bluuebunny/crossref_metadata_2025 huggingface dataset:
The Primitive Mind and Modern Man
Authors: Alan Cohan John
Published: September 2012

This book is in the field of cultural anthropology and transcultural psychology, and is intended for college courses in anthropology and psychology, and general readership. The book focuses on intriguing facts about primitive cultures around the world, and provides insights into living traditions and different world views. A principal theme of the book is that we can gain a better understanding of ourselves by a "detour" to other cultures. The book shows how modern ways of thinking are parallel to those of primitive cultures, and engages readers to become more aware of who they are. As shown throughout the book, there is not, after all, a very wide gulf between primitive and modern cultures. The book covers many topics including animism, shamanism, totemism, hunting and cultivation rituals, altered states of consciousness, envy and the evil eye, how people deal with conflicts, potlatches, cargo cults, how people satisfy the need for social approval, culture-bound syndromes, folk medicine, treatment of women, raising of children, nomadic peoples, treatment of the dead, and other topics.
Response to Dietary Oxalate after Bariatric Surgery
Authors: Froeder Leila , Arasaki Carlos Haruo , Malheiros Carlos Alberto , Baxmann Alessandra Calábria , Heilberg Ita Pfeferman
Published: September 2012

Background and objectives

Bariatric surgery (BS) may be associated with increased oxalate excretion and a higher risk of nephrolithiasis. This study aimed to investigate urinary abnormalities and responses to an acute oxalate load as an indirect assessment of the intestinal absorption of oxalate in this population.

Design, setting, participants, & measurements

Twenty-four–hour urine specimens were collected from 61 patients a median of 48 months after BS (post-BS) as well as from 30 morbidly obese (MO) participants; dietary information was obtained through 24-hour food recalls. An oral oxalate load test (OLT), consisting of 2-hour urine samples after overnight fasting and 2, 4, and 6 hours after consuming 375 mg of oxalate (spinach juice), was performed on 21 MO and 22 post-BS patients 12 months after BS. Ten post-BS patients also underwent OLT before surgery (pre-BS).

Results

There was a higher percentage of low urinary volume (<1.5 L/d) in post-BS versus MO (P<0.001). Hypocitraturia and hyperoxaluria (P=0.13 andP=0.36, respectively) were more frequent in BS versus MO patients. The OLT showed intragroup (P<0.001 for all periods versus baseline) and intergroup differences (P<0.001 for post-BS versus MO;P=0.03for post-BS versus pre-BS). The total mean increment in oxaluria after 6 hours of load, expressed as area under the curve, was higher in both post-BS versus MO and in post-BS versus pre-BS participants (P<0.001 for both).

Conclusions

The mean oxaluric response to an oxalate load is markedly elevated in post-bariatric surgery patients, suggesting that increased intestinal absorption of dietary oxalate is a predisposing mechanism for enteric hyperoxaluria.
Association between Albuminuria, Kidney Function, and Inflammatory Biomarker Profile in CKD in CRIC
Authors: Gupta Jayanta , Mitra Nandita , Kanetsky Peter A. , Devaney Joe , Wing Maria R. , Reilly Muredach , Shah Vallabh O. , Balakrishnan Vaidyanathapura S. , Guzman Nicolas J. , Girndt Matthias , Periera Brian G. , Feldman Harold I. , Kusek John W. , Joffe Marshall M. , Raj Dominic S.
Published: September 2012

Background and objectives

Increased risk of mortality in patients with CKD has been attributed to inflammation. However, the association between kidney function, albuminuria, and biomarkers of inflammation has not been examined in a large cohort of CKD patients.

Design, setting, participants, & measurements

This study measured the plasma levels of IL-1β, IL-1 receptor antagonist (IL-1RA), IL-6, TNF-α, TGF-β, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, and serum albumin in 3939 participants enrolled in the Chronic Renal Insufficiency Cohort study between June 2003 and September 2008. An inflammation score was established based on plasma levels of IL-1β, IL-6, TNF-α, hs-CRP, and fibrinogen. Estimated GFR (eGFR) and serum cystatin C were used as measures of kidney function. Albuminuria was quantitated by urine albumin to creatinine ratio (UACR).

Results

Plasma levels of IL-1β, IL-1RA, IL-6, TNF-α, hs-CRP, and fibrinogen were higher among participants with lower levels of eGFR. Inflammation score was higher among those with lower eGFR and higher UACR. In regression analysis adjusted for multiple covariates, eGFR, cystatin C, and UACR were strongly associated with fibrinogen, serum albumin, IL-6, and TNF-α. Each unit increase in eGFR, cystatin C, and UACR was associated with a −1.2% (95% confidence interval, −1.4, −1), 64.9% (56.8, 73.3) and 0.6% (0.4, 0.8) change in IL-6, respectively (P<0.001).

Conclusions

Biomarkers of inflammation were inversely associated with measures of kidney function and positively with albuminuria.
Attitudes Toward Strategies to Increase Organ Donation
Authors: Barnieh Lianne , Klarenbach Scott , Gill John S. , Caulfield Tim , Manns Braden
Published: September 2012

Background and objective

The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation.

Design, setting, participants, & measurements

Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives.

Results

Responses were collected from 2004 members of the Canadian public October 11–18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4-week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in >70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable.

