bluuebunny/crossref_metadata_2025 huggingface dataset:
Seeking the Source: Criminal Defendants’ Constitutional Right to Source Code
Authors: Bellovin Steven M. , Blaze Matt , Landau Susan , Owsley Brian
Published: February 2020

The right to a fair trial is fundamental to American jurisprudence. The Fifth Amendment of the Bill of Rights guarantees “due process,” while the Sixth provides the accused with the right to be “confronted with the witnesses against him.” But “time works changes, brings into existence new conditions and purposes.” So it is with software. From the smartphones we access multiple times a day to more exotic tools—the software “genies” of Amazon Echo and Google Home—software is increasingly embedded in day-to-day life. It does glorious things, such as flying planes and creating CAT scans, but it also has problems: software errors. Software has also found its way into trials. Software’s errors have meant that defendants are often denied their fundamental rights. In this paper, we focus on “evidentiary software”—computer software used for producing evidence—that is routinely introduced in modern courtrooms. Whether from breathalyzers, computer forensic analysis, data taps, or even FitBits, computer code increasingly provides crucial trial evidence. Yet despite the central role software plays in convictions, computer code is often unavailable to examination by the defense. This may be for proprietary reasons—the vendor wishes to protect its confidential software—or it may result from a decision by the government to withhold the code for security reasons. Because computer software is far from infallible—software programs can create incorrect information, erase details, vary data depending on when and how they are accessed—or fail in a myriad of other ways—the only way that the accused can properly and fully defend himself is to have an ability to access the software that produced the evidence. Yet often the defendants are denied such critical access. In this paper, we do an in-depth examination of the problem. Then, providing a variety of examples of software failure and discussing the limitations of technologists’ ability to prove software programs correct, we suggest potential processes for disclosing software that enable fair trials while nonetheless prevent wide release of the code.
The Link Between Personal Self-Control and Dieting Intent is not accounted for by Body Dissatisfaction or Dieting Success Perceptions.
Authors: Bouguettaya Ayoub , Moulding Richard , King Ross , Bliuc Ana-Maria , Doley Joanna
Published: February 2020

Dietary restraint is associated with a number of health risks, especially in young women. Research has shown that dispositional self-control negatively predicts dieting behaviour. However, it is possible that empirical findings regarding this relationship have been confounded by a number of related variables, such as prior dieting success and body dissatisfaction. This study, therefore, aimed to clarify the relationship between self-control and dieting intent by controlling for these pertinent variables. We also investigated how individuals’ self-control might relate to expectations of dieting success, in an online sample of female dieters from the USA and the UK (N = 381, Mage = 26.00 years, SD = 5.20) who completed self-report measures online. Even when controlling for all forms of body dissatisfaction and dieting success perceptions, self-control related to dieting intentions. These findings provide further evidence that self-control is a key variable that predicts dieting intent, regardless of body dissatisfaction and dieting success beliefs.
The self and its nature: a psychopathological perspective on the risk-reducing effects of environmental green space for psychosis
Authors: Ebisch Sjoerd
Published: February 2020

Epidemiological studies have shown that environmental green space contributes to the reduction of psychosis incidence in the population. Clarifying the psychological and neuro-functional mechanisms underlying the risk-decreasing effects of green surroundings could help optimize preventive environmental interventions. This perspective article specifically aims to open a new window on the link between environmental green space and psychosis by considering its core psychopathological features. Psychotic disorders, such as schizophrenia, are essentially characterized by self-disturbances. The psychological structure of the self has been described as a multidimensional phenomenon that emerges from the reciprocal interaction with the environment through intrinsic and extrinsic self-processes. The intrinsic self refers to the experience of mental activity and environmental information as inherently related to one’s own person, which involves self-referential processing, self-reflection, memory, interoception, and emotional evaluation. The extrinsic self refers to sensorimotor interactions with the environment and the sense of agency, that is, the experience of being the source of one’s own actions and the multisensory consequences thereof. In psychosis, anomalous self-processing has been related to a functional fragmentation of intrinsic and extrinsic self-processes and related brain networks. Moreover, evidence from cognitive neuroscience suggests that green space could have beneficial effects on self-related processing. Based on the literature, it could be hypothesized that self-processing is involved in mediating the beneficial effects of green space for psychosis. Considering the multidimensionality of the self, it is proposed that urban green space design aimed at improving mental health ideally impacts the complexity of self-facets and thus restores the individual’s self.
Resting state cortico-limbic functional connectivity and dispositional use of emotion regulation strategies: A replication and extension study
Authors: Dörfel Denise , Gärtner Anne , Scheffel Christoph
Published: February 2020

