bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic gene expression following consumption of soy protein isolate in female Sprague–Dawley rats differs from that produced by 17β-estradiol treatment
Authors: Singhal Rohit , Shankar Kartik , Badger Thomas M , Ronis Martin J
Published: April 2009

Although soy foods have been recognized as an excellent source of protein, there have been recent concerns regarding potential adverse effects of isoflavone phytochemicals found in soy products, which are known to bind and activate estrogen receptors. Here, we used global hepatic gene expression profiles in ovariectomized female Sprague–Dawley rats treated with 17β-estradiol (E2) or fed with soy protein isolate (SPI) as a means of estimating potential estrogenicity of SPI. Female Sprague–Dawley rats were fed AIN-93G diets containing casein (CAS) or SPI starting at postnatal day (PND) 30. Rats were ovariectomized on PND 50 and infused with E2 or vehicle in osmotic pumps for 14 d. Microarray analysis was performed on liver using Affymetrix GeneChip Rat 230 2.0. Serum E2 levels were within normal ranges for the rat and SPI feeding did not increase uterine wet weight in the absence or presence of E2. SPI feeding altered (P<0.05, ≥±1.5-fold) the expression of 82 genes, while E2 treatment altered 892 genes. Moreover, only 4% of E2-affected genes were also modulated by SPI, including some whose expression was reversed by SPI feeding. The interaction between E2 and SPI uniquely modulated the expression profile of 225 genes including the reduction of those involved in fatty acid biosynthesis or glucocorticoid signaling and an induction of those involved in cholesterol metabolism. The different hepatic gene signatures produced by SPI feeding compared with E2 and the lack of increase in uterine wet weight in rats fed with SPI suggest that SPI is not estrogenic in these tissues.
The role of calcium influx pathways in phospholipase D activation in bovine adrenal glomerulosa cells
Authors: Qin Haixia , Kent Patricia , Isales Carlos M , Parker Peter M , Wilson Mariya V , Bollag Wendy B
Published: April 2009

The steroid hormone aldosterone maintains sodium homeostasis and is therefore important in the control of blood volume and pressure. Angiotensin II (AngII) and elevated extracellular potassium concentrations ([K+]e), the prime physiologic regulators of aldosterone secretion from adrenal glomerulosa cells, activate phospholipase D (PLD) in these cells. The role of Ca2+ in the activation by these agents is unknown, although nitrendipine, a voltage-dependent Ca2+ channel antagonist, does not inhibit AngII-elicited PLD activation, despite the fact that this compound blocked elevated [K+]e-stimulated PLD activity. PLD activation triggered by AngII was also unaffected by the T-type calcium channel inhibitor nickel. Nevertheless, Ca2+ influx was required for AngII-induced PLD activation in both primary cultures of bovine adrenal glomerulosa cells and a glomerulosa cell model, the NCI H295R adrenocortical carcinoma cell line. The involvement of store-operated Ca2+ (SOC) influx and Ca2+ release-activated Ca2+ (CRAC) influx pathways in PLD activation was investigated using thapsigargin, an endoplasmic reticulum Ca2+ pump inhibitor that empties the store to induce SOC influx, and the SOC inhibitor YM-58483 (BTP2), as well as a CRAC inhibitor, tyrphostin A9. In bovine glomerulosa cells, tyrphostin A9 inhibited AngII-induced PLD activation without affecting elevated [K+]e-stimulated enzyme activity. On the other hand, differences were observed between the bovine adrenal glomerulosa and H295R cells in the involvement of Ca2+ influx pathways in PLD activation, with the involvement of the SOC pathway suggested in the H295R cells. In summary, our results indicate that Ca2+ entry only through certain Ca2+ influx pathways is linked to PLD activation.
Drug Use and High-Risk Sexual Behaviors Among African American Men Who Have Sex With Men and Men Who Have Sex With Women
Authors: Browne Dorothy C. , Clubb Patricia A. , Wang Yan , Wagner Fernando
Published: April 2009

Objectives. We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs).

Methods. Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease.

Results. Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors.