Conclusion

The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.
Searching for Uremic Toxins
Authors: Dobre Mirela , Meyer Timothy W. , Hostetter Thomas H.
Published: September 2012

Treatment of uremia by hemodialysis has become widespread over the last 40 years and has improved substantially over that time. However, people treated with this modality continue to suffer from multiple disabilities. Retention of organic solutes, especially those poorly removed by hemodialysis, likely contributes to these disabilities. Certain classes of solutes are removed less well than urea by hemodialysis and by the normal kidney. These include protein-bound solutes, relatively large solutes, sequestered compounds, and substances removed at rates higher than urea by the normal kidney. Several strategies could be used to discover the solutes responsible for residual morbidities in standardly dialyzed people. Rather than continue to focus only on urea removal as an index for dialysis adequacy, finding additional approaches for removing toxic solutes with characteristics different from urea (and the similar small solutes it represents) is a desirable and feasible goal.
Comparison of Symptom Management Strategies for Pain, Erectile Dysfunction, and Depression in Patients Receiving Chronic Hemodialysis
Authors: Weisbord Steven D. , Mor Maria K. , Green Jamie A. , Sevick Mary Ann , Shields Anne Marie , Zhao Xinhua , Rollman Bruce L. , Palevsky Paul M. , Arnold Robert M. , Fine Michael J.
Published: September 2012

Background and objectives

Pain, erectile dysfunction (ED), and depression are common yet frequently untreated in chronic hemodialysis patients. This study compared two management strategies for these symptoms in this patient population.

Design, setting, participants, & measurements

Pain, ED, and depression were assessed monthly during an observation usual care phase. Patients were then randomized to 12-month participation in either a feedback arm in which these symptoms were assessed monthly, renal providers were informed of patients' symptoms, and treatment was left treatment at their discretion; or a nurse management arm in which symptoms were assessed monthly and trained nurses were used to evaluate patients and generate and facilitate the implementation of treatment recommendations.

Results

Of 288 patients enrolled into observation between January 1, 2009 and March 30, 2010, 220 (76%) were randomized. Compared with the feedback approach, the results (shown as Δ symptom score [95% confidence interval]) indicated that nurse management was not associated with improved pain (0.49 [−0.56, 1.54]), ED (0.20 [−0.55, 0.95]), or depression (0.32 [−0.94, 1.58]). Relative to their symptoms during observation, feedback patients experienced small, statistically significant improvements in pain (−0.98 [−1.67, −0.28]), ED (−0.98 [−1.54, −0.41]), and depression (−1.36 [−2.19, −0.54]), whereas nurse management patients experienced small, statistically significant improvements in ED (−0.78 [−1.41, −0.15]) and depression (−1.04 [−2.04, −0.04]).

Conclusions

Compared with informing renal providers of their patients' pain, ED, and depression and leaving management at their discretion, a nurse-implemented management strategy does not improve these symptoms. Both approaches modestly reduced symptoms relative to usual care.
Differential Diagnosis of Lupus and Primary Membranous Nephropathies by IgG Subclass Analysis
Authors: Song Young Soo , Min Kyueng-Whan , Kim Ju Han , Kim Gheun-Ho , Park Moon Hyang
Published: September 2012

Background and objectives

Previous studies showed that the accuracy of IgG subclasses (ISs) in differentiating membranous lupus nephritis (MLN) from primary membranous nephropathy (PMN) is <80%. This study hypothesized that diagnostic accuracy of ISs would be increased if renal compartment measurements and decision tree analysis are applied.

Design, setting, participants, & measurements

Renal biopsy specimens from 41 patients with MLN and 59 patients with PMN between October 2004 and March 2010 were examined, and immunofluorescence staining against IgG1, IgG2, IgG3, and IgG4 as well as C3, C1q, and C4 was evaluated in five different renal compartments (glomerular capillary walls, mesangium, tubules, interstitium, and blood vessels). From IS data, a decision tree to differentiate MLN from PMN was produced (IS decision tree) and its accuracy was compared with that of previous studies. Diagnostic accuracy of the IS decision tree was also compared with that of the complement decision tree as a reference.

Results

The demographic information and patterns of IS deposition were similar to those of previous studies. The IS decision tree had, as decision markers, IgG1 in the mesangium and IgG2 and IgG4 along the glomerular capillary wall. The IS decision tree showed higher accuracy (88%) than that of previous studies (<80%) and also that of the complement decision tree (81%).

