bluuebunny/crossref_metadata_2025 huggingface dataset:
Volatilization kinetics of secondary compounds from sugarcane spirits during double distillation in rectifying still
Authors: Alcarde André Ricardo , Souza Paula Araújo de , Belluco André Eduardo de Souza
Published: June 2010

The qualitative variation of secondary components plays a key role in the aroma and taste of the sugarcane spirit. The objective of this work was to study the volatilization kinetics of secondary components of sugarcane spirits during double distillation process in a rectifying still to verify the cutoff point in ethanol between "head" and "tail" fractions. Fermented sugarcane juice was distilled in rectifying still according to the methodology used for whisky production. Both distillates from first and second distillations were collected in fractions of 500 mL and analyzed for the concentrations of ethanol, copper, volatile acidity, furfural and hydroxymethylfurfural, aldehydes, esters, methanol and higher alcohols. In the first distillation, aldehydes and esters were distilled at the beginning of the distillation, while acetic acid was distilled at the end of the distillation. Methanol was found in the fractions up to almost half of the first distillation. Higher alcohols were distilled during the whole first distillation, but with greater intensity up to the alcoholic degree of 40% v v-1 of the distillate. During the second distillation, aldehydes, esters and methanol were distilled in the first distillate fractions, being collected mainly at alcohol concentrations above 80% v v-1. Acetic acid was distilled in the final distillate fractions, with concentrations in alcohol content below 20% v v-1. Higher alcohols followed a distillation kinetics pattern similar to ethanol, being collected mainly at alcoholic concentrations above 60% v v-1 of the distillate. The presence of copper, furfural and hydroxymethylfurfural was not detected in any fraction of the distillates of the first and second distillation.
Regularização ambiental de minerações em Minas Gerais
Authors: Viana Maurício Boratto , Bursztyn Maria Augusta Almeida
Published: June 2010

Esse artigo tem por objeto de estudo a regularização ambiental de minerações em Minas Gerais, Estado onde tais atividades apresentam destacada importância econômica, social e ambiental. Descrevem-se as principais normas e resultados do licenciamento ambiental, bem como o pós-licenciamento, etapa em que o sistema fica, parcialmente, comprometido, em razão da insuficiente assessoria técnica às empresas de mineração e do assistemático acompanhamento das atividades impactantes pelo órgão ambiental. Também é feita uma avaliação preliminar das modificações introduzidas na gestão ambiental em Minas Gerais nos últimos cinco anos, incluindo a desconcentração ("regionalização") do sistema de regularização - e da gestão ambiental como um todo -, com a criação de oito escritórios regionais e a instituição, em substituição ao licenciamento tradicional, da autorização ambiental de funcionamento, de natureza declaratória, para empreendimentos de menor porte e de menor potencial poluidor.
Hydrolysis of galacto-oligosaccharides in soy molasses by α -galactosidases and invertase from Aspergillus terreus
Authors: Reis Angélica Pataro , Guimarães Valéria Monteze , Ferreira Joana Gasperazzo , Queiroz José Humberto de , Oliveira Maria Goreti Almeida , Falkoski Daniel Luciano , Almeida Maíra Nicolau de , Rezende Sebastião Tavares de
Published: June 2010

Two α -galactosidase (P1 and P2) and one invertase present in the culture of Aspergillus terreus grown on wheat straw for 168 h at 28ÂºC were partially purified by gel filtration and hydrophobic interaction chromatographies. Optimum pH and temperatures for P1, P2 and invertase preparations were 4.5-5.0, 5.5 and 4.0 and 60, 55 and 65ÂºC, respectively. The K M app for Ï� -nitrophenyl-α -D-galactopyranoside were 1.32 mM and 0.72 mM for P1 and P2, respectively, while the K M app value for invertase, using sacarose as a substrate was 15.66 mM. Enzyme preparations P1 and P2 maintained their activities after pre-incubation for 3 h at 50ÂºC and invertase maintained about 90% after 6 h at 55 ÂºC. P1 and P2 presented different inhibition sensitivities by Ag+, D-galactose, and SDS. All enzyme preparations hydrolyzed galacto-ologosaccharides present in soymolasses.
Pancreas-specific Gsα deficiency has divergent effects on pancreatic α- and β-cell proliferation
Authors: Xie Tao , Chen Min , Weinstein Lee S
Published: June 2010

