bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns and Prognostic Value of Total and Differential Leukocyte Count in Chronic Kidney Disease
Authors: Agarwal Rajiv , Light Robert P.
Published: May 2011

Background and objectives

The purpose of this study was to evaluate the levels and patterns of total and differential leukocyte counts and their prognostic importance in a cohort of people with and without chronic kidney disease (CKD).

Design, setting, participants, & measurements

Among 153 veterans without CKD and 267 with, blood leukocyte count was measured at baseline and then repeatedly over a decade. The patterns of change in leukocyte count between the two groups were compared. In the CKD cohort, the spikes in leukocyte counts were compared to the combined endpoint of ESRD and death.

Results

Patients with CKD had more granulocytes and eosinophils and fewer lymphocytes. Over time, granulocytes increased and lymphocytes decreased in those with and without CKD. In addition, in those with CKD, over time eosinophils fell and monocytes increased. Compared with their non-CKD counterparts, patients with CKD had between 1.5- and 3.0-fold more spikes in leukocyte counts. Independent risk factors for the combined endpoint were associated with spikes in the leukocyte counts of absolute and percent eosinophil count, percent granulocyte, and percent monocyte counts. In a multivariate adjusted joint model, both granulocyte and monocyte spikes were independently associated with ESRD and death (hazard ratio 1.67 and 1.52 respectively, P < 0.05).

Conclusions

Compared with those without CKD, patients with CKD have more eosinophils and granulocytes and fewer lymphocytes. Greater variation in leukocytes is seen. Spikes in granulocyte and monocyte percentages among patients with CKD are of independent prognostic importance.
Determinants of enamel decalcification during simulated orthodontic treatment
Authors: Hess Elizabeth , Campbell Phillip M. , Honeyman Allen L. , Buschang Peter H.
Published: May 2011

Objective:

To determine the relative effects that phosphoric acid etching, metal brackets, composite resin adhesives, and filled resin sealants have on enamel decalcification.

Materials and Methods:

One hundred and fifty teeth were randomly divided into six groups to test the effects of acid etching, brackets, and a composite resin adhesive. The right side of each tooth was sealed. The teeth were submitted to a simulated carious challenge by Streptococcus mutans in a nutritive media for 42 days. Scanning electron photomicrographs (SEMs) were used to qualitatively evaluate the tooth surfaces. DIAGNOdent laser fluorescence was used to quantify the decalcification changes that occurred.

Results:

SEMs showed normal enamel on the control teeth, etching patterns on the acid-etched teeth, surface degradation on the teeth that had resin, and sealant tags on the sealed side. The untreated control group showed significantly less decalcification (P ≤ .05) than did all groups except the no etch+bracket group. The no etch+bracket group showed significantly less decalcification than did the etch+bracket, no etch+resin, and the etch+resin groups. Acid-etched teeth demonstrated significantly more decalcification (34%) than did those that were not etched. The teeth with resin showed significantly more decalcification (24%) than did those without resin. There was no significant difference between teeth that did and did not have brackets. The unsealed side of the teeth showed small amounts of—but significantly more—decalcification (5%) compared to the sealed side.

Conclusions:

Acid etching and composite resin adhesives increase enamel decalcification in vitro, while brackets do not. Filled resin sealants protect the teeth from decalcification.
Effect of atmosphere above specimen on welding results during remote welding
Authors: Oiwa Shinpei , Kawahito Yousuke , Mizutani Masami , Katayama Seiji
Published: May 2011

Remote welding has already been applied in the automobile industry [S. Ream, Proceedings of the 69th Laser Materials Processing Conference, Tokyo, Japan, 2007, pp. 1–14: M. H. Rhee et al., Proceedings of the 68th Laser Materials Processing Conference, Osaka, Japan, 2007, pp. 141–146), owing to many advantages. The authors revealed that the weld bead changed from full to partial penetration during remote welding of a steel sheet at the focal position without shielding gas (S. Oiwa et al., Proceedings of the Eighth International Welding Symposium, Kyoto, Japan, 2008, p. 36: S. Oiwa et al., Proceedings of LAMP2009, Kobe, Japan, 2009, pp. 9–128]. It was attributed to the phenomena that a laser-induced plume ascended high and an incident laser beam was apparently refracted and defocused by its interaction to the tall plume. It was also considered that the interaction zone between the plume and the laser beam above the specimen was heated spatially and consequently, its refractive index distribution affected the beam shape and focusing conditions. In this study, therefore, the laser-induced plume and low refractive index zones above the specimen during laser welding using focusing optics of long focal distance were simultaneously observed with high-speed video cameras and a Michelson interferometer, respectively. As a result, it was confirmed that the interaction zones with small refractive index values ascended high together with the growth of a plume and exerted a great effect on welding results in the atmosphere without a fan or shielding gas flow. Laser welding using a fan was also confirmed to be beneficial to the production of a stable penetration weld by suppressing the rise of a plume and a zone with low refractive index values. Furthermore, it was found that the refractive index distribution inside the plume and the peripheral atmosphere had such an inclination as to decrease their values toward the beam central axis.
Welding of thick stainless steel plates up to 50 mm with high brightness lasers
Authors: Zhang Xudong , Ashida Eiji , Tarasawa Shoh , Anma Yusuke , Okada Masaya , Katayama Seiji , Mizutani Masami
Published: May 2011