Conclusions. Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.
Childhood Sexual Abuse and the Sociocultural Context of Sexual Risk Among Adult Latino Gay and Bisexual Men
Authors: Arreola Sonya Grant , Neilands Torsten B. , Díaz Rafael
Published: April 2009

Objectives. We sought to examine the relationships among childhood sexual abuse, social discrimination, psychological distress, and HIV-risk among Latino gay and bisexual men in the United States.

Methods. Data were from a probability sample of 912 men from Miami, FL; Los Angeles, CA; and New York, NY. We used logistic regression and path analyses to examine direct and indirect effects of childhood sexual abuse on psychological distress and sexual risk behavior.

Results. We found a 15.8% (95% confidence interval = 12.3%, 19.2%) prevalence of childhood sexual abuse. Not having sex before age 16 years and having consensual sex before age 16 years did not differ from each other in predicting any of the outcomes of interest. Forced sex was associated with a significantly increased risk for all outcomes. A path analyses yielded direct effects of childhood sexual abuse and exposure to homophobia during childhood and during adulthood on psychological distress and indirect effects on risky sexual behavior.

Conclusions. HIV-risk patterns among Latino gay and bisexual men are related to childhood sexual abuse and a social context of discrimination, which combined lead to symptoms of psychological distress and participation in risky sexual situations that increase risky sexual behaviors associated with HIV acquisition.
Accessing Social Networks With High Rates of Undiagnosed HIV Infection: The Social Networks Demonstration Project
Authors: Kimbrough Lisa W. , Fisher Holly E. , Jones Kenneth T. , Johnson Wayne , Thadiparthi Sekhar , Dooley Samuel
Published: April 2009

Objectives. We evaluated the use of social networks to reach persons with undiagnosed HIV infection in ethnic minority communities and link them to medical care and HIV prevention services.

Methods. Nine community-based organizations in 7 cities received funding from the Centers for Disease Control and Prevention to enlist HIV-positive persons to refer others from their social, sexual, or drug-using networks for HIV testing; to provide HIV counseling, testing, and referral services; and to link HIV-positive and high-risk HIV-negative persons to appropriate medical care and prevention services.

Results. From October 1, 2003, to December 31, 2005, 422 recruiters referred 3172 of their peers for HIV services, of whom 177 were determined to be HIV positive; 63% of those who were HIV-positive were successfully linked to medical care and prevention services. The HIV prevalence of 5.6% among those recruited in this project was significantly higher than the approximately 1% identified in other counseling, testing, and referral sites funded by the Centers for Disease Control and Prevention.

Conclusions. This peer-driven approach is highly effective and can help programs identify persons with undiagnosed HIV infection in high-risk networks.
Hospitalized HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Authors: Metsch Lisa R. , Bell Christine , Pereyra Margaret , Cardenas Gabriel , Sullivan Tanisha , Rodriguez Allan , Gooden Lauren , Khoury Nayla , Kuper Tamy , Brewer Toye , del Rio Carlos
Published: April 2009

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations.
Structural and Social Contexts of HIV Risk Among African Americans
Authors: Friedman Samuel R. , Cooper Hannah L. F. , Osborne Andrew H.
Published: April 2009

HIV continues to be transmitted at unacceptably high rates among African Americans, and most HIV-prevention interventions have focused on behavioral change.

To theorize additional approaches to HIV prevention among African Americans, we discuss how sexual networks and drug-injection networks are as important as behavior for HIV transmission. We also describe how higher-order social structures and processes, such as residential racial segregation and racialized policing, may help shape risk networks and behaviors. We then discuss 3 themes in African American culture—survival, propriety, and struggle—that also help shape networks and behaviors.

Finally, we conclude with a discussion of how these perspectives might help reduce HIV transmission among African Americans.
Effects of Written Informed Consent Requirements on HIV Testing Rates: Evidence From a Natural Experiment
Authors: Wing Coady
Published: April 2009

Objectives. I evaluated the effects of written informed consent requirements on HIV testing rates in New York State to determine whether such consent creates barriers that discourage HIV testing.

Methods. New York streamlined its HIV testing consent procedures on June 1, 2005. If written informed consent creates barriers to HIV testing, then New York's streamlining exercise should have reduced such barriers and increased HIV testing rates. I used logistic regression to estimate the effects of New York's policy change.