The ubiquitously expressed G protein α-subunit Gsα mediates the intracellular cAMP response to glucagon-like peptide 1 (GLP1) and other incretin hormones in pancreatic islet cells. We have shown previously that mice with β-cell-specific Gsα deficiency (βGsKO) develop severe early-onset insulin-deficient diabetes with a severe defect in β-cell proliferation. We have now generated mice with Gsα deficiency throughout the whole pancreas by mating Gsα-floxed mice with Pdx1-cre transgenic mice (PGsKO). PGsKO mice also developed severe insulin-deficient diabetes at a young age, confirming the important role of Gsα signaling in β-cell growth and function. Unlike in βGsKO mice, islets in PGsKO mice had a relatively greater proportion of α-cells, which were spread throughout the interior of the islet. Similar findings were observed in mice with pancreatic islet cell-specific Gsα deficiency using a neurogenin 3 promoter-cre recombinase transgenic mouse line. Studies in the α-cell line αTC1 confirmed that reduced cAMP signaling increased cell proliferation while increasing cAMP produced the opposite effect. Therefore, it appears that Gsα/cAMP signaling has opposite effects on pancreatic α- and β-cell proliferation, and that impaired GLP1 action in α- and β-cells via Gsα signaling may be an important contributor to the reciprocal effects on insulin and glucagon observed in type 2 diabetics. In addition, PGsKO mice show morphological changes in exocrine pancreas and evidence for malnutrition and dehydration, indicating an important role for Gsα in the exocrine pancreas as well.
Doses of Insulin and Its Analogues and Cancer Occurrence in Insulin-Treated Type 2 Diabetic Patients
Authors: Mannucci Edoardo , Monami Matteo , Balzi Daniela , Cresci Barbara , Pala Laura , Melani Cecilia , Lamanna Caterina , Bracali Ilaria , Bigiarini Michela , Barchielli Alessandro , Marchionni Niccol̀o , Rotella Carlo Maria
Published: June 2010

OBJECTIVE

Recent epidemiological studies suggested that some insulin analogues could be associated with increased risk of cancer. The present study is aimed at assessing the long-term association of different insulin analogues with cancer incidence.

RESEARCH DESIGN AND METHODS

A nested case-control study dataset was generated from the cohort study dataset (n = 1,340 insulin-treated diabetic outpatients) by sampling control subjects from the risk sets. For each case subject, the control subjects (up to five) were chosen randomly from those members of the cohort who are at risk for the same follow-up time of the case subject. Five-year age classes, sex, and BMI classes (<18.5, 18.5–24.9, 25–29.9, and ≥30 kg/m2) were considered as additional categorical matching variables.

RESULTS

During a median follow-up of 75.9 months (interquartile range 27.4–133.7), 112 case subjects of incident cancer were compared with 370 matched control subjects. A significantly higher mean daily dose of glargine was observed in case subjects than in control subjects (0.24 IU/kg/day [0.10–0.39] versus 0.16 IU/kg/day [0.12–0.24], P = 0.036). Incident cancer was associated with a dose of glargine ≥0.3 IU/kg/day even after adjusting for Charlson comorbidity score, other types of insulin administration, and metformin exposure (odds ratio 5.43 [95% CI 2.18–13.53], P < 0.001). No association between incident cancer and insulin doses was found for human insulin or other analogues.

CONCLUSIONS

The possibility of association between cancer and higher glargine doses suggests that dosages should always be considered when assessing the possible association of insulin and its analogues with cancer.
Interaction of methoxy- and methylenedioxyamphetamines with carbon and polymeric adsorbents in polar liquids
Authors: Tomaszewski Waldemar , Gun’ko Vladimir , Leboda Roman , Skubiszewska-Zięba Jadwiga
Published: June 2010

Solid phase extraction (SPE) of methoxy- and methylenedioxyamphetamines from diluted aqueous solutions was investigated on carbon and polymeric adsorbents of different textures and chemical compositions. Those adsorbents were applied cartridges packed with three chemically modified carbons prepared from plum stones (initial A2PS, oxidized A2PS-O, and reduced A2PS-H) and commercially available adsorbents (polymeric LiChrolut EN, graphitized Hypercarb and Carboprep). Several factors influence the recovery rates of amphetamine derivatives such as the polarity of adsorbates (free energy of salvation), the specific surface area and surface composition of adsorbents, and the solvent characteristics. Different combinations of these factors affect the recovery rate (R1) for high- and low-surface area adsorbents. The minimal R1 values are observed for an amphetamine derivative at a maximal solvation effect and for a set of amphetamines adsorbed on graphitized carbons.
Synthesis, characterization, catalytic and antimicrobial studies of ruthenium(III) complexes
Authors: Thilagavathi Natarajan , Jayabalakrishnan Chinnasamy
Published: June 2010

Ru(III) complexes of the type [RuXB(L)2] have been prepared by the reaction of 3,4-dihydropyrimidin-2(1H)-ones/thiones (HL1–HL4) with the precursors of the type [RuX3B3] where X=Cl or Br; B=PPh3 or AsPh3 and L is the deprotonated ligand. The synthesized complexes were characterized by physico-chemical methods, electrochemical and magnetic moment data. The catalytic efficiency of the complexes were examined in the oxidation of alcohols and antimicrobial studies were also carried out.
Spectroscopic, thermal and toxicity studies of some 2-amino — 3- cyano — 1, 5 -diphenylpyrrole containing Schiff bases copper (II) complexes
Authors: El-Boraey Hanaa , Abdel-Rahman Randa , Atia Ensaf , Hilmy Khalid
Published: June 2010