Neuroimaging functional connectivity analyses have shown that the negative coupling between amygdala and cortical regions is linked to better emotion regulation (ER) in experimental task settings. However, less is known about the neural correlates of ER traits or dispositions. The present study aimed to (1) replicate the findings of differential cortico-limbic coupling during resting state depending on the dispositional use of emotion regulation strategies. Furthermore, the study aimed to (2) extend prior findings by examining whether differences in cortico-limbic coupling during resting state predict experiential and neuronal ER success in a standard ER task. To this end, N=107 healthy adults completed the Emotion Regulation Questionnaire (ERQ), underwent an 8-min resting-state fMRI acquisition and completed a reappraisal task during fMRI. Functional connectivity maps of basolateral and centromedial amygdala nuclei were estimated with a seed-based approach regarding associations with regions of the prefrontal cortex, and were then correlated with ERQ scores as well as experiential and neuronal ER success. All hypotheses and the analysis plan are preregistered at https://osf.io/8wsgu. Opposed to prior findings, we were not able to replicate a correlation of dispositional ER strategy use with functional connectivity between amygdala and PFC regions (p > 0.05, FWE-corrected). Furthermore, there was no association of experiential and neuronal reappraisal success with functional connectivity between amygdala and insula as well as PFC (p > 0.05, FWE-corrected). The present preregistered study calls into question the reported association between individual differences in resting state cortico-limbic connectivity and dispositional use of ER strategies. However, ongoing advances in functional brain imaging and distributed network approaches may leverage the identification of reliable functional connectivity patterns that underlie successful emotion regulation.
Utility of Polygenic Scores in Capturing Resilience
Authors: Bucknor Brianna , Derringer Jaime
Published: February 2020

Although resilience has been identified to be moderately heritable, little is known about the genetic variants involved. While there has not yet been a robust genome-wide association study (GWAS) of resilience, existing GWAS of related phenotypes may provide a starting point for developing our understanding of the heritability of resilience. In a sample of older, US adults (N= 9,480), we examined the extent to which proxy polygenic scores (PGS) explained the variance in resilience. Four of the 32 PGS assessed (subjective wellbeing, neuroticism, depressive symptoms, and educational attainment) reached significance among participants with European ancestries, but with relatively small effects (|β|= 0.002 – 0.09). Notably, PGSs derived from GWAS of PTSD among participants with either European or African ancestries were uncorrelated with resilience. Even aggregated across all available proxy PGSs, existing PGSs are not sufficient to inform our understanding of the genetics underlying the heritability of resilience. A large-scale GWAS of resilience is needed as it would provide greater insight into the genetic mechanisms underlying the heritability of resilience.
Measuring the subjective cost of listening effort using a discounting task
Authors: McLaughlin Drew Jordan , Braver Todd Samuel , Peelle Jonathan E.
Published: February 2020

Purpose: Objective measures of listening effort have been gaining prominence, as they provide metrics to quantify the difficulty of understanding speech under a variety of circumstances. A key challenge has been to develop paradigms that enable the complementary measurement of subjective listening effort in a quantitatively precise manner. In the present study, we introduce a novel decision-making paradigm to examine age-related and individual differences in subjective effort during listening.Method: Older and younger adults were presented with spoken sentences mixed with speech-shaped noise at multiple signal-to-noise ratios (SNRs). On each trial subjects were offered the choice between completing an easier listening trial (presented at +20 dB SNR) for a smaller monetary reward, or a harder listening trial (presented at either +4, 0, -4, -8, or -12 dB SNR) for a greater monetary reward. By varying the amount of the reward offered for the easier option, the subjective value of performing effortful listening trials at each SNR could be assessed. Results: Older adults discounted the value of effortful listening to a greater degree than young adults, opting to accept less money in order to avoid more difficult SNRs. Additionally, older adults with poorer hearing and smaller working memory capacities were more likely to choose easier trials; however, in younger adults, no relationship with hearing or working memory was found. Self-reported measures of economic status did not affect these relationships. Conclusion: These findings suggest that subjective listening effort depends on factors including, but not necessarily limited to, hearing and working memory. Additionally, this study demonstrates that economic decision-making paradigms can be a useful approach for assessing subjective listening effort, and may prove beneficial in future research.
A functional magnetic resonance imaging study on sleep deprivation and its effect on empathy for pain and emotional regulation.
Authors: Karimi Poyan
Published: February 2020

Introduction: Empathy and emotional regulation are considered important in social interactions. The relationship between sleep and higher order neurological functions connected to social interactions is poorly understood and results have been inconclusive. Aims: The aim of this study was to investigate how total sleep deprivation affects empathy for pain in others and emotional regulation through self-rated unpleasantness scores and fMRI activity in predetermined regions of interest. Material and Methods: In a cross over design with one night of total sleep deprivation and one night of full sleep, 18 healthy young participants were instructed to downregulate or maintain emotional response to 48 images of hands or feet in painful or non-painful situations followed by ratings of unpleasantness on a scale from 0-100, while functional images were acquired. Results: Unpleasantness scores showed a significant increase when comparing pain to no-pain stimuli (13.4 [11.6 – 15.2], p < 0.00001) and a significant decrease in unpleasantness from pain stimuli following sleep deprivation (-4.8 [-8.34 – -1.25], p = 0.0079). fMRI results demonstrated a significant increase when comparing pain vs no-pain stimuli in the anterior midcingulate cortex (T =2.52 [0.17 – 2.18], p <0.024) as expected. No significant functional outcomes were seen in the anterior insula, lateral orbitofrontal cortex, anterior midcingulate cortex or dorsolateral prefrontal cortex when comparing the full sleep to the sleep deprived condition. Conclusions: This study indicate that sleep deprivation causes less subjective empathy for pain in others, however without functional correlates. Future studies should combine larger sample sizes with total sleep deprivation interventions.
Uso de morfina como tratamiento del dolor agudo en el Servicio de Emergencia del Hospital General Ambato
Authors: Carrasco Calle Rodolfo Salomon , Hurtado Linda , Toscano Daniela , Quisiguiña Sofía
Published: February 2020

Introducción: El dolor es el principal síntoma por el cual los pacientes acuden al servicio de emergencia de nuestro hospital, representando hasta un 80% de las consultas médicas y un 10% refieren tener dolor agudo.

