis was made. We report this unusual presentation of ocular herpes manifesting as a posterior corneal and anterior chamber abscess. Keywords: ocular herpes; corneal abscess; acyclovir DOI: 10.3126/nepjoph.v1i2.3689 Nep J Oph 2009;1(2):136-138
Terrien’s marginal degeneration: an unusual presentation in an Indian female
Authors: Jain K , Kumar S , Jain C , Malik VK
Published: September 2010

An interesting case of bilateral corneal ectasia resulting from its marginal degeneration in a young female is reported. Terriens marginal degeneration is a rare disorder of unknown etiology. It is usually bilateral, although often asymmetric, and is seen mainly in young men. It generally starts superiorly as marginal opacification and stromal thinning. This case was unique in that, unlike routine presentation seen in this type of disorder, the gutter was located more anteriorly in the cornea and was not associated with any vascularization. Keyword: ectasia; keratoconus; Terrien's marginal degeneration DOI: 10.3126/nepjoph.v1i2.3691 Nep J Oph 2009;1(2):141-142
Rethinking eye care: from exclusion to equity
Authors: Upadhyay MP
Published: September 2010

DOI: 10.3126/nepjoph.v2i1.3696 Nep J Oph 2010;2(1):1-2
An overview of idiopathic optic neuritis in eastern Nepal
Authors: Das H , Gautam Maria , Lavaju P
Published: September 2010

Background: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology. Objective: To report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in eastern Nepal. Materials and methods: The hospital data of patients with idiopathic optic neuritis admitted to the department of ophthalmology in a tertiary level center in eastern Nepal between Jan 2000 to Dec 2006 were retrospectively analyzed. The parameters studied were demographic pattern, clinical features, visual acuity and field defects. Results: Thirty-six patients (52 eyes) were found to have optic neuritis (papillits in 36 and retrobulbar optic neuritis in16 eyes). The male to female ratio was1.25:1. The mean age of the patients was 33.56±17.88 years (95 % CI=24.66 - 42.45). The most common modes of presentation were loss of visual acuity and color vision defect. One patient had features suggestive of multiple sclerosis. Vision improved in 42 eyes at discharge from the hospital. Response to pulse methylprednisolone therapy was good in most (42 eyes) of the cases except for the patients having initial visual acuity of no light perception. Conclusion: Response to pulse methylprednisolone therapy is good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world. Some similarity was observed between studies reported from the oriental countries. Keywords: optic neuritis; demographic pattern; pulse steroid therapy. DOI: 10.3126/nepjoph.v2i1.3698 Nep J Oph 2010;2(1):10-15
Surgical outcome of pars plana vitrectomy: a retrospective study in a peripheral tertiary eye care centre of Nepal
Authors: Subedi S , Sharma MK , Sharma BR , Kansakar I , Dhakwa K , Adhikari RK
Published: September 2010

Back ground: Trans-pars plana vitrectomy (TPPV) is an effective surgical procedure to retain the useful vision in vitreoretinal diseases. Objective: To evaluate the surgical outcome of pars plana vitreoretinal surgery. Study design: Retrospective non-comparative interventional case series. Materials and methods: A hospital-based retrospective interventional study of series of cases was carried out in retina clinic of Lumbini Eye Institute, Nepal, over a period of one-and-a-half years. Records of 64 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Outcome measurement: The parameters studied were post-operative visual acuity and complications. Results: Of 64 patients, 61 % presented 2 months after the onset of symptoms. Preoperatively, 65.5 % had visual acuity of hand motions to 3/60 followed by perception of light only in 26.6 %.The main indication for TPPV was vitreous haemorrhage (VH), in 53 %. The visual acuity improved to better than 6/60 in patients with VH (68 %), whereas, overall, in 72 % of the subjects, it improved by 2 lines postoperatively. The commonest intra-operative complications were iatrogenic retinal break (5, 7.8%) at the sclerostomy site. Conclusion: The main indication for TPPV is vitreous haemorrhage. Useful vision can be restored by pars plana vitrectomy in the majority of the patients. Retinal break is the commonest complication of TPPV. Keywords: Trans-pars plana vitrectomy; vitreous haemorrhage; visual outcome; retinal break. DOI: 10.3126/nepjoph.v2i1.3703 Nep J Oph 2010;2(1) 39-44
A critical review of some of the articles published in the Nep J Oph 2009; 1(2)
Authors: Dulal S
Published: September 2010