Two novel Schiff base ligands of 2-amino-3-cyano-1,5-diphenylpyrrole and salicylaldehyde (HL1) or 2- hydroxy1-naphthylaldehyde (HL2) and their copper(II) complexes have been synthesized and characterized by elemental analyses, spectral (UV-Vis, IR, EPR, Mass (for ligands)), thermal (DTA-TGA) methods, magnetic and conductance measurements. IR results demonstrate the bidentate binding of the Schiff base ligands involving azomethine nitrogen, phenolic or naphtholic oxygen and suggest the presence of HL2 and complexes (1, 2, 4 and 8) in enolimine-ketonamine tautomeric forms in the solid state. The EPR spectral data of complexes (2, 5, 6) show that the metal — ligand bonds have considerable covalent character. The thermal studies show that complexes (1, 2, 4 and 8) that are present in enolimine-ketonamine tautomeric forms exhibit lower thermal stability. The effect of synthesized ligands (HL1, HL2) and complexes (1, 5) were tested on the mortality of entomopathogenic nematodes (EPN) (Heterorhabditis bacteriophora and Steinernema carpocapsae). The study shows that the mortality of the nematodes increased with increasing concentrations of copper(II) ion, ligands and complexes. Copper(II) ion was the most toxic for EPN.
Modeling the activity of 2-phenylnaphthalene inhibitors using self-training artificial neural networks
Authors: Garkani-Nejad Zahra , Jalili-Jahani Naser
Published: June 2010

The present study investigates the quantitative structure-activity relationship (QSAR) of 2-phenylnaphthalene ligands on an estrogen receptor (ERα). A data set comprising 70 derivatives of 2-phenylnaphthalene is used. The most suitable parameters, classified as topological, geometric and electronic are selected using a combination of genetic algorithm and multiple linear regression (GA-MLR) methods. Then, selected descriptors are used as inputs for a self-training artificial neural network (STANN). Analysis of the results suggests that the STANN model shows superior results compared to the multiple linear regressions (MLR) by accounting for 91.0% of the variances of the antiseptic potency of the 2-phenylnaphthalene derivatives. The accuracy of the 8-4-1 STANN model is illustrated using leave-multiple-out (LMO) cross-validation and Y-randomization techniques.
Preparation and utilization of a molecularly imprinted polymer for solid phase extraction of tramadol
Authors: Azodi-Deilami Saman , Abdouss Majid , Hasani Seyed
Published: June 2010

In this paper, a highly selective molecularly imprinted polymer (MIP) for tramadol hydrochloride, a drug used to treat moderate to severe pain, was prepared and its use as solid-phase extraction (SPE) sorbent was demonstrated. The molecularly imprinted solid-phase extraction procedure followed by high performance liquid chromatography with ultraviolet detector (MISPE-HPLC) was developed for selective extraction and determination of tramadol in human plasma and urine. The optimal conditions for molecularly imprinted solid-phase extraction (MISPE) consisted of conditioning with 1 mL methanol and 1 mL of deionized water at neutral pH, loading of tramadol sample (50 µg L−1) at pH 7.5, washing using 1 mL acetone and elution with 3 × 1 mL of 10% (v/v) acetic acid in methanol. The MIP selectivity was evaluated by checking several substances with similar molecular structures to that of tramadol. Results from the HPLC analyses showed that the calibration curve of tramadol (using MIP from human plasma and urine) is linear in the ranges of 6–100 and 3–120 µg L−1 with good precisions (1.9% and 2.9% for 5.0 µg L−1), respectively. The recoveries for plasma and urine samples were higher than 81%.
Formation and study of mixed copper sulfide-copper telluride layers on the surface of polyamide 6
Authors: Janickis Vitalijus , Žalenkienė Skirma
Published: June 2010