Thick-section stainless steels are widely used in the components and structures for nuclear power plants. Laser welding is being considered as a high-efficiency method instead of arc welding for some components, so as to improve the production efficiency and reduce the residual stresses of the heat-affected zone. In this paper, multipasses narrow-gap welding of 50 mm thick Type 316L plates with an 8 kW disk laser was first investigated. The effect of welding conditions on the weld bead geometry and welding defects was studied. It shows that lack of fusion could be prevented by optimizing the relationship between laser power intensity and the deposited metal volume. Butt joint of 50 mm thick plates with narrow gap could be performed with eight-layers welding at laser power of 6 kW and welding speed of 0.4 m/min. In order to reduce the weld passes further, gas jet assisted laser welding was tried to weld thick Type 316L plates with a 10 kW fiber laser. The result shows that butt-joint welding of 40 mm plates without filler wire could be carried out at 0.3 m/min welding speed with no porosity or other welding defects. As for 50 mm thick plate, a good weld bead could be obtained with bead-on-plate welding from both sides at 0.2 m/min welding speed.
Surface texturing by laser cladding
Authors: Grueninger A. , Hustedt M. , Herzog D. , Huse M. , Kracht D. , Haferkamp H. , Ostendorf A.
Published: May 2011

Surface texturing is an established method for altering the structure of a surface. All known methods deal with material removal. For applications where only small walls remain on the surface, this means that most of the surface must be treated. In this paper, a new approach is presented in which texturing and laser cladding are combined in a single-step buildup process. Since only small selected areas are built up, instead of removing large areas, optimization of the processing time is expected. A galvanometer scanner and a lateral flat-bed powder nozzle are used. First results showed proof of the principle. Cladding thicknesses of more than 100 μm can be generated for small structures as well as for large areas.
Microcomputed tomography analysis of intralayer porosity generation in laser direct metal deposition and its causes
Authors: Ahsan M. Naveed , Bradley Robert , Pinkerton Andrew J.
Published: May 2011

Laser direct metal deposition has wide application in the areas of rapid manufacturing, surface coating, and component repair. Defects of interlayer and intralayer porosity are often observed in laser deposited structures and repaired components. Interlayer porosity can be controlled to some extent by adjusting processing parameters, but there is still disagreement as to the source of intralayer porosity and whether process conditions, process parameters, or initial powder materials are the dominant causal factor. In this work, two samples of Ti–6Al–4V powder, prepared using gas-atomization and the plasma rotating electrode (PREP) process, were analyzed using laser diffraction and microcomputed tomography for any initial porosity content. A 1.5 kW diode laser with a coaxial deposition head was then used to deposit a number of thin-wall structures with the different powders at different processing parameters. The deposited structures were characterized using scanning electron microscopy and microcomputed tomography. The results show a clear positive relationship between initial power porosity and intralayer porosity in deposition samples. However, the effect of processing parameters is more complex and analysis reveals that other factors such as strong Marangoni flow, pool instability, and the surrounding atmosphere may have an effect. The main trends found are a reduction in porosity with increased power and high porosity at very low mass flow rates; thus, for high value parts, PREP powder, higher power, and moderate powder mass flow rate, as dictated by other process constraints, appears to be a practical combination.
Viscoelastic changes in the blood and vascular wall in a pulsating circular flow
Authors: Beraia Merab , Todua Fridon , Khomeriki Irina
Published: May 2011

Viscoelastic changes in the blood and vascular wall in a pulsating circular flow

Altered flow conditions, such as separation and recirculationg zones, low and oscillatory shear stress, play an important role in the development of arterial disease. Endothelial denudation by the blood flow is the first step in atherosclerosis. The description of blood flow in vivo is complicated due to the viscoelasticity of vessel walls. However, conventional researches of the effect of the blood vessel viscoelasticity on the blood pressure wave propagation using non-linear one-dimensional models do not take into account the viscoelasticity, despite it being importance in the analysis of pulse wave propagation in arteries.

The purpose of this paper is to study the impact of the arterial pulse wave on the viscoelastic blood flow and initial factors of atherosclerosis.

In 12 healthy men (25-39 years of age) peak velocity, mean velocity, mean flow and net flow in the aorta have been investigated by MR angiography.

Initial velocity was registered after 43msec of the ECG-R wave, and it differed from zero at all sites of the aorta, although net flow was equal to zero. Womersley's number from the ascending to the thoracic aorta decreased from 12.5 ± 1.5 to 7.3 ± 1.2; flow modified from inertio-elastic to viscous. Pulse pressure wave move on artery walls fifteen or more times more rapidly than the blood flow. In the aortic arch in protodiastole blood flow separated into the opposite directed streams resulting in wave superposition with the high net flow. At the isthmus area separated waves interferences and reflects to anterograde direction.