Conclusions

Accuracy of ISs was increased due to the study methods, but the same methodology was less effective using complement measurements. Appropriate data analysis may enhance diagnostic value, but the analysis alone cannot achieve the ideal diagnostic value.
Antiplatelet Therapy in the Management of Cardiovascular Disease in Patients with CKD
Authors: Jain Nishank , Hedayati S. Susan , Sarode Ravindra , Banerjee Subhash , Reilly Robert F.
Published: September 2012

Antiplatelet agents (APAs) are proven to reduce risk of major cardiovascular events in patients with cardiovascular disease and normal kidney function. With recent post hoc analyses of large trials questioning the safety and efficacy of APAs in CKD, major gaps exist in our understanding of platelet aggregability and the effects of APAs on thrombosis and bleeding in CKD. Clinical practice guidelines are ambiguous about use of such agents in CKD patients, because patients with moderate to advanced CKD were systematically excluded from clinical trials of APAs. CKD patients experience excessive rates of cardiovascular thrombotic events, yet paradoxically are at higher risk for major bleeding while receiving APAs. Furthermore, observational studies suggest that CKD patients may exhibit poor response to APAs. High residual platelet aggregability, as determined by inhibition of platelet aggregation, is associated with increased risk for cardiovascular events. In addition, metabolism of certain APAs may be altered in CKD patients. It is, therefore, imperative to explore the mechanisms responsible for poor response to APAs in CKD patients in order to use these drugs more safely and effectively. This review identifies the knowledge gaps and future trials needed to address those issues with the use of APAs in CKD patients.
Urinary Albumin Excretion Patterns of Patients with Cast Nephropathy and Other Monoclonal Gammopathy–Related Kidney Diseases
Authors: Leung Nelson , Gertz Morie , Kyle Robert A. , Fervenza Fernando C. , Irazabal Maria V. , Eirin Alfonso , Kumar Shaji , Cha Stephen S. , Rajkumar S. Vincent , Lacy Martha Q. , Zeldenrust Steve R. , Buadi Francis K. , Hayman Suzanne R. , Nasr Samih H. , Sethi Sanjeev , Ramirez-Alvarado Marina , Witzig Thomas E. , Herrmann Sandra M. , Dispenzieri Angela
Published: September 2012

Background and objectives

Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN).

Design, setting, participants, & measurements

Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis.

Results

From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99.

Conclusions

This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.
Surface coverage determination of iron-phosphate coatings on steel using voltammetric anodic dissolution technique
Authors: Popic Jovan , Jegdic Bore , Bajat Jelena , Mitric Miodrag , Miskovic-Stankovic Vesna
Published: September 2012

In this study, the effect of deposition time and concentration of NaNO2 in
the phosphate bath on the surface morphology of iron-phosphate coatings on
low carbon steel was investigated using scanning electron microscopy (SEM)
and atomic force microscopy (AFM). The composition of iron-phosphate coatings
was determined using energy dispersive X-ray spectroscopy (EDS) and X-ray
diffraction (XRD), while surface coverage was evaluated by the voltammetric
anodic dissolution (VAD) technique in the borate solution. The addition of
NaNO2 in the phosphate bath significantly increased the surface coverage
since better packed crystals of smaller size, which favour the phosphate
nucleation, were obtained. It was also shown that prolonged deposition time
increased the surface coverage, coating roughness and crystal size in lateral
direction, altering also the crystal shape from big platelets nonuniformly
distributed on steel surface during initial time, to better packed laminated
and needle-like structures during prolonged exposure.
Body weight and waist circumference as predictors of vitamin D deficiency in patients with type 2 diabetes and cardiovascular disease
Authors: Kavaric Sreten , Vuksanovic Milica , Bozovic Dragica , Jovanovic Marko , Jeremic Veljko , Radojicic Zoran , Pekic Sandra , Popovic Vera
Published: September 2012

Background/Aim. Vitamin D deficiency is a well-established risk factor for
bone disease, but emerging data suggest that altered vitamin D homeostasis
may play a role in the development of type 2 diabetes mellitus (T2DM),
dyslipidemia hypertension, and other cardiovascular diseases (CVD). The aim
of this study was to investigate the prevalence of vitamin D deficiency in
patients with T2DM with/without CVD, to correlate it with anthropometric and
metabolic parameters and to determine the predictors of vitamin D
deficiency. Methods. A total of 88 patients with T2DM (49 male/39 female,
aged 61.0 ? 0.9 yrs, body mass index (BMI) 29.9 ? 0.4 kg/m2) and 67 patients
(44 male/23 female, aged 63.6 ? 1.0 yrs, BMI 29.2 ? 0.5 kg/m2) with T2DM and
CVD (myocardial infarction in 57 patients and angina pectoris in 10
patients) were included in this study. These patients were compared with 87
healthy subjects (35 male/52 female, aged 52.8 ? 1.4 yrs, BMI 27.2 ? 0.5
kg/m2). Weight, height, waist circumference and BMI were recorded in all
patients. Also, total cholesterol, triglycerides, hemoglobin A1c (HbA1c) and
25-hydroxy-vitamin D [25(OH)D] levels were measured in all. According to
25(OH)D level, all subjects were divided into three categories: severe
vitamin D deficiency (? 15 ng/mL), vitamin D insufficiency (15-20 ng/mL) and
vitamin D sufficiency (20 ng/mL). We correlated vitamin D levels with
anthropometric and metabolic status and determined the predictors of vitamin
D deficiency. Results. Severe vitamin D deficiency was registered in 16.1%
healthy subjects, in 21.6% patients with T2DM and in 26.9% patients with
T2DM and CVD. Patients with T2DM who were vitamin D deficient had increased
weight, waist circumference, cholesterol and triglyceride levels when
compared with patients with T2DM who had sufficient vitamin D level. 25(OH)D
levels correlated with BMI and waist circumference in all subjects, but did
not correlate with metabolic parameters (lipids, HbA1c). The best predictors
of vitamin D level in all subjects were weight, waist circumference and BMI.
Conclusion. The high prevalence of vitamin D deficiency in patients with
T2DM and particularly in patients with T2DM and CVD suggests that
supplementation with vitamin D may be beneficial although there is still not
sufficient evidence for recommending prescribing vitamin D.
Plasma homocysteine levels in patients with liver cirrhosis
Authors: Culafic Djordje , Markovic Miroslav , Obrenovic Radmila , Mijac Dragana
Published: September 2012

