bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetic basis for global loss of fidelity arising from mismatches in the P-site codon:anticodon helix
Authors: Zaher Hani S. , Green Rachel
Published: August 2010

Faithful decoding of the genetic information by the ribosome relies on kinetically driven mechanisms that promote selection of cognate substrates during elongation. Recently, we have shown that in addition to these kinetically driven mechanisms, the ribosome possesses a post peptidyl transfer quality control system that retrospectively monitors the codon–anticodon interaction in the P site, triggering substantial losses in the specificity of the A site during subsequent tRNA and RF selection when a mistake has occurred. Here, we report a detailed kinetic analysis of tRNA selection in the context of a mismatched P-site codon:anticodon interaction. We observe pleiotropic effects of a P-site mismatch on tRNA selection, such that near-cognate tRNA is processed by the ribosome almost as efficiently as cognate. In particular, after a miscoding event, near-cognate codon–anticodon complexes are stabilized on the ribosome to an extent similar to that observed for cognate ones. Moreover, the two observed forward rates of GTPase activation and accommodation are greatly accelerated (∼10-fold) for near-cognate tRNAs. Because the ensemble of effects of a mismatched P site on substrate selection were found to be different from those reported for other ribosomal perturbations and miscoding agents, we propose that the structural integrity of the mRNA–tRNA helix in the P site provides a distinct molecular switch that dictates the specificity of the A site.
Truck Driver Scheduling in the European Union
Authors: Goel Asvin
Published: August 2010

Since April 2007 working hours of truck drivers in the European Union are controlled by regulation (EC) No. 561/2006. According to the new regulation, road transport undertakings must organise the work of drivers in a way that drivers are able to comply with the regulations and can be made liable for infringements committed by the drivers. Although of particular importance in long-distance haulage, regulations on working hours of truck drivers have received very little attention in the scheduling literature. This paper presents a method for scheduling driving and working hours of truck drivers with respect to regulation (EC) No. 561/2006. Given a sequence of locations to be visited within specified time windows, the approach is guaranteed to find a schedule complying with the regulation if such a schedule exists.
Aldehyde Dehydrogenase 3B1 (ALDH3B1): Immunohistochemical Tissue Distribution and Cellular-specific Localization in Normal and Cancerous Human Tissues
Authors: Marchitti Satori A. , Orlicky David J. , Brocker Chad , Vasiliou Vasilis
Published: August 2010

Aldehyde dehydrogenase (ALDH) enzymes are critical in the detoxification of endogenous and exogenous aldehydes. Our previous findings indicate that the ALDH3B1 enzyme is expressed in several mouse tissues and is catalytically active toward aldehydes derived from lipid peroxidation, suggesting a potential role against oxidative stress. The aim of this study was to elucidate by immunohistochemistry the tissue, cellular, and subcellular distribution of ALDH3B1 in normal human tissues and in tumors of human lung, colon, breast, and ovary. Our results indicate that ALDH3B1 is expressed in a tissue-specific manner and in a limited number of cell types, including hepatocytes, proximal convoluted tubule cells, cerebellar astrocytes, bronchiole ciliated cells, testis efferent ductule ciliated cells, and histiocytes. ALDH3B1 expression was upregulated in a high percentage of human tumors (lung > breast = ovarian > colon). Increased ALDH3B1 expression in tumor cells may confer a growth advantage or be the result of an induction mechanism mediated by increased oxidative stress. Subcellular localization of ALDH3B1 was predominantly cytosolic in tissues, with the exception of normal human lung and testis, in which localization appeared membrane-bound or membrane-associated. The specificity of ALDH3B1 distribution may prove to be directly related to the functional role of this enzyme in human tissues.
Thromboemboliás szövődmények előfordulása és megelőzése egynapos sebészeti beavatkozások során
Authors: Pfliegler György , Fülesdi Béla , Damjanovich László , Janecskó Mária
Published: August 2010

