bluuebunny/crossref_metadata_2025 huggingface dataset:
Tdap Vaccine Effectiveness in Adolescents During the 2012 Washington State Pertussis Epidemic
Authors: Acosta Anna M. , DeBolt Chas , Tasslimi Azadeh , Lewis Melissa , Stewart Laurie K. , Misegades Lara K. , Messonnier Nancy E. , Clark Thomas A. , Martin Stacey W. , Patel Manisha
Published: May 2015

BACKGROUND:

Acellular pertussis vaccines replaced whole-cell vaccines for the 5-dose childhood vaccination series in 1997. A sixth dose of pertussis-containing vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap), was recommended in 2005 for adolescents and adults. Studies examining Tdap vaccine effectiveness (VE) among adolescents who have received all acellular vaccines are limited.

METHODS:

To assess Tdap VE and duration of protection, we conducted a matched case-control study during the 2012 pertussis epidemic in Washington among adolescents born during 1993–2000. All pertussis cases reported from January 1 through June 30, 2012, in 7 counties were included; 3 controls were matched by primary provider clinic and birth year to each case. Vaccination histories were obtained through medical records, the state immunization registry, and parent interviews. Participants were classified by type of pertussis vaccine received on the basis of birth year: a mix of whole-cell and acellular vaccines (1993–1997) or all acellular vaccines (1998–2000). We used conditional logistic regression to calculate odds ratios comparing Tdap receipt between cases and controls.

RESULTS:

Among adolescents who received all acellular vaccines (450 cases, 1246 controls), overall Tdap VE was 63.9% (95% confidence interval [CI]: 50% to 74%). VE within 1 year of vaccination was 73% (95% CI: 60% to 82%). At 2 to 4 years postvaccination, VE declined to 34% (95% CI: −0.03% to 58%).

CONCLUSIONS:

Tdap protection wanes within 2 to 4 years. Lack of long-term protection after vaccination is likely contributing to increases in pertussis among adolescents.
A Pterygoneurum squamosum Segarra et Kürschner előfordulása egy Győr melletti rekultivált hulladéklerakón
Authors: Szűcs Péter
Published: May 2015

A közlemény ismerteti a Pterygoneurum squamosum újabb hazai előfordulását, valamint a moha aktuális elterjedését és élőhelyének leírását. Eddig ismert lelőhelyeitől eltérően antropogén jellegű élőhelyen, erodált, agyagos talajfelszínről került elő ez a hazánkban ritka, mediterrán elterjedésű lombosmoha. Élőhelyének klimatikus és termőhelyi adottságait figyelembe véve valószínűsíthető, hogy a faj nagyobb ökológiai toleranciával rendelkezik, és a löszfalakon kívül egyéb mesterséges nyílt élőhelyeken is számítanunk kell megjelenésére.
Particle’s Trajectory – Implementation in Maritime Traffic
Authors:   University of Dubrovnik, Department of  Electrical Engineering and Computing, Lale Dinka , Županović Vesna , Grbavac Ivan
Published: May 2015

The paper addresses the application of the mathematical definition of a particle’s trajectory in maritime traffic. After the introductory definition of the concept of a particle’s trajectory, it goes on to provide a definition of the concept necessary for the understanding of the issues in question: the concept of the manoeuverability. Next, an example is given which defines the concept of a wave particle’s trajectory and the method of ship manoeuvring along a trajectory. Finally, there is a definition of the trajectory error and the method how to calculate it. There is also following the description of block scheme which depicts the way of steering a ship along a given trajectory with corresponding transfer functions. At the end, there is a conclusion.
Primjena Bayesove mreže u analizama rizika u pomorstvu
Authors: Lale Stijepo , Ćavar Stjepan , Lale Dinka , Krile Srećko
Published: May 2015