Objetivo: Evaluar si el uso de morfina como primera elección terapéutica es adecuado para disminuir la intensidad del dolor agudo en pacientes que acuden al servicio de emergencia.

Metodología: Se realizó un estudio descriptivo retrospectivo en pacientes atendidos durante el año 2018 en el Servicio de Emergencia del Hospital General Ambato, en los cuales se utilizó morfina como primera elección para tratamiento de dolor agudo con escala de dolor de EVA 7 a 10 puntos.

Resultados: Durante el periodo 2018 en el servicio de Emergencia del Hospital Iess Ambato se utilizó como primera elección para el tratamiento del dolor agudo analgésicos tipo morfina en 370 pacientes,  con gran disminución en su intensidad en poco tiempo de la administración.

Conclusiones: Se debe considerar la utilización de morfina como primera línea de tratamiento para dolor agudo por su rápida acción y disminución de la sintomatología en pacientes que acuden al servicio de emergencia con EVA >7/10.
Neumatosis quistica intestinal, como causa infrecuente de neumoperitoneo
Authors: Asquel Cadena Víctor Hugo , Tovar Noroña Carla Estefanía
Published: February 2020

Introducción: La neumatosis quística intestinal se caracteriza por la presencia de múltiples quistes llenos de gas localizado en la submucosa o subserosa de la pared intestinal, esta patología predomina en el sexo masculino y su localización más frecuente es el colon. Con respecto a su etiología es poco conocida y posiblemente multifactorial, siendo idiopática en el 15% de todos los casos o secundaria a una amplia variedad de enfermedades en el 85%. Las complicaciones ocurren en el 3% de los casos, incluyendo neumoperitoneo puede ocurrir debido a la ruptura de quistes subserosos, cuyo tratamiento es conservador en la mayoría de los casos.

Objetivo: Describir un caso clínico enfocado en neumatosis intestinal como causa infrecuente de neumoperitoneo.

Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico en el Hospital Básico “IESS Latacunga”, caso que fue tratado en el Servicio de Cirugía General del hospital.  Se presenta el caso de un paciente de sexo femenino de 67 años de edad, con antecedentes personales de enfermedad pulmonar obstructiva crónica sin tratamiento, acude por dolor abdominal en hipocondrio derecho, de varios años de evolución, que se exacerba en las últimas 24 horas de leve intensidad. En la exploración física se observó un abdomen distendido, doloroso a la palpación en hipocondrio derecho, Murphy positivo, sin signos de peritonismo. En la radiografía estándar de tórax se observó neumoperitoneo, en la ecografía de abdomen superior se encontró múltiples cálculos en vesícula biliar. Ante estos hallazgos se decidió practicar una colecistectomía convencional en la que se identificó incidentalmente una neumatosis quística intestinal. La evolución de la paciente fue favorable.

Resultados: Luego de la valoración del paciente, se determinó una impresión diagnostica y su resolución quirúrgica, logrando evitar posteriores complicaciones. Como impresión diagnostica inicial se sospechó colelitiasis y neumoperitoneo en estudio. La causa de neumoperitoneo se determinó durante el procedimiento quirúrgico, hallando una neumatosis quística intestinal.

Conclusiones: La neumatosis quística intestinal es un signo radiológico o endoscópico, caracterizado por la presencia de gas en la pared intestinal, de etiología muy variable. La ruptura de dichos quistes, en pocas condiciones causa neumoperitoneo, generalmente asintomático con tratamiento conservador.
Meningoencefalocele occipital
Authors: Deleg Guartan Ruth Carolina , Paguay Paredes Diana Cecilia , Piña Yungasaca Ruth Elizabeth , Villacís Sandoval Jorge Rodrigo , Aguilar Castillo Jenner Quilson
Published: February 2020

Introducción: El encefalocele es un tipo de malformación del tubo neural, en donde la falta de separación del ectodermo superficial del neuroectodermo durante la embriogénesis, origina un defecto mesodérmico en la calota, permitiendo al cerebro y/o meninges protruir a través del defecto en el cráneo.

Objetivo: Describir un caso clínico enfocado en el Meningoencefalocele occipital.

Material y métodos: Estudio descriptivo retrospectivo, presentación de un caso clínico de meningoencefalocele occipital.

Resultados: Se trata de un recién nacido masculino de 2 horas 20 minutos obtenido mediante cesárea por cesárea, a término grande para la edad gestacional, de 40 SG. Antecedentes prenatales: madre con obesidad mórbida, toma de hierro y ácido fólico en los últimos 4 meses de embarazo. En la ecografía realizada a las 28 semanas se reporta trastorno de la migración neuronal. Al examen físico se evidencia macrocefalia y masa blanda multilobulada a nivel de región occipital. Tras valoración por neurocirugía, se indica realización de una TAC de cráneo donde se reporta meningocele occipital, hidrocefalia y malformación de Dandy Walker.