Absztrakt

A perioperatív antithromboticus megelőzés, illetve a tartósan antithromboticus kezelésben részesülő betegek műtéti ellátása (ún. áthidaló kezelés) mind a vénás thromboemboliák (VTE) megelőzése, mind a műtéti vérzéses szövődmények számának és súlyosságának csökkentése szempontjából kiemelt jelentőségű feladat. A nagyszámú irodalom és a nyomukban született ajánlások – érthető módon – elsősorban a hagyományos, általában többnapos hospitalizációt igénylő, nyílt műtétek különféle formáival foglalkoznak, sokkal kevesebb figyelem jutott ez ideig az egynapos sebészet során fellépő VTE kockázataira, illetve megelőzésére. A szerzők áttekintik az egynapos sebészeti eljárásokhoz kapcsolódó VTE epidemiológiáját, ismertetik az új nemzetközi, illetve a 4. Magyar Antithrombotikus Irányelv ajánlásait. Ezek lényege: amennyiben a műtétre kerülő betegnél egyidejűleg szerzett vagy veleszületett thrombosisra hajlamosító tényezők igazolhatók, az általános, nem gyógyszeres thrombosismegelőzési módszereken túlmenően egynapos sebészeti eljárások során is indokolt a gyógyszeres (kis molekulatömegű heparin) profilaxis.
Distalis pancreasresectio világos sejtes veserák metastasisa miatt
Authors: Szabó Károly Gábor , Szentkereszty Zsolt , Tóth László András , Damjanovich László , Sápy Péter
Published: August 2010

Absztrakt

Esetismertetés: A vesetumorok áttétet általában a májba és a tüdőbe adnak. Más hasüregi szervben (duodenum, másik oldali vese, mellékvese, colon-transversum) való előfordulásuk ritka, a pancreasba történő áttétképződés irodalmi ritkaságnak számít. A szerzők sikeresen operált 82 éves férfi beteg esetét ismertetik, akinek világos sejtes vesetumor pancreas-metastasisát távolították el. A beteg anamnaesisében 8 évvel korábban bal oldali vesetumor miatt nephrectomia szerepel. Magas subileusra utaló tünetek miatt kezelt és kivizsgált betegnél a hasi CT-vizsgálat a pancreasfarok területén térfoglalást igazolt. Az elváltozást splenectomiával kiegészített distalis pancreasresectióval távolították el. A szövettani vizsgálat a világos sejtes vesetumor metastasisát igazolta. Megbeszélés: A pancreas szekunder daganata ritka. Bár a vesetumorok túlnyomórészt máj- és tüdőáttétet képeznek, a világos sejtes vesetumor a pancreasba is adhat áttétet, ezért a hasnyálmirigyben megjelenő térfoglalás esetén gondolni kell az áttétképződésre.
Alcohol Retail Density and Demographic Predictors of Health Disparities: A Geographic Analysis
Authors: Berke Ethan M. , Tanski Susanne E. , Demidenko Eugene , Alford-Teaster Jennifer , Shi Xun , Sargent James D.
Published: August 2010

Objectives. We examined whether the geographic density of alcohol retailers was greater in geographic areas with higher levels of demographic characteristics that predict health disparities.

Methods. We obtained the locations of all alcohol retailers in the continental United States and created a map depicting alcohol retail outlet density at the US Census tract level. US Census data provided tract-level measures of poverty, education, crowding, and race/ethnicity. We used multiple linear regression to assess relationships between these variables and retail alcohol density.

Results. In urban areas, retail alcohol density had significant nonlinear relationships with Black race, Latino ethnicity, poverty, and education, with slopes increasing substantially throughout the highest quartile for each predictor. In high-proportion Latino communities, retail alcohol density was twice as high as the median density. Retail alcohol density had little or no relationship with the demographic factors of interest in suburban, large town, or rural census tracts.

Conclusions. Greater density of alcohol retailers was associated with higher levels of poverty and with higher proportions of Blacks and Latinos in urban census tracts. These disparities could contribute to higher morbidity in these geographic areas.
Concurrent Partnerships, Nonmonogamous Partners, and Substance Use Among Women in the United States
Authors: Adimora Adaora A. , Schoenbach Victor J. , Taylor Eboni M. , Khan Maria R. , Schwartz Robert J.
Published: August 2010

Objectives. We determined the prevalence, distribution, and correlates of US women's involvement in concurrent sexual partnerships, a sexual-network pattern that speeds population-wide HIV dissemination.

Methods. We used sexual partnership dates reported by 7643 women in the 2002 National Survey of Family Growth to determine prevalence of concurrent sexual partnerships during the preceding 12 months. We examined associations between concurrency and sociodemographic characteristics and risk behaviors.