Rad počinje definicijom analize rizika i nužnosti njezine primjene u svakodnevnom životu. Nastavlja definiranjem Bayesovih mreža, njihovim osnovnim i općenitim značajkama, te se posebno ističe Bayesov teorem. Nakon toga slijede primjene Bayesovih mreža u pomorstvu. Najprije je primjer nesreće na brodu koja je analizirana uz pomoć BN-a. Potom se pobliže opisuje SARGOS sustav koji je inovativni sustav zaštite offshore naftnih konstrukcija od pomorskog piratstva koji je postao sve veći problem u pomorskom svijetu. Na kraju se opisuje pet različitih primjeraa korištenja Bayesovih mreža u gospodarskoj grani pomorstva.
Dubrovačke plaže u kontekstu Altmanove teorije teritorijalnosti
Authors:   Institut za antropologiju Zagreb, Hrvatska, Sindik Joško
Published: May 2015

Doživljaj plaže kao teritorija rijetko je istraživano pitanje, posebno u hrvatskim okvirima. Ciljevi istraživanja bili su: konstrukcija upitnika „Teritorijalnost na plažama“ koji pokriva tri vrste teritorija po Altmanovom konceptu teritorijalnosti (1), utvrditi razlike u dimenzijama upitnika (tri vrste teritorija), u odnosu prema rodu, mjestu stanovanja, vrsti plaže te za vrstu zanimanja (2); utvrditi povezanosti između aspekata teritorijalnosti (latentnih dimenzija dobivenih faktorizacijom upitnika) i dobi te radnog staža (3). Usporedno istraživanje provedeno je na uzorku od 83 sudionika/ca (40 muškaraca i 43 žene) iz Dubrovnika, primjenom upitnika „Teritorijalnost na plažama“. Upitnik je uspješno konstruiran i pokazao je dobre metrijske karakteristike. Dobivene latentne dimenzije jasno reprezentiraju tri dimenzije subjektivne pripadnosti plažama: kao primarni, sekundarni i kao javni teritorij. U odnosu prema te tri dimenzije upitnika, nisu pronađene niti rodne razlike, niti statistički značajne povezanosti s dobi i radnim stažem. Također, plaže kao primarni teritorij češće doživljavaju stanovnici stare gradske jezgre (u odnosu prema onima koji žive na drugim lokacijama), odnosno oni koji se kupaju na „kultnim” gradskim plažama kao što su Danče, Šulić, Porporela i Bellevue.
Modelling Transport Demands in Maritime Passenger Traffic
Authors:   Polytehnic of Rijeka, Pupavac Drago , Plazibat Veljko , Krčum Maja
Published: May 2015

In this paper, the research has been carried out on the impact of gross domestic product (GDP) and the number of tourist arrivals (TA) on traffic demand in maritime passenger traffic in the Republic of Croatia. The initial assumption of this study is that the number of passengers carried in Croatian maritime transport (NP) depends on the number of tourist arrivals and the gross domestic product. The results are based on statistical methods of regression and correlation analysis. Tha analysis period spans over the years 1979. – 2013. The obtained insights could help help shippers in maritime passenger transport, and managers at all levels in maritime industry.
Technological and Educational Requirements for Inland Navigation Simulator in the Danube Region
Authors:   University of Žilina, The Faculty of Operation and Economics of Transport and Communications, Department of Water Transport, Jurkovič Martin , Dávid Andrej
Published: May 2015

Education and practical training of the crew members in water transport have been directed towards harmonisation within the EU. One of the basic goals of the project HINT (Harmonized Inland Navigation Transport through education and information technology) is the implementation of inland navigation simulators into the educational process. They might become an alternative way for practical training of crew members in near future. In this article we analyse the requirements for the functions and complexity of an inland navigation simulator in the educational process within the Danube region. The analysis comes from the research that was carried out by the organisations that work in Inland Water Transport (IWT) in the Danube region in October 2013.
Distribution and Population Structure of Greater Weever, Trachinus draco (Linnaeus, 1758.), in the Northern and Central Adriatic Sea
Authors:   Sveučilišta u Splitu,  Prirodoslovno-matematički fakultet, Čustović Selma , Vrgoč Nedo , Isajlović Igor , Krstulović Šifner Svjetlana , Piccinetti Corrado
Published: May 2015