Results. New York's streamlined consent procedures led to a 31.4% (95% confidence interval [CI] = 20.9%, 41.9%) increase in the state's HIV testing rate. In absolute terms, 7% of the state's population had been tested for HIV in the preceding 6 months under the streamlined procedures, whereas only 5.3% would have been tested under the original procedures. These estimates imply that the streamlined consent procedures accounted for approximately 328 000 additional HIV tests in the 6 months after the policy change.

Conclusions. Written informed consent requirements are a substantial barrier to HIV testing in the United States.There may be a trade-off between efforts to increase HIV testing rates and efforts to improve patient awareness.
Associations Between Availability and Coverage of HIV-Prevention Measures and Subsequent Incidence of Diagnosed HIV Infection Among Injection Drug Users
Authors: Wiessing Lucas , Likatavičius Giedrius , Klempová Danica , Hedrich Dagmar , Nardone Anthony , Griffiths Paul
Published: April 2009

HIV-prevention measures specific to injection drug users (IDUs), such as opioid substitution treatment and needle-and-syringe programs, are not provided in many countries where injection drug use is endemic. We describe the incidence of diagnosed HIV infection in IDUs and the availability and coverage of opioid substitution and needle-and-syringe programs in the European Union and 5 middle- and high-income countries. Countries with greater provision of both prevention measures in 2000 to 2004 had lower incidence of diagnosed HIV infection in 2005 and 2006.
Concurrent Partnerships and HIV Prevalence Disparities by Race: Linking Science and Public Health Practice
Authors: Morris Martina , Kurth Ann E. , Hamilton Deven T. , Moody James , Wakefield Steve
Published: April 2009

Concurrent sexual partnerships may help to explain the disproportionately high prevalence of HIV and other sexually transmitted infections among African Americans. The persistence of such disparities would also require strong assortative mixing by race. We examined descriptive evidence from 4 nationally representative US surveys and found consistent support for both elements of this hypothesis. Using a data-driven network simulation model, we found that the levels of concurrency and assortative mixing observed produced a 2.6-fold racial disparity in the epidemic potential among young African American adults.
Beyond Health and Wealth: Predictors of Women's Retirement Satisfaction
Authors: Price Christine A. , Balaswamy Shantha
Published: April 2009

Despite empirical support for the positive effects of health and wealth on retirement satisfaction, alternative variables also play a key role in helping to shape women's assessment of retirement. In the present study, we explore personal and psychosocial predictors of women's retirement satisfaction while controlling for financial security and health. Data from 330 retired women were analyzed using stepwise regression analysis. Results indicate the most significant predictors of women's retirement satisfaction are self-esteem, mastery, emotional support, and ethnicity. Financial security remained a significant predictor of satisfaction; whereas health did not. Suggestions are made to recognize the importance of women's psychological health in retirement, examine different types of social support in relation to stage of retirement, and incorporate diverse audiences in women's retirement research.
Effects of time delay on the statistical fluctuations for a bistable system driven by cross-correlated noises
Authors: Zeng Chun-hua , Zhou Xiao-feng , Tao Shu-fen
Published: April 2009

We study the effects of time delay on the normalized correlation function C(s) and the associated relaxation time T
c for a bistable system with correlations between multiplicative and additive white noises under the condition of small time delay. Using the projection operator method, the expressions of T
c and C(s) are obtained. Based on numerical computations, it is found that the delay time τ slows down the rate of fluctuation decay of dynamical variable for the presence of positive feedback intensity (∈ > 0), while speeds up the rate of fluctuation decay of dynamical variable for the presence of negative feedback intensity (∈ < 0). The effects of the delay time τ on the T
c and C(s) are entirely opposite for ∈ 〉 0 and ∈ < 0.
Fluctuation theorems from non-equilibrium Onsager-Machlup theory for a Brownian particle in a time-dependent harmonic potential
Authors: Deza Roberto , Izús Gonzalo , Wio Horacio
Published: April 2009

