bluuebunny/crossref_metadata_2025 huggingface dataset:
Examination of the Relationship Between Oncology Drug Labeling Revision Frequency and FDA Product Categorization
Authors: Berlin Robert J.
Published: April 2009

Objectives. I examined the relationship between the Food and Drug Administration's (FDA's) use of special regulatory designations and the frequency with which labels of oncology drugs are revised to explore how the FDA's designation of products relates to product development and refinement.

Methods. One hundred oncology drugs, designated by the FDA as accelerated approval, priority review, orphan drug, or traditional review, were identified from publicly available information. Drug information for each product was evaluated to assess the rate at which manufacturers revised product labeling. Rates were compared between specially categorized products and traditional review products (e.g., orphan vs nonorphan drugs) to produce revision rate ratios for each special category.

Results. Labeling for accelerated approval and priority review products are revised significantly more frequently than are labels for traditional products.

Conclusions. Accelerated approval products are approved based on surrogate endpoints; this approval process anticipates subsequent labeling refinement. Priority review products, however, are approved through a process that is ostensibly as rigorous as traditional review. Their higher than expected label revision rate may suggest deficiencies in the FDA's current priority review evaluation processes.
Adding the Female Condom to the Public Health Agenda on Prevention of HIV and Other Sexually Transmitted Infections Among Men and Women During Anal Intercourse
Authors: Kelvin Elizabeth A. , Smith Raymond A. , Mantell Joanne E. , Stein Zena A.
Published: April 2009

Legal barriers to conducting public health research on methods of protection for anal intercourse were lifted in the United States in 2003 when the US Supreme Court invalidated all state antisodomy laws. Although research funding has been available for the development of rectal microbicides, the female condom, which has already been approved for vaginal use, has not been evaluated for anal use.

Although there is no evidence that the female condom is safe for anal intercourse, it has already been taken up for off-label use by some men who have sex with men. This demonstrates the urgent need for more protection options for anal intercourse and, more immediately, the need to evaluate the safety and efficacy of the female condom for anal intercourse.
Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development
Authors: Spikes Pilgrim S. , Purcell David W. , Williams Kim M. , Chen Ying , Ding Helen , Sullivan Patrick S.
Published: April 2009

Objectives. We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups.

Methods. We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n = 1186), with men (n = 741), or with men and women (n = 111).

Results. Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode.

Conclusions. HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.
Risks of Recreational Exposure to Waterborne Pathogens Among Persons With HIV/AIDS in Baltimore, Maryland
Authors: McOliver Cynthia C. , Lemerman Hanna B. , Silbergeld Ellen K. , Moore Richard D. , Graczyk Thaddeus K.
Published: April 2009

Objectives. We assessed the prevalence of recreational activities in the waterways of Baltimore, MD, and the risk of exposure to Cryptosporidium among persons with HIV/AIDS.

Methods. We studied patients at the Johns Hopkins Moore Outpatient AIDS Clinic. We conducted oral interviews with a convenience sample of 157 HIV/AIDS patients to ascertain the sites used for recreational water contact within Baltimore waters and assess risk behaviors.

Results. Approximately 48% of respondents reported participating in recreational water activities (fishing, crabbing, boating, and swimming). Men and women were almost equally likely to engage in recreational water activities (53.3% versus 51.3%). Approximately 67% (105 of 157) ate their own catch or that of friends or family members, and a majority (61%, or 46 of 75) of respondents who reported recreational water contact reported consumption of their own catch.

Conclusions. Baltimoreans with HIV/AIDS are engaging in recreational water activities in urban waters that may expose them to waterborne pathogens and recreational water illnesses. Susceptible persons, such as patients with HIV/AIDS, should be cautioned regarding potential microbial risks from recreational water contact with surface waters.
Natural brane-confinement from massive Z
2-spontaneously broken Kaluza-Klein excitations in the bulk
Authors: Dariescu Marina , Dariescu Ciprian , Romero Carlos
Published: April 2009

For a real scalar field minimally coupled to bulk gravity, in five dimensions, we analytically solve the Gordon equation, near one of the degenerated vacua of an effective potential with a spontaneously broken Z
2-symmetry. Dealing with the back-reaction from the excited massive modes on the whole scale function, we are pointing out that the lighter excitations of the scalar in the bulk turn more and more the warp function into the one of a partition on the confined brane.
Coherent states for Smorodinsky-Winternitz potentials
Authors: Ünal Nuri
Published: April 2009