Results. Prevalence of concurrent partnerships was 5.7% based on reported partnerships and 8.3% after adjustment for possible underreporting. Concurrency was associated with younger age (22 to 24 years: prevalence odds ratio [POR] = 2.44) versus older age (40 to 44 years); marital status (formerly married: POR = 6.56; never married: POR = 3.81; vs married); Black race/ethnicity (POR = 1.78); younger age at first sexual intercourse (12 to 13 years: POR = 2.89) versus 18 years or older); having a nonmonogamous sexual partner (POR = 6.96); having intercourse while “high” on drugs or alcohol (POR = 1.61); binge drinking (POR = 1.70); and crack or cocaine use (POR = 2.72).

Conclusions. The association of concurrency with nonmonogamous sexual partners and substance use suggests the existence of extensive sexual networks that link people at higher risk for HIV infection with increased opportunities for disseminating infection.
Can Medicaid Reimbursement Help Give Female Condoms a Second Chance in the United States?
Authors: Witte Susan S. , Stefano Kyle , Hawkins Courtney
Published: August 2010

The female condom is the only other barrier contraception method besides the male condom, and it is the only “woman-initiated” device for prevention of sexually transmitted infections. Although studies demonstrate high acceptability and effectiveness for this device, overall use in the United States remains low.

The female condom has been available through Medicaid in many states since 1994. We provide the first published summary of data on Medicaid reimbursement for the female condom. Our findings demonstrate low rates of claims for female condoms but high rates of reimbursement.

In light of the 2009 approval of a new, cheaper female condom and the recent passage of comprehensive health care reform, we call for research examining how health care providers can best promote consumer use of Medicaid reimbursement to obtain this important infection-prevention device.
Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults
Authors: Burton Deron C. , Flannery Brendan , Bennett Nancy M. , Farley Monica M. , Gershman Ken , Harrison Lee H. , Lynfield Ruth , Petit Susan , Reingold Arthur L. , Schaffner William , Thomas Ann , Plikaytis Brian D. , Rose Charles E. , Whitney Cynthia G. , Schuchat Anne ,   for the Active Bacterial Core Surveillance/Emerging Infections Program Network
Published: August 2010

Objectives. We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults.

Methods. We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs).

Results. During 2003 to 2004, the average annual incidence of bacteremic pneumonia was 24.2 episodes per 100 000 Black adults versus 10.1 per 100 000 White adults (RR = 2.40; 95% CI = 2.24, 2.57). Incidence among Black residents of census tracts with 20% or more of persons in poverty (most impoverished) was 4.4 times the incidence among White residents of census tracts with less than 5% of persons in poverty (least impoverished). Racial disparities in incidence were reduced but remained significant in models that controlled for age, census tract poverty level, and state.

Conclusions. Adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts.
Workplace Assaults on Nursing Assistants in US Nursing Homes: A Multilevel Analysis
Authors: Tak SangWoo , Sweeney Marie Haring , Alterman Toni , Baron Sherry , Calvert Geoffrey M.
Published: August 2010

Objectives. We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level.

Methods. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect.

Results. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents.

Conclusions. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.
The Ethical Significance of Expectations and the Case of Microsoft Office Accounting
Authors: Ploug Thomas
Published: August 2010

Late 2009, the Microsoft Corporation terminated its sales, distribution and upgrading of Microsoft Office Accounting. This article presents an ethical analysis of the way in which Microsoft Corporation effected its decision to withdraw the product with special emphasis on how consumer expectations were formed, maintained and handled throughout the lifecycle of the accounting software in question. The analysis proceeds from initial reflections on and arguments for the ethical significance of consumer expectations  an area which has until recently only received little attention in moral analysis.
Evaluation of A2BP1 as an Obesity Gene
Authors: Ma Lijun , Hanson Robert L. , Traurig Michael T. , Muller Yunhua L. , Kaur Bakhshish P. , Perez Jessica M. , Meyre David , Fu Mao , Körner Antje , Franks Paul W. , Kiess Wieland , Kobes Sayuko , Knowler William C. , Kovacs Peter , Froguel Philippe , Shuldiner Alan R. , Bogardus Clifton , Baier Leslie J.
Published: August 2010

OBJECTIVE

A genome-wide association study (GWAS) in Pima Indians (n = 413) identified variation in the ataxin-2 binding protein 1 gene (A2BP1) that was associated with percent body fat. On the basis of this association and the obese phenotype of ataxin-2 knockout mice, A2BP1 was genetically and functionally analyzed to assess its potential role in human obesity.