DOI: 10.3126/nepjoph.v2i1.3711Nep J Oph 2010;2(1) 78
Cataract surgery in Nepal: then and now
Authors: Henning A
Published: September 2010

DOI: 10.3126/nepjoph.v2i2.3713 Nep J Oph 2010;2(2) 83-86
Pattern of refractive errors among the Nepalese population: a retrospective study
Authors: Shrestha SP , Bhat KS , Binu VS , Barthakur R , Natarajan M , Subba SH
Published: September 2010

Introduction: Refractive errors are a major cause of visual impairment in the population. Purpose: To find the pattern of refractive errors among patients evaluated in a tertiary care hospital in the western region of Nepal. Materials and methods: The present hospital-based retrospective study was conducted in the Department of Ophthalmology of the Manipal Teaching Hospital, situated in Pokhara, Nepal. Patients who had refractive error of at least 0.5 D (dioptre) were included for the study. Results: During the study period, 15,410 patients attended the outpatient department and 10.8% of the patients were identified as having refractive error. The age of the patients in the present study ranged between 5 - 90 years. Myopia was the commonest refractive error followed by hypermetropia. There was no difference in the frequency of the type of refractive errors when they were defined using right the eye, the left eye or both the eyes. Males predominated among myopics and females predominated among hypermetropics. The majority of spherical errors was less than or equal to 2 D. Astigmatic power above 1D was rarely seen with hypermetropic astigmatism and was seen in around 13 % with myopic astigmatism. "Astigmatism against the rule" was more common than "astigmatism with the rule", irrespective of age. Conclusion: Refractive errors progressively shift along myopia up to the third decade and change to hypermetropia till the seventh decade. Hyperopic shift in the refractive error in young adults should be well noted while planning any refractive surgery in younger patients with myopia. Keywords: myopia; hypermetropia; astigmatism; ethnicities; age DOI: 10.3126/nepjoph.v2i2.3714 Nep J Oph 2010;2(2) 87-96
Etiology of vitreous hemorrhage in a tertiary eye care center in Nepal
Authors: Sharma R , Joshi SN , Shrestha JK
Published: September 2010

Introduction: Vitreous hemorrhage is one of the most common differential diagnoses of sudden painless decrease in vision. Objective: To find out the etiology of vitreous hemorrhage in cases of vitreous hemorrhage at a tertiary eye centre in Nepal. Materials and methods: This was a hospital-based cross-sectional study done over a period of one-and-a-half years. One hundred and one subjects with vitreous hemorrhage were evaluated in detail to establish the etiology. Statistics: The mean value and standard deviation were calculated. The data were analyzed using microsoft excel and SPSS 11.5 program. Results: A total of 122 eyes of 101 patients were evaluated. The mean age was 41.90 (± 21.50) years with a range of 2 months to 84 years. Male were 73 %. Bilateral involvement was found in 20.8 %. Proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, rhegmatogenous retinal detachment together with ocular trauma constituted the etilogoy of vitreous hemorrhage in more than 75 % of patients. Conclusion: Proliferative diabetic retinopathy, retinal vasculitis and branch retinal vein occlusion are the most common causes of vitreous hemorrhage in adults whereas in children trauma is the commonest cause. Keywords: vasculitis; vitreous hemorrhage; diabetic retinopathy; Eales disease DOI: 10.3126/nepjoph.v2i2.3718 Nep J Oph 2010;2(2) 121-126
A profile of low vision among the blind school students in Lumbini Zone of Nepal
Authors: Sharma MK , Thapa H , Paudyal B , Adhikari RK , Dhakwa K
Published: September 2010