This study describes the distribution patterns and population structure of greater weever in the Adriatic Sea. Biological data were obtained during MEDITS surveys in the spring-summer period. The aim of this study is to provide recent data for better understanding of species biology and to create basis for fisheries management based on ecological approach.
Some Experiences of Specialists in Maritime Transport Education at SUAI (Russia) and the University of Dubrovnik (Croatia)
Authors:   Saint-Petersburg State University of Aerospace Instrumentation, Department of System Analysis and Logistics, Russia, Fetisov Vladimir A. , Maiorov Nikolaj N. , Krile Srećko , Đurđević Tomaš Ivica
Published: May 2015

Transport sector is traditionally globally oriented, so education is necessarily connected with standardization. The importance of experience exchange between education centers and schools is obvious. More and more skills that are necessary for specialist in transport sector are connected with logistics and ICT. The most effective approach is that one in which the education is governed by simulators and especially educated instructors with great experience from real sector. In this paper, we have presented some experiences from Saint-Petersburg State University of Aerospace Instrumentation (SUAI) in Russia and Maritime Department from The University of Dubrovnik in Croatia.
Impact of E-Navigation on ECDIS Development as a Decision Support System
Authors:   University of Rijeka, Faculty of Maritime Studies, Rijeka, Bistrović Miroslav , Komorčec Domagoj
Published: May 2015

Density of sea traffic and an increasing number of ships requires the application of new technologies in vessel traffic monitoring in order to find new solutions for existing problems. The solution is identified through application of e-navigation concept by connecting maritime institutions on shore with ships and vessels for better information sharing and integration. The implementation of e-navigation requires adaptation of existing navigation and communication systems to this new concept. The aim of this paper is to present the ECDIS development possibility through requirements of e-navigation, based on end-user needs. Given the large number of devices and systems used in navigation, ECDIS adaptation to e-navigation requirements makes sense only through a thorough understanding of user’s needs. By integrating all available information, organizing them into a database, and presenting them in a specific fashion, a suitable platform for decision-making in everyday ship navigation is created. Since the application of ECDIS onboard has become obligatory and ship’s primary navigational device, the adaptation to e -navigation requirements would mean also becoming a central decision support system onboard.
A Technique for Seabed Mining
Authors:   Institute of Technology and Business in České Budějovice, Department of Transport and  Logistics, Czech Republic, Jeřábek Karel , Stopka Ondrej , Vondráčková Terezie , Voštová Věra
Published: May 2015

The paper deals with the necessity to look for other potential uses of unconventional sources of raw materials to meet the growing needs of human society. The first part of the paper contains the overview of the materials located in seas and oceans. This part describes the alternatives of mining, the dredging systems for extreme depths and the functional structure of the hoisting mechanism for dredging as well. The second part of the paper describes the future prospects for the extraction of minerals from seas and oceans.
Utjecaj prakse Europskog suda pravde na kriterije za imenovanje zapovjednika broda - kriterij “državljanstva”
Authors: Vuković Ante , Bodul Dejan
Published: May 2015

Sloboda kretanja radnika jedna je od temeljnih sloboda na kojima počiva Europska unija (uz slobodno kretanje roba, usluga i kapitala). Definirana je čl. 45. Ugovora o funkcioniranju Europske unije (dalje: UFEU) (pročišćena inačica 2012., Sl. list C 326, 26.10.2012.) te podrazumijeva ukidanje svake diskriminacije na temelju državljanstva među radnicima iz država članica u vezi zapošljavanja Čl. 45., st. 4. UFEU propisano je da se odredbe ovoga članka ne primijenjuju na zapošljavanje u javnim službama. U suštini, funkcije zapovjednika broda su: a.) odgovornost za sigurnost broda i red na brodu, b.) javna ovlaštenja na brodu te c.) zastupanje brodara. Budući da javne ovlasti zapovjednik broda obavlja povremeno, one u stvarnosti predstavljaju tek manji dio njegovih aktivnosti pa se postavlja pitanje mogu li kao takve odrediti funkciju zapovjednika kao javnog službenika, odnosno predstavlja li u suprotnom definiranje državljanstva kao uvjeta za obavljanje funkcije zapovjednika u hrvatskom pomorskom pravu diskriminatorsko postupanje. U radu će se analizirati i stajališta Europskog suda za ljudska prava u postupcima prema čl. 14. Europske konvencije za zaštitu ljudskih prava i temeljnih sloboda (Zabrana diskriminacije), kao i relevantna praksa Europskog Suda pravde.
Informacijski sustav podržan rfid tehnologijom u procesu prodaje i kontrole karata u brodskom putničkom prometu
Authors:   Pomorski fakultet Split, Ristov Pančo , Mrvica Ante , Komadina Pavao , Tomas Vinko
Published: May 2015