RESEARCH DESIGN AND METHODS

Variants spanning A2BP1 were genotyped in a population-based sample of 3,234 full-heritage Pima Indians, 2,843 of whom were not part of the initial GWAS study and therefore could serve as a sample to assess replication. Published GWAS data across A2BP1 were additionally analyzed in French adult (n = 1,426) and children case/control subjects (n = 1,392) (Meyre et al. Nat Genet 2009;41:157–159). Selected variants were genotyped in two additional samples of Caucasians (Amish, n = 1,149, and German children case/control subjects, n = 998) and one additional Native American (n = 2,531) sample. Small interfering RNA was used to knockdown A2bp1 message levels in mouse embryonic hypothalamus cells.

RESULTS

No single variant in A2BP1 was reproducibly associated with obesity across the different populations. However, different variants within intron 1 of A2BP1 were associated with BMI in full-heritage Pima Indians (rs10500331, P = 1.9 × 10−7) and obesity in French Caucasian adult (rs4786847, P = 1.9 × 10−10) and children (rs8054147, P = 9.2 × 10−6) case/control subjects. Reduction of A2bp1 in mouse embryonic hypothalamus cells decreased expression of Atxn2, Insr, and Mc4r.

CONCLUSIONS

Association analysis suggests that variation in A2BP1 influences obesity, and functional studies suggest that A2BP1 could potentially affect adiposity via the hypothalamic MC4R pathway.
Pparg-P465L Mutation Worsens Hyperglycemia in Ins2-Akita Female Mice via Adipose-Specific Insulin Resistance and Storage Dysfunction
Authors: Pendse Avani A. , Johnson Lance A. , Tsai Yau-Sheng , Maeda Nobuyo
Published: August 2010

OBJECTIVE

The dominant-negative P467L mutation in peroxisome proliferator activated receptor-γ (PPARγ) was identified in insulin-resistant patients with hyperglycemia and lipodystrophy. In contrast, mice carrying the corresponding Pparg-P465L mutation have normal insulin sensitivity, with mild hyperinsulinemia. We hypothesized that murine Pparg-P465L mutation leads to covert insulin resistance, which is masked by hyperinsulinemia and increased pancreatic islet mass, to retain normal plasma glucose.

RESEARCH DESIGN AND METHODS

We introduced in PpargP465L/+ mice an Ins2-Akita mutation that causes improper protein folding and islet apoptosis to lower plasma insulin.

RESULTS

Unlike Ins2Akita/+ littermates, male PpargP465L/+Ins2Akita/+ mice have drastically reduced life span with enhanced type 1 diabetes. Hyperglycemia in Ins2Akita/+ females is mild. However, PpargP465L/+Ins2Akita/+ females have aggravated hyperglycemia, smaller islets, and reduced plasma insulin. In an insulin tolerance test, they showed smaller reduction in plasma glucose, indicating impaired insulin sensitivity. Although gluconeogenesis is enhanced in PpargP465L/+Ins2Akita/+ mice compared with Ins2Akita/+, exogenous insulin equally suppressed gluconeogenesis in hepatocytes, suggesting that PpargP465L/+Ins2Akita/+ livers are insulin sensitive. Expression of genes regulating insulin sensitivity and glycogen and triglyceride contents suggest that skeletal muscles are equally insulin sensitive. In contrast, adipose tissue and isolated adipocytes from PpargP465L/+Ins2Akita/+ mice have impaired glucose uptake in response to exogenous insulin. PpargP465L/+Ins2Akita/+ mice have smaller fat depots composed of larger adipocytes, suggesting impaired lipid storage with subsequent hepatomegaly and hypertriglyceridemia.

CONCLUSIONS

PPARg-P465L mutation worsens hyperglycemia in Ins2Akita/+ mice primarily because of adipose-specific insulin resistance and altered storage function. This underscores the important interplay between insulin and PPARγ in adipose tissues in diabetes.
Neck Circumference Positively Related With Central Obesity, Overweight, and Metabolic Syndrome in Chinese Subjects With Type 2 Diabetes: Beijing Community Diabetes Study 4
Authors: Yang Guang-ran , Yuan Shen-yuan , Fu Han-jing , Wan Gang , Zhu Liang-xiang , Bu Xiang-lei , Zhang Jian-dong , Du Xue-ping , Li Yu-ling , Ji Yu , Gu Xiao-ning , Li Yue ,   Beijing Community Diabetes Study Group
Published: August 2010

OBJECTIVE

To investigate the association between neck circumference and central obesity, overweight, and metabolic syndrome in Chinese individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 3,182 diabetic subjects (aged 20–80 years) were recruited from 15 community health centers in Beijing using a multistage random sampling approach.