Introduction: There is an increasing awareness about the needs of students with low vision, particularly in developing countries where programs of integrated education are being developed. However, the appropriate low vision services are usually neither available, nor affordable. Objectives: To study the profile of students with low vision in Lumbini Zone of Nepal. Materials and methods: A cross-sectional study included students with low vision from 8 integrated schools. The reading performance was measured using their own text-books with optical low vision devices prescribed for near reading. The reading rates were measured on a range of print sizes. The Standard Clinical Low Vision Assessment Form and the National Low Vision Program protocol were used. SPSS software was used in data analysis. Results: Of 46 students enrolled, 23 had a mild visual impairment, 18 had severe visual impairment and 5 were blind. Spectacles were needed for 29 (63 %) students. Of the 11 students who had been wearing glasses, the visual acuity improved in 4 with a change in prescription. 91 % of the students had near vision better or equal to 1.5 M with optical low vision services for near reading. The reading rate was 24 WPM at the age of 5 years, whereas at the age of 21 years, it was 55 WPM. Conclusion: The majority of the students with low vision need optical low vision services. Accurate refraction is important in these students. The reading rate increases significantly with improved near visual acuity. Keywords: low vision aids; low vision rehabilitation; low vision treatment DOI: 10.3126/nepjoph.v2i2.3719 Nep J Oph 2010;2(2) 127-131
Probable Vogt-Koyanagi-Harada's Syndrome associated with tonic pupils
Authors: Narang S , Sood S
Published: September 2010

Background: Pupillary abnormalities with complete or incomplete form of VKH have rarely been reported. We report a case of "probable" Vogt- Koyanagi-Haradas (VKH) disease associated with tonic pupils. Case: A young healthy male presented with 15 days' history of bilateral decrease in vision. The patient had bilateral panuveitis with exudative retinal detachment associated with tonic pupils. There were no other systemic associations. The ultrasonography and fluorescein angiography findings were consistent with VKH disease. Conclusion: Pupillary reaction abnormalities though uncommon could be seen in association with "probable" VKH disease. Keywords: probable Vogt-Koyanagi-Harada's disease; pupillary abnormalities   DOI: 10.3126/nepjoph.v2i2.3723 Nep J Oph 2010;2(2) 154-156
A closer look at unilateral versus bilateral deep brain stimulation: results of the National Institutes of Health COMPARE cohort
Authors: Taba Houtan A. , Wu Samuel S. , Foote Kelly D. , Hass Chris J. , Fernandez Hubert H. , Malaty Irene A. , Rodriguez Ramon L. , Dai Yunfeng , Zeilman Pamela R. , Jacobson Charles E. , Okun Michael S.
Published: September 2010

Object

In this paper, the authors' aim was to examine reasons underpinning decisions to undergo, or alternatively forgo, a second-sided deep brain stimulation (DBS) implantation in patients with Parkinson disease (PD).

Methods

Fifty-two patients with Parkinson disease (PD) were randomized to receive DBS to the subthalamic nucleus or globus pallidus internus (GPi) as part of the COMPARE trial. Forty-four patients had complete data sets. All patients were offered a choice at 6 months after unilateral implantation whether to receive a contralateral DBS implant. All patients had advanced PD. The mean patient age was 59.8 years (range 43–76 years), and the mean duration of disease was 12.2 years (range 5–21 years). The mean baseline Unified Parkinson's Disease Rating Scale (UPDRS)–III motor score was 42.7. The main outcome measures used in this study were the UPDRS-III Motor Scale and the UPDRS-IV Dyskinesia Scale.

Results

Twenty-one (48%) of the 44 patients in the cohort did not undergo bilateral implantation and have been successfully treated for an average of 3.5 years; of these, 14 (67%) had a GPi target. The most common reason for adding a second side was inadequacy to address motor symptoms. Patient satisfaction with motor outcomes after unilateral DBS implantation was the most common reason for not undergoing bilateral implantation. Those who chose a second DBS procedure had significantly higher baseline UPDRS-III motor and ipsilateral UPDRS-III scores, and a significantly lower asymmetrical index. The logistic regression analysis revealed that the odds of proceeding to bilateral DBS was 5.2 times higher for STN than for GPi DBS. For every 1% increase in asymmetry, the odds of bilateral DBS decreased by 0.96.