U ovom radu predložen je podsustav za prodaju i kontrolu putničkih karata u brodskom putničkom prometu. Spomenuti podsustav temeljen je na uporabi RFID tehnologije. Podsustav se može jednostavno integrirati u postojeći integrirani informacijski sustav brodske putničke kompanije ili u integrirani lučki informacijski sustav. Kao prometne karte koriste se pasivni RFID tagovi koji se mogu kupiti u bilo kojoj ovlaštenoj agenciji za prodaju brodskih karata. Kontrola karata vrši se automatski, jednostavnim unošenjem kartice u polje RFID čitača. Kontrola karte traje veoma kratko i omogućava brzi protok putnika i automobila, a to znači i manje gužve u lukama i vezovima. Srž predloženog podsustava je softverska aplikacija koja povezuje sve komponente RFID tehnologije i distribuirana baza podataka. Primjenom RFID tehnologije ubrzava se proces ukrcaja putnika/auta, smanjuju se gužve u luci, eliminira ukrcaj putnika u pogrešnu brodsku liniju te se značajno smanjuje upotreba gotovinskog plaćanja.
Dynamical changes of basic chemical indicators and significant lipophilic vitamins in caprine colostrum
Authors: Hodulová Lucia , Vorlová Lenka , Kostrhounová Romana
Published: May 2015

Colostrum is currently used as a food supplement. It has been sought after by an increasing number of consumers for its unique composition. Its use is supported by EU legislation that defines colostrum as an animal product for human consumption. Therefore, information on its chemical properties and the content of lipophilic vitamins are important when evaluating colostrum quality and safety. The aim of this study was to assess the dynamic changes of basic chemical properties (protein, fat, lactose, and dry matter) and the content of selected lipophilic vitamins (vitamin A and vitamin E) in white short-haired goat’s colostrum. Attention was paid to the first milk from the first hour to the sixth day after parturition as the initial milk composition changes rapidly during this period. Protein, fat, and lactose concentrations were measured by near infrared spectroscopy, vitamins were analysed simultaneously by ultra-high performance liquid chromatography with detection in the ultraviolet part of the spectrum. The most significant changes in chemical indicators occurred during the first three days (P ≤ 0.01) post partum. The highest decrease was observed in protein concentrations. It was × 2 lower than in the first hour post partum. The concentration of vitamin A rapidly decreased during 36 h. In the following hours, gradual changes were observed (P > 0.05). The analysed components in caprine colostrum were similar to mature milk after 132 h post partum.
Biogenic amines in the meat of hunted pheasant and hare during the course of storage
Authors: Hutařová Zdeňka , Večerek Vladimír , Maršálek Petr
Published: May 2015

Venison is becoming more and more interesting for consumers. Although treatment procedures of hunted game differ from slaughtered livestock, the hygienic quality of game meat must still be ensured. Potential indicators of meat hygienic quality include the content of biogenic amines. The aim of the present study was to assess the content and changes of biogenic amines in the muscles of selected kinds of small game (common pheasant and brown hare) during storage, and based on the obtained results, to assess the hygienic quality of the meat. Biogenic amines (putrescine, cadaverine, histamine, tyramine, phenylethylamine, and tryptamine) in the breast and thigh muscles separated by reverse phase liquid chromatography and consequently were detected using tandem mass spectrometry. Based on the determined content of biogenic amines, both pheasant and hare meats complied with values of high quality meat. The sum of biogenic amines did not exceed the value of 5 mg/kg after 7 days at 0 °C or 7 °C in pheasant meat, and after 21 days at 0 °C or after 14 days at 7 °C in brown hare meat. The biogenic amine content and the speed of their formation in venison can be very helpful for the evaluation of both meat hygienic quality and safety of these foods during storage.
Comparison of new immunofluorescence method for detection of soy protein in meat products with immunohistochemical, histochemical, and ELISA methods
Authors: Petrášová Michaela , Pospiech Matěj , Řezáčová Lukášková Zuzana , Tremlová Bohuslava
Published: May 2015