Background/Aim. Homocysteine (2-amino-4-mercaptobutyric acid) is an amino
acid that may be found in small quantities in all cells, and is
quantitatively the major methionine metabolite. The most prevalent form is
protein-bound homocysteine (about 80%), mostly to albumins. If catabolism of
homocysteine is impaired either due to enzyme defect or deficiency of
required intracellular cofactors, homocysteine accumulates in cells and
reaches the circulation. The aim of our study was to determine homocysteine
values and factors affecting homocysteine metabolism in patients with liver
cirrhosis. Methods. The prospective study included 35 patients with liver
cirrhosis and 30 age and sex matched healthy controls. All the examinations
were based on: medical history, physical examination, laboratory tests
including serum homocysteine levels and liver biopsy. The degree of liver
failure was assessed according to the Child-Pugh classification. Results. The
mean plasma homocysteine levels were much higher in the patients with liver
cirrhosis than in the healthy controls (t-test, p < 0.001). There was no
significant difference between the plasma homocysteine concentration and
etiology of liver cirrhosis (ANOVA, p > 0.05). Correlation analysis showed a
positive correlation between the homocysteine and creatinine concentrations
and between the serum albumin and homocysteine values, (Pearson's
correlation, p < 0.01, and p < 0.05 respectively). Conclusion. In liver
cirrhosis, the genesis of homocysteinemia is multifactorial, influenced
significantly by impaired catabolic liver function, renal failure and
hypoalbuminemia.
The effect of parental attitudes on habilitation of hearing impaired children
Authors: Ristic Snezana , Kocic Biljana , Milosevic Zoran
Published: September 2012

Background/Aim. Habilitation of children with hearing loss is a very complex
process and requires a team work. Habilitation period length, as well as the
effects themselves are individual and depend on many factors. The goal of
any habilitation process is to improve the quality of life of each
individual to the maximal extent possible, regardless of whether embedded
cochlear implant, or other forms of amplification applied. A long-standing
practice has shown that the influence of parents and their attitudes in the
habilitation process is great. The aim of this study was to examine the
extent of this influence in order to educate the parents so to help their
children maximize their potential. Methods. The instruments used in this
study were: semi-structured interview, the Parental Attitudes Scale (PAD),
Package Nottingham Early Estimates (NEAP). The participants in this study
were the parents with children aged 4-15 years. The extent of hearing loss
in the children was recorded at the beginning and during the habilitation
process and all were actively involved at least three months. For
statistical analysis of this study the descriptive and inferential
statistical techniques were applied. Results. The results of our study show
significant differences in certain parental attitudes. A close cooperation
of the parents and quality experts interactions with the parents are a
prerequisite for a successful habilitation. Conclusion. The result of this
research show that the process of habilitation of children with hearing and
speech disorders is significantly affected by the parent attitudes. Parental
attitudes were proved to be especially important for children with greater
hearing loss. It was also noted that in our society mainly mothers are
concerned with hearing-damaged children, which indicates that the
educational process should be extend to both parents.
Are Short Sellers Informed? Evidence from the Bond Market
Authors: Kecskés Ambrus , Mansi Sattar A. , Zhang Andrew (Jianzhong
Published: September 2012

We examine whether short sellers in the equity market provide valuable information to investors in the bond market. Using a sample of publicly traded bond data covering the period from 1988 to 2011, we find that firms with high short interest have lower credit ratings and are more likely to have their ratings downgraded. We also find that firms with highly shorted stocks are associated with higher bond yield spreads (about 24 basis points). Evidence of causality from short interest spikes and a natural experiment based on the SEC's Regulation SHO pilot program confirms our findings. Overall, our results suggest that equity short sellers provide predictive information to creditors in the bond market.

JEL Classifications: G12; G14.

Data Availability:  Data are publicly available from the sources identified in the study with the exception of the bond data from Lehman Brothers, which is a proprietary dataset.
Group Audits, Group-Level Controls, and Component Materiality: How Much Auditing Is Enough?
Authors: Stewart Trevor R. , Kinney William R.
Published: September 2012

Auditing standards now mandate that group auditors determine and implement appropriate component materiality amounts, which ultimately affect group audit scope, reliability, and value. However, standards are silent about how these amounts should be determined and methods being used in practice vary widely, lack theoretical support, and may either fail to meet the audit objective or do so at excessive cost. We develop a Bayesian group audit model that generalizes and extends the single-component audit risk model to aggregate assurance across multiple components. The model formally incorporates group auditor knowledge of group-level structure, controls, and context as well as component-level constraints imposed by statutory audit or other requirements. Application of the model yields component materiality amounts that achieve the group auditor's overall assurance objective by finding the optimal solution on an efficient materiality frontier. Numerical results suggest group-level controls and structured subgroups of components are central to efficient group audits.