We discuss the case of a Brownian particle which is harmonically bound and multiplicatively forced-namely bound by V(x,t)=1/2 a(t)x
2 where a(t)is externally controlled-as another instance that provides a generalization of Onsager-Machlup’s theory to non-equilibrium states, thus allowing establishment of several fluctuation theorems. In particular, we outline the derivation of a fluctuation theorem for work, through the calculation of the work probability distribution as a functional integral over stochastic trajectories.
Lagrangian relative equilibria for a gyrostat in the three-body problem
Authors: López Juan
Published: April 2009

In this paper we consider the noncanonical Hamiltonian dynamics of a gyrostat in the three-body problem. By means of geometric mechanics methods, we study the approximate Poisson dynamics that arise when we develop the potential of the system in Legendre series and truncate this to an arbitrary order k. After reduction of the dynamics by means of the two symmetries of the system, we consider the existence and number of equilibria which we denominate of Lagrangian type, in analogy with classic results on the topic. Necessary and sufficient conditions are established for their existence in an approximate dynamics of order k, and explicit expressions for these equilibria are given, this being useful for the subsequent study of their stability. The number of Lagrangian equilibria is thoroughly studied in approximate dynamics of orders zero and one. The main result of this work indicates that the number of Lagrangian equilibria in an approximate dynamics of order k for k ≥1 is independent of the order of truncation of the potential, if the gyrostat S
0 is almost spherical. In relation to the stability of these equilibria, necessary and sufficient conditions are given for linear stability of Lagrangian equilibria when the gyrostat is almost spherical. In this way, we generalize the classical results on equilibria of the three-body problem and many results provided by other authors using more classical techniques for the case of rigid bodies.
Photoacoustic spectroscopy for trace gas detection with cryogenic and room-temperature continuous-wave quantum cascade lasers
Authors: Zeninari Virginie , Grossel Agnès , Joly Lilian , Decarpenterie Thomas , Grouiez Bruno , Bonno Bernard , Parvitte Bertrand
Published: April 2009

The main characteristics that a sensor must possess for trace gas detection and pollution monitoring are high sensitivity, high selectivity and the capability to perform in situ measurements. The photacoustic Helmholtz sensor developed in Reims, used in conjunction with powerful Quantum Cascade Lasers (QCLs), fulfils all these requirements. The best cell response is # 1200 V W−1 cm and the corresponding ultimate sensitivity is j 3.3 × 10−10 W cm−11 Hz−11/2. This efficient sensor is used with mid-infrared QCLs from Alpes Lasers to reach the strong fundamental absorption bands of some atmospheric gases. A first cryogenic QCL emitting at 7.9 μm demonstrates the detection of methane in air with a detection limit of 3 ppb. A detection limit of 20 ppb of NO in air is demonstrated using another cryogenic QCL emitting in the 5.4 μm region. Real in-situ measurements can be achieved only with room-temperature QCLs. A room-temperature QCL emitting in the 7.9 μm region demonstrates the simultaneous detection of methane and nitrous oxide in air (17 and 7 ppb detection limit, respectively). All these reliable measurements allow the estimated detection limit for various atmospheric gases using quantum cascade lasers to be obtained. Each gas absorbing in the infrared may be detected at a detection limit in the ppb or low-ppb range.
Mixed spin-1/2 and spin-1 Ising model with uniaxial and biaxial single-ion anisotropy on the Bethe lattice
Authors: Ekiz Cesur , Strečka Jozef , Jaščur Michal
Published: April 2009

The mixed spin-1/2 and spin-1 Ising model on the Bethe lattice with both uniaxial as well as biaxial single-ion anisotropy terms is solved exactly by combining star-triangle and triangle-star mapping transformations with exact recursion relations. Magnetic properties (magnetization, phase diagrams, and compensation phenomenon) are investigated in detail. Particular attention is focused on the effect of uniaxial and biaxial single-ion anisotropies that basically influence the magnetic behavior of the spin-1 atoms.
Effectiveness of addition of neostigmine or dexamethasone to local anaesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study
Authors: Yadav RK , Sah BP , Kumar P , Singh SN
Published: April 2009

Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The group A [Lignocaine with adrenaline (1.5%)], group B [Lignocaine with adrenaline (1.5%)] +500?g Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4±0.8 , 3.8±1.8 mins in group A, B and C respectively and the Mean onset of motor blockade were 7.7±2.0, 7.0±1.8, 6.0±2.1mins in group A, B and C respectively. Similarly Mean Complete sensory block in 10.6±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically significant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was significantly (p- 0.005) lower. The mean VAS was significantly lower in group C in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement. doi: 10.3126/kumj.v6i3.1704 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 302-309
Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy
Authors: Gautam B , Shrestha BR , Lama P , Rai S
Published: April 2009

Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the efficacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and fifty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was defined as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to first analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Significantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the first six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is significantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy. Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative nausea and vomiting (PONV) doi: 10.3126/kumj.v6i3.1706 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 319-328
Blood loss during and after transurethral resection of prostate: A prospective study
Authors: Shrestha BM , Prasopshanti K , Matanhelia SS , Peeling WB
Published: April 2009

Objectives: Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to significant morbidity and mortality. The purpose of this study was to assess the influence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology. Materials and methods: This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa specifically designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology. Results: Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not significantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically significant (95% C.I - 67.2 to 1120.4, p = 0.87). Conclusions: The intraoperative, postoperative and total blood losses related to TURP were not influenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology. Key Words: Transurethral resection of prostate, blood loss, anaesthesia, prostatitis, carcinoma, aspirin doi: 10.3126/kumj.v6i3.1707 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 329-334
The outcome of pneumatic lithotripsy for the management of ureteric calculi
Authors: Shrestha B , Karki DV , Baidya JL
Published: April 2009

Background: Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. Objectives: To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. Study design: A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Materials and methods: Ninety-two consecutive patients having ninety-five ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Results: Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both significant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Conclusion: Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal. Key words: SIRS- Systemic Inflammatory Response Syndrome, ESWL- Extra corporeal shockwave lithotripsy, JJ stent: Double J stent, URS: Ureterorenoscope, Steinstrasse. doi: 10.3126/kumj.v6i3.1711 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 355-360
Association between axial length of the eye and primary angle closure glaucoma
Authors: Sherpa D , Badhu BP
Published: April 2009

Background: Angle closure glaucoma is emerging as a leading cause of blindness in Asia. Objective: To compare the ocular axial length of normal individuals and the subjects with primary angle closure glaucoma. This study has been conducted to determine axial length of eye as a risk factor of primary angle closure glaucoma. Materials and Methods: A cross-sectional comparative study was carried out in Mechi Eye Care Centre, Jhapa, Nepal including forty eyes of 20 diagnosed cases of primary angle closure glaucoma (40 eyes) and 40 eyes of 20 normal subjects selected by simple random sampling. A complete ocular examination of all the subjects was carried out. Axial length measurement was done using ultrasound A scan. Results: Out of 80 eyes, there were 40 eyes of 20 diagnosed primary angle closure subjects and 40 eyes of 20 normal subjects. The mean axial length and standard deviation of primary angle closure glaucoma were 21.93 ± 1.16 mm (95% CI = 21.41 - 22.45) and those of control group were 23.01 ± 0.49 (95% CI = 22.79 - 23.23). The axial length of less than 23 mm was found as a risk factor for angle closure glaucoma (Relative risk =3.40; p = 0.0032). Conclusion: This study showed that patients with the axial length of less than 23 mm are at risk to develop primary angle closure glaucoma. This result can be confirmed by doing population based study in a larger sample size. Keywords: Axial length, Primary angle closure glaucoma, Nepal doi: 10.3126/kumj.v6i3.1712 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 361-363
Protective role of Annona squamosa linn bark extracts in DMBA induced genotoxicity
Authors: Suresh K , Manoharn S , Blessy D
Published: April 2009