Soy proteins are commonly used in the food industry thanks to their technological properties. However, soy is, along with cow’s milk, eggs, wheat, peanuts, tree nuts, fish, crustaceans, and molluscs, responsible for around 90% of food allergies, and is also one of the foodstuffs that can cause anaphylaxis. The aim of this work was to compare the immunofluorescence method for the detection of soy protein in meat products purchased from the retail market with other microscopic methods (immunohistochemical and histochemical), with the ELISA reference method and with the confirmatory results. Within the research, 127 meat products purchased in the retail network were examined using the immunofluorescence method used for the detection of soy protein. The method was compared to Enzyme-Linked ImmunoSorbent Assay (ELISA), immunohistochemical, and histochemical methods. According to McNemar’s test, non-compliance between the immunofluorescence method and immunohistochemical method was low. In addition, a significant difference between the fluorescence method and ELISA (P < 0.05) and a highly significant difference between the fluorescence method and histochemical examination (P < 0.01) was found. The immunofluorescence method was also compared with confirmatory results. According to McNemar’s test, non-compliance between the immunofluorescence method and confirmatory results was low. The results showed the possibilities of this new method to detect the content of soy protein in meat products.
The appreciation of nature and landscape by tourism service providers and visitors in the Ore Mountains (Germany)
Authors: Bastian Olaf , Stein Christian , Lupp Gerd , Behrens Jan , Renner Christina , Grunewald Karsten
Published: May 2015

The paper presents empirical studies on the appreciation of nature and landscape in the Eastern Ore Mountains (Saxony, Germany) by tourism service providers (TSP) and visitors. Attractive landscape and experience of nature are the most important reasons to visit this region and to spend leisure time there. Particularly mountain meadows, raised bogs and mixed forests are highly appreciated. Deforestation, industrial development and the decline of biodiversity would reduce attractiveness for visitors. We also assessed whether the tourism sector is prepared to contribute to the funding of nature conservation and landscape management. Use of general tax revenues is favoured, but other modes would also be accepted, e.g. a nature tax. Willingness to pay (WTP) is ranging between €0.75 and €1.36 per guest per night by TSP, or between €1.06 and €2.73 per day by visitors. With respect to landscape preference and WTP we found in some cases significant differences among visitors, depending on region of residence, age and education level. A major part of the annual costs for nature conservation and landscape could be covered by public funds (taxes), if the results of the WTP approach were understood as a sign of societal demand and a call to action.
Aesthetic Practice in Nepal
Authors: Karn D
Published: May 2015

DOI: http://dx.doi.org/10.3126/kumj.v11i2.12483 Kathmandu University Medical Journal Vol.11(2) 2013: 109
Clinical and Electroencephalographic Profile Of Children
Authors: Limbu N , Paudel BH , Thakur D
Published: May 2015

Background Reports on pediatric electroencephalogram of Nepalese patients are rare. Objective We aimed to study the relationship between provisional clinical and electrophysiological diagnoses of pediatric patients with documentation of demographic profiles, and type and frequency of the disorders/diseases. Methods Electroencephalographic reports of 634 children from 2006 to 2009 were analyzed at neurophysiology laboratory, department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, retrospectively. Chi-Square test was applied after detail descriptive statistics. Results Male and female were 72.2 % (n=458/634) and 27.76 % (n=176/634) respectively. Most frequent EEG abnormality was seizure disorder (n=370, 59.39%), then febrile seizure (n= 94, 15.08%) and birth asphyxia with hypoxic-induced encephalopathy (n=68, 10.91%). Electroencephalogram showed significant epileptiform discharges in seizure disorder (p=0.001, OR= 2.26, 95 % CI= 1.61 to 3.18) and in cerebral palsy (p=0.049, OR=6.88, 95 % CI=0.89 to 145.95), specifically in 6 to 12 (p=0.001, OR=2.94, 95 % CI=1.43 to 6.06) and one to five (p=0.019) years, respectively. Electroencephalogram detected significantly less epileptiform discharges (p=0.001, OR=0.25, 95 % CI= 0.15 to 0.42) in febrile seizure specifically in 1 to 5 years (p=0.003, OR=0.16, 95 % CI= 0.04 to 0.63). Conclusion Predominant Electroencephalographic abnormality was seizure disorder, followed by febrile seizure and birth asphyxia with hypoxic-induced encephalopathy respectively. Electroencephalographic abnormality was highly associated with seizure disorder and cerebral palsy but was not associated with febrile seizure. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12484 Kathmandu University Medical Journal Vol.11(2) 2013: 110-116
Fluoride Concentration in Community Water and Bottled Drinking Water: A Dilemma Today
Authors: Dhingra S , Marya CM , Jnaneswar A , Kumar H
Published: May 2015