Conclusions

Unilateral DBS is an effective treatment for a subset of patients with PD. Baseline asymmetry is an important factor in the effectiveness and decision-making process between unilateral and bilateral DBS. Patients with GPi DBS in this cohort were more likely to choose to remain with unilateral implantation.
Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I
Authors: Bahuleyan Biji , Menon Girish , Hariharan Easwer , Sharma Mridul , Nair Suresh
Published: September 2010

Symptomatic subdural hygroma due to foramen magnum decompression for Chiari malformation Type I is extremely rare. The authors present their experience with 2 patients harboring such lesions and discuss treatment issues. They conclude that the possibility of subdural hygromas should be considered in all patients presenting with increased intracranial tension following foramen magnum decompression for Chiari malformation Type I. Immediate neuroimaging and appropriate surgical intervention provides a good outcome.
Reid and Hall on Perceptual Relativity and Error
Authors: Horn Walter
Published: September 2010

Epistemological realists have long struggled to explain perceptual error without introducing a tertium quid between perceivers and physical objects. Two leading realist philosophers, Thomas Reid and Everett Hall, agreed in denying that mental entities are the immediate objects of perceptions of the external world, but each relied upon strange metaphysical entities of his own in the construction of a realist philosophy of perception. Reid added ‘visible figures’ to sensory impressions and specific sorts of mental events, while Hall utilized an array of ways that he maintained properties may participate in the world. This paper assesses each realist's attempt to explain perceptual relativity and illusion without contradicting either the science of his time or the structure of common sense.
Samuel Stanhope Smith and Common Sense Philosophy at Princeton
Authors: Bow Charles Bradford
Published: September 2010

In this article, I discuss how Samuel Stanhope Smith advanced Reidian themes in his moral philosophy and examine their reception by Presbyterian revivalists Ashbel Green, Samuel Miller, and Archibald Alexander. Smith, seventh president and moral philosophy professor of the College of New Jersey (1779–1812), has received marginal scholarly attention regarding his moral philosophy and rational theology, in comparison to his predecessor John Witherspoon. As an early American philosopher who drew on the ideals of the Scottish Enlightenment including Common Sense philosophy, Smith faced heightened scrutiny from American revivalists regarding the danger his epistemology presented to the institution of religion. The Scottish School of Common Sense was widely praised and applied in nineteenth-century American moral philosophy, but before the more general American acceptance of Common Sense, Smith already appealed to Reidian themes in his methodology and treatment of external sensations, internal sensations, intellectual powers, and active powers of the human mind. In this paper, I argue that Smith's use of Reidian themes for grooming his student's morality conflicted with the educational expectations from revivalists on Princeton's board of trustees who demanded more attention on orthodox theology. I identify Smith's notions of causation, liberty, and the moral faculty as primary reasons for this tension over Princeton's educational purpose during the first decade of the nineteenth century.
Change in floral orientation inAnisodus luridus(Solanaceae) protects pollen grains and facilitates development of fertilized ovules
Authors: Wang Yun , Meng Li‐Hua , Yang Yong‐Ping , Duan Yuan‐Wen
Published: September 2010

•Premise of the study: Some floral traits could be selected by pollinators and nonpollinator agents, and studying the floral traits shaped by physical agents could reveal adaptive mechanisms to the environment. We explored the adaptive significance of the change in floral orientation, from pendulous flowers to erect fruits that have a persistent calyx, inAnisodus luridus, a perennial native to the Qinghai‐Tibet Plateau (QTP).

•Methods: We examined the effect of flower orientation on pollinator visitation rates, pollen deposition efficiency, pollen quantity, and pollen viability to estimate whether pendulous flowers have improved male fitness. We then measured seed production and seed germination rate to assess whether erect fruits have enhanced female fitness.