Tras 24 horas de su nacimiento es intervenido quirúrgicamente para cierre de meningocele y colocación de válvula de derivación ventrículo-peritoneal derecha, sin complicación.  A las 24 horas postquirúrgicas se realiza nueva TAC de cráneo reportando malformación de Dandy Walker. El paciente evoluciona favorablemente, se restablece alimentación con leche materna con buena succión, decidiéndose el alta, al décimo día de hospitalización, el 6 de septiembre de 2018 con control por consulta externa.

Conclusiones: El encefalocele es un tipo de malformación del tubo neural, lo cual permite que el cerebro y/o meninges protruyan a través del defecto en el cráneo. Aunque a través de la ultrasonografía la mayoría de los encefaloceles son diagnosticados fácilmente, constituye un reto indagar e intervenir en los factores de riesgo modificables prenatales, así como la intervención quirúrgica para el cierre del meningocele
Malrotación intestinal, cuadro agudo en paciente adulto
Authors: Loaiza Merino Iván Patricio , Poma Macias Jairo Jose , Sánchez Sánchez Joselyn Gabriela
Published: February 2020

Introducción: El síndrome de Malrotación Intestinal (MI) es un trastorno anatómico producido por una rotación y fijación anómala del intestino medio en la cavidad abdominal durante el período embrionario. Existen 3 variantes subdivididas de acuerdo a sus hallazgos. El 90% se diagnostica en pacientes pediátricos con clínica de abdomen agudo obstructivo sin embargo en pacientes adultos se asocian síntomas crónicos que evidencian malnutrición y rara vez con un cuadro agudo únicamente. El vólvulo y una inadecuada respuesta al tratamiento clínico constituyen una urgencia quirúrgica por el riesgo de necrosis extensa. El tránsito intestinal es el gold estándar para su diagnóstico y la tomografía se puede considerar como complementario de apoyo para definir hallazgos extraintestinales.

Objetivo: Describir un caso clínico de malrotación intestinal con cuadro agudo en un paciente adulto.

Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico

Resultados: Se trata de un paciente masculino de 39 años sin antecedentes de interés que acude por cuadro de 24 horas de evolución caracterizado por distensión más dolor abdominal tipo cólico en epigastrio y marco colónico, de gran intensidad asociado a vómitos por 15 ocasiones de contenido alimentario y posterior bilioso con ruidos disminuidos y mate a la percusión difusa, se realiza Rx de abdomen evidenciándose niveles hidroaéreos, distensión de asas intestinales y válvulas conniventes visibles, se determina abdomen agudo obstructivo se coloca enema evacuante y sonda nasogástrica con producción inicial de 450ml y logrando canalizar flatos sin embargo a las 24 y 48 horas con producciones de 300ml/día por lo que se realiza tomografía que revela asas distendidas con contenido líquido y gaseoso y desplazamiento de las mismas hacia la derecha por lo que con tórpida evolución clínica se decide laparotomía a las 72 horas encontrándose ciego y colon ascendente sin fijación, asas yeyunales en bolsa peritoneal, ángulo de Treitz en hipocondrio derecho, asas yeyunales distendidas desde 40 centímetros de ángulo de Treitz hasta 180 centímetros hacia distal por lo que se cataloga como SMI tipo III A y B. Por íleo postquirúrgico con producciones elevadas en SNG se inicia NPT, que con adecuada evolución clínica se retira y se reinicia tolerancia a dieta progresiva que con paciente asintomático se prescribe el alta.

Conclusiones: La mal rotación intestinal en adultos como causa de obstrucción intestinal suele ser infrecuente al igual que un cuadro agudo; y con mala evolución a medidas clínicas su tratamiento es quirúrgico.
¿Cómo guía la mente al cuerpo? Reganancia de peso dos años después de la cirugía bariátrica, desde un enfoque psico-social
Authors: Salazar Robalino Andrea Carolina , Balague Ponz Carmen
Published: February 2020

Introducción: No existe un consenso acerca de la relación causa-efecto entre las psicopatologías y la obesidad, pero se acepta que el estado emocional puede interferir en la desestructuración de los patrones alimentarios y en el sedentarismo, teniendo importante influencia ambos en el peso corporal.

Objetivo: Analizar la relación que existe entre los trastornos psiquiátricos y la falla en la pérdida de peso, dos años después de la cirugía bariátrica.

Material y métodos: Estudio de cohorte, retrospectivo. Población: 331 pacientes a los que se les realizó cirugía bariátrica desde el año 2007 hasta el año 2016 en el Hospital de la Santa Creu y Sant Pau. Muestra: 331 pacientes. Los datos se obtuvieron del registro de consultas. Se aplicaron métodos de estadística descriptiva e inferencial, se utilizó el test de ANOVA factorial de medidas repetidas, para todos los casos, se consideró una significación estadística p<0,05.

Resultados: se analizaron 331 pacientes, de los cuales 95(28,7%) hombres y 236 (n=71,3%) mujeres. El rango de edad oscilaba entre los 18 y 65 años. Se practicó sleeve gástrico en 208 (62,8%) de los casos y bypass en 123 (37,2%). El trastorno alimentario más frecuente fue el Glotón (n=44; 12,4%). El trastorno psiquiátrico más frecuente fue la depresión (n=34; 76,7%). Con la prueba t de student se obtuvieron diferencias significativas en la pérdida de peso en el control al primer año y al segundo año de la cirugía (p<0,05). En el test de ANOVA factorial de medidas repetidas, se obtuvo una relación estadísticamente significativa entre los síntomas depresivos y la falla en la pérdida de peso, de igual manera, entre el tipo de cirugía (Sleeve gástrico) y la falla en la pérdida de peso.