Pulse oscillation increases strain rate to the contiguous vessel wall flow layers. At the sites with the flow wave negative interference vessel pulse oscillation attenuates and at the boundary reflection flow wave can shift the vessel wall.
Study of dosimetric variation due to interfraction organ movement in High Dose Rate Interstital (MUPIT) brachytherapy for gynecologic malignancies
Authors: Velmurugan Thanigaimalai , Sukumar Prabakar , Krishnappan Chokkalingam , Boopathy Raghavendiran
Published: May 2011

Study of dosimetric variation due to interfraction organ movement in High Dose Rate Interstital (MUPIT) brachytherapy for gynecologic malignancies

Ten patients with cancer of uterine cervix who underwent interstitial brachytherapy using MUPIT templates were CT scanned (CT1) using which bladder, rectum and CTV were delineated. The treatment plan PCT1 was generated and optimized geometrically on the volume. CT scan (CT2) was repeated before the second fraction of the treatment CTV and critical organs were delineated. The plan (PCT2) was created by reproducing the Plan PCT1 in the CT2 images and compared with PCT1. Bladder, Rectum and CTV percentage volume variation ranges from +28.6% to -34.3%, 38.4% to -14.9% and 8.5% to -15.2% respectively. Maximum dose variation in bladder was +17.1%, in rectum was up to +410% and in CTV was -13.0%. The dose to these structures varies independently with no strong correlation with the volume variation. Hence it is suggested that repeat CT and re-planning is mandatory before second fraction execution.
Baseline survey of level of quality control in medical radiology in Cross River State, Nigeria
Authors: Inyang S. , Egbe N. , Inyang I. , Oshi D.
Published: May 2011

Baseline survey of level of quality control in medical radiology in Cross River State, Nigeria

Quality control (QC) in radiology is meant to ensure that accurate diagnoses are obtained with radiation doses kept as low as reasonably achievable. It is also a fundamental requirement by the Regulatory Authorities in issuing operational license to operators of radiology facilities. In Nigeria, QC issues in Radiation Medicine have recently been introduced and are being enforced by the Nigerian Nuclear Regulatory Authority (NNRA). The level of QC practice in the radiology facilities in Cross River State, Nigeria was evaluated to obtain baseline information that could be relied on in the future to determine the level of improvement. It was observed that radiology practitioners appreciate QC and its importance in their practice, the present low level of its implementation notwithstanding.
A Scenario of Poisoning in Children in Manipal Teaching Hospital
Authors: Malla Tejesh , Malla Kalpana K , Rao KS , Gauchan Eva , Basnet Sahisnuta , Koirala DP
Published: May 2011

Objective: To see the pattern and prevalence of poisoning in children in Manipal Teaching Hospital, Pokhara. The cases were also considered in relevance to the age groups with various agents, the commonly observed clinical features in various poisonings and mortality. Study design: Hospital based retrospective study. Study period: 4 years (January 2006 – January 2010). Study place: Department of Paediatric, Manipal Teaching Hospital, Pokhara. Material and Methods: A detailed study of all the case files of the children admitted with various acute poisonings, where the causative agent was known, was done. Results: A total number of 94 children (56 males & 38 females) were admitted with poisoning (1.79% of the total admissions) during that period. Maximum number of children were of the preschool age group i.e. < 5 years (64.89%). Organophosphorus Compounds (OPC) (27%) and Kerosene Oil (23%) were the two most frequent agents involved. The other agents included Snake bite (19%), Drugs/ Chemicals (16%), Dhatura (12%), and Mushroom poisoning (3%). The most common nature of poisoning noted was accidental (95%). The mortality rate observed was 6.38%. Conclusion: OPC and Kerosene Oil poisoning were the two most common poisoning observed in this study comprising almost half the cases; accidental poisoning was the most common pattern noted and there was a male predominance. Early recognition and timely treatment can decrease the mortality. Key words: Poisoning; Organophosphorus and Kerosene poisoning; Snake bite.DOI: 10.3126/jnps.v31i2.3634 J Nep Paedtr Soc 2010;31(2):83-88
Case of Pseudo-Bartter's Syndrome: An atypical presentation of cystic fibrosis
Authors: Khorasani Enayatollah Nemat
Published: May 2011

A three months infant who in the beginning had disease cystic fibrosis was diagonosed with pseudo-bartter's syndrome. The disease began with coughing, diarrhoea, vomiting and weakness. Investigation revealed; electrolytes showin hyponatremia (110 mmol/L) and hypokalemic (2.6 mmol/L) and hypochloremic (63 mmol/L) metabolic alkalosis (HCO3=43 mmol/L). Key words: Pseudo Bartter's Syndrome; Cystic fibrosis; Metabolic alkalosis. DOI: 10.3126/jnps.v31i2.3911 J Nep Paedtr Soc 2010;31(2):121-123
Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal
Authors: Sharma Krishna Sagar , Singh Rupa , Shah Gauri Shankar
Published: May 2011