Data Availability: Upon request, Dr. Stewart will provide Excel-based software that facilitates exploration and application of the model described in this paper.
Passing the Reign
Authors: Aryal Gopi
Published: September 2012

Journal of Pathology of Nepal (2012) Vol. 2, IDOI: http://dx.doi.org/10.3126/jpn.v2i4.6873
Chordoma: study of five cases
Authors: Sigdel B , Baidya R
Published: September 2012

Background: Chordoma is a rare slow growing but malignant midline bone tumor arising from the notochordal remnant and recapitulates the notochord at various stages of differentiation. They involve the axial skeleton. The aim of this study was to find the frequency of this tumor and to analyze the clinical, radiological and pathological findings.Materials and Methods: Cases of chordoma diagnosed at B & B Hospital from January 1999 to November 2011 were studied for clinicopathologic features and immunohistochemical profile.Results: There were 5 cases of chordoma during the study period. Females were affected more with male to female ratio of 1:1.5. Sixty percent of the tumors involved the sacrum, while 40% were intracranial and located at the base of the skull. Median age of diagnosis was 44.8 years. Four cases (80%) were conventional chordoma and 1 case (20%) was a chondroid variant. Two cases evaluated were immunoreactive for S-100 protein, pan-cytokeratin and EMA.Conclusion: Though a low grade tumor with prolonged clinical course, chordomas can cause extensive local destruction with significant morbidity and mortality. Hence a prompt diagnosis with adequate excision is important to save the patient’s life.Journal of Pathology of Nepal (2012) Vol. 2, 260-264DOI: http://dx.doi.org/10.3126/jpn.v2i4.6874
Evaluation of bone marrow in patients with pancytopenia
Authors: Pathak R , Jha A , Sayami G
Published: September 2012

Background: Pancytopenia is a common hematological finding resulting from varieties of disease processes that require evaluation of bone marrow. This study was carried out to evaluate bone marrow findings in patients presenting with pancytopenia.Materials and Method: This was a prospective cross sectional study carried out to identify the causes of pancytopenia based on bone marrow examination. Bone marrow examinations were performed in 503 cases for different indications over a period of one year.Results: One hundred and two (20.27%) cases fulfilled the criteria of pancytopenia. Trephine biopsy was possible only in 48 cases. In 75% cases aspiration findings were similar to biopsy. Mean age of patients was 38.8 years. Maximum number of cases was seen in age group of 15-30 years. Hypoplastic anemia was the commonest cause followed by hematological malignancies, megaloblastic anemia, leishmaniasis and Gaucher disease. Bone marrow examination alone was able to establish the diagnosis in 76.5% cases. In rest marrow findings were nonspecific and in 4.9% cases findings were normal.Conclusion: Bone marrow aspiration coupled with trephine biopsy can diagnose majority but not all the cases of pancytopenia. Hypoplastic anemia, hematological malignancies and megaloblastic anemia are the commonest causes of pancytopenia. Maximum diagnostic yield can be achieved by correlation with clinical findings, peripheral blood findings and with other laboratory and radiological parameters.Journal of Pathology of Nepal (2012) Vol. 2, 265-271DOI: http://dx.doi.org/10.3126/jpn.v2i4.6875
Role of cell block preparation in neoplastic lesions
Authors: Basnet S , Talwar OP
Published: September 2012

Background: Fine needle aspiration cytology of superficial lesion or deep anatomical site is an increasingly common procedure in diagnosis of neoplastic lesions. Sometimes fine needle aspiration does not yield sufficient information for precise diagnosis and the risk of false negative or intermediate diagnosis always exists. In order to overcome these problems, cell block technique has been resorted to make the best use of available material.Materials and Methods:This was a prospective hospital based study conducted in the department of pathology, Manipal Teaching Hospital, Pokhara, Nepal over a period of 2 years from the year 2009 October to 2011. There were total of 49 cases included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available.Results: A total of 49 such cases were included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available. Of all the malignant cases, 12 cases were from lungs aspirate, 10 were from breast, 15 from lymph node and 12 from thyroid. With the combined use of smear and cell block, the diagnostic accuracy of the tumors approaches 100% and also significantly improves diagnostic and sub typing accuracy of malignancies. Cell blocks were found superior in diagnosing neoplasm than smears with diagnostic accuracy of 95.91% and 91.8% respectively.Conclusion: Cell block method allows the recovery and processing of minute amounts of cellular material and facilitates the better classification of tumor when reviewed along with cytological smears. The method is simple to perform and no expertise is required to handle the specimen. Therefore the routine preparation of the cell block improves the accuracy of fine needle aspiration cytology diagnosis.Journal of Pathology of Nepal (2012) Vol. 2, 272-276DOI: http://dx.doi.org/10.3126/jpn.v2i4.6876
Histological pattern of esophageal cancer at BP Koirala memorial cancer hospital in Nepal: a three year retrospective study
Authors: Pun CB , Aryal G , Basyal R , Shrestha S , Pathak T , Bastola S , Neupane S , Shrestha BM , Thakur BK , Lee MC
Published: September 2012