The layers of mixed copper chalcogenides, CuxS-CuyTe, were formed on the surface of polyamide using solutions of potassium and sodium telluropentathionates, K2TeS4O6 and Na2TeS4O6, respectively, and of telluropentathionic acid, H2TeS4O6, as precursors of chalcogens. The concentration of sorbed chalcogens increased with the increasing time of the treatment, concentration and temperature of precursor solution. CuxS-CuyTe layers are formed on the surface of polyamide after the treatment of chalcogenized polymer with Cu(II/I) salt solution. The concentration of copper in the layer increases with the increase of chalcogenization duration, concentration and the temperature of chalcogenization solution. In the surface of CuxS-CuyTe layers various copper, sulfur, tellurium and oxygen compounds (Cu2S, CuS, S8, CuxS, CuyTe, Cu(OH)2 and TeO2) were present. Chalcogenides were the major components in the layer. Chalcogenide phases — digenite, Cu1.8S, djurleite, Cu1.9375S, anilite, Cu7S4, geerite, CuS2, chalcocite, Cu2S, tetragonal Cu3.18Te2, Cu2.72Te, hexagonal Cu2Te, Cu4Te3, Cu1.80Te, Cu1.85Te2, and orthorhombic vulcanite, CuTe were identified in the layers by X-ray diffraction. Electrical sheet resistance of CuxS-CuyTe layers vary from ∼ 1.0 kW cm−2 to 4×103 kΩ cm−2. It is concluded that the formation of chalcogenide layers proceeds in the form of islands which grow into larger agglomerates. Use of the gathered data enables design and formation of the CuxS-CuyTe layers with desired conductivities.
Inter-molecular physiochemical characterization for etodolac-hydroxypropyl-β-cyclodextrin polymeric systems in solid and liquid state
Authors: Sinha Vivek , Amita  , Chadha Renu , Goel Honey
Published: June 2010

The purpose of this study was to explore the utility of hydroxypropyl-β-cyclodextrin (HP-β-CD) systems in forming inclusion complexes with the anti-rheumatic or anti-arthritic drug, etodolac (EDC), in order to overcome the limitation of its poor aqueous solubility. This inclusion system achieved high solubility for the hydrophobic molecule. The physical and chemical properties of each inclusion compound were investigated. Complexes of EDC with HP-β-CD were obtained using the kneading and co-evaporation techniques. Solid state characterization of the products was carried out using Fourier transform infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC), powder X-ray diffraction (XRD) and Scanning electron microscopy (SEM). Studies in the solution state were performed using UV-Vis spectrophotometry and 1H-NMR spectroscopy. Phase solubility profiles with HP-β-CD employed was found to be AL type. Stability constants (Kc) from the phase solubility diagrams were calculated indicating the formation of 1:1 inclusion complex. Stability studies in the solid state and in liquid state were performed; the possible degradation by RP-HPLC was monitored. The dissolution studies revealed that EDC dissolution rate was improved by the formation of inclusion complexes.
PXPd-catalyzed borylation of aniline derivatives
Authors: Wheaton Susan , Humanayun Kabir S. , Zhang Haiwen , Vogels Christopher , Decken Andreas , Westcott Stephen
Published: June 2010

Addition of pinacolborane (HBO2C2Me4) to 2-iodoaniline can be catalyzed using a number of palladium complexes, including [(t-Bu)2PCl]2PdCl2 (PXPd), to give the corresponding boronate ester 2-H2NC6H4(BO2C2Me4) in excellent yields. The PXPd system could also be used in the catalyzed borylation of substituted anilines to give the corresponding aminoboronate esters in moderate to high yields.
LΣ(≤ ω)-spaces and spaces of continuous functions
Authors: Lara Israel , Okunev Oleg
Published: June 2010

We present a few results and problems related to spaces of continuous functions with the topology of pointwise convergence and the classes of LΣ(≤ ω)-spaces; in particular, we prove that every Gul’ko compact space of cardinality less or equal to $$ \mathfrak{c} $$ is an LΣ(≤ ω)-space.
Evaluating the evaluation system
Authors: Sharma SK
Published: June 2010

DOI: 10.3126/kumj.v8i1.3212 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 1-2
Human trafficking in Nepal: A rising concern for all
Authors: Joshi SK
Published: June 2010

DOI: 10.3126/kumj.v8i1.3213 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 3-4
Determinants of post-partum amenorrhea among Nepalese rural mothers: A multivariate analysis
Authors: Aryal TR
Published: June 2010

Introduction: Post-partum amenorrhea (PPA) is the duration variable, which is directly related to the levels of fertility. The timing of occurrence of the first menstruation after delivery is known as the duration of PPA. It is a temporary infecundable period where mothers are most likely to be free from possible conception. Objective: This paper investigates the determinants of the duration of PPA in relation to some characteristics of mother and her child by using both current as well as retrospective status reporting data. Materials and methods: Data are taken from a sample survey of rural Palpa and Rupandehi districts. A sample of 1019 ever-married mothers was interviewed. Of them, 642 mothers were provided PPA information for their last birth child, and 481 mothers were provided PPA information for their last but one child. Cox proportional hazard model analysis has been utilized to identify the determinants of PPA duration. Results: A lower relative risk of PPA period was found among mothers who have higher parity, larger birth interval and longer period of breastfeeding (BF). Education was inversely associated with PPA, and about 1.5 times higher risk of returning menstruation early was found among educated mothers as compared uneducated counter-part. BF is significantly associated with PPA where the longer is the duration of BF the longer is the duration of PPA. The relative risk was found increased with increases the level of socio-economic status. Over twice times higher risk of returning menstruation early was found among mothers who had experienced dead child as compared to mothers who have no child loss. Conclusion: The variables like birth interval, parity, breastfeeding, education, socio-economic status and child survival are found the main determinants of PPA duration among Nepalese mothers. Key words: Post-partum amenorrhea; breastfeeding; fertility   DOI: 10.3126/kumj.v8i1.3214 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 5-11
Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates
Authors: Lakhey S , Manandhar RR , Pradhan RL , Pandey BK , Sharma S , Rijal KP
Published: June 2010

Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates. Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates. Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also enquired about their satisfaction with their treatment outcome. Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment. Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intraarticular fractures, have good functional results with high patient satisfaction rate. Key words: displaced intra-articular calcaneal fractures; operative treatment. DOI: 10.3126/kumj.v8i1.3215 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 12-17
Prevalence of dry socket following extraction of permanent teeth at Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Kavre, Nepal: A study
Authors: Upadhyaya C , Humagain M
Published: June 2010

Background: One of the most common postoperative complications following the extraction of permanent teeth is a condition known as dry socket. Although the aetiology of dry socket is debated, it is probably multifactoral, and its pathogenesis remains unknown. Objectives: The aim of the study was to evaluate incidence of dry socket following extraction of permanent teeth at dental out-patient department (OPD) of Dhulikhel hospital, Kathmandu university teaching hospital (KUTH), Kavre, Nepal. Materials and methods: Retrospective reviews of records of total 1860 no of patients were studied who underwent extraction of permanent teeth for various reasons since January 2007 to December 2008 period. There were 873(47%) male patients and 987(53%) female patients. Information regarding indications for extraction, extracted tooth status, onset of symptoms, relevant findings of the examining clinician, interval between presentation, management given, and its outcome were retrieved and analysed. Results: A total 1860 no of patients were studied who underwent extraction of total 2640 number of permanent teeth for various reasons. A total of 103 (3.9%) extractions were complicated by dry socket in patients aged 11 to 80 years with female predominance (54.4%). Conclusion: The etiology of dry socket is multifactorial and ultimately it is the host's healing potential which determines the severity and duration of the condition. The incidence of dry socket was found as 3.9% in this study. The incidence was higher in female patients (54.4%) and in mandibular teeth extraction cases (68.93%). Key words: Extraction; Dry socket; Teeth DOI: 10.3126/kumj.v8i1.3216 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 18-24
Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients
Authors: Ravikumar VN , Rudresh K , Jalihal U , Satish R , Manjunath R
Published: June 2010

Background: Human Immunodeficiency Virus (HIV) infected patient frequently report upper gastrointestinal (GI) symptoms; however their prevalence and diagnostic approach is not well known. Objective: The objective of this study was to study clinical, endoscopic and histopathological changes in HIV infected patients with upper GI symptoms and their correlation with CD4 count. Materials and methods: We evaluated 50 HIV infected patients who presented to M.S. Ramaiah hospital with upper GI symptoms. All patients answered questionnaire assessing upper GI symptoms and underwent upper GI endoscopy. Mucosal biopsy was taken wherever mucosal abnormality seen. Results: In our study, the mean age of patients was 40.98 yrs, of which 80% were males. Vomiting (36%), epigastric pain (36 %), weight loss (34 %) and anorexia (34%) were the predominant symptoms. Esophagogastroduodenoscopy (EGD) findings revealed- Oesophageal candidiasis in 28.0%, esophagitis in 22.0%, gastritis in 20.0 %, duodenitis in 14 %, normal upper GI mucosa in 18 % patients. Oesophageal candidiasis was the most common finding on histopathological examination and the mean CD4 count was 157.92 cells/μl. Conclusion: Vomiting, epigastric pain, weight loss and anorexia were most frequent symptoms. Oral candidiasis was the most common oral lesion. Oesophageal candidiasis, oesophagitis and oesophageal ulcers were the common findings on EGD. Patient with CD4 count less than 200cells/μl had more frequent upper GI mucosal involvement than in patients with CD4 count more than 200. Majority of the patients with GI symptoms had upper GI mucosal changes and opportunistic infections. Thus endoscopic and histopathological evaluation is advisable for the early diagnosis and treatment of upper GI complications in patients with HIV infection. Key words: AIDS; Oesophageal candidiasis; Esophagogastroduodenoscopy; HIV; Upper gastrointestinal symptoms. DOI: 10.3126/kumj.v8i1.3217 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 25-28
Community intervention to improve knowledge and practices on commonly used drugs
Authors: Kafle KK , Karkee SB , Shrestha N , Prasad RR , Bhuju GB , Das PL , Chataut BD
Published: June 2010