In this study, we construct the coherent states for a particle in the Smorodinsky-Winternitz potentials, which are the generalizations of the two-dimensional harmonic oscillator problem. In the first case, we find the non-spreading wave packets by transforming the system into four oscillators in Cartesian, and also polar, coordinates. In the second case, the coherent states are constructed in Cartesian coordinates by transforming the system into three non-isotropic harmonic oscillators. All of these states evolve in physical-time. We also show that in parametric-time, the second case can be transformed to the first one with vanishing eigenvalues.
The Yang-Mills fields — from the gauge theory to the mechanical model
Authors: Constantinescu Radu , Ionescu Carmen
Published: April 2009

The paper presents some mechanical models of gauge theories, i.e. gauge fields transposed in a space with a finite number of degree of freedom. The main focus is on how a global symmetry as the BRST one could be transferred in this context. The mechanical Yang-Mills model modified by taking the ghost type variables into account will be considered as an example of nonlinear dynamical systems.
First principles study of electronic and optical properties of InAs
Authors: Feng Zhenbao , Hu Haiquan , Cui Shouxin , Wang Wenjun , Lu Canyun
Published: April 2009

The electronic and optical properties of InAs in core-level spectra are calculated using the full-potential linearized augmented plane wave plus local orbitials (FP-LAPW +lo) method. The real and imaginary parts of the dielectric function ε(ω), the optical absorption coefficient I(ω), the reflectivity R(ω), the refractive index n(ω), and the extinction coefficient k(ω)are calculated. All these values are in good agreement with the experimental data. The effect of spin-orbit coupling on optical properties is also investigated and found to be quite small.
A mathematical structure for the generalization of conventional algebra
Authors: Kaabouchi Aziz , Nivanen Laurent , Wang Qiuping , Badiali Jean , Méhauté Alain
Published: April 2009

An abstract mathematical framework is presented in this paper as a unification of several deformed or generalized algebra proposed recently in the context of generalized statistical theories intended to treat certain complex thermodynamic or statistical systems. It is shown that, from a mathematical point of view, any bijective function can in principle be used to formulate an algebra in which the conventional algebraic rules are generalized.
Effects of Forced Use on Arm Function in the Subacute Phase After Stroke: A Randomized, Clinical Pilot Study
Authors: Hammer Ann M. , Lindmark Birgitta
Published: April 2009

Background and Objective: Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke.

Design: A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups.

Setting: The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital.

Participants: A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up.

Intervention: All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day.

Measurements: The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements.

Results: The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55).

Limitations: The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size.

Conclusions: The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.
Physical Therapists’ Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study
Authors: Salbach Nancy M. , Veinot Paula , Rappolt Susan , Bayley Mark , Burnett Dawn , Judd Maria , Jaglal Susan B.
Published: April 2009

Background: Little is known about physical therapists’ experiences using research evidence to improve the delivery of stroke rehabilitation.

Objectives: The purpose of this study was to explore how physical therapists use research evidence to update the clinical management of walking rehabilitation after stroke. Specific objectives were to identify physical therapists’ clinical questions related to walking rehabilitation, sources of information sought to address these questions, and factors influencing the incorporation of research evidence into practice.

Design and Methods: Two authors conducted in-depth telephone interviews with 23 physical therapists who treat people with stroke and who had participated in a previous survey on evidence-based practice. Data were analyzed with a constant comparative approach to identify emerging themes.

Results: Therapists commonly raised questions about the selection of treatments or outcome measures. Therapists relied foremost on peers for information because of their availability, ease of access, and minimal cost. Participants sought information from research literature themselves or with the help of librarians or students. Research syntheses (eg, systematic reviews) enabled access to a body of research. Older therapists described insufficient computer and search skills. Most participants considered appraisal and application of research findings challenging and identified insufficient time and peer isolation as organizational barriers to the use of research.

Conclusions: Physical therapists require efficient access to research syntheses primarily to inform the measurement and treatment of walking limitation after stroke. Continuing education is needed to enhance skills in appraising research findings and applying them to practice. Older therapists require additional training to develop computer and search skills. Peer networks and student internships may optimize the exchange of new knowledge for therapists working in isolation.
The Contested Classroom Space: A Decade of Lived Educational Policy in Texas Schools
Authors: Craig Cheryl J.
Published: April 2009

In this article, examples excerpted from research studies conducted in Houston, Texas, the fourth largest city in the United States, are used to demonstrate how the discretionary classroom space where teachers and students actively live curriculum—guided, though, not controlled, by official documents and administrative oversight—has become increasingly disputed. Through meta-level narrative analysis, excerpts from several accounts that elucidate different manifestations of the contested classroom space in multiple school contexts are woven together. In the process, the ways that teachers, principals, parents, professors, consultants, district personnel, the media, researchers, and students contributed to the contentious environment are explicated. Also, versions of curriculum and instruction that increased the contestation are named. As a result, changes that teachers and students lived in classrooms from 1997 to 2007, the decade when educational policy making in Texas served as the prototype for the U.S. No Child Left Behind Act, are characterized.
Revitalising primary health care
Authors: Karkee R
Published: April 2009

doi: 10.3126/kumj.v6i3.1701Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 297-298
Treatment of supracondylar fracture of the humerus (type IIB and III) in children: A prospective randomized controlled trial comparing two methods
Authors: Pandey S , Shrestha D , Gorg M , Singh GK , Singh MP
Published: April 2009