RESULTS

Receiver operating characteristic analysis showed that the area under the curve for neck circumference and central obesity was 0.77 for men and 0.75 for women (P < 0.001). Furthermore, a neck circumference of ≥38 cm for men and ≥35 cm for women was the best cutoff point for determining overweight subjects. A neck circumference of ≥39 cm for men and ≥35 cm for women was the best cutoff point to determine subjects with metabolic syndrome.

CONCLUSIONS

In the present study, neck circumference is positively related with BMI, waist circumference, and metabolic syndrome in Chinese individuals with type 2 diabetes.
Leptin Gene Epigenetic Adaptation to Impaired Glucose Metabolism During Pregnancy
Authors: Bouchard Luigi , Thibault Stéphanie , Guay Simon-Pierre , Santure Marta , Monpetit Alexandre , St-Pierre Julie , Perron Patrice , Brisson Diane
Published: August 2010

OBJECTIVE

To verify whether the leptin gene epigenetic (DNA methylation) profile is altered in the offspring of mothers with gestational impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS

Placental tissues and maternal and cord blood samples were obtained from 48 women at term including 23 subjects with gestational IGT. Leptin DNA methylation, gene expression levels, and circulating concentration were measured using the Sequenom EpiTYPER system, quantitative real-time RT-PCR, and enzyme-linked immunosorbent assay, respectively. IGT was assessed after a 75-g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation.

RESULTS

We have shown that placental leptin gene DNA methylation levels were correlated with glucose levels (2-h post-OGTT) in women with IGT (fetal side: ρ = −0.44, P ≤ 0.05; maternal side: ρ = 0.53, P ≤ 0.01) and with decreased leptin gene expression (n = 48; ρ ≥ −0.30, P ≤ 0.05) in the whole cohort. Placental leptin mRNA levels accounted for 16% of the variance in maternal circulating leptin concentration (P < 0.05).

CONCLUSIONS

IGT during pregnancy was associated with leptin gene DNA methylation adaptations with potential functional impacts. These epigenetic changes provide novel mechanisms that could contribute to explaining the detrimental health effects associated with fetal programming, such as long-term increased risk of developing obesity and type 2 diabetes.
Measurement of Femoral Torsion by Ultrasound and Magnetic Resonance Imaging: Concurrent Validity
Authors: Kulig Kornelia , Harper-Hanigan Kellee , Souza Richard B. , Powers Christopher M.
Published: August 2010

Background

Abnormal femoral torsion has been linked to osteoarthritis in the knee as well as to patellofemoral pain. Inexpensive, valid, and reliable methods for assessing femoral torsion are needed. Ultrasound (US) is a noninvasive and clinically accessible method that can be used for the assessment of bone morphology, such as femoral torsion.

Objective

The objective of this study was to determine the concurrent validity of US for the measurement of femoral torsion with a reference method, magnetic resonance imaging (MRI).

Design

Repeated measurements of femoral torsion were obtained with US and MRI in a laboratory setting.

Methods

Twenty-eight people (4 men, 24 women; mean age=26.8 years [SD=4.0 years], mean body height=170.3 cm [SD=8.0 cm], mean body weight=64.7 kg [SD=9.8 kg]) participated in this study. T1-weighted axial oblique images of the femoral neck and epicondylar axis were acquired with a 1.5-T magnetic resonance system. Ultrasonographic measurements then were obtained by a tilting technique with a linear transducer that was 4.5 cm long and operated at a frequency of 10 MHz and a depth of 5 cm.

Results

The average angles of anteversion measured by US and by MRI were 20.7 degrees (SD=11.0) and 19 degrees (SD=11.3), respectively. The reliability, reported as the intraclass correlation coefficient [ICC (2,1)], of repeated measurements of in vivo femoral torsion by US was .98. The reliability [ICC (2,1)] of magnetic resonance image analysis was .96. The standard error of the measurement for US was 2.2 degrees, and that for MRI was 1.9 degrees. The concurrent validity of US with MRI (R2) was .93 (r=.96).

Limitations

Obtaining measurements by US requires appropriate training before data collection.