•Key results: Pendulous flowers did not have any preferred pollinators or increased pollen deposition. In artificially erected flowers, the number of pollen grains greatly decreased after rainwash. Pollen germination experiments indicated that pollen damage by water and exposure to solar radiation is serious. In the persistent calyx that holds water within it, the temperature inside the calyx changed slower than in the calyx that had the water removed. After supplemental pollination, the seed number, seed set, and seed mass of fruits that had water removed from the calyx were reduced greatly in both years.

•Conclusions: We conclude that the change in floral orientation could enhance male and female fitness ofA. luridusand is effectively adaptive to the alpine environments, indicating a strong selection by the combined pressure from various abiotic nonpollinator agents in shaping the floral traits of this alpine plant.
The seed dispersal catapult of Cardamine parviflora (Brassicaceae) is efficient but unreliable
Authors: Hayashi Marika , Gerry Shannon P. , Ellerby David J.
Published: September 2010

• Premise of the study: Seed dispersal performance is an essential component of plant fitness. Despite their significance in shaping performance, the mechanical processes that drive dispersal are poorly understood. We have quantified seed dispersal mechanics in Cardamine parviflora (Brassicaceae), a ballistic disperser that launches seeds with specialized catapult‐like structures. To determine which aspects of catapult function dictate interspecific dispersal differences, we compared this disperser with other ballistic dispersers. Comparison with brassicas that lack ballistic dispersal may also provide insight into the evolution of this mechanism.

• Methods: Catapult performance was quantified using high‐speed video analysis of dehiscence, ballistic modeling of seed trajectories, and measuring the mechanical energy storage capacity of the spring‐like siliqua valve tissue that launched the seeds.

• Key results: The siliquae valves coiled rapidly outward, launching the seeds in 4.7 ± 1.3 ms (mean ± SD, N = 11). Coiling was likely driven by the bilayered valve structure. The catapult was 21.3 ± 10.3% efficient (mean ± SD, N = 11) at transferring stored elastic energy to the seeds as kinetic energy. The majority of seeds (71.4%) were not launched effectively.

• Conclusions: The efficiency of the C. parviflora catapult was high in comparison to that of a ballistic diplochore, a dispersal mode associated with poor ballistic performance, although the unreliability of the launch mechanism limited dispersal distance. Effective launching requires temporary seed‐valve adhesion. The adhesion mechanism may be the source of the unreliability. Valve curvature is likely driven by the bilayered valve structure, a feature absent in nonballistic brassicas.
Isolation and characterization of microsatellite loci in Santalum lanceolatum and Santalum leptocladum (Santalaceae)
Authors: Jones Brendan L. , Waycott Michelle , Robson Heather L. A. , Calladine Ainsley , Page Tony
Published: September 2010

• Premise of the study: Microsatellite primers were developed for the first time in the native Australian sandalwood species Santalum lanceolatum.

• Methods and Results: Using an enrichment cloning protocol, five novel polymorphic codominant loci were developed and characterized in S. lanceolatum and S. leptocladum. In addition to these, three existing microsatellite loci from other sandalwood species were successfully amplified and characterized for S. lanceolatum and S. leptocladum. Among the eight loci, allelic diversity ranged from 4 to 29.

• Conclusions: Primers will be useful for studies of clonality, genetic diversity and spatial genetic structure in wild populations. When coupled with other molecular techniques will help investigate the relationship between S. lanceolatum and S. leptocladum, species of commercial and conservation interest.
Les formations techniques et professionnelles entre l'État, la ville et le patronat : l'emploi de la taxe d'apprentissage à Lyon dans l'entre-deux-guerres
Authors: Thivend Marianne
Published: September 2010

Résumé Avec la loi Astier votée en 1919, l’État entend non seulement organiser et contrôler l’offre locale de formation technique et professionnelle, développer la formation professionnelle des jeunes de moins de 18 ans employé(e)s dans l’industrie et le commerce, mais également étoffer le réseau d’écoles techniques publiques. Pour financer cette nouvelle politique, la loi de finances du 13 juillet 1925 instaure une taxe d’apprentissage alimentée par les entreprises. Le présent article se propose d’examiner, à l’échelle de la ville de Lyon, l’usage qui est fait de cette taxe. Un compromis s’instaure progressivement entre l’État, la Ville et les milieux économiques locaux pour soutenir fortement les écoles techniques publiques et privées de la métallurgie ainsi que les cours professionnels dont l’offre est étoffée et structurée. Les formations commerciales ne soulèvent quant à elles pas les mêmes enjeux.
L'ouverture sociale des grandes écoles : diversification des élites ou renouveau des politiques publiques d'éducation ?
Authors: van Zanten Agnès
Published: September 2010