Conclusiones: El antecedente de trastornos depresivos antes de la cirugía y la técnica del Sleeve gástrico se relacionaron con la falla en la pérdida de peso en estos pacientes
Fundamentos para desarrollar programas de estudios de posgrado en Ecuador
Authors: Chicaiza Tayupanta Jesus Onorato
Published: February 2020

Constituye una prioridad para las instituciones de Educación Superior y el Ministerio de Salud Pública la apertura de posgrados (Maestria y/o Especialización) para dar respuesta a los problemas de salud de la población y disminuir las brechas identificadas a nivel de país. La Facultad de Ciencias de la Salud de la Universidad Técnica de Ambato con el liderazgo que le caracteriza se ha propuesto la apertura masiva de estos programas para cubrir las necesidades identificadas en la Zona 3 y el resto del país.
Debut de lupus eritematoso sistémico en paciente masculino
Authors: Albán Recalde Jair , Jácome Sánchez Andrés , Trujillo Medina Danny , Sánchez Villaroel Mateo
Published: February 2020

Introducción: El lupus eritematoso sistémico (LES) es una enfermedad multisistémica inflamatoria crónica y autoinmune que produce anticuerpos antinucleares, misma que es capaz de afectar cualquier órgano, su prevalencia es mayor en las mujeres sobre todo en edad fértil que en hombres con una relación 9:1. Su presentación clínica es insidiosa y variable desde lesiones cutáneas típicas como el eritema malar hasta alteraciones sistémicas cardíacas, pulmonares o renales. Su diagnóstico se enfoca en la clínica más la determinación de Anticuerpos antinucleares y de varios anticuerpos y exámenes de laboratorio, así como de imagen para determinar la presencia de otras complicaciones.

Objetivo: Aplicar los conocimientos teóricos del Lupus eritematoso sistémico para analizar el caso clínico del debut de un paciente masculino de 60 años.

Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico.

Resultados: Se presenta un caso clínico de un paciente masculino de 60 años de edad que presentó un síndrome coronario agudo, acompañado de lesiones dérmicas y pérdida de peso que después de varias sospechas diagnósticas se confirmó el diagnóstico de LES.

Conclusiones: A pesar de la prevalencia más frecuente del LES en mujeres jóvenes; esta patología puede presentarse en varones mayores de 50 años y su sospecha diagnóstica debe estar presente en pacientes que presenten características clínicas insidiosas de LES ya que su diagnóstico temprano puede evitar las complicaciones sistémicas que esta patología puede desarrollar si no se da el tratamiento adecuado
Nutritional Status and its Associated Factors among Under Five Children in BhimtarofSindhupalchowk District Nepal
Authors: Gautam Jyoti , Acharya Rija
Published: February 2020

Introduction: The nutritional status of an individual is often the result of many inter-related factors. It is a major public health problem in most of the developing countries and occurs prominently among under-five children. Nepal is also the one of the developing country where the prevalence of malnutrition is high. 

Objective: This study aimedtoassess the nutritional status and its associated factors among under-five children. 

Methodology: A descriptive cross-sectional study was conducted in Bhimtar Village Development Committee of Sindhupalchowk.Study conducted in Jan 27 2017 to Feb 8 2017 with the sample 115, self-constructed semi-structured interview schedule was used for data collection and nutritional status was assessed using anthropometric measurements. Descriptive (Frequency, Percentage, Mean, Standard Deviation) and inferential statistic (chi-square test) were used for data analysis. 

Results: Among total children 47% were stunted, 30.4% were underweight and 11.3% were wasted. Age of child, frequency of antenatal visit and age of mother at child birth had significant association with nutritional status of children.

Conclusion: The study concludes that significant proportion of under-five children in Sindhupalchowk district were malnourished with stunting and wasting being pre-dominant form of malnutrition. Occurrence of malnutrition was slightly higher among male compared to female children. Child’s age, mother’s age during childbirth and completion of atleast four antenatal visits during pregnancy were found to be significantly associated with child’s nutritional status.
Comparative study of Modified Tension Band Wiring versus Tension Band Through Parallel CannulatedCancellous Screws in Patella Fractures
Authors: Shrestha Praphulla , Chalise Pralhad Kumar , Paudel Sujan Raj
Published: February 2020

Introduction: Open reduction and internal fixation is indicated in patients with displaced patella fracturesand loss of the extensor apparatus.Transverse fractures of the patella are commonly treated with modified tension band wire (MTBW). Loosening of the wires along with the implant construct and soft tissue irritation by the wires had already been reported. The newer technique, tension band wiring through cannulated cancellousscrews(TBWCCS) is soft tissue friendly and gives better stability. 

Objective: The objective of this study is to compare the outcome of treatment of patella fractures by modified tension band wiring with k wires and tension band wiring through parallel cannulated cancellous screws in terms of union rate, functional outcome and complication rate.