Conclusions

Ultrasound measurement of femoral torsion has high concurrent validity with in vivo MRI and may be used when an assessment of bony morphology is needed but MRI is not available.
The Move & PLAY Study: An Example of Comprehensive Rehabilitation Outcomes Research
Authors: Bartlett Doreen J. , Chiarello Lisa A. , McCoy Sarah Westcott , Palisano Robert J. , Rosenbaum Peter L. , Jeffries Lynn , Fiss Alyssa LaForme , Stoskopf Barbara
Published: August 2010

This perspective article provides an example of a study planned using guidelines for comprehensive rehabilitation outcomes research, an approach that is believed to give service providers meaningful evidence to support practice. This line of investigation has been guided by the World Health Organization's International Classification of Functioning, Disability and Health. The short title of a study under way is Move & PLAY (Movement and Participation in Life Activities of Young Children). The article briefly describes the conceptual model, provides guidelines on how indicators and measures are selected, alludes to the details of selected measures, and describes processes of preparing for data collection, including obtaining ethics approval, preparing data collection booklets, training assessors and interviewers, and sampling. The aim of this investigation is to gain a better understanding of the multiple child, family, and service factors associated with changes in mobility, self-care, and play of preschool children with cerebral palsy as a result of using this research method. Comprehensive rehabilitation outcomes research holds promise in providing evidence that supports the complexities of planning rehabilitation services with clients with chronic conditions, such as children with cerebral palsy.
Preoperative embolization or ligature of the uterine arteries in preparation for conservative uterine fibroma surgery
Authors: Tixier Hervé , Grevoul Julie , Loffroy Romaric , Lauferon Juliette , Guiu Boris , Mutamba William , Filipuzzi Laurence , Cercueil Jean Pierre , Douvier Serge , Krause Denis , Sagot Paul
Published: August 2010

Objective. To compare the efficacy, feasibility and morbidity of two preparation techniques for conservative uterine myoma surgery: temporary embolization and temporary surgical ligature of the uterine arteries. Design. Retrospective study. Setting. Gynecological Surgery and Interventional Radiology departments, Centre Hospitalier Universitaire of Dijon, France. Population. A total of 100 women undergoing myomectomy between 2000 and 2008. Methods. Three groups were constituted: (1) no preparation (43 patients), (2) uterine artery embolization (UAE) (30 patients) and (3) temporary surgical ligature of the uterine arteries (SLUA) (27 patients). The choice of technique depended on the number, size and topography of the fibromas. Main outcomes measures. Quantification of peroperative blood loss, delta hemoglobin, complications, subsequent fertility. Results. Blood loss and delta hemoglobin were both lower in group 2 (p = 0.026 and p = 0.0002) and in group 3 (p = 0.048 and p = 0.001), respectively, than in group 1. The two preparation techniques were efficient. SLUA increased the duration of the operation (p < 0.0001). Hospitalization was longer following UAE (p = 0.0001). The rate of complications was 16.3, 23.3 and 3.7%, and of synechiae 9.3, 13.3 and 0% for groups 1, 2 and 3, respectively. The number of pregnancies was 8, 5 and 6 after a mean postoperative period of 5.6, 4.3 and 3.9 years, respectively. Conclusion. Both UAE and SLUA for myomectomy are feasible, reproducible and effective techniques for reducing peroperative blood loss. Use of these techniques must be generalized in patients with a high risk of hemorrhage, but may be compatible with subsequent fertility.
Gendericide: A scary truth
Authors: Shrestha NS
Published: August 2010

DOI: 10.3126/kumj.v8i2.3548Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 153
Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease
Authors: Lakhey M , Ghimire R , Shrestha R , Bhatta AD
Published: August 2010

Background: Prostate Specifi c Antigen (PSA) has been widely used in the diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major bound form (cPSA) and a free form (fPSA). Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic findings in biopsy specimens of men with prostatic disease. Material and methods: This study includes 91 patients planned for transurethral resection of prostate (TURP). Blood samples were collected before TURP and tested for fPSA. Histology of the tissue samples collected after TURP were studied and the relationship with fPSA analysed using SPSS 11.5. Results: The median values for benign, premalignant and malignant lesions were 1.8ng/ml, 4.5ng/ml and 13.20ng/ml respectively (p<0.001). Most cases of benign prostatic hyperplasia(BPH) without inflammation had fPSA levels <2ng/ ml, while most with active inflammation had levels >5ng/ml. Low grade prostatic intraepithelial neoplasia (LGPIN) saw levels <5ng/ml while high grade intraepithelial neoplasia (HGPIN) and prostate cancer (PCa) had levels > 5ng/mL (p<0.05). For detection of high grade lesions (HGPIN and PCa), the sensitivity and specificity of fPSA level > 5ng/ml was found to be 88.8% and 90.2% respectively. Conclusions: Serum fPSA is elevated marginally in patients with BPH without inflammation. Active inflammation and high grade lesions are associated with fPSA level more than 5 ng/ml. Key words: Benign prostatic hyperplasia; fPSA; prostate cancer; prostatic intraepithelial neoplasia. DOI: 10.3126/kumj.v8i2.3550 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 158-163
Antimicrobial susceptibility pattern and serotyping of Streptococcus pneumoniae isolated from Kanti Children Hospital in Nepal
Authors: Rijal B , Tandukar S , Adhikari R , Taludhar NR , Sharma PR , Pokharel BM , Gami FC , Shah A , Sharma A , Gauchan P , Sherchand JB , Burlakoti T , Upreti HC , Lalitha MK , Thomas K , Steinhoff M
Published: August 2010

Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal. Objectives: The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal. Materials and methods: All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed. Results: The study showed that 24 (52.17%) isolates were resistant to Cotrimoxazole, 3 (6.5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2.17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2.17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19.14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F. Conclusions: Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal. Key words: Antimicrobial susceptibility; Streptococcus pneumoniae; Serotyping; Nepal DOI: 10.3126/kumj.v8i2.3551 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 164-168
Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients
Authors: Gupta N , Karki P , Sharma S , Shrestha N , Acharya P
Published: August 2010

Background: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. Objective: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. Material and methods: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. Results: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r=.35, p<.004) and stroke volume(r=-.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r=.36, p<.02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. Conclusion: In untreated patients with hypertension patient's body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients. Key words: Echocardiography; Haemodynamic; Metabolic Factors; Left Ventricular Mass; Non-diabetic; Hypertensive DOI: 10.3126/kumj.v8i2.3553 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 173-178
Use of double-balloon catheter in the management of epistaxis: A boon for the periphery
Authors: Bista M , Baranwal C , Maharjan M , Kafle P , Shresth S , Toran KC
Published: August 2010

Background: Epistaxis is one of the most commonly encountered emergencies in ENT practise. It has been reported that almost 60% of general population experience epistaxis of small or large quantity in his /her lifetime1. Objective: The objective of this study was to compare the outcome of double ballon catheter to normal packing method for epistaxis. Materials and methods: An interventional study of 30 patients admitted in Kathmandu Medical College, Sinamangal, Kathmandu, Nepal from mid April 2008 to mid April 2009 with bleeding from the nose were taken into study. These patients were analysed on the basis of duration of hospital stay, any related cause for epistaxis, modalities of treatment, success of balloon catheter etc. Result: Results with double-balloon catheter showed less hospital stay and better compliance by the patient. Conclusion: This study highlights that double-balloon catheter has a higher chance of acceptance by the patient and is better in the treatment of epistaxis. This method can be undertaken without anaesthetic assistance thus it is very feasible even in the most remote areas of our nation. Key words: Epistaxis; Double-balloon catheter; Anterior nasal packing; Posterior nasal packing DOI: 10.3126/kumj.v8i2.3558 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 199-202
Morbidity and early outcome of transurethral resection of prostate: A prospective single-institute evaluation of 100 patients
Authors: Shrestha B , Baidya JL
Published: August 2010

Background: Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications. Objectives: The objective of the study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute. Materials and methods: We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient. Results: The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88ml per second from 9.24ml per second and average fl ow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46ml from preoperative 86.59 ml. Conclusions: TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate. Key words: TURP ( Transurethral resection of prostate); LUTS ( Lower urinary tract symptoms); BOO (Bladder outlet obstruction) DOI: 10.3126/kumj.v8i2.3559 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 203-207
Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital
Authors: Shrestha NS , Saha R , Karki C
Published: August 2010

Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity; Maternal mortality; Five factor scoring system DOI: 10.3126/kumj.v8i2.3563 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 222-226
Acute appendicitis: Analysis of 518 histopathologically diagnosed cases at the Kathmandu University Hospital, Nepal
Authors: Makaju R , Mohammad A , Shakya A
Published: August 2010