Background: Their has been no dearth of scientific literature that genotoxic agents have a causative effect in the pathogenesis of carcinomas. 7,12dimethylbenz(a)anthracene (DMBA) which is, a potent organ specific carcinogen has been found to produce mutagenic effects on cells10. Annona squamosa has a long history in traditional indian medicine for being used to treat several diseases including cancer. Objective: Aim of the present study was to investigate the protective role of Annona squamosa bark extracts in DMBA induced genotoxicity in golden Syrian hamsters. Material and methods: Genotoxicity was induced in golden Syrian hamsters by single intraperitonial injection of DMBA (30 mg/kg body weight). The antigenotoxic effect of aqueous and ethanolic bark extracts of Annona squamosa was assessed by determining the frequency of micronucleated polychromatic erythrocytes (MnPCEs) and chromosomal aberrations. Results: The frequency of MnPCEs and chromosomal aberrations in bone marrow were higher in DMBA treated animals as compared to control animals. Oral administration of aqueous and ethanolic bark extracts significantly reduced the frequency of MnPCEs and chromosomal aberration in DMBA treated hamsters. Conclusion: Although both extracts have shown antigenotoxic effect, the effect of ethanolic extract was found to be more prominent than the aqueous extract. The present study thus demonstrates the antigenotoxic effect of Annona squamosa bark extracts in DMBA induced genotoxicity in golden Syrian hamsters. Key words: Genotoxicity, DMBA, Chromosomal aberrations, MnPCEs, Annona squamosa    doi: 10.3126/kumj.v6i3.1713 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 364-369
Anaesthetic management of a parturient with severe kyphoscoliosis
Authors: Bansal N , Gupta S
Published: April 2009

Use of neuraxial block in a patient with severe kyphoscoliosis is controversial. We describe the anaesthetic management by spinal anaesthesia of a parturient with severe kyphoscoliosis in obstructed labour. The perioperative course was uneventful. We suggest that a patient with severe kyphoscoliosis may be successfully managed by spinal anaesthesia for caesarean section. doi: 10.3126/kumj.v6i3.1716 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 379-382
Antenatal diagnosis of large sacro-coccygeal teratoma with foetal cardiomegaly and hydrops
Authors: Gupta N , Shah D , Singh U , Tiwari A
Published: April 2009

We report the case of a young primigravida who presented with a 20 weeks pregnancy with a previous diagnosis of uterine fibroid. However, ultrasound evaluation revealed the presence of a large sacro-coccygeal teratoma in the foetus which was heterogeneous with cystic areas and calcific foci, and showed increased vascularity. There was also evidence of foetal cardiomegaly and hydrops foetalis, indicated by subcutaneous oedema in the foetus, thickened placenta and polyhydramnios. The presence of hydrops with sacro-coccygeal teratoma has a grave prognosis for the mother and child; hence termination of pregnancy was done. A 20 weeks old foetus with a huge sacro-coccygeal mass, which was ruptured at many places and showed areas of active bleed, was expelled. doi: 10.3126/kumj.v6i3.1717 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 383-385
Irrational fixed dose combinations in Nepal: Need for intervention
Authors: Poudel A , Palaian S , Shankar PR , Jayasekera J , Izham MIM
Published: April 2009

A large proportion of drugs available are of little importance in terms of fulfilling primary healthcare needs. Combination drugs increase the risk of side effects, lead to an ineffective dosage and liability to abuse and may also needlessly increase the cost. Drug combinations make it more difficult to find the causative agent responsible for the adverse reactions. In many cases their stability is doubtful, reducing the efficacy of many preparations. The Fifteenth WHO model list of essential medicines (March 2007) contains only 25 approved fixed dose combinations, whereas in Nepal, there are innumerable examples of irrational drug combinations, which are easily available and can be bought even without a prescription. A system of screening the drug combinations that are already licensed and available in the market is implemented in many developed and developing countries. Rational combinations can be of immense help to the health care system. These combinations may improve the quality of life for many and increase compliance. But irrational fixed dose combination products can be equally harmful. Key words: Adverse drug reaction, Combination drugs, Fixed dose combination, Irrational drug use, Nepal doi: 10.3126/kumj.v6i3.1723 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 399-405
Women and depression
Authors: Kharel B
Published: April 2009

doi: 10.3126/kumj.v6i3.1729  Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 430-432
Need for community-based primary prevention of coronary heart disease in Nepal
Authors: Vaidya A
Published: April 2009

doi: 10.3126/kumj.v6i4.1730  Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 435-436
Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy
Authors: Sharma BR
Published: April 2009