Introduction. Guillain Barre Syndrome (GBS) is a post infectious polyneuropathy involving mainly motor but sometimes sensory and autonomic nerves. It is an acquired disease of the peripheral nerves that is characterized by rapidly progressing paralysis, areflexia and albumino-cytological dissociation in CSF. Methodology: Prospective, descriptive, observational, hospital based study was carried out to find out the clinico-epidemiological features of GBS including existing treatment modalities and its outcome. All cases fulfilled the criteria for AFP (Acute flaccid Paralysis) surveillance was included. Cases were reviewed for full medical history and examinations. To confirm the diagnosis, necessary investigations were carried out and combined with clinical symptoms. Results: Thirty patients were included in the study during study period. Among them 90% were diagnosed as GBS, 7.4% patients of GBS were associated with hypokalemic paralysis, 7.4% diagnosed as transverse myelitis and 3.7% diagnosed as idiopathic neuropathy. Different types of GBS were classified as AIDP (Acute inflammatory demyelinating polyneuropathy) 62.96%, AMAN (Acute motor axonal neuropathy) - 25.52%, AMASAN (Acute motor and sensory axonal neuropathy) - 3.3% and MFS (Miller fisher's syndrome) - 6.6% according to NCV result. Male female ratio is 1.7:1.0. There was 14.8% patients had relapse within 5 year. Associated diseases were URTI, pneumonia, sore throat and diarrhea. Facial Nerve palsy was commonest cranial nerve involvement.Sixty percentage of patients presented with sensory symptoms. There was transient bowel and bladder involvement in 20% of the cases. 69.2% patients became bed ridden at the nadir. There was albumin-cytological dissociation in 80% case. Majority of patients improved with supportive treatment alone, 19.5% patient required ventilator support among them 40% died. 7.4% of cases expired during treatment. Half of the patients fully recovered within 3 months. Conclusion: GBS is the commonest cause of AFP, AIDP being commonest subtype in our setting. We have to improve our existing treatment facilities and extend to different centers to detect and treat GBS. Most of the patients improve with supportive treatment alone. Ventilator support indicates grave prognosis. Key words: GBS (Gullein Barre Syndrome); AFP (Acute flaccid Paralysis); AIDP (Acute inflammatory demyelinating polyneuropathy; AMAN (Acute motor axonal neuropathy); AMASAN (Acute motor and sensory axonal neuropathy); MFS (Miller fisher's syndrome). DOI: 10.3126/jnps.v31i2.4065 J Nep Paedtr Soc 2010;31(2):93-97
Cerebellar Mutism After Pineal Tumour Excision: A Case Report
Authors: Roka Yam Bahadur , Shrestha Manzil , Puri Pushpa Raj , Aryal Sameer
Published: May 2011

Cerebellar mutism syndrome (CMS) was first described by Rekate et al in 1985. This syndrome is a common complication of posterior fossa surgery in children with range of 11-29% and usually manifests as diminished speech, hypotonia, and ataxia. The cause is due to bilateral pertubation of the dentate nuclei and their efferent pathways by edema, perfusional defects, axonal damage or metabolic disturbances. Other rare causes of CMS like acute subdural hematoma of the posterior fossa, head injury, brainstem glioma surgery, meningitis and basilar artery occlusion have also been reported. CMS after supracerebellar resection of the pineal tumor is a very rare with very few cases reported. We report such a case in a 10- year old boy who underwent excision of a pineal tumor through the infratentorial supracerebellar route. Key Words: Cerebellar mutism; hydrocephalus; pineal tumor; posterior fossa. DOI: 10.3126/jnps.v31i2.4167 J Nep Paedtr Soc 2010;31(2):124-126
Clinical and Biochemical Profile of Acute Liver Failure with Hepatic Encephalopathy in Children from Eastern Nepal
Authors: Shah Gauri Shankar , Singh Manoj Kumar , Shah Dheeraj
Published: May 2011

Introduction: Hepatic encephalopathy is a potentially reversible neurophyschiatric abnormality in the setting of liver failure. Acute liver failure (ALF) is a potentially life-threatening disorder in children. Objectives: The present study evaluated the clinical profile, outcome and factors influencing the outcome of children presenting with acute liver failure and hepatic encephalopathy presenting to a referral hospital of Eastern Nepal. Methodology: Thirty children (17 males and 13 females) were admitted with this diagnosis during two year period.Prospective study. Results: The most common cause of acute liver failure was mushroom poisoning seen in 30% of cases. Only 37% (11 out of 30) children survived, most of them in early stages (Stage I and II) of encephalopathy. Bleeding manifestations were significantly more common (P=0.002) in deaths as compared to survivors. Conclusion: As liver failure is associated with high mortality rates especially in absence of facilities for liver transplantation, efforts should be directed in favor of implementing preventive measures such as vaccination and community education to prevent toxin ingestion. Key Words: Acute liver failure; Hepatic encephalopathy; Mushroom poisoning DOI: 10.3126/jnps.v31i2.4639 J Nep Paedtr Soc 2010;31(2):89-92
Knowledge and Management Practices of Paediatricians about Autism Spectrum Disorder in Kathmandu, Nepal
Authors: Khatri Goma Kumari , Onta Sharad Raj , Tiwari Suresh , Choulagai BP
Published: May 2011