Background Because of the potential for contamination of municipal water supplies, people appear to be turning to alternative sources for their pure drinking water. Objectives The present study analyzed the fluoride concentration in community water and bottled drinking water sold in Faridabad city. Methods A comparative evaluation of fluoride content in community water supply and bottled drinking water was done using ion-selective electrode method. The community water samples were collected from six different areas (i.e. north zone, south zone, east zone, west zone and central zone) in the city from public health water supply taps while bottled drinking water samples were randomly picked from grocery shops or supermarkets. Results The fluoride concentration in the community water supply in this study ranges from 0.11 to 0.26 mg/L with mean fluoride concentration of 0.17 mg/L. The mean concentration of fluoride in bottled drinking water was 0.06 mg/L. The differences observed between mean of two water samples was statistically significant. Conclusion The results obtained from the present study clearly state that the fluoride concentration was insufficient in community water supply from all the areas and also was deficient in bottled drinking water sold in Faridabad city. So, Alternative sources of fluorides should be supplemented for optimal dental benefits from the use of fluoride. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12485 Kathmandu University Medical Journal Vol.11(2) 2013: 117-120
A Comparative Study of Sexual Dysfunction in Schizophrenia Patients Taking Aripiprazole Versus Risperidone
Authors: Shah SK
Published: May 2015

Background Sexual dysfunction due to antipsychotics is a significant problem encountered with first-generation antipsychotics. Even the second-generation antipsychotics like risperidone are not free of sexual dysfunction due to its D2 blocking properties leading to hyperprolactinaemia. Newer antipsychotic aripiprazole, partial dopamine agonist, with neutral effect on prolactin level or even decreasing it, is associated with avoidance of sexual dysfunction. Objectives To assess the effect of risperidone and aripiprazole on sexual function of schizophrenic patients. Methods This was an open-label, cross-sectional, observational study conducted at College of Medical Sciences, Bharatpur. Schizophrenic patients attending OPD and inpatient, taking risperidone or aripiprazole for at least two months were included in this study. Forty one patients, without chronic medical illness and sexual dysfunction before starting drugs, with informed consent were studied during Jan 2012 and Aug 2012. Results Changes in sexual activity was found in 11(55%) of those taking risperidone while, only 3(14.3%) had any kind of sexual difficulty. This was statistically significant (p=0.006). Majority, 92.7% of the patients did not report about changes in sexual activity spontaneously. Conclusion Sexual dysfunction was statistically significantly higher in those taking risperidone. Prevalence of sexual dysfunction was low with aripiprazole. Except those having poor sexual functions due to the drugs, the majority had to be specifically inquired about the effects of drug on sex life.DOI: http://dx.doi.org/10.3126/kumj.v11i2.12486 Kathmandu University Medical Journal Vol.11(2) 2013: 121-125
Cervical Epidural Anaesthesia with Ropivacaine for Modified Radical Mastectomy
Authors: Kulkarni K , Namazi IJ , Deshpande S , Goel R
Published: May 2015