Aims and Objectives: To compare the success rates of non endoscopic endonasal dacryocystorhinostomy and conventional external dacryocystorhinostomy for the surgical management of primary acquired nasolacrimal duct obstruction. Materials and methods: A retrospective, nonrandomized, comparative interventional case series of 302 patients who underwent either endonasal or external dacryocystorhinostomy over a period of 2 years. All surgeries were performed by a single surgeon and patients with primary nasolacrimal duct obstruction with a minimum of 6 months post operative follow up were included in the study. While external dacryocystorhinostomy was performed using traditional technique, endonasal dacryocystorhinostomy was performed using direct method of nonendoscopic visualization. Results: Of the 302 cases included in the study 165 patients had endonasal dacryocystorhinostomy whereas 137 underwent external dacryocystorhinostomy. Success was defined by resolution of symptoms of tearing, a negative fluorescein dye disappearance test and patency of the canalicular system on lacrimal irrigation. In the external dacryocystorhinostomy group 124 (90.5%) patients had surgical success whereas 146 (88.5%) of the endonasal dacryocystorhinostomy patients had successful outcome. The overall success rate was 89.4%, and the difference of surgical success between the two groups was not statistically significant ( P=0.57). Conclusion: Non endoscopic endonasal dacryocystorhinostomy gives surgical results comparable to those of external dacryocystorhinostomy and is a viable alternative where dacryocystorhinostomy is indicated for primary acquired nasolacrimal duct obstruction. Key words: Endonasal Dacryocystorhinostomy (ENDCR), External Dacryocystorhinostomy (EXDCR), Primary acquired nasolacrimal duct obstruction (PANLDO)   doi: 10.3126/kumj.v6i4.1731  Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 437-442
Peripheral intravenous catheter related phlebitis and its contributing factors among adult population at KU Teaching Hospital
Authors: Singh R , Bhandary S , Pun KD
Published: April 2009

Background: Peripheral intravenous catheter-related phlebitis is a common and significant problem in clinical practice. This study was carried out to determine the occurrence of peripheral intravenous catheter related phlebitis and to define the possible factors associated to its development. Materials and methods: Prospective observational study was carried out on 230 clients who were under first time peripheral infusion therapy during two months period: September - October, 2007. Peripheral infusion site was examined for signs of phlebitis once a day. Jackson Standard visual phlebitis scale was used to measure the severity of the phlebitis. SPSS software was used to enter, edit and analyze the data and t-test, chi-square test, binary logistic regression and ROC curve were used to draw the statistical inferences. Results: Phlebitis developed in 136/230 clients (59.1%). It was very mild in most cases. Increased incidence rates of infusion related phlebitis were associated with male sex, small catheter size (20 gauge), insertion at the sites of forearm, IV drug administration and blood product transfusions. The incidence rate of phlebitis rose sharply after 36 hours of catheter insertion. Conclusion: Peripheral Intravenous therapy related phlebitis at KUTH, Dhulikhel Hospital is a significant problem. Related risk factors as found in the present study were insertion site (forearm), size of catheter (20G) and dwell time (>= 36 hours). There were higher incident of phlebitis among the client with Intra venous drug administration and especially between ages 21 - 40 years. Therefore more attention and care are needed in these areas by the care provider. Key words: Phlebitis, Intravenous Therapy, Catheter, Risk Factors, KUTH, Nepal.   doi: 10.3126/kumj.v6i4.1732   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 443-447
Experiencing stigma: Nepalese perspectives
Authors: Adhikari SR , Pradhan SN , Sharma SC
Published: April 2009