Introduction: Autism Spectrum Disorder is increasing day by day around the world. Recent finding of CDC shows that this problem occurs 1 in 110 populations. This problem is such a disorder, which not only affects to the individuals but also the families, society and nation as a whole if not managed properly. Aim: The aim of this study was to assess the knowledge and management practices of Paediatricians about Autism Spectrum Disorder. Methods: The study design was descriptive and cross sectional. A census was used to select the study unit and self-administered questionnaire was used to collect data. Results: Out of 54 Paediatricians, 64.8 percent had inadequet knowledge and 59.3 percent had inadequet practice related to Autism Spectrum Disorder. Majority of them (79.6%) knew that Autism Spectrum Disorder is a Developmental Disorder but they (24.1%) also mentioned it to be mental retardation and 13 percent thought that it as a form of psychosis. Most of Paediatricians, (72.2%) knew that Autism Spectrum Disorder could be due to genetic reason. However, a significant number of respondents 22.2 percent also believed that Autism Spectrum Disorder could occur due to the neglect of children. Almost fifty percent of Paediatricians had rarely handled the Autistic child and a majority of the Paediatricians, (90.7%) found it difficult to diagnose this disease. Conclusion: Most of the Paediatricians in Nepal have inadequet knowledge and practice related to Autism Spectrum Disorder. Although some of the practice was good, they also had misconceptions as to managing the children with Autistic disorders. Most of the Paediatricians need to improve their knowledge and practice related to Autism Spectrum Disorder. Key words: Autism Spectrum Disorder (ASD); Autistic; socialisation problem; communication problem; steriotyped behavior. DOI: 10.3126/jnps.v31i2.4640 J Nep Paedtr Soc 2010;31(2):98-104
Rotavirus and its Genotype Distribution among Children Less than Three Years Presenting with Acute Watery Diarrhoea to a General Hospital in Urban Nepal
Authors: Shrestha Shrijana , Upadhyay Bishwas , Limbu Bhupendra , Pradhan Rahul , Nakagomi Tokoko , Thorson Stephen , Pollard Andrew J , Adhikari Neelam
Published: May 2011

Introduction: Viruses are the most common cause for diarrhoea in infants and small children. Rotavirus is the most frequent viral etiology, causing 125 million episodes of infantile diarrhoea and over 600,000 deaths per year. Materials and methods: A cross sectional study between January and March 2008 was conducted at Patan Hospital, Kathmandu to find out the prevalence of rotavirus among children < 3 years with watery diarrhoea and to identify common strains of rotavirus in the study population. Testing for rotavirus was undertaken by using Rota/Adeno screen Dipstick M583CE. Rotavirus strain identification was done at Nagasaki University Japan. Data was analyzed using SPSS® for Windows V 15.0 software. Results: 119 children with acute watery diarrhoea were enrolled. Rotavirus antigen was found in 63 cases (53%). The highest percentage of rotavirus infection was found in the second six months of life. Among the children with positive rotavirus antigen, the median age was 10 months (IRQ 8.00). The most predominant strain of rotavirus identified was G12 followed by G9 and G1. Most predominant G and P combination was G9 P[8] followed by G12P[6]. Conclusion: The study has shown the prevalence of unusual serotypes of rotavirus. Though rotavirus vaccine has been studied, used widely and found to be very effective, none of the vaccine efficacy studies have included common serotypes identified in Nepal. Level of protection conferred by infant immunization with the current rotavirus vaccines against the strains circulating in Nepal is unknown and careful surveillance through vaccine implementation is needed. Key words: Diarrhoea; Nepal; rotavirus; rotavirus genotypes; vaccine DOI: 10.3126/jnps.v31i2.4641 J Nep Paedtr Soc 2010;31(2):110-115
Wheeze among Pneumonia Patients in Paediatrics Department of Patan Hospital
Authors: Shrestha Sita Ram , Yadhav B , Shresta S
Published: May 2011

Background: Acute respiratory infections are major causes of morbidity and mortality in children in developing countries. It is estimated that 3.9 million children die annually from acute respiratary diseases and most of them in developing countries. In significant cases, wheeze is associated with Pneumonia. This study was done to find out the outcome of pneumonia patients admitted in the paediatric ward with wheeze and without wheeze in terms of hospital stay, age predominance, sex ratio, mortality and morbity of patients. Some comorbidies of patients were also studied, Methods: This was a retrospective study done in the paediatric ward of Patan Hospital from April-June 2004 to March-April 2006 AD with following inclusion and exclusion criteria. All the children presented to Emergency ward up to 14 years with symptoms and sign of pneumonia were included in the study(high grade fever with chills and rigor,cough,fast breathing,creps and wheeze in auscultation)Age more than 14 years,history of Asthma,Tuberculosis,Acute wheeze associated with cardiac problems were excluded from study.Pneumonia patients admitted not from Emergency department were also excluded from study. Pneumonia with wheeze, outcome, and the hospital stay were studied. The outcome was measured in terms of improvement, deterioration or death of patients. Co morbidities associated with Pneumonia were also studied. Results: Out of 4620 children admitted in pediatric ward eleven hundred and sixty four (Twenty five percent) cases were of pneumonia and among them two hundred eighty three(twenty four percent) had wheeze. Majority of patients with pneumonia having wheeze falls on age group in between 2 and 12 months, followed by 1-5 years. The male children were more frequently affected. The co morbidities were febrile seizure, acute gastroenteritis, sepsis and urinary tract infection. Conclusion: The children admitted in Paediatric ward with Pneumonia were eleven hundred and sixty four and with wheeze were two hundred and eight three. Among them male were more than females. Majority of patients falls on age group two to twelve months. and study showed that they had prolonged hospital stay in relation to without wheeze. Three percent of the cases had blood culture positive among eleven hundred and sixty four sample Key words: Acute respiratory infections (ARI); Wheeze; Paediatric ward; Sepsis; hospital stay. DOI: 10.3126/jnps.v31i2.4642 J Nep Paedtr Soc 2010;31(2):116-120
Impact of Interspousal Violence and Maternal Deprivation on a Child’s Mental and Physical Health: A Case Report
Authors: Onyiriuka Alphonsus N
Published: May 2011