Background: World Health Organisation (WHO) estimates that about half of all medicines are inappropriately prescribed, dispensed and sold and about half of all patients fail to take their medicines properly. Objective: The overall objective of the study was improving use of medicines in the community by creating awareness among different target groups. Materials and methods: It was a pre-post comparison of intervention implemented at the community level in purposively selected Bhaktapur District of Kathmandu Valley, Nepal. The study was conducted in the private schools of the study district. Twelve schools were randomly selected. Thereafter, students from 6-9 grades were listed from the selected schools. Then 15% of the total students in each grade were randomly selected to get six students from each grade of the each school, totaling 288 students. The households of the selected students served as the sample households for the study. Thus, there were 288 households sampled for the study. The intervention and the targeted intermediary groups consisted of a. training of schools teachers b. training of journalists c. interactive discussions of trained school teachers with school children using key messages and c. communication of key messages through the local F.M. radio, newspaper/ magazine. Results: There was a significant increase in correct knowledge on action of antibiotics and excellent knowledge on the methods of administration of antibiotics of households after the intervention. Similarly, there was a significant increase in knowledge on cough as a disease and a significant decrease in the use of cough medicines after intervention. There was also a significant increase in excellent knowledge on the sources of vitamins and a significant decrease in the use of vitamin/tonics after the intervention. Conclusion: The participation of intermediary groups eg. school teachers, journalists and school children in the implementation of intervention were successful. The groups have fulfilled the commitments in implementing the plan of action. The key messages have effectively reached the households, and the knowledge and practices of the community members in drug use have improved. Key words: Community intervention; Use of common drugs; Knowledge and practice DOI: 10.3126/kumj.v8i1.3218 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 29-34
Does short-term endotracheal intubation affects the acoustic characteristics?
Authors: Toran KC , Lal BK
Published: June 2010

Introduction: Endotracheal intubation can produce various degrees of temporary and sometimes permanent damage to the laryngotracheal mechanism. Recent development of computer based voice analysis technology can now detect a minute changes in acoustic waveforms which a normal human ear cannot. In the study we compared and analyzed the acoustic waveforms of 35 patients undergoing surgery under intubation anaesthesia. Objective: The aim of the present series is to analyze the effects of short term intubation with computerized voice laboratory. Materials and methods: Values of acoustic waveforms obtained from 35 patients were compared 48 hours after the short term endotracheal intubation anaesthesia. The comparisons were made in terms of perturbation (jitter and shimmer), harmonic- to noise ratio (HNR) and fundamental frequency (F0). Results: The pre-intubated voice characteristics when compared with the post-intubation group did not reveal any statistical difference (P>0.05). However, there was only a minimal decrease in F0. Conclusion: The study revealed that, short term intubation anaesthesia does not alter the acoustic characteristics. The analysis of acoustic waveforms is a non invasive technique that helps to evaluate the effects of tracheal intubation on laryngeal function, a technique that warrants further evaluation. Key words: Acoustic characteristics; Endotracheal intubation; Voice DOI: 10.3126/kumj.v8i1.3219 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 35-39
Multiple drug resistance in bacterial isolates from liquid wastes generated in central hospitals of Nepal
Authors: Sharma Dr , Pradhan B , Mishra SK
Published: June 2010

Background: Healthcare liquid wastes are the reservoirs of harmful infectious agents such as the pathogens and multiple drug resistant microorganisms. Potential infectious risks include the spread of infectious diseases and microbial resistance from health-care establishments into the environment and thereby posing risks of getting infections and antibiotic resistance in the communities. Objectives: The objectives of this study were to assess the bacterial load of healthcare liquid waste generated in central hospitals and to explore the antimicrobial resistance pattern of these bacterial isolates. Materials and methods: A descriptive study was carried out in 10 conveniently selected central hospitals of Nepal during the period of May to December 2008. Effluent specimens from each hospital were subjected to total viable count studies by spread plate method in nutrient agar plate and incubated for 24 hours at 37°C using standard laboratory protocol. Similarly, all the specimens were cultured in Mac Conkey Agar media supplemented with 30 μg/ml of Chloramphenicol and 20 μg/ml of Gentamycin for the enumeration of multiple drug resistant (MDR) bacteria, which were further subjected to in-vitro antibiotic susceptibility test by modified Kirby Bauer disc diffusion technique for resistance patterns. Results: Total viable counts of hospital effluents significantly exceeded the standard heterotrophic plate count (p=0.000). Similarly, the numbers of multiple drug resistant bacteria were alarmingly high in three (more than 30% in 2 and 50% in 1) hospitals of this study. Drug resistant hospital effluent isolates showed simultaneous resistance for most of the antibiotics including Penicillin, Cephalosporin, Cotrimoxazole, Gentamycin and Quinolones. Conclusion: Healthcare liquid wastes were laden with MDR bacteria and seemed to pose a huge public health threat in the transfer of such resistance to the bacterial pathogens causing community acquired infections, thereby limiting our antibiotic pool. Key words: Healthcare liquid waste management; viable count; multiple drug resistance; hospitals; Nepal DOI: 10.3126/kumj.v8i1.3220 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 40-44
Epidemiology of malaria in two Eastern districts of Nepal
Authors: Parajuli K , Ghimire P
Published: June 2010