Background: The incidence of esophageal adenocarcinoma is increasing in trends. Squamous cell carcinoma is associated with tobacco and alcohol consumption. Adenocarcinoma is often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. The aim of this study was to find out the histological pattern of esophageal cancer in one of the largest Cancer center in Nepal.Materials and Methods: Between January 2008 and December 2011, a total of 106 cases of esophageal cancer were received in the department of pathology, BP Koirala Memorial Cancer Hospital. Relevant clinical data were retrieved from computer database of the hospital.Results: A total of 106 cases of esophageal carcinomas were diagnosed during a three years period. There were 68 (64.15%) cases of squamous cell carcinoma, 33 (31.13%) cases of adenocarcinoma including signet ring cell carcinoma, 4 (3.76%) cases of undifferentiated carcinoma and 1 (0.94%) case of small cell carcinoma. The esophageal cancer was most common in the age group of 61-70 years of age. Distal third of esophagus was the most common site for esophageal carcinoma, followed by middle esophagus and proximal esophagus.Conclusion: The most frequent type of esophageal carcinoma is squamous cell carcinoma followed by adenocarcinoma. Distal esophagus is the most common site with male preponderance.Journal of Pathology of Nepal (2012) Vol. 2, 277-281DOI: http://dx.doi.org/10.3126/jpn.v2i4.6877
Evaluation of touch smears cytology and biopsy findings in the diagnosis of gastric carcinoma
Authors: Dhakhwa R , Shrestha HG , Joshi DM , Lakhey M
Published: September 2012

Background: Gastric carcinoma is one of the leading causes of cancer deaths worldwide, with a mortality rate directly related to the stage at diagnosis. Endoscopic biopsy and cytology are well established techniques for the diagnosis of carcinoma of stomach.Materials and Methods: This study was conducted on 50 patients, suspected of gastric cancer on endoscopy, during a period of 18 months (October 2010 to March 2012). Endoscopic biopsy and touch smear cytology were evaluated. Biopsy was considered gold standard for final diagnosis.Results: A total of 50 cases were included out of which 36 were malignant and 14 cases were benign. Cytology was able to diagnose 33 out of 36 malignant cases. Of 17 cases which were diagnosed as benign on cytology, 3 cases turned out to be malignant on biopsy. The sensitivity and specificity of touch smear cytology are 91.6% and 100% respectively.Conclusion: Touch smear cytology is a useful adjunct in the diagnosis of gastric carcinoma and should be considered a routine method along with biopsy.Journal of Pathology of Nepal (2012) Vol. 2, 282-284DOI: http://dx.doi.org/10.3126/jpn.v2i4.6878
Fine needle aspiration cytology findings of mucinous carcinoma of breast: a study of eight cases with histological correlation
Authors: Adhikari RC , Jha A
Published: September 2012

Background: Pure mucinous carcinoma is a rare histologic type of mammary neoplasm and may exist as mixed mucinous-ductal carcinoma. This study aims to describe fine needle aspiration cytology features of mucinous carcinoma of breast diagnosed in Tribhuvan University Teaching Hospital, Nepal over the period of 2 years and to correlate with histological findings.Materials and Methods: There were a total of 8 cases of mucinous carcinoma of breast, diagnosed on fine needle aspiration cytology in TUTH during the period from April 2010 to March 2012. The patient’s age, laterality of involvement, fine needle aspiration cytology features, gross and histological findings, type of surgery performed and tumor size were evaluated. Fine needle aspiration cytology smears were evaluated for cellularity, amount of mucin, chicken-wire vasculature and nuclear atypia.Results: Fine needle aspiration cytology provided a pre-operative diagnosis of mucinous carcinoma in 5 cases and mixed mucinous carcinoma-invasive ductal carcinoma in 3 cases. Histological examination showed pure mucinous carcinoma in 3 cases, mixed mucinous carcinoma-invasive ductal carcinoma in 4 cases and mixed cribriform carcinoma and ductal carcinoma in 1 case.Conclusion: Mucinous carcinoma may appear clinically and radiologically benign and fine needle aspiration cytology plays important role in the correct pre-operative diagnosis. Significant nuclear pleomorphism and necrosis, in addition to extracellular mucin suggests mixed mucinous carcinomainvasive ductal carcinoma.Journal of Pathology of Nepal (2012) Vol. 2, 285-288DOI: http://dx.doi.org/10.3126/jpn.v2i4.6879
Study of malignant germ cell tumors with special reference to malignant ovarian germ cell tumors: 5 years experience
Authors: Jha R , Jha S
Published: September 2012

Background: Germ cell tumors are rare and complex group of heterogenous neoplasms that comprise both benign and malignant histology. The testes and ovaries are the most common sites. This descriptive study focused on distribution of malignant germ cell tumors with more detail study of ovarian malignant germ cell tumors.Materials and Methods: All cases of malignant germ cell tumor reported from department of pathology of Tribhuvan University Teaching Hospital over five years from April 2007 to April 2012 were included in the study.Results: Thirty five cases (24 female and 11 male) were diagnosed as having malignant germ cell tumors. Most patients were below 30 years of age. Ovary was the most common site followed by testes. Malignant ovarian germ cell tumor comprised 54.3% of all malignant germ cell tumors. Age of these patients ranged from 6 years to 32 years. Most common histologic type was yolk sac tumor.Conclusion: Malignant germ cell tumors can be seen in any age group from new born to old age. However malignant ovarian germ cell tumors occur mainly in first three decades of life, are mostly unilateral and are of large size at the time of diagnosis due to rapid growth. However these tumors are often of low stage and managed with conservative surgery.Journal of Pathology of Nepal (2012) Vol. 2, 289-292DOI: http://dx.doi.org/10.3126/jpn.v2i4.6880
Value of Calcium and Phosphorous in chronic kidney disease patients under hemodialysis: A retrospective study
Authors: Singh S , Upadhyay-Dhungel K , Aryal G
Published: September 2012