Background Cervical epidural anaesthesia (CEA) using local anesthetics (LA) is a well established technique for the surgeries in the neck, chest and upper arms. Recently ropivacaine is introduced with better safety profile. Objectives The aim was to observe the safety of Cervical epidural anaesthesia as an anaesthetic technique and to compare the efficacy of epidural 0.25% bupivacaine with 0.375% ropivacaine for radical mastectomies. Methods A double blind study was conducted on 40 ASA grade I / II females who received CEA with 10 ml of 0.25% of bupivacaine +25μg of fentanyl in group B (n=20) and 10 ml of 0.375% of ropivacaine +25μg of fentanyl in group R (n=20) epidurally. Assessment of the block, vital monitoring and complications noted. Results No significant differences observed in the onset of sensory block (5.05min and 5.4min in group B and R respectively, P>0.05).The mean motor blockade score, time to achieve complete blockade and time to grade I motor recovery was significantly longer in group B (2.3, 22.5 and 79.5 minutes respectively) as compared to group R (1.5, 18.3 and 66.3 minutes respectively, P<0.05). Respiratory distress developed in two patients of group B that required general anaesthesia (GA) with intubation. Conclusion Use of 0.37% ropivacaine is safer than 0.25% bupivacaine for CEA for radical mastectomy. It provides good surgical anaesthesia with lesser degree of motor blockade and the respiratory effects. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12487 Kathmandu University Medical Journal Vol.11(2) 2013: 126-131
Lymphocytes Protect Cortical Neurons Against Excitotoxicity Mediated by Kainic Acid, an in vitro Model for Neurodegeneration
Authors: Shrestha R , Millington O , Brewer J , Bushell T
Published: May 2015

Background Neurodegenerative disease is a progressive loss of neurons from the central nervous system (CNS). Various conditions have been implicated for such conditions including ageing, inflammation, stress and genetic predisposition. Recently, studies have linked neurodegeneration with inflammation. Some studies have suggested the harmful effect of immune response while others have argued its neuroprotective role in neurodegeneration of the CNS. However, the precise role of inflammation and immune cells in such condition is still not clear. Objective To investigate the role of lymphocytes in neurodegeneration of the CNS and determine the underlying mechanism. Method We have used 4-7 days old mouse pups (C57Bl6) to prepare organotypic slice cultures which were cultured for 13-15 days prior to experiment. To induced cell death kainic acid was used and considered as an in vitro model for neurodegeneration. Lymphocytes were obtained from peripheral lymph nodes of 5-10 weeks old adult mouse which were used in the current study. Propidium iodide was used as a fluorescent dye to determine cell death in brain slice cultures. Result Lymphocytes do not induce cell death in slice cultures in the absence of any toxic insult whereas, after applying toxic insult to the slice cultures using kainic acid, lymphocytes show neuroprotection against such insult. Similarly, purified non-activated and purified activated T cells along with T cells depleted lymphocyte preparation also exhibit neuroprotection against kainic acid-induced cell death. We further, have demonstrated that the observed neuroprotection is contact-independent and soluble mediators released from lymphocytes are responsible for the observed neuroprotection. Moreover, our study has revealed that soluble mediators exhibiting neuroprotection act via astrocytes. Conclusion Lymphocyte preparations are neuroprotective and the observed neuroprotection is contact-independent. Soluble mediators released from lymphocytes are responsible for the observed neuroprotection. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12488 Kathmandu University Medical Journal Vol.11(2) 2013: 132-138
Epidemiological and Outcome Analysis of Orthopedic Implants Removal in Kathmandu University Hospital
Authors: Shrestha R , Shrestha D , Dhoju D , Parajuli N , Bhandari B , Kayastha SR
Published: May 2015