Résumé Les politiques que l'on désigne comme participant de l'« ouverture sociale des grandes écoles » accordent divers avantages à de jeunes issus de groupes défavorisés afin de faciliter leur accès aux filières d'excellence de l'enseignement supérieur. Cet article s'intéresse plus particulièrement aux programmes « Conventions Éducation Prioritaire » de Sciences Po et « Pourquoi Pas Moi ? » de l'ESSEC. Dans le but de mieux cerner les visées et les effets globaux de ces dispositifs, le mode d'analyse adopté combine deux perspectives complémentaires. La première consiste à rapporter les phénomènes observés au problème public auquel ces politiques cherchent explicitement à répondre, celui de la diversification des établissements d'élite. La seconde, à les analyser en tant qu'innovations managériales susceptibles de transformer les instruments de la discrimination positive et les modes de gouvernance du système éducatif.
A Least-Squares/Fictitious Domain Method for Linear Elliptic Problems with Robin Boundary Conditions
Authors: Glowinski Roland , He Qiaolin
Published: September 2010

In this article, we discuss a least-squares/fictitious domain method for the solution of linear elliptic boundary value problems with Robin boundary conditions. Let Ω and ω be two bounded domains of Rd such that ω̅⊂Ω. For a linear elliptic problem in Ω\ω̅ with Robin boundary condition on the boundary ϒ of ω, our goal here is to develop a fictitious domain method where one solves a variant of the original problem on the full Ω, followed by a well-chosen correction over ω. This method is of the virtual control type and relies on a least-squares formulation making the problem solvable by a conjugate gradient algorithm operating in a well chosen control space. Numerical results obtained when applying our method to the solution of two-dimensional elliptic and parabolic problems are given; they suggest optimal order of convergence.
Adaptive Conservative Cell Average Spectral Element Methods for Transient Wigner Equation in Quantum Transport
Authors: Shao Sihong , Lu Tiao , Cai Wei
Published: September 2010

A new adaptive cell average spectral element method (SEM) is proposed to solve the time-dependent Wigner equation for transport in quantum devices. The proposed cell average SEM allows adaptive non-uniform meshes in phase spaces to reduce the high-dimensional computational cost of Wigner functions while preserving exactly the mass conservation for the numerical solutions. The key feature of the proposed method is an analytical relation between the cell averages of the Wigner function in the k-space (local electron density for finite range velocity) and the point values of the distribution, resulting in fast transforms between the local electron density and local fluxes of the discretized Wigner equation via the fast sine and cosine transforms. Numerical results with the proposed method are provided to demonstrate its high accuracy, conservation, convergence and a reduction of the cost using adaptive meshes.
A Well-Conditioned Hierarchical Basis for Triangular H(curl)-Conforming Elements
Authors: Xin Jianguo , Cai Wei
Published: September 2010

We construct a well-conditioned hierarchical basis for triangular H(curl)-conforming elements with selected orthogonality. The basis functions are grouped into edge and interior functions, and the later is further grouped into normal and bubble functions. In our construction, the trace of the edge shape functions are orthonormal on the associated edge. The interior normal functions, which are perpendicular to an edge, and the bubble functions are both orthonormal among themselves over the reference element. The construction is made possible with classic orthogonal polynomials, viz., Legendre and Jacobi polynomials. For both the mass matrix and the quasi-stiffness matrix, better conditioning of the new basis is shown by a comparison with the basis previously proposed by Ainsworth and Coyle [Comput. Methods. Appl. Mech. Engrg., 190 (2001), 6709-6733].