Background: Derangements of mineral metabolism occur during early stages of chronic kidney disease (CKD). Mineral metabolism has emerged as important predictors of morbidity and mortality in dialysis patients. This study aims to evaluate the values of calcium and phosphorous in reference to practice guidelines issued by National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) in patients undergoing hemodialysis in KIST Medical College Teaching Hospital.Materials and Methods: It was a retrospective study which included 101 patients who underwent hemodialysis in KIST Medical College Teaching Hospital over a period of three months (October 2010 to December 2010). The laboratory parameters of serum calcium, and phosphorus were evaluated and were compared with that of recommended values by K/DOQI guidelines.Results: The mean values for serum calcium, phosphorus, and calcium-phosphorus product were 8.79 ± 1.48 mg/dL, 5.30 ± 1.32 mg/dL and 46.62 ± 1.96 mg2/dL2 respectively. Forty (40%), 53 (53%) and 76 (76%) cases of CKD patients met K/DOQI target value for calcium, phosphorous and calciumphosphorous product respectively. Twenty one percent of the patients meet the three K/DOQI guidelines and 14% did not meet any of the recommended guidelines by K/DOQI.Conclusion: To achieve all the K/DOQI guidelines multi-disciplinary team approach is crucial. More extensive multicenter studies need to be carried out. It is necessary to develop our national guidelines in future.Journal of Pathology of Nepal (2012) Vol. 2, 293-296DOI: http://dx.doi.org/10.3126/jpn.v2i4.6881
Histopathological analysis of testicular tumors
Authors: Karki S , Bhatta RR
Published: September 2012

Background: Testicular cancers are rare in most countries. However, in many western countries its incidence has been increasing since the middle of the twentieth century. A definite geographic and racial distribution is seen in testicular tumors. The purpose of the study was to analyze the pattern and distribution of testicular cancers in one of the hospital in Nepal.Materials and methods: This was a retrospective study, in which cases were retrieved from the computer database between September 2006 and August 2011 in the department of Pathology. Pertinent data like age and histopathology of tumor were collected from the surgical pathology reports.Results: Testicular tumors were uncommon, comprising only 11.4% (8/70 cases) of all testicular lesions. Most of these tumors (50%) were seen between 4th and 5th decades. Germ cell tumors were the commonest tumors (62.5%), among which seminomas and mixed germ cell tumors were most frequently encountered, two cases each. Thirty percent of the biopsies consisted of undescended testis and none of them showed malignancy. Other tumors diagnosed were Non Hodgkin Lymphoma, leukemic infiltration and metastasis.Conclusion: Testicular tumors are uncommon in our population. As evident in other parts of the world, germ cell tumor was common in this study as well. However, unlike in Western population, no tumor was seen in undescended testis.Journal of Pathology of Nepal (2012) Vol. 2, 301-304DOI: http://dx.doi.org/10.3126/jpn.v2i4.6883
Efficacy of fine needle aspiration cytology in diagnosing soft tissue tumors
Authors: Parajuli S , Lakhey M
Published: September 2012

Background: Fine needle aspiration cytology has an established role in the diagnosis of various neoplastic and non-neoplastic lesions. Its accuracy when applied by experienced and well trained practitioners matches that of histopathology in providing an equivocal diagnosis; so it can also be used as a very useful alternative to excision biopsy in the diagnostic workup of soft tissue tumors.Materials and Methods: This retrospective study was done in the Department of Pathology, Kathmandu Medical College for a period of one year from January 2006 to December 2006. A total of 60 cases presented with soft tissue tumors, of which only 50 were biopsied and the correlation done. A detailed history, clinical findings, routine relevant laboratory investigations and radiological findings were carried.Results: Fine needle aspiration cytology revealed diagnostic materials in 47 cases and 3 cases were inconclusive for a definite diagnosis. 40 cases were diagnosed as benign lesions and 7 cases as malignant lesions. Out of the benign cases, the most common were lipomas which accounted for 52.5% of cases followed by benign mesenchymal tumor- 17.5%. Out of the malignant cases 71.42% were diagnosed as malignant mesenchymal tumor and 28.57% as malignant nerve sheath tumor. The overall diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors in the present study was 86%. The sensitivity and specificity of diagnosing benign soft tissue tumors was 97.36% and 66.67% respectively and for malignant soft tissue tumors 66.67% and 97.36% respectively.Conclusion: Fine needle aspiration cytology can be effective and reliable diagnostic tool in the evaluation of soft tissue tumors. It is highly sensitive to detect benign soft tissue tumors and highly specific for malignant soft tissue tumors.Journal of Pathology of Nepal (2012) Vol. 2, 305-308DOI: http://dx.doi.org/10.3126/jpn.v2i4.6884
Interpretation of bone marrow aspiration in hematological disorder
Authors: Pudasaini S , Prasad KBR , Rauniyar SK , Shrestha R , Gautam K , Pathak R , Koirala S , Manandhar U , Shrestha B
Published: September 2012