Background: Consensus on method of treatment of displaced supracondylar fracture of the humerus in children is still lacking. Purpose of this prospective randomized controlled study is to compare closed reduction and long arm slab application with closed reduction and percutaneous crossed Kirschner wires fixation. Materials and methods: Children of age less than 12 years presented in B.P. Koirala institute of health sciences, Dharan in one year were randomly allocated to group A and group B consisting 30 patients in each group. Closed reduction and long arm posterior slab was applied in group A and in group B, closed reduction was followed by crossed Kirschner wires fixation. Clinical and radiological evaluation of reduction was performed immediately after procedure and at the end of first week, third week, third month and sixth month. Results: The groups were matched for pre fracture characteristics and post reduction evaluation. The mean follow up period in group A was 6.9 months and in group B was 7.1 months. Closed reduction failed in two patients at the first attempt and one patient failed to retain reduction at first week in group A. 11 patients (5 in group A and 6 in group B) were lost to follow up. Range of movement, valgus, varus and carrying angle of elbow in two groups were not significantly different. The mean difference of carrying angle of affected elbow as compare to normal elbow was significant in group A (p ? 0.05). Flynn's overall rating showed 32% excellent, 36% good, 18% fair and14 % poor result in patents treated with long arm slab as compared to 58% excellent, 29% good, 13 % fair and no poor results in patients with crossed Kirschner wires fixation. Conclusion: The outcome of displaced extension type supracondylar fracture of the humerus in children, managed with closed reduction and slab application are comparable with closed reduction and crossed Kirschner wire fixation in terms of range of motion but is inferior in restoration of carrying angle. Good to excellent cosmetic and functional results are higher with crossed percutaneous Kirschner wires fixation than with slab immobilization. Key words: closed reduction; percutaneous fixation; supracondylar fracture doi: 10.3126/kumj.v6i3.1705 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 310-318
Opportunistic infection among HIV seropositive cases in Manipal Teaching Hospital, Pokhara, Nepal
Authors: Dhungel BA , Dhungel KU , Easow JM , Singh YI
Published: April 2009

Background: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. Objective: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. Results: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). Conclusion: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV. Key words: HIV, AIDS, Opportunistic infection, Tuberculosis doi: 10.3126/kumj.v6i3.1708 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 335-339
Asthma and dental erosion
Authors: Manuel ST , Kundabaka M , Shetty N , Parolia A
Published: April 2009

Asthma is a chronic inflammatory condition of the airway, characterised by the presence of airflow obstruction which is variable over short periods of time, or is reversible with treatment. Medication comprises of bronchodilators, corticosteroids and anticholinergic drugs. Most asthma drugs are inhaled using various forms of inhalers or nebulizers. Inhaled drugs must be used regularly. The effects of these drugs on the dentition such as tooth decay and erosion have been a subject of debate among dental practitioners. Asthmatic medications can place the patient at risk of dental erosion by reducing salivary protection against extrinsic or intrinsic acids. Asthmatic individuals are one of the higher risk groups suffering from dental erosion. Therefore patients with bronchial asthma should receive special prophylactic attention. This article presents a case of an asthmatic with dental manifestations and reviews the possible causes and management of the same. Key words: Asthma, dry powder inhalers, beta-2 agonist, gastro-esophageal reflux, dental erosion. doi: 10.3126/kumj.v6i3.1714 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 370-374
Immediate reattachment of fractured tooth segment using dual cure resin
Authors: Joshi N , Shetty N , Kundabala M
Published: April 2009

Crown fracture of maxillary anterior teeth is frequent dental injuries for which patients seek immediate dental treatment. Immediate reattachment of the intact fractured tooth segment is a therapeutic choice in such cases. This case report presents one of the best methods used for reattachment, which is an ultraconservative technique. It allows the restoration of original tooth contour, colour and aesthetics. Key words: Crown Fracture, Aesthetics, Dual cure resins doi: 10.3126/kumj.v6i3.1718 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 386-388
Scimitar syndrome
Authors: Kumar A , Paudel K
Published: April 2009

A seven month old female child admitted to intensive care unit with increasing respiratory distress. Clinical examination revealed absence of cyanosis, wide and fixed normal intensity second heart sound. Chest radiograph revealed crescent like radio opacity in right lower lung and subsequent contrast enhanced computed tomography (CT) chest demonstrated abnormal vessel in right lung draining into the inferior vena cava. Key words: Scimitar syndrome, partial anomalous pulmonary venous return, computed tomography doi: 10.3126/kumj.v6i3.1720 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 389-390
Isolated hepatic tuberculosis
Authors: Jayakumar J
Published: April 2009