This paper presents a case of an emotionally deprived child with some evidence of child neglect resulting from separation of parents (maternal deprivation). It also further confirms the long recognized fact that the most successful treatment of growth failure and weight loss due to psychosocial deprivation is restoration of a normal social environment. In particular, it highlights the need for a high index of suspicion and awareness on the part of medical personnel with regard to emotional disorders in children. Key words: Maternal deprivation; child neglect; psychological deprivation. DOI: 10.3126/jnps.v31i2.4643 J Nep Paedtr Soc 2010;31(2):137-140
Medical Harm and Patient Safety-III: Procedural Errors
Authors: Adhikari Neelam
Published: May 2011

Key words: Procedural errors; procedural and surgical site infections; protocols and guidelines; verification process; communication failure; teamworkDOI: 10.3126/jnps.v31i2.4646 J Nep Paedtr Soc 2010;31(2):157-159
Histopathological features with angiographic correlates of internal carotid artery pseudo-occlusion: impact of plaque compositions
Authors: Hirata Yoko , Sakata Noriyuki , Inoue Tooru , Yasumori Kotaro , Yasaka Masahiro , Okada Yasushi
Published: May 2011

Object

This study describes clinicopathological characteristics of pseudo-occlusion of the internal carotid artery with regard to its possible mechanisms.

Methods

The authors retrospectively reviewed 17 patients with pseudo-occlusion and 23 with high-grade stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria ≥ 90%, but no collapsed distal internal carotid artery) who underwent carotid endarterectomy. Atherosclerotic risk factors, clinical presentation, angiographic findings, and histological features of plaque obtained from the carotid endarterectomy were investigated and comparisons were made between groups.

Results

Plaques obtained in the pseudo-occlusion group were significantly more fibrous and less atheromatous than those in the high-grade stenosis group. Old, organized thrombi were more frequently found in pseudo-occlusion group plaques than in high-grade stenosis group plaques. Plaques acquired in the pseudo-occlusion group had 2 different histological features: the presence or absence of the original lumen. The pseudo-occlusion plaques with total occlusion and recanalization (8 patients) were composed of thrombotic total occlusion with lumen recanalization by large neovascular channels, whereas those with severe stenosis (9 patients) were fibrous or fibroatheromatous and had severe stenosis of the original lumen. In patients with pseudo-occlusion and total occlusion and recanalization, the authors observed a significantly higher incidence of transient ischemic attack and anterior communicating artery–posterior communicating artery collateral flow than those with high-grade stenosis and pseudo-occlusion with severe stenosis.

Conclusions

Plaques of the pseudo-occlusion group were more fibrous than those of the high-grade stenosis group and had 2 different histological features: pseudo-occlusion with total occlusion and recanalization or pseudoocclusion with severe stenosis. This difference in plaque histology may be related to the clinical features of pseudoocclusion, such as symptoms and collateral flow patterns.
A 10-year experience of radiosurgical treatment for cerebral arteriovenous malformations: a perspective from a series with large malformations
Authors: Murray Gisela , Brau Ricardo H.
Published: May 2011

Object

The purpose of this study was to describe a 10-year experience in the use of radiosurgery (RS) for patients with arteriovenous malformations (AVMs) in Puerto Rico.

Methods

This retrospective analysis was performed for all patients with AVMs treated with RS by the senior author (R.H.B.) in Puerto Rico. Between February 1999 and December 2009, a total of 83 patients underwent the procedure. All charts were reviewed for recollection of demographic data, and AVM and treatment characteristics. Clinical and radiographic follow-up information was collected retrospectively.

Results

Eighty-three patients were treated and 86 RS procedures for AVMs were performed during a 10-year period. Eight patients were lost to follow-up. The remaining 75 patients included 36 males and 39 females, whose median age was 34.5 years. Hemorrhage was the initial presentation in 40% of patients. Fifty-seven AVMs (73%) were treated previously with endovascular neurosurgery, without success. The median volume of the malformation was 17.7 ml. Nearly 65% of the malformations were considered large (≥ 10 ml) in volume. Forty patients had AVMs with largest diameter ≥ 3.5 cm.

The overall obliteration rate was 56.4%, and the median time for obliteration was 29 months. The AVMs ≥ 3.5 cm in diameter had a greater latency period than those < 3.5 cm (31 months vs 46 months, respectively; p = 0.01). In addition, AVM obliteration was inversely associated with its volume, especially in large lesions (p = 0.037). In bivariate analysis, patients achieving obliteration had lower Spetzler-Martin scores compared with patients in whom obliteration was not achieved (p = 0.009). Postradiosurgery hemorrhages were seen in 9 cases. Eleven patients underwent surgery after RS. Major neurological deficits developed in 9 patients, whereas 17 had only minor deficits. The occurrence of neurological deficits was significantly associated with lesions with volume ≥ 10 ml.

Conclusions

Radiosurgery is a reasonable treatment option for AVMs in the majority of cases, in spite of the large, difficult-to-treat malformations.
Comprehensive analysis of risk factors for seizures after deep brain stimulation surgery
Authors: Pouratian Nader , Reames Davis L. , Frysinger Robert , Elias W. Jeff
Published: May 2011

Object

The aim of this study was to assess risk factors for postoperative seizures after deep brain stimulation (DBS) lead implantation surgery and the impact of such seizures on length of stay and discharge disposition.