Background: Hematological disorders are quite frequent in all age group. Most of this hematological disorder first present as anemia. Bone Marrow Aspiration plays a major role in the diagnosis of its underlying cause. The aim of this study was to analyze the causes of hematological disorders, its spectrum and to interprete the bone marrow aspiration findings.Materials and Methods: This was a retrospective and prospective study carried out in the department of Pathology of Nepal Medical College in a period of two years. (July 2010 - June 2012). Bone marrow examination of 57 cases of suspected hematological disorders was carried out. All details of the patients were obtained from the record file in the department of pathology.Results: Out of 57 cases of bone marrow aspiration, erythroid hyperplasia was seen in 12 cases (21%). Megaloblastic anemia was seen in 7 cases (12.3%) and microcytic anemia was seen in 4 cases (7%). There were 6 cases (10.5%) of Idiopathic Thrombocypenic Purpura. Acute leukemia was diagnosed in 7 cases (12.3%) and among this acute myeloid leukemia (10.5%) was more common than acute lymphoid leukemia (1.8%). Myelodysplastic syndrome and multiple myeloma was seen in 3.5 % cases each. Aplastic anemia and kalaazar was seen in 5.3% and 1.8% cases respectively.Conclusion: Bone marrow examination is an important step to arrive at the confirmatory diagnosis of many hematological disorders.Journal of Pathology of Nepal (2012) Vol. 2, 309-312DOI: http://dx.doi.org/10.3126/jpn.v2i4.6885
MicroRNA in modern genetics
Authors: Thapa JB
Published: September 2012

In recent years microRNAs have emerged as important players in modern genetics. This review attempts to introduce the biogenesis of microRNA and its important physiological role in protein synthesis. The association of microRNA with different cancers is discussed. Lastly the frontier field of therapy based on microRNAs to treat different diseases is introduced.Journal of Pathology of Nepal (2012) Vol. 2, 313-316DOI: http://dx.doi.org/10.3126/jpn.v2i4.6886
Autoimmune Hepatitis: A Review with emphasis on its histomorphology
Authors: Pradhan SV
Published: September 2012

Autoimmune hepatitis is a chronic inflammatory disorder characterized by periportal inflammation, hypergammaglobulinemia with elevated autoantibodies, and a dramatic response to immunosuppression. Various environmental and genetic influences can trigger the immune mediated destruction of the liver. A plethora of clinical presentations can be seen ranging from chronic indolent disease to fulminant hepatic failure. Autoimmune hepatitis does not have a pathognomonic feature, and its laboratory, serologic, and histologic manifestations are found in acute and chronic liver disease of diverse causes. Difficulties in distinguishing toxic, drug-related, virus-induced, and autoimmune causes of severe acute liver injury can result in misclassification. Our paper discusses autoimmune hepatitis, giving a detailed overview of its clinical presentation, immunopathogenesis, emphasis on histomorphological changes and the diagnostic criteria.Journal of Pathology of Nepal (2012) Vol. 2, 317-323DOI: http://dx.doi.org/10.3126/jpn.v2i4.6887
Idiopathic myelofibrosis mimicking hemolytic anemia
Authors: Baral R , Aryal G , Raj KC Shiva
Published: September 2012

Idiopathic Myelofibrosis is an infrequent chronic myeloproliferative disorder characterized by varying degrees of bone marrow fibrosis and extra medullary hematopoiesis, with the fibrosis being a reactive phenomenon to a neoplastic proliferation of a pluripotent hematopoietic stem cell. Idiopathic Myelofibrosis is heterogeneous in presentation and clinical course, with anemia being one of the most important problems. We present a case of a 59 year old male who presented with severe anemia, the peripheral blood picture mimicking hemolysis with numerous schistocytes and teardrop cells.Journal of Pathology of Nepal (2012) Vol. 2, 323-327DOI: http://dx.doi.org/10.3126/jpn.v2i4.6888
Papillary thyroid carcinoma of thyroglossal duct cyst; a case report and review of the literature
Authors: Shelke VN , Raut WK
Published: September 2012

Thyroglossal duct remnants are the most common midline neck swellings, but malignancy arising in them is a rare finding. Among the carcinomas arising in the thyroglossal duct cyst, papillary thyroid carcinoma is the commonest. Most of the cases of papillary thyroid carcinoma of thyroglossal duct cyst are asymptomatic and clinically diagnosed as thyroglossal duct cyst. It may remain undetected on fine needle aspiration cytology and ultrasonography; therefore diagnosis is established only after pathologic evaluation of biopsy. Hence careful histopathological examination of the excised specimen with high level of suspicion is mandatory in these cases. We are report a case of papillary thyroid carcinoma of thyroglossal duct cyst in a 30-year-old female.Journal of Pathology of Nepal (2012) Vol. 2, 328-330DOI: http://dx.doi.org/10.3126/jpn.v2i4.6889