Backgrounds: Malaria is one of the major public health problems in Southeast Asia including Nepal having relatively high burden of malaria. Jhapa and Morang districts are malaria endemic plain area of South-eastern part of Nepal Objectives: The evaluate the recent epidemiology of malaria situation in Jhapa and Morang districts, which are the districts in eastern Nepal with high transmission of malaria and to assess the knowledge, attitudes and practices of the people in prevention and treatment for malaria infection. Materials and methods: This descriptive cross-sectional study was carried out with volunteer participation of suspected malaria patients seeking care at the government of Nepal managed primary health care centres located in 2 malaria endemic districts in eastern Nepal. Conventional Giemsa stained thick and thin blood smears prepared from finger prick blood were examined following standard protocols. Suspected patients' / attendants' knowledge on malaria, disease symptoms, prevention and control measures were assessed using a structured questionnaire. Chi square and Fisher exact test were used for statistical analysis of the data. Results: Among the total 199 malaria suspected cases studied, 32 (16.1%) cases were confirmed by microscopic findings; where, P. vivax was 12.6% (25/199) and P. falciparum in only 3.1% (6/199). The highest numbers of cases were in age group 20-29 years. Among the total positive cases 75% were male and 37.5% were labourers in occupation. Among the total cases, 32 had provided the history of recent travel to malaria endemic area in India, among them 43.8% (P<0.001) were found to be infected with the malarial parasites (P<0.001). Among the total cases, 69.7% showed some knowledge of malaria, among which fever was the most common symptom mentioned by 68.3%. Occupation (P<0.001) and education (P<0.001) were found significantly associated with the knowledge on mode of transmission. Conclusion: Jhapa district showed higher SPR than Morang, which indicated that Jhapa may be more malaria affected than Morang. Knowledge on malaria transmission and preventive measures are still lacking in deep villages, in spite of different efforts of the government. To improve the malaria morbidity in the districts, health education of the most marginalized people through audio visual methods may be beneficial. Key words: Epidemiology; Malaria; Knowledge; Practice; Eastern Nepal DOI: 10.3126/kumj.v8i1.3221 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 45-50
Physicians and communities knowledge and awareness about new vaccines in immunization program: A study to derive lesson for increasing uptake
Authors: Lahariya C , Khandekar J , Vachher AS , Pradhan SK
Published: June 2010

Background: The knowledge, attitude of physicians about any interventions has effect on the practices while the perceptions about such intervention by caregivers have impact on the acceptance in community.   Objectives: This study was conducted to assess the knowledge and attitude of physicians and perception of the caregivers about new vaccines, and to identify the solutions to address the knowledge gap, if any.   Materials and methods: A cross sectional study was conducted a major city of India from Sept 2006-Jan 2007. 107 physicians and 298 caregivers were interviewed using a pre-tested semi structured interview schedule. The data so collected was analyzed using chi square test and proportions. P value of less than 0.05 was considered statistically significant.   Results: It was found that only 3/5th physicians were aware that typhoid vaccination was part of the immunisation program. The knowledge about all the aspects of typhoid was poor amongst physicians in comparison of other vaccine (Hepatitis B) in the immunisation program. Physicians at private health facilities had poor knowledge than those working at government health facilities. However, majority of the physicians had positive attitude towards typhoid vaccination. All the caregivers had heard about typhoid disease and 39.8% about the vaccine also. Almost 80% of them were ready to pay for typhoid vaccination. Conclusions: The study underlines the need for special efforts to increase the awareness about typhoid vaccination amongst these groups to increase the uptake of the vaccine. Key words: Child Health; Hepatitis B, India; Newer vaccines; Typhoid DOI: 10.3126/kumj.v8i1.3222 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 51-56
Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis
Authors: Gurung R , Bhattacharya SK , Pradhan B , Gurung S , Singh YI
Published: June 2010

Background: Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries Objective: To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. Materials and methods: A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. Results: Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/ intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. Conclusion: EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration. Key words: Phenotypic characterization; drug susceptibility; extra pulmonary tuberculosis DOI: 10.3126/kumj.v8i1.3223 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 57-61
Kala azar in Nepal: Estimating the effects of socioeconomic factors on disease incidence
Authors: Adhikari SR , Supakankunti S , Khan MM
Published: June 2010