Background: Appendicitis is important as it is a common surgical emergency. There is no medical treatment for it, timely surgery is mandatory to prevent morbidity and mortality. Objectives: The objective of this study was to analyse the pathologic findings, the demographics, and, look for the existence of the so called aetiopathogenetic factors in the context of current prevailing beliefs regarding acute appendicitis, the most common current reason for emergency abdominal surgery. Materials and methods: This was a retrospective study. It was carried out at the Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. All histopathologically diagnosed cases of acute appendicitis during the period January 1, 2004 to April 30, 2010 were included. Their macrospcopic and light microscopic examination findings were analyzed. Results: A total of 518 histopathologically diagnosed cases of acute appendicitis were found. Age distribution of these cases was between 6 to 84 years. Mean age was 30. 94 ± 15.75 years. Sex distribution consisted of 313 (60.42%) cases in males and 205 (39.58%) cases in females. Fecalith in the appendiceal lumen was seen only in 8 (1.54%) of cases. Granuloma and carcinoid was seen in 3 (0.58%) and 1 (0.19%) cases respectively. Perforation was seen in 11 (2.12%) cases. Foreign bodies, gallstones, strictures, helminthic infection, carcinoma or any other obvious/apparent aetiologic/ pathogenetic lesions/findings were not seen in any of the cases. Histopathologically staged distribution revealed that 180 (34.75%) cases were of early acute appendicitis, 250 (48.26%) cases were of acute suppurative appendicitis, and 88 (16.99%) cases were of acute gangrenous appendicitis. Conclusion: This study did not confirm the existing popular notion that luminal obstruction is the pathogenetic hallmark for acute appendicitis. Therefore, further research on this common surgical emergency is surely warranted. Key words: Acute appendicitis; fecalith; gangrenous DOI: 10.3126/kumj.v8i2.3564 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 227-230
Subclinical hypothyroidism in eastern Nepal: A hospital based study
Authors: Rohil V , Mishra AK , Shrewastwa MK , Mehta KD , Lamsal M , Baral N , Majhi S
Published: August 2010

Background: Subclinical hypothyroidism itself is associated with serious complications and also there is a known risk of subclinical hypothyroidism patients getting converted into overt disease. Objectives: The objective of the present study was to find out the prevalence of subclinical hypothyroidism in the suspected cases i.e. amongst the cases attending the thyroid laboratory at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and methods: It was a retrospective cross sectional study. Data of the free T3, free T4 and TSH estimations of the year 2007 of the Thyroid lab at BPKIHS, Dharan, Nepal was analyzed. ELISA based free T3, free T4 and TSH tests in the serum had been performed in all the cases. Results: Total cases were 1714 including 24.446% males and 75.554% females. Cases with raised TSH levels were 26.021%, cases with normal TSH levels were 54.66% and cases with low TSH levels were 19.316%. Total 350 cases (20.42 %) had subclinical hypothyroid dysfunction which includes 84 (4.901 %) males and 266 (15.519%) females. And the maximum percentage of cases in either gender was between the age groups 20 -59 years. Conclusion: The prevalence of subclinical thyroid hypothyroidism amongst the suspected cases was 20.42% which is much higher compared to the other parts of the world. The highest percentage was found in the female age group 20 - 59 years. The routine screening of the whole population is not cost effective and on the basis of the present study it is suggested that there may be routine screening of the selected populations, especially women between 20 to 59 years of age in Nepal region. The preferred screening method advised is a sensitive ELISA based TSH test. Key words: Subclinical hypothyroidism DOI: 10.3126/kumj.v8i2.3565 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 231-237
Chronic bilateral dislocation of temporomandibular joint
Authors: Shakya S , Ongole R , Sumanth KN , Denny CE
Published: August 2010

Dislocation of the condyle of the mandible is a common condition that may occur in an acute or chronic form. It is characterised by inability to close the mouth with or without pain. Dislocation has to be differentiated from subluxation which is a self reducible condition. Dislocation can occur in any direction with anterior dislocation being the commonest one. Various predisposing factors have been associated with dislocation like muscle fatigue and spasm, the defect in the bony surface like shallow articular eminence, and laxity of the capsular ligament. People with defect in collagen synthesis like Ehler Danlos syndrome, Marfan syndrome are said to be genetically predisposed to this condition. Various treatment modalities have been used ranging from conservative techniques to surgical methods. Acute dislocations can be reduced manually or with conservative approach and recurrent and chronic cases can be reduced by surgical intervention. Though the dislocation in our case was 4 months a simple manual reduction proved to be successful. We believe that manual reduction can be attempted as first line of treatment prior to surgical intervention. Key words: Temporomandibular joint; Dislocation; Management DOI: 10.3126/kumj.v8i2.3570 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 251-256