Methods

The authors reviewed a consecutive series of 161 cases involving patients who underwent implantation of 288 electrodes for treatment of movement disorders at a single institution to determine the absolute risk of postoperative seizures, to describe the timing and type of seizures, to identify statistically significant risk factors for seizures, and to determine whether there are possible indications for seizure prophylaxis after DBS lead implantation. The electronic medical records were reviewed to identify demographic details, medical history, operative course, and postoperative outcomes and complications. To evaluate significant associations between potential risk factors and postoperative seizures, both univariate and multivariate analyses were performed.

Results

Seven (4.3%) of 161 patients experienced postoperative seizures, all of which were documented to have been generalized tonic-clonic seizures. In 5 (71%) of 7 cases, patients only experienced a single seizure. Similarly, in 5 of 7 cases, patients experienced seizures within 24 hours of surgery. In 6 (86%) of the 7 cases, seizures occurred within 48 hours of surgery. Univariate analysis identified 3 significant associations (or risk factors) for postoperative seizures: abnormal findings on postoperative imaging (hemorrhage, edema, and or ischemia; p < 0.001), age greater than 60 years (p = 0.021), and transventricular electrode trajectories (p = 0.023). The only significant factor identified on multivariate analysis was abnormal findings on postoperative imaging (p < 0.0001, OR 50.4, 95% CI 5.7–444.3). Patients who experienced postoperative seizures had a significantly longer length of stay than those who were seizure free (mean ± SD 5.29 ± 3.77 days vs 2.38 ± 2.38 days; p = 0.002, Student 2-tailed t-test). Likewise, final discharge to home was significantly less likely in patients who experienced seizures after implantation (43%) compared with those patients who did not (92%; p = 0.00194, Fisher exact test).

Conclusions

These results affirm that seizures are an uncommon complication of DBS surgery and generally occur within 48 hours of surgery. The results also indicate that hemorrhage, edema, or ischemia on postoperative images (“abnormal” imaging findings) increases the relative risk of postoperative seizures by 30- to 50-fold, providing statistical credence to the long-held assumption that seizures are associated with intracranial vascular events. Even in the setting of a postimplantation imaging abnormality, long-term anticonvulsant therapy will not likely be required because none of our patients developed chronic epilepsy.
Perineural extension of cutaneous desmoplastic melanoma mimicking an intracranial malignant peripheral nerve sheath tumor
Authors: Barnett Samuel L. , Wells Michael J. , Mickey Bruce , Hatanpaa Kimmo J.
Published: May 2011

The authors present a case illustrating the importance of obtaining a biopsy of any facial skin lesions in a patient presenting with an intracranial tumor involving the facial or trigeminal nerve. Conventional malignant melanoma metastasizes to the brain frequently and does not usually pose diagnostic difficulties. Direct intracranial spread of cutaneous melanoma is rare. In our patient, desmoplastic melanoma with perineural spread to the Meckel cave mimicked a malignant peripheral nerve sheath tumor clinically, radiographically, and histologically.
Pesticide Exposure, Safety Issues, and Risk Assessment Indicators
Authors: Damalas Christos A. , Eleftherohorinos Ilias G.
Published: May 2011

Pesticides are widely used in agricultural production to prevent or control pests, diseases, weeds, and other plant pathogens in an effort to reduce or eliminate yield losses and maintain high product quality. Although pesticides are developed through very strict regulation processes to function with reasonable certainty and minimal impact on human health and the environment, serious concerns have been raised about health risks resulting from occupational exposure and from residues in food and drinking water. Occupational exposure to pesticides often occurs in the case of agricultural workers in open fields and greenhouses, workers in the pesticide industry, and exterminators of house pests. Exposure of the general population to pesticides occurs primarily through eating food and drinking water contaminated with pesticide residues, whereas substantial exposure can also occur in or around the home. Regarding the adverse effects on the environment (water, soil and air contamination from leaching, runoff, and spray drift, as well as the detrimental effects on wildlife, fish, plants, and other non-target organisms), many of these effects depend on the toxicity of the pesticide, the measures taken during its application, the dosage applied, the adsorption on soil colloids, the weather conditions prevailing after application, and how long the pesticide persists in the environment. Therefore, the risk assessment of the impact of pesticides either on human health or on the environment is not an easy and particularly accurate process because of differences in the periods and levels of exposure, the types of pesticides used (regarding toxicity and persistence), and the environmental characteristics of the areas where pesticides are usually applied. Also, the number of the criteria used and the method of their implementation to assess the adverse effects of pesticides on human health could affect risk assessment and would possibly affect the characterization of the already approved pesticides and the approval of the new compounds in the near future. Thus, new tools or techniques with greater reliability than those already existing are needed to predict the potential hazards of pesticides and thus contribute to reduction of the adverse effects on human health and the environment. On the other hand, the implementation of alternative cropping systems that are less dependent on pesticides, the development of new pesticides with novel modes of action and improved safety profiles, and the improvement of the already used pesticide formulations towards safer formulations (e.g., microcapsule suspensions) could reduce the adverse effects of farming and particularly the toxic effects of pesticides. In addition, the use of appropriate and well-maintained spraying equipment along with taking all precautions that are required in all stages of pesticide handling could minimize human exposure to pesticides and their potential adverse effects on the environment.
A Geostatistical Approach to Assess the Spatial Association between Indoor Radon Concentration, Geological Features and Building Characteristics: The Case of Lombardy, Northern Italy
Authors: Borgoni Riccardo , Tritto Valeria , Bigliotto Carlo , De Bartolo Daniela
Published: May 2011