Background: The incidence of Kala Azar (KA), a neglected tropical infectious disease, describes the pattern of disease, but is not principally concerned with explaining its causes. The transmission of the infectious diseases is determined by the complex interactions between environmental and socioeconomic factors. Environmental factors are predicted to have a significant impact on disease transmission; moreover, socioeconomic factors modify the magnitude and direction of these impacts. A number of studies have examined possible determinants of KA in endemic countries of the world; however, most of them appear to have used either qualitative approaches or subjective speculations. None of the studies indicates in quantitative terms the potential effects of poverty-alleviation programs on the incidence of KA. Materials and methods: Data related to charecteristics of community were collected from primary as well as secondary sources. Underlying socioeconomic determints on KA incidence were estimated by exploiting a linear multiple regression. Results: The multivariate analysis has confirmed that burden of KA is disproportionately borne by vulnerable and marginalized groups. KA is most entrenched in the poorest communities. Elimination of KA is directly related to poverty alleviation because if the poverty incidence reduces by10 percent, it will lead to reduction of KA incidence by 16 percent. The strategy for disease control or elimination should shift from traditional disease-centered approaches to a holistic approach that can break the links between poverty and KA. Conclusions: To achieve the target of elimination of KA in Nepal by 2015, the poverty incidence should be reduced from existing poverty 27 percent to at least 16 percent in KA endemic areas. The association between poverty and KA reflects causality running in both directions: poverty multiplies KA incidence and KA pushes poor into marginal poor or further poverty. Key words: Kala azar; Socioeconomic factors; Leishmaniasis DOI: 10.3126/kumj.v8i1.3225 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 73-79
Two interesting cases of left atrial myxoma
Authors: Alurkar VM , Neupane S
Published: June 2010

Atrial myxoma is the most common type of benign primary heart tumours. Most of these tumours are sporadic in origin occurring at 3rd to 6th decade of life, while hereditary forms do exist. They are mostly found in the left atrium followed by right atrium and ventricles. A left atrial myxoma may present with features of mitral valve obstruction, embolic phenomenon or systemic disease. On diagnosis, prompt surgical removal is necessary which usually gives a complete cure, though recurrences have been reported. We hereby present two cases of solitary left atrial myxoma. Key words: atrial myxoma; echocardiography; tumour impaction DOI: 10.3126/kumj.v8i1.3226 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 80-92
Treatment of neglected elbow dislocations with combination of speed V-Y muscleplasty and intra-articular injection of hydrocorticosone
Authors: Bansal P , Lal H , Khare R , Mittal D
Published: June 2010

Neglected dislocations of the elbow are not uncommon in developing countries. We report case series of 3 cases of neglected dislocations of elbow. All the three cases were treated by combination of Speeds procedure and intraarticular injection of 25mg of hydrocorticosone acetate in 5ml of distilled water. Mean time from injury was 5 months and mean follow-up was 10 months. According to Mayo Elbow Performance Index, 2 outcomes were excellent and 1 outcome was good. Key words: Dislocations; elbow; neglected. DOI: 10.3126/kumj.v8i1.3229 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 91-94
Outcome of cluster endophthalmitis in western plain region of Nepal
Authors: Bajimaya S , Kansakar I , Sharma BR , Byanju R
Published: June 2010

Background: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. Objective: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. Materials and methods: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for 7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. Results: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. Conclusion: Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis. Key words: Manual small incision cataract surgery; Cluster Endophthalmitis; Nepal DOI: 10.3126/kumj.v8i1.3232 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 102-108
Diabetes mellitus: A review of its associations with different environmental factors
Authors: Joshi SK , Shrestha S
Published: June 2010

Diabetes Mellitus is a global health problem with a worldwide prevalence of 2.8% in 2000. Type 1 diabetes mellitus is an auto immune disorder genetically mediated, while type 2 is more of a life style induced disorder although the role of genetic susceptibility, infections are also equally strong. Many studies have backed up these statements. However, there have been very few researches that show association of diabetes with environmental factors like pollution, exposure to chemicals e.g. mercury, arsenic, psychological condition e.g. depression, stress, and socio-economic conditions e.g. occupation, earnings etc. Recently, the role of these factors in causation and progression of diabetes have received much attention. Thus, this review has been designed to explore more on association of diabetes with physical, socio-economic and psychological environment. Key words: arsenic; diabetes; environment; mercury; occupation; POPs; sleep; socio-economic status; stress DOI: 10.3126/kumj.v8i1.3233 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 109-115
Rotavirus infection: An unrecognised disease in Nepal
Authors: Pun SB
Published: June 2010

Rotavirus is the most common cause of acute infectious gastroenteritis in young children and is associated with substantial morbidity and mortality worldwide, mostly in developing countries. The global rotavirus disease burden has prompted study on their basic research, molecular epidemiology and vaccine development. Little is known about rotavirus infection among health professionals in Nepal. This article summarises basic and clinical features, treatment and prevention, epidemiological pattern, challenges and recommendations of human rotavirus infections in Nepal. Key words: Rotavirus; Epidemiology; Challenges and Recommendations; Nepal DOI: 10.3126/kumj.v8i1.3236 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 135-140