We report a case of carcinoma stomach who had fever of three weeks duration. On evaluation he was detected to have hepatic nodules. It was initially presumed to be due to metastasis. The biopsy of the nodules showed it to be of tubercular in origin. He was treated with antitubercular treatment (ATT) and the fever resolved. Key words: hepatic isolated tuberculosis   doi: 10.3126/kumj.v6i3.1721 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 391-392
Secrets of omega-3 oil
Authors: Suvarna BS
Published: April 2009

doi: 10.3126/kumj.v6i3.1724 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 406-411
Stress among medical students of Gorgan (South East of Caspian Sea), Iran
Authors: Marjani A , Gharavi AM , Jahanshahi M , Vahidirad A , Alizadeh F
Published: April 2009

Objective: This study aims to estimate the prevalence of psychological stress and association between the levels of stress and study variables among Gorgan medical students. Materials and methods: All three year medical students (129 basic sciences students) in Gorgan Faculty of Medicine, Golestan University of medical Sciences, were asked to complete the Kessler 10 questionnaire. Results: The findings showed mild, moderate and severe stress among 26.22%, 20.50% and 14.75% study subjects. 39.35% of medical students had no stress. There was statistically significant association between year of study and stress levels (p= 0.040). Conclusion: The results indicate that there is a decrease in the psychological health of first year medical students. Provided that stress management courses are organised by medical schools, when the students arrive, they will cope up with the stress in coming years. These courses may reduce the negative effects of stress on medical students. By providing such courses and reducing stress level, medical students may improve their medical education. Key words: Medical students, stress, Gorgan     doi: 10.3126/kumj.v6i3.1726   Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 421-425
Being a patient party
Authors: Shrestha A
Published: April 2009

doi: 10.3126/kumj.v6i3.1728  Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 428-429
Retrospective analysis of management of patients presenting with acute urinary retention due to benign prostatic hyperplasia: A hospital based study
Authors: Pandit RK , Agrawal CS , Chalise PR , Sapkota G
Published: April 2009

Objectives: To analyze current practice of management of acute urinary retention (AUR) in men above 40 years of age at B.P.Koirala Institute of Health Sciences, Nepal. Materials and methods: A total of 68 patients (aged 50-91 years) presenting with indwelling catheter for AUR were included in the study. Because of lack of clear guideline and limited health care facility in our setup trial without catheter (TWOC) was given selectively depending mainly on preexisting symptoms. AUR presumed to be due to urinary tract infection received only antibiotic and others diagnosed of benign prostatic hyperplasia (BPH) received alfa1 blocker prior to TWOC. TWOC was given 3-15 days after such treatment. Those satisfied without catheter for at least a week were considered successful TWOC. Results: The data was available for 68 patients (mean age 66.1 years). Of 15 patients treated with antibiotic alone, 11 (73.3 %) had successful TWOC. Of 57 with presumptive diagnosis of BPH, 68.9% (31 of 45) had successful TWOC. Mean age, symptom score and prostate volume were higher for patients with unsuccessful TWOC. Conclusion: Selective TWOC may be imperative to minimize unnecessary suffering from AUR in less easily accessible health care facilities like ours. It may also reduce total cost of treatment. Key words: Acute urinary retention, benign prostatic hyperplasia, trial without catheter doi: 10.3126/kumj.v6i4.1733   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 448-452
Chondrolipoma of tongue
Authors: Goel G , Khadilkar UN , Kumar S
Published: April 2009

Although lipomas can occur in any part of the body, they are found infrequently in the oral cavity. Variants of lipoma have been described according to the type of tissue present; a lipoma with cartilaginous metaplasia is a chondrolipoma which is a rare variant. We describe a chondrolipoma of tongue in a 36 year old lady. Key words: Tongue, Chondrolipoma doi: 10.3126/kumj.v6i4.1745     Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 505-507
Are we progressing towards elimination of diphtheria, pertusis, tetanus from Nepal?
Authors: Jha N , Kumar S
Published: April 2009

Diphtheria, Pertussis and Tetanus (DPT) are the vaccine preventable diseases of childhood. The published literatures and reports related to DPT immunization coverage are relatively more than DPT diseases. The striking reduction in deaths and in the incidence of these diseases has been closely associated with the introduction of specific vaccination program. Expanded Program on Immunization (EPI) is a priority program in the country. Nepal has been running country-wide immunization program since 1989. However, there is no doubt that the program has contributed significantly towards reduction of infants and child mortality. Effective and efficient surveillance system and strengthening the routine immunization against DPT are the key steps for elimination of DPT diseases. Key words: DPT, Diphtheria, Pertussis, Tetanus, Immunization, DPT Vaccine, surveillance, vaccine coverage, Nepal.   doi: 10.3126/kumj.v6i4.1749     Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 520-525
Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: A prospective cohort study
Authors: Kalakheti BK , Singh R , Bhatta NK , Karki A , Baral N
Published: April 2009