Methodology: We performed acomparative study between the two procedures from September 2017 to January 2019 at Nepal Medical College Teaching Hospital. Total of 40 patients, 20 in each groupware enrolled in the study.Allthe patients were followed at regular intervals. Time taken for radiographic union was recorded. Variables of Modified Hospital for Special Surgery Knee Score (MHSSKS) were recorded and graded till the last follow-up at 24 weeks. Complications of each procedure were recorded.The data was analyzed using SPSS version 16.

Results: All fractures united at 12.20±3.03 weeks in MTBWgroup and 11.20±2.78 weeks in TBWCCS group. Complication rate was significantly higher in MTBW group. In TBWCCS group, 90% patients had good to excellent MHSSKS score whilein MTBW group, 75% had good to excellent results at 24 weeks. Pain during walking was significantly better in TBWCCS group. 

Conclusion: On the basis of our study, tension band wiring through cannulated cancellousscrews is an effective method of treatment of patellar fractures.
An experience of gynaecological laparoscopic surgeries at low resource setting.
Authors: Agrawal Ajay , Chandra Regmi Mohan Chandra Regmi , Rijal Pappu , Thakur Achala , Basnet Pritha
Published: February 2020

Introduction: Evolution of laparoscopy has revolutionised the field of gynaecological surgery for more than 40 years.Owing to the long learning curve, added expenses and lack of awareness among patients and surgeons, its introduction and development in Nepal is not upto the timeline. Gynaecologic laparoscopy (GL) seems to be introduced at BP Koirala institute of Health Sciences, Dharan,Nepal (BPKIHS) since 2002. It remained in latency because of widespread lack of equipment and skilled personnel. Some laparoscopic procedures like diagnostic laparoscopy, laparoscopic tubal ligation and very few laparoscopic assisted vaginal hysterectomy (LAVH) were done from 2002 - 2012 (10 years). Since then more gynecologists  have been trained in GL which has contributed to expansion of GL.

Objective: The objective of this study is to study and share trends of gynaecological laparoscopic surgeries performed at BPKIHS.

Methodology: All the patients undergoing GL surgeries have been analyzed for the indication, type of procedure, conversion and its complications.  We took data from operation theatre register and patient case sheet from July 2004 to May 2018. We divided this period into two phase viz Phase 1: July 2004-June 2013 and Phase 2: July 2013- till May 2018.

Results: Total number of GL done in this period was 427. Out of which 102 cases were from phase one and rest of the cases were done in five years of phase II. Number of operative laparoscopy has increased in phase 2 compared to phase 1. In last five years there was155 (47.6%) cases of adnexal surgery, 77 (23.6%) cases of diagnostic laparoscopy.Total laparoscopic hysterectomy was done in 25 (7.6%) cases. Conversion to laparotomy was done in4.6% (n=15) cases. Overall 12(3.7%) patient had major complications. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. Seventy percent of patient had a hospital stay of 2days and rest stayed for 3 days.

Conclusions: There is rising trend in operative GL at BPKIHS.  We are facing less complication with expanding experience. There has been good learning from each case. GL has well demonstrated its advantages of reducing postoperative pain and morbidity, short hospital stay, and less postoperative recovery time. We have plans to get new gadgets and expand services in GL.
Correlation of Body Mass Index and Estimated Glomerular Filtration Rate in Patients with Rheumatic Heart Disease at Tertiary Care Hospital
Authors: Shreewastav, Rupesh Kumar , Nepal Rajesh , Dhungana Sahadeb Prasad , Singh Arambam Giridhari
Published: February 2020

Introduction: Rheumatic heart disease (RHD), the leading causes of acquired heart disease worldwide, is a major health problem in developing countries. Rheumatic Heart Disease (RHD), affecting the heart valve system, leading to congestive heart failure and arrhythmias. The effects of body mass index (BMI) on kidney function have been reported and become a subject of increased concern. BMI is strongly associated with decreased eGFR in healthy persons. But the association between BMI and eGFR is not well characterized in chronic disease like RHD.

Objective: The aim of this study was to investigate the association between body mass index (BMI) and estimated glomerular filtration rate (eGFR) among RHD patients as studies have evaluated the significance BMI as a risk factor for the development of kidney diseases.

Methodology: It was an analytical cross-sectional study, which was conducted in a tertiary care hospital. A questionnaire was used to record the demographic characteristics of the patients. Height in meter and weight in kg of the study patients were recorded to calculate body mass index. Serum creatinine level of the patients was estimated in the clinical laboratory and estimated glomerular filtration rate was calculated by cockroft-Gault formula. The data was analyzed into SPSS 20.0 V

Results: The total number of rheumatic heart disease patients enrolled in this study was 120. The Mean ± Standard deviation values of body mass index, serum creatinine and estimated glomerular filtration rate of all the patients were 21.39 ± 3.91 kg/m2, 0.93 ± 0.41 mg/dl and 69.53±19.4 ml/min respectively. Increased body mass index was associated with reduced estimated glomerular filtration rate (r = -0.04) of the patients. Similarly, body mass index showed negative correlation with that of serum creatinine (r = -0.03) and also with that of age (r = -0.05) of the patients. Age (r = -0.043) and serum creatinine (r = -0.056) of the patients were negatively correlated with estimated glomerular filtration rate.