Background: Experiencing stigma by patients with mental illness in their day to day lives has substantial importance in treatment, compliance and quality of life. There is dearth of information and researches in experiences/ perceptions and coping of stigma in Nepal. Aims: The objective of this study was to find out experiences/ perceptions and coping of stigma and stigmatizations among patients with mental illness. Materials and methods: This is a retrospective, cross sectional study of patients admitted in psychiatry ward. Patients were assessed using self-report questionnaire which focused on beliefs about discrimination against mental illness, rejection experiences, and ways of coping with stigma. Patient's socio demographic profiles were also assessed. Results: Fifty three patients completed questionnaire concerning various constructs of stigma. There were 29 male patients and 24 female patients. Majority (N=45; 84.9%) were of Hindu religion but there were mixed numbers regarding caste. Most of the patients were aware of the stigma associated with mental illness. There were experiences of rejection by family members and colleagues (N=23; 43.4%) and health care professional (N=16; 30.2%). There were strong perceptions of stigmatization felt by patients in different social circumstances. Though maintaining secrecy and avoidance/withdrawal of stigma provoking scenario were not experienced much, there was a strong sense of advocacy whenever there was any negative view of mental illness. Some of the questionnaire items in "perception", "rejection" and "coping" showed statistical significance (p=0.001). Conclusion: People with mental illness experience stigma during their course of illness and treatment and it is an important determinant for the relapse of symptoms and non-compliance to treatment. Despite experiencing stigma, patients were generally treated fairly by other people. Patients develop various mechanisms to cope with stigma, mostly secrecy and avoidance. Advocacy and anti-stigma campaign along with positive attitudes of health professionals play important role in decreasing stigmatizing experiences in patients. Key Words: Stigma, stigmatization, mental illness, coping, perception. doi: 10.3126/kumj.v6i4.1736 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 458-465
Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal
Authors: Thapa R , Shrestha MK , Gurung R , Ruit S , Paudyal G
Published: April 2009

Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment. Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility. Study design: This was a retrospective- prospective, interventional case series. Materials and methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study. Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of < 6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure. Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce. Key words: Rhegmatogenous retinal detachment, retinal break, pneumatic retinopexy, Nepal   doi: 10.3126/kumj.v6i4.1737   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 466-471
Seroprevalence of anti HCV antibodies among blood donors in Kathmandu valley, Nepal
Authors: Karki S , Ghimire P , Tiwari BR , Rajkarnikar M
Published: April 2009

Aims and objectives: To study the seroprevalence of anti HCV antibodies among Nepalese blood donors in relation to their age, sex, type of donation and times of donation. Materials and methods: Descriptive cross-sectional study conducted in Nepal Red Cross Society (NRCS), Central Blood Transfusion Service (CBTS), Kathmandu, from December 1, 2006 to September 1, 2007. A total of 33,255 blood donors were screened for anti HCV antibodies by ELISA. Donor's information was collected from blood donor's record form and statistical analysis was done using the software ‘SPSS 11.5' and ‘Winpepi ver. 3.8'. Result: The seroprevalence of anti HCV antibodies in blood donors was 0.66% (95% CI= 0.58-0.76). Higher seroprevalence was observed in male donors (0.7%, 95% CI= 0.6-0.8) than in female donors (0.4%, 95% CI= 0.2-0.6) (P < 0.05). The seroprevalence was highest (0.82%) in the age group of 21-30 years and there was significantly decreasing trends in seroprevalence with increasing age (P < 0.05). The highest seroprevalence among the male donors (0.88%) was also observed in the age group of 21-30 years (P < 0.001). Among female donors the seroprevalence (0.47 %) was highest in age group 41-50 years (P > 0.05). The seroprevalence of anti HCV was significantly higher in volunteer donors (0.7%) than in replacement donors (0.4%) (P < 0.05). Similar seroprevalence of anti HCV was observed in first time (0.65%) and repeat blood donors (0.67%) (P > 0.05). Conclusion: The seroprevalence of anti HCV antibodies among blood donors in this study was similar to the seroprevalence reported for general population by other studies. Similar seroprevalence in first time and repeat blood donors as well as higher seroprevalence in volunteer donors than in replacement donors are the potential threats to safe blood supply, which urges the need of more effective donor education and counselling of blood donors. Key words: . doi: 10.3126/kumj.v6i4.1741   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 491-496
Anterior dislocation of the shoulder with ipsilateral humerus shaft fracture
Authors: Pradhan I , Banskota AK
Published: April 2009

Anterior dislocation of the shoulder joint with ipsilateral humerus shaft fracture is a very rare injury. Until July 2006 only 18 cases have been reported in the literature. Here we report a case of Anterior Shoulder dislocation with greater tuberosity and shaft of humerus fracture. The patient was treated by Open reduction and internal fixation of the shaft fracture followed by closed reduction of the dislocation. A post-operative rehabilitation program was instituted for complete rehabilitation of the shoulder function. Key words: Shoulder dislocation, Ipsilateral, Humerus, Fracture, Open reduction. doi: 10.3126/kumj.v6i4.1743     Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 502-504