Background Orthopedic Implant removal is one of the commonly performed elective orthopedic surgeries. Implants are generally removed after the purpose of keeping implant is solved by healing of the fracture, but there is no consensus whether routine implant removal should be a policy for all fractures that were fixed. Objective This study aims to analyze the epidemiology and outcome of implant removal surgery carried out in the past three years in Kathmandu University Hospital. Methods Patients who underwent implant removal between 2010 January to 2012 December constituted the study cohort. Demographic data, indications, types of hardware and location of fractures were recorded. Similarly, duration of surgery, type of anesthesia and duration of hospital stay were recorded. All the patients who had undergone implant removal in this three years period were called for follow up examination but those who were not able to come were interviewed on telephone. Results There were 275 implant removals constituting 7.8% of total orthopedic operations and 26.3% of fracture fixations. Male to Female ratio was 189: 86. Pediatric age group (34.5%) had the highest incidence of implant removal. Moderate sized implants were the commonest hardwares removed (63.2%). Femur (27.3%) followed by radius (26.9%) were the commonest bone for implant removal. Average operative time was 47.3 minutes with average hospital inpatient stay of 2.6 days. Commonest indication for the implant removal procedure was pain (45%). Conclusion Implant removal procedures are one of the most commonly performed elective orthopedic surgeries. Though, after orthopedic implants removal, pain relief can be expected but it is not so predictive and hence patient should be well counseled before and the indications for implant removal has to be evaluated for better patient satisfaction and safety. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12489 Kathmandu University Medical Journal Vol.11(2) 2013: 139-143
Post-Operative Drop in Hemoglobin and Need of Blood Transfusion in Cesarean Section at Dhulikhel Hospital, Kathmandu University Hospital
Authors: Singh B , Adhikari N , Ghimire S , Dhital S
Published: May 2015

Background Cesarean section has been identified as one of the commonest indication for blood transfusion in obstetric practice because it involves risk of major intra-operative blood loss. Different figures varying from less than 500 ml to more than 1000 ml have been quoted as estimated blood loss associated with caesarean section. There is also a wide variation in blood ordering practices for this surgery. Objective The objective of this study is to evaluate the blood ordering practice and transfusion for cesarean sections at our institute, to see post-operative drop in hemoglobin and hematocrit and to correlate those parameters with the duration between uterine incision and repair. Methods In this prospective observational study, non-randomised purposive sample was taken from 121 ladies who underwent elective and emergency cesarean section at the department of obstetrics of Dhulikhel Hospital-Kathmandu University Hospital. Post-cesarean drop in hemoglobin and hematocrit and their relation with duration of uterine manipulation was calculated. Cross-match to transfusion (C/T ratio) ratio, transfusion probability (%T) and transfusion index (Ti) were also calculated. Results Most frequent blood group was found to be O positive (38%) among those ladies. Average post-cesarean drop in hemoglobin was 1.52±1.27 gm/dl and drop in haematocrit was 5.49±4.1%. Post-operative drop in hemoglobin and haematocrit had weak and positive linear relation with duration between uterine incision and repair. Cross-match to transfusion ratio was 1, transfusion probability 100% and transfusion index was 2. Conclusion There is no need of routine cross-matching of blood for cesarean section. Only grouping with confirmation of availability should be done for emergency situation. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12490 Kathmandu University Medical Journal Vol.11(2) 2013: 144-146
A Convenient Way to do Valgus Osteotomy for Neglected Fracture Neck of Femur
Authors: Bansal P , Singhal V , Lal H , Mittal D , Arya RK
Published: May 2015

Background Neglected fracture of neck of femur in young adults is a major problem in developing countries. Existing treatment options varies from osteotomy to various graft techniques (muscle pedicle, vascularized and nonvascularized fibula etc.). There is paucity of literature regarding the use of double angle barrel plate and hip screw in such cases. We conducted a prospective longitudinal observational study with displaced, neglected fracture neck of femur in young adults and compared the results with literature. Objectives The aim of this study was to determine feasibility and effectiveness of 120° double angle barrel plate and hip screw fixation in neglected fracture neck of femur. Effectiveness of fixed 30 degree closed wedge osteotomy in neglected fracture neck of femur. Methods Thirty cases of neglected (more than three weeks) femoral neck fracture (Pauwel II and III) of age 20-60 years were included in the study conducted at Postgraduate Institute Of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India in year 2004-06. Average age of the patient was 35.4 years (range, 22yrs-55yrs). In all cases internal fixation was done by 120° double angle barrel plate and hip Screw. At the end of follow-up, results were evaluated according to Askin Bryan Criteria and Harris-hip score. Results Union was achieved in 28 of 30 patients. Two patients that went into nonunion were later treated with hemireplacement arthroplasty. According to Askin Bryan Criteria at the end of study, 35% patients had excellent results, 50% patients had good results. Minimum follow-up in our study was 12 months and maximum was five years. Conclusion This study validates