Conclusion: The study reveals that in rheumatic heart disease, body mass index is negatively but non-significantly associated with estimated glomerular filtration rate.
Association between depression and anxiety among the COPD patients in a Nepalese community hospital: a cross sectional study
Authors: Shakya Regan , Gautam Bandana
Published: February 2020

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disabling illness characterized by persistent airflow limitation affecting physical, psychological and social aspect of the individual. Amongst the associated co morbidities, depression and anxiety has been identified as common modifiable psychiatric comorbidities of COPD which impacts the patient’s quality of life. 

Objectives: To establish the prevalence of depression and anxiety among the COPD patient and determine the association between them.

Methodology: The cross sectional study was conducted at Dhulikhel Hospital. We used a convenient sampling method to recruit seventy three COPD participants admitted in the Medicine ward. We interviewed the participants to evaluate anxiety and depression using the Nepali version of Hospital Anxiety and Depression Scale questionnaire. We considered positive result of anxiety and depression when the Hospital Anxiety and Depression score was above eight. 

Results: Depressive and Anxiety symptoms were observed in 30 % and 33% of the participants respectively. Similarly 20% of the participants had both the symptoms of depression and anxiety. The association between depression and anxiety was found to be highly significant (p<0.001). In the multivariate model the odds of depression and anxiety was nine percent increase with every one year increase in age after adjusting for gender and duration of illness. (adjusted OR: 1.07; CI 1.00- 1.17; p-value: 0.03). In an unadjusted model depression was significantly associated to every year increase in age (unadjusted OR: 1.07; CI: 1.00- 1.13; p-value: 0.03)

Conclusion: Depression and anxiety is prevalent among COPD patient at Dhulikhel hospital with one fifth of the patient demonstrating both depression and anxiety symptoms.
Morphological Variation of Anterior Clinoid Process in Dry Human Skulls
Authors: Dhakal Arun , Mehta Umesh Kumar , Sah Sanjib Kumar , Kumar  Chaudhary Raju Kumar  Chaudhary
Published: February 2020

Introduction: The anatomical relationship of the Anterior Clinoid Process (ACP) with its neighboring structures in the base of the skull is complex with different variations. Thus, study of its morphology is essential in defining and directing surgery.

Objective: This study aims to investigate the anatomy of the anterior clinoid process and prevalence of Caroticoclinoid foramen (CCF) to highlight its variations.

Methodology: The measurements were performed in 31 dry human skulls to define the structure of ACP, the presence of CCF and other relevant landmarks using digital Vernier Calipers.

Results: The mean length, basal width and thickness of the right ACP was 9.88+/- 1.36 mm, 8.72+/-1.50 mm, and 5.21+/-1.83 mm respectively and that of the left was 10.30+/-1.47, 8.73+/-1.71, and 5.33+/-1.60 mm respectively.  Paired t-test was used to compare the mean of these sides. Type III was the most common form of ACP for both the sides. Out of 31 skulls, CCF was observed in 12 (38.7%) skulls with 7 (22.6%) in right and 5 (16.13%) in left side. Distances between neighboring ACP’s, between Posterior Clinoid process (PCP), between ACP to Crista Galli (CG) and ACP to PCP were 24.41+/-2.32, 20.01+/-3.23, 31.6+/-2.20, and 8.30+/-3.10 mm respectively.

Conclusion: This article highlights the detailed morphology of ACP. There is variation in relation to its dimensions across other studies. This study also explores the prevalence of CCF and parasellar landmarks in relation to ACP giving an idea of the exposure achievable during surgical approach of the region.
Safety and efficacy of electrophysiological studies and radiofrequency ablation of paroxysmal supraventricular tachycardia
Authors: Monib Abdul Khaliq , Nepal Rajesh , Dhungana Sahadeb Prasad , Raut Roshan
Published: February 2020

Introduction: Cardiac electrophysiological study (EPS) and radiofrequency ablation (RFA) is an established mode of treatment either as first-line or for drug-refractory arrhythmias. Our center has recently started this service under 2-D mapping outside Kathmandu valley

Objective: The aim was to evaluate the safety and efficacy of EPS and RFA for paroxysmal supraventricular tachycardias (PSVT).

Methodology: This is an observational prospective study carried out in the Cardiac Unit of Nobel medical college, Biratnagar, Nepal. All cases diagnosed to have PSVT based on electrocardiogram or Holter recordingfromAugust 2018 and May2019wereincluded in the study. Data on clinical profile and findings of EPS were recorded. Fifty-nine cases were chosen for safety and efficacy analysis, using SPSS statistical software version 19.

Results: There were 59 patients, 28(47.5%) males, and 31(52.5%) females. The mean age was 38.2 ± 15.9 years. Fifty-three patients underwent RFA while 6 patients underwent only EPS. In the Atrioventricular nodal reentry tachycardia (AVNRT) group, there was female dominance (P=0.2) while in Atrioventricular reentry tachycardia (AVRT) group, there was no significant gender difference (p=0.4). Left-sided pathway (68%) was more common in the AVRT group. Among the left accessory pathway (AP), left lateral AP (44%) was more common. No major complications including death were noted. Two cases of successful ablation relapsed in one month follow up.