Introduction: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in ‘A' and ‘B' blood group babies of O ‘+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). Objectives: To find out the incidence of hyperbilirubinemia in babies born to ‘O' positive mothers. To estimate the risk of ABO incompatibility in babies born to ‘O' positive mothers. Materials and methods: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having ‘O' positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. Results: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having ‘O' Positive blood group and 23 (62%) were from group of babies having other than ‘O' Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than ‘O' Positive babies after adjusting other significant variables. Conclusion: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O ‘+ve' blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates. Key words: Hyperbilirubinemia, Neonatal Jaundice, ABO-incompatibility doi: 10.3126/kumj.v7i1.1758       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 11-15
Evaluation of predictive factors for conversion of laparoscopic cholecystectomy
Authors: Gabriel R , Kumar S , Shrestha A
Published: April 2009

Background: Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, certain cases still require conversion to open procedures. This study identifies and evaluates risk factors that may predict conversion from laparoscopic to an open procedure. Objectives: To identify and evaluate the predictive factors for conversion of laparoscopic to open cholecystectomy. Materials and methods: A total of 234 Laparoscopic cholecystectomies were attempted at the Kasturba Medical College Hospital, Manipal, from January 2003 to July 2005. Of these, 61 had to be converted to open cholecystectomy. A retro and prospective analysis of different parameters, including Patient factors, Intra-operative factors and Surgeon factors were performed. Results: Sixty one (26.1%) laparoscopic cholecystectomies required conversion. Factors contributing to conversion included male sex, age group of 31-40 years, over weight and history of biliary pain within last two to four months, ultrasonography findings of multiple calculi and gall bladder wall thickness of more than 3 mm. Intraoperative gall bladder perforation with spillage of its contents in abdominal cavity and dense adhesions with difficult anatomy resulted in higher conversion rates. Surgery performed by surgeons in learning phase of laparoscopic surgery was more prone to conversion. Conclusion: Patient factors, presentation, preoperative ultrasonography findings and surgeon's experience, all contribute to the possibility of conversion of laparoscopic cholecystectomy. Knowledge of these factors may help in preinformation to patient for psychological preparations for conversion and an experienced surgeon can plan to operate on these patients. Key words: Cholecystectomy, laparoscopy, conversion. doi: 10.3126/kumj.v7i1.1761       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 26-30
Unusually large prostatic utricle cyst
Authors: Paudel K , Kumar A
Published: April 2009

Prostatic utricle cyst is one of the uncommon conditions and only a few cases have been reported. We present a case of unusually large prostatic utricle cyst in a 13- year- old male. He presented with burning urination and post-void dribbling of urine. A cystic mass was felt on digital per rectal examination. Ultrasound pelvis revealed a well-defined midline cystic mass posterior to the urinary bladder. Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated fluid containing cystic lesion communicating with posterior urethra. Surgical resection of the cyst was performed through the posterior sagittal approach. Follow up of the patient after three months of operation, there was complete resolution of the symptoms. Key words: Prostatic utricle cyst, MRI, Ultrasound doi: 10.3126/kumj.v7i1.1770 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 73-75
An image-guided, noninvasive method of cannulation of the foramen ovale for awake, percutaneous radiofrequency rhizotomy
Authors: Mandat Tomasz , Brozyna Boguslaw , Krzymanski Grzegorz , Podgorski Jan K.
Published: April 2009

The authors describe a simple and low-cost technique for image-guided cannulation of the foramen ovale during treatment of medically refractory trigeminal neuralgia using percutaneous radiofrequency rhizotomy. Computed tomography-guided neuronavigation and the noninvasive ear, nose, and throat Small Active Frame system were applied for visualization of cannulation of the foramen ovale in the awake patient. Use of invasive head-clamp fixation was unnecessary. Three patients were treated using this technique in which the foramen ovale was reached using a single tract. No adverse effects of this technique were reported. The potential benefits and disadvantages of this method are presented.
Dynamic imaging of a model of intracranial saccular aneurysms using ultra-high-resolution flat-panel volumetric computed tomography
Authors: Mitha Alim P. , Reichardt Benjamin , Grasruck Michael , Macklin Eric , Bartling Soenke , Leidecker Christianne , Schmidt Bernhard , Flohr Thomas , Brady Thomas J. , Ogilvy Christopher S. , Gupta Rajiv
Published: April 2009

Object

Imaging of intracranial aneurysms using conventional multidetector CT (MDCT) is limited because of nonvisualization of features such as perforating vessels, pulsatile blebs, and neck remnants after clip placement or coil embolization. In this study, a model of intracranial saccular aneurysms in rabbits was used to assess the ultra-high resolution and dynamic scanning capabilities of a prototype flat-panel volumetric CT (fpVCT) scanner in demonstrating these features.