Radon is a natural gas known to be the main contributor to natural background radiation exposure and second to smoking, a major leading cause of lung cancer. The main source of radon is the soil, but the gas can enter buildings in many different ways and reach high indoor concentrations. Monitoring surveys have been promoted in many countries in order to assess the exposure of people to radon. In this paper, two complementary aspects are investigated. Firstly, we mapped indoor radon concentration in a large and inhomogeneous region using a geostatistical approach which borrows strength from the geologic nature of the soil. Secondly, knowing that geologic and anthropogenic factors, such as building characteristics, can foster the gas to flow into a building or protect against this, we evaluated these effects through a multiple regression model which takes into account the spatial correlation of the data. This allows us to rank different building typologies, identified by architectonic and geological characteristics, according to their proneness to radon. Our results suggest the opportunity to differentiate construction requirements in a large and inhomogeneous area, as the one considered in this paper, according to different places and provide a method to identify those dwellings which should be monitored more carefully.
Playing It Safe: Assessing Cumulative Impact and Social Vulnerability through an Environmental Justice Screening Method in the South Coast Air Basin, California
Authors: Sadd James L. , Pastor Manuel , Morello-Frosch Rachel , Scoggins Justin , Jesdale Bill
Published: May 2011

Regulatory agencies, including the U.S. Environmental Protection Agency (US EPA) and state authorities like the California Air Resources Board (CARB), have sought to address the concerns of environmental justice (EJ) advocates who argue that chemical-by-chemical and source-specific assessments of potential health risks of environmental hazards do not reflect the multiple environmental and social stressors faced by vulnerable communities. We propose an Environmental Justice Screening Method (EJSM) as a relatively simple, flexible and transparent way to examine the relative rank of cumulative impacts and social vulnerability within metropolitan regions and determine environmental justice areas based on more than simply the demographics of income and race. We specifically organize 23 indicator metrics into three categories: (1) hazard proximity and land use; (2) air pollution exposure and estimated health risk; and (3) social and health vulnerability. For hazard proximity, the EJSM uses GIS analysis to create a base map by intersecting land use data with census block polygons, and calculates hazard proximity measures based on locations within various buffer distances. These proximity metrics are then summarized to the census tract level where they are combined with tract centroid-based estimates of pollution exposure and health risk and socio-economic status (SES) measures. The result is a cumulative impacts (CI) score for ranking neighborhoods within regions that can inform diverse stakeholders seeking to identify local areas that might need targeted regulatory strategies to address environmental justice concerns.
Carotenoid β-Ring Hydroxylase and Ketolase from Marine Bacteria—Promiscuous Enzymes for Synthesizing Functional Xanthophylls
Authors: Misawa Norihiko
Published: May 2011

Marine bacteria belonging to genera Paracoccus and Brevundimonas of the α-Proteobacteria class can produce C40-type dicyclic carotenoids containing two β-end groups (β rings) that are modified with keto and hydroxyl groups. These bacteria produce astaxanthin, adonixanthin, and their derivatives, which are ketolated by carotenoid β-ring 4(4′)-ketolase (4(4′)-oxygenase; CrtW) and hydroxylated by carotenoid β-ring 3(3′)-hydroxylase (CrtZ). In addition, the genus Brevundimonas possesses a gene for carotenoid β-ring 2(2′)-hydroxylase (CrtG). This review focuses on these carotenoid β-ring-modifying enzymes that are promiscuous for carotenoid substrates, and pathway engineering for the production of xanthophylls (oxygen-containing carotenoids) in Escherichia coli, using these enzyme genes. Such pathway engineering researches are performed towards efficient production not only of commercially important xanthophylls such as astaxanthin, but also of xanthophylls minor in nature (e.g., β-ring(s)-2(2′)-hydroxylated carotenoids).
Trade Liberalization and Climate Change: A Computable General Equilibrium Analysis of the Impacts on Global Agriculture
Authors: Calzadilla Alvaro , Rehdanz Katrin , Tol Richard S.J.
Published: May 2011

Based on predicted changes in the magnitude and distribution of global precipitation, temperature and river flow under the A1B and A2 scenarios of the Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios (IPCC SRES), this study assesses the potential impacts of climate change and CO2 fertilization on global agriculture, and its interactions with trade liberalization, as proposed for the Doha Development Round. The analysis uses the new version of the GTAP-W model, which distinguishes between rainfed and irrigated agriculture and implements water as an explicit factor of production for irrigated agriculture. Significant reductions in agricultural tariffs lead to modest changes in regional water use. Patterns are non-linear. On the regional level, water use may go up for partial liberalization, and down for more complete liberalization. This is because different crops respond differently to tariff reductions, and because trade and competition matter too. Moreover, trade liberalization tends to reduce water use in water scarce regions, and increase water use in water abundant regions, even though water markets do not exist in most countries. Considering impacts of climate change, the results show that global food production, welfare and GDP fall over time while food prices increase. Larger changes are observed under the SRES A2 scenario for the medium term (2020) and under the SRES A1B scenario for the long term (2050). Combining scenarios of future climate change with trade liberalization, countries are affected differently. However, the overall effect on welfare does not change much.