Conclusions: Early results of this small study in patients with PSVT confirm the efficacy and safety of RFA in newly established electrophysiology (EP) laboratory.
Prevalence and Correlates of Vitamin B12 Deficiency among Depressive Patients Presenting in the Tertiary Care Hospital of Gandaki Province of Nepal
Authors: Khattri Jai Bahadur , Godar Srijana Thapa , Subedi Anil
Published: February 2020

Introduction: The prevalence of vitamin B12 deficiency in depression is not clear and more research is needed.

Objectives: The objective of this study is to find the prevalence of deficiency of vitamin B12 level in the depressed patient. The second objective is to find the prevalence of deficiency of vitamin B12 according to different socio-demographic variables.

Methodology: The patients diagnosed as depressive episodes according to the International Classification of Disease – 10 Classification of Mental and Behavioural Disorders were selected from the Psychiatric Out-Patient Department of Manipal Teaching Hospital, Pokhara.  The proforma was used to collect the socio-demographic profile of the patient. The serum sample of the 50 patients was sent for vitamin B12 estimation. Serum concentrations less than 239 pg/ml was considered deficient in this study.

Results: The overall prevalence of vitamin B12 deficiency was 22% in the depressed patients. The mean age of the total patients were 39.2 years with the standard deviation of 13.75 years. Vitamin B12 deficiency was more prevalent in the socio-demographic variables like age above 61 years, Brahmin and Chhetri caste, female gender, unmarried groups, and in the patients living in the urban area as compared to other variables.

Conclusion: The result shows that vitamin B12 deficiency is common in the patients with depression. Clinicians should be aware of the risk for vitamin B12 deficiency in depressive patients.  As this study was done in limited geographical area and sample size being small, further larger studies are needed before generalizing these results.
Use of Superficial Cervical Plexus Block in Submandibular and Submental Space Abscess Drainage
Authors: Singh Vivek , KC Bijay , Giri Ritesh , Bhagat Prachi
Published: February 2020

Introduction: Methods for lessening the sensation of pain during surgery date back to ancient times. Although general anesthesia is preferred over locoregional anesthesia in incision and drainage  of space infection in neck region, it is expensive, with increased morbidity and mortality. Sometimes, anesthetist experienced in fiber optic-guided nasal intubation may be required due to reduced mouth opening. Hence, in such cases and poor risk patients, Superficial Cervical Plexus Block  can be used in association with trigeminal V3 local anesthesia.

Objective: To evaluate the efficacy of Superficial Cervical Plexus Block in incision and drainage of submandibular and submental space infection.

Methodology: A prospective clinical study was carried out at Nobel Medical College and Teaching Hospital, Biratnagar, Nepal from June 2018 to May 2019 suffering from submandibular and submental space infection arising from odontogenic causes who required incision and drainage. Pain response was measured using Visual Analogue Scale.

Result: Out of Twenty four patients sixteen were female and 8 were male. The age ranged from 16 to 82 years with a mean age of 40.5±18.53. The Visual Analogue Scale score ranged from 0 to 8 with a mean score of 1.5 ±1.87. One patient complained of unbearable pain and had to be converted into general anesthesia (4.16%).

Conclusion: Superficial Cervical Plexus Block with trigeminal mandibular local anesthesia has a high success rate, low complication rate, and high patient acceptance rate. However, caution should be exercised to ensure a low complication rate.
Association of serum uric acid and serum lipid profile in pre- eclampsia- A hospital based case-control study
Authors: Rizal Shikha , Joshi Bishal Raj , Dhakal Amita , Sagtani Reshu Agrawal
Published: February 2020

Introduction: Pre-eclampsia, one of the most common medical complication in pregnancy results in considerable maternal and fetal morbidity and mortality. Endothelial dysfunction is a central feature of pre-eclampsia. Elevated serum uric acid level may serve as a marker for early diagnosis of the disease as well as a surrogate for clinical severity of the condition. High serum values of triglycerides, total cholesterol, low- density lipoprotein and and low levels of high density lipoprotein are all significantly related to risk developing preeclampsia. 

Objective: To find out the association between serum uric acid levels and lipid profile in pre-eclamptic women and compare it with the normal pregnant women. 

Methodology: A case control study was conducted among 180 pregnant women (90 cases of pre-eclamptic women and 90 cases of age matched normal pregnant women) between 21-35 years who were admitted in the Gynaecology and Obstetrics ward of Nobel Medical College and Teaching Hospital, Biratnagar.

Blood pressure was measured. Serum from all the patients were analyzed for the following biochemical parameters: serum uric acid, triglyceride, total cholesterol, LDL-C and HDL- C. The data were collected and entered in MS-Excel and analyzed using Statistical Package for Social Sciences (SPSS) ver. 16 software.

Results: Mean serum uric acid of pre-eclamptic women was higher than those of normal pregnant women  which was found to be statistically significant with p value <0.001. Among the lipid parameters, serum triglyceride and total cholesterol was significantly higher in pre-eclamptic women whereas high density lipoprotein was significantly lower in pre-eclamptic. Also there was a positive co-relation between triglyceride and blood pressure and a negative co-relation between HDL-C in preeclamptic women.

Conclusion: Development of simple and inexpensive methods to predict and prevent pre-eclampsia in early stage is very important. Thus, our study concludes the utility of measurement of serum uric acid and lipid profile for screening patients at risk of developing pre-eclampsia.