Methods

Ten New Zealand white rabbits underwent imaging before and after clipping or coil embolization of surgically created aneurysms in the proximal right carotid artery. Imaging was performed using a prototype fpVCT scanner, a 64-slice MDCT scanner, and traditional catheter angiography. In addition to the slice data and 3D views, 4D dynamic views, a capability unique to fpVCT, were also created and reviewed. The images were subjectively compared on 1) 4 image quality metrics (spatial resolution, noise, motion artifacts, and aneurysm surface features); 2) 4 posttreatment features reflecting the metal artifact profile of the various imaging modalities (visualization of clip or coil placement, perianeurysmal clip/coil anatomy, neck remnant, and white-collar sign); and 3) 2 dynamic features (blood flow pattern and aneurysm pulsation).

Results

Flat-panel volumetric CT provided better image resolution than MDCT and was comparable to traditional catheter angiography. The surface features of aneurysms were demonstrated with much higher resolution, detail, and clarity by fpVCT compared with MDCT and angiography. Flat-panel volumetric CT was inferior to both MDCT and angiography in terms of image noise and motion artifacts. In fpVCT images, the metallic artifacts from clips and coils were significantly fewer than those in MDCT images. As a result, clinically important information about posttreatment aneurysm neck remnants could be derived from fpVCT images but not from MDCT images. Time-resolved dynamic sequences were judged slightly inferior to conventional angiography but superior to static MDCT images.

Conclusions

The spatial resolution, surface anatomy visualization, metal artifact profile, and 4D dynamic images from fpVCT are superior to those from MDCT. Flat-panel volumetric CT demonstrates aneurysm surface features to better advantage than angiography and is comparable to angiography in metal artifact profile. Even though the temporal resolution of fpVCT is not quite as good as that of angiography, fpVCT images yield clinically important anatomical information about aneurysm surface features and posttreatment neck remnants not attainable with either angiography or MDCT images.
Emergency transorbital ventricular puncture: refinement of external landmarks
Authors: Tubbs R. Shane , Loukas Marios , Shoja Mohammadali M. , Cohen-Gadol Aaron A.
Published: April 2009

Object

Emergency access to the ventricular system is sometimes necessary for the treatment of raised intracranial pressure with ensuing herniation. One procedure described in the literature is a transorbital approach performed using a spinal needle. Because past publications have been case reports with minimal definition of external landmarks, the present study was performed.

Methods

Five adult cadavers (10 sides) underwent transorbital puncture of the lateral ventricles. This approach was performed following an axial section through the cranium that exposed the lateral ventricular system. Landmarks for the ideal placement of catheters into the ventricular system were then evaluated.

Results

The authors found that the lateral ventricular system was consistently entered just superior to the level of the foramen of Monro by puncturing the roof of the orbit just medial to a midpupillary line, with the trajectory of the perforation aimed 45° from a horizontal line and 15–20° medial to a vertical line.

Conclusions

Although it is uncommon, transorbital ventriculostomy may be used in emergency cases of raised intracranial pressure. Such refined landmarks as described in the present study may be of use to the neurosurgeon.
Withdrawal of life support in critically ill neurosurgical patients and in-hospital death after discharge from the neurosurgical intensive care unit
Authors: Varelas Panayiotis N. , Hacein-Bey Lotfi , Schultz Lonni , Conti Mary , Spanaki Marianna V. , Gennarelli Thomas A.
Published: April 2009

Object

The aim of this study was to examine the variables influencing the mode and location of death in patients admitted to a neurosurgical intensive care unit (NICU), including the participation of a newly appointed neurointensivist (NI).

Methods

Data from all patients admitted to a university hospital NICU were prospectively collected and compared between 2 consecutive 19-month periods before and after the appointment of an NI.

Results

One thousand eighty-seven patients were admitted before and 1279 after the NI's appointment. The withdrawal of life support (WOLS) occurred in 52% of all cases of death. Death following WOLS compared with survival was independently associated with an older patient age (OR 1.04/year, 95% CI 1.03–1.05), a higher University Hospitals Consortium (UHC) expected mortality rate (OR 1.05/%, 95% CI 1.04–1.07), transfer from another hospital (OR 3.7, 95% CI 1.6–8.4) or admission through the emergency department (OR 5.3, 95% CI 2.4–12), admission to the neurosurgery service (OR 7.5, 95% CI 3.2–17.6), and diagnosis of an ischemic stroke (OR 5.4, 95% CI 1.4–20.8) or intracerebral hemorrhage (OR 5.7, 95% CI 1.9–16.7). On discharge from the NICU, 54 patients died on the hospital ward (2.7% mortality rate). A younger patient age (OR 0.94/year, 95% CI 0.92–0.96), higher UHC-expected mortality rate (OR 1.01/%, 95% CI 1–1.03), and admission to the neurosurgery service (OR 9.35, 95% CI 1.83–47.7) were associated with death in the NICU rather than the ward. There was no association between the participation of an NI and WOLS or ward mortality rate.

Conclusions

The mode and location of death in NICU-admitted patients did not change after the appointment of an NI. Factors other than the participation of an NI—including patient age and the severity and type of neurological injury—play a significant role in the decision to withdraw life support in the NICU or dying in-hospital after discharge from the NICU.
Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease
Authors: Starke Robert M. , Komotar Ricardo J. , Hickman Zachary L. , Paz Yehuda E. , Pugliese Angela G. , Otten Marc L. , Garrett Matthew C. , Elkind Mitchell S. V. , Marshall Randolph S. , Festa Joanne R. , Meyers Philip M. , Connolly E. Sander
Published: April 2009

Object

The object of this study was to report the clinical features, surgical treatment, and long-term outcomes in adults with moyamoya phenomenon treated at a single institution in the US.

Methods

Forty-three adult patients with moyamoya disease (mean age 40 ± 11 years [SD], range 18–69 years) were treated with encephaloduroarteriosynangiosis (EDAS). Neurologists examined patients pre- and postoperatively. Follow-up was obtained in person or by structured telephone interview (median 41 months, range 4–126 months). The following outcomes were collected: transient ischemic attack (TIA), infarction, graft collateralization, change in cerebral perfusion, and functional level according to the modified Rankin scale (mRS). Kaplan-Meier estimates of infarction risk were calculated for comparison of surgically treated and contralateral hemispheres.

Results

The majority of patients were women (65%), were Caucasian (65%), presented with ischemic symptoms (98%), and had bilateral disease (86%). Nineteen patients underwent unilateral and 24 patients bilateral EDAS (67 treated hemispheres). Collateral vessels developed in 50 (98%) of 52 hemispheres for which imaging was available and there was evidence of increased perfusion on SPECT scans in 41 (82%) of the 50 hemispheres evaluated. Periprocedural infarction (< 48 hours) occurred in 3% of the hemispheres treated. In the follow-up period patients experienced 10 TIAs, 6 infarctions, and 1 intracranial hemorrhage. Although the hemisphere selected for surgery was based upon patients' symptoms and severity of pathology, the 5-year infarction-free survival rate was 94% in the surgically treated hemispheres versus < 36% in the untreated hemispheres (p = 0.007). After controlling for age and sex, infarction was 89% less likely to occur in the surgically treated hemispheres than in the contralateral hemispheres (hazard ratio 0.11, 95% CI 0.02–0.56). Thirty-eight (88%) of 43 patients had preserved or improved mRS scores, relative to baseline status.

Conclusions

In this mixed-race population of North American patients, indirect bypass promoted adequate pial collateral development and increased perfusion in the majority of adult patients with moyamoya disease. Patients had low rates of postoperative TIAs, infarction, and hemorrhage, and the majority of patients had preserved or improved functional status.
Origins of Systems Biology in William Harvey’s Masterpiece on the Movement of the Heart and the Blood in Animals
Authors: Auffray Charles , Noble Denis
Published: April 2009

In this article we continue our exploration of the historical roots of systems biology by considering the work of William Harvey. Central arguments in his work on the movement of the heart and the circulation of the blood can be shown to presage the concepts and methods of integrative systems biology. These include: (a) the analysis of the level of biological organization at which a function (e.g. cardiac rhythm) can be said to occur; (b) the use of quantitative mathematical modelling to generate testable hypotheses and deduce a fundamental physiological principle (the circulation of the blood) and (c) the iterative submission of his predictions to an experimental test. This article is the result of a tri-lingual study: as Harvey’s masterpiece was published in Latin in 1628, we have checked the original edition and compared it with and between the English and French translations, some of which are given as notes to inform the reader of differences in interpretation.
Rupture Pathway of Phosphatidylcholine Liposomes on Silicon Dioxide
Authors: Reimhult Erik , Kasemo Bengt , Höök Fredrik
Published: April 2009

We have investigated the pathway by which unilamellar POPC liposomes upon adsorption undergo rupture and form a supported lipid bilayer (SLB) on a SiO2 surface. Biotinylated lipids were selectively incorporated in the outer monolayer of POPC liposomes to create liposomes with asymmetric lipid compositions in the outer and inner leaflets. The specific binding of neutravidin and anti-biotin to SLBs formed by liposome fusion, prior to and after equilibrated flip-flop between the upper and lower monolayers in the SLB, were then investigated. It was concluded that the lipids in the outer monolayer of the vesicle predominantly end up on the SLB side facing the SiO2 substrate, as demonstrated by having maximum 30-40% of lipids in the liposome outer monolayer orienting towards the bulk after forming the SLB.
tert-Butyl methoxy(2-propynyl)carbamate
Authors: Caprio Vittorio , Jones Michael , Brimble Margaret
Published: April 2009

The general part of the experimental section [1] has been presented elsewhere.[...]
Methyl 3-Hydroxythieno[2,3-b]pyridine-2-carboxylate
Authors: Moloney Gerard
Published: April 2009

As part of a research programme targeting novel molecules as potential anti-inflammatory agents we synthesised methyl 3-hydroxythieno[2,3-b]pyridine-2-carboxylate based on the reported anti-inflammatory activity of the structurally related molecule 3-isopropoxy-5-methoxy-N-(1H-1,2,3,4-tetraazol-5-yl)-1-benzothiophene-2-carboxamide [1,2].[...]
1-(Pyridin-3-yl)-4-(triethylsilyloxy)-2-butyn-1-ol
Authors: Caprio Vittorio , Jones Michael , Brimble Margaret
Published: April 2009

The general part of the experimental section [1] has been presented elsewhere.[...]
(E)-2-[2-(4'-Methyl-[2,2']bipyridinyl-4-yl)-vinyl]-[1,4]benzoquinone
Authors: Zieg Harald , Koenig Burkhard
Published: April 2009

Lehn et al. [1] have reported the synthesis of a compound similar to 2, which has a saturated ethano bridged between the 2,2'-bipyridine and the para-benzoquinone moiety.[...]
2-[(2-Isopropyl-5-methylphenoxy)acetyl]-N-phenylhydrazine Carbothioamide
Authors: Asiri Abdullah
Published: April 2009

The phenylthiosemicarbazide derivative 3 was prepared from 2-isopropyl-5-methylphenoxyacyl hydrazide (1) and phenyl isothiocyanate (2) [1,2].[...]
1-(Phenanthrolo[5,6-d]imidazol-2-yl)-3-(phenanthro[5,6-d]imidazol-2-yl)benzene
Authors: Chao Hui , Jiang Cai-Wu , Wang Xiang-Li , Ji Liang-Nian
Published: April 2009

2-(3-Formylphenyl)imidazo[4,5-f][1,10]phenanthroline was prepared by a previously published method [1].[...]
2-(2-Hydroxy-5-methyl-3-formylphenyl)-imidazo[4,5-f][1,10]-phenanthroline
Authors: Chao Hui , Jiang Cai-Wu , Hong Xian-Lan , Ji Liang-Nian
Published: April 2009

1,10-phenanthroline-5,6-dione was prepared by a previously published method [1].[...]
[4-(2-Bromoethyl)phenoxy]-(1,1-dimethylethyl)dimethylsilane
Authors: Treu Matthias , Jordis Ulrich
Published: April 2009

To 4-(2-bromoethyl)phenol [1] (28.75 g, 143 mmol) and tert-butyldimethylchlorosilane (23.64 g, 159 mmol) in dry THF (600 mL), imidazole (24.27 g, 357 mmol) was added at 15 °C over 10 min and stirred at ambient temperature.[...]
4-Bromo-5-(chloromethyl)-2-methoxyphenol
Authors: Treu Matthias , Jordis Ulrich
Published: April 2009

2-Bromo-5-hydroxy-4-methoxybenzenemethanol [1] (38.8 g, 166 mmol) in dry chloroform (200 mL) was treated with thionyl chloride (200 mL, 2.76 mol) at 0 °C and stirred for 3 h at ambient temperature.[...]
Methyl 8a-Formyloxy-labd-13Z-en-15-oate [(-)-(2Z)-5-((1R,2R,4aS,8aS)-2-Formyloxy-2,5,5,8a-tetramethyldecahydro-1-naphthalenyl)-3-methyl- 2-pentenoic Acid Methyl Ester]
Authors: Castro Juan , Salido Sofia , Altarejos Joaquin , Nogueras Manuel , Sanchez Adolfo
Published: April 2009

A sample (0.03 mL, 0.45 mmol) of formic acid-acetic anhydride mixture (FAM), prepared from Ac2O and formic acid as described in the literature [1], was added to the alcohol 1 [2] (29 mg, 0.09 mmol) at 10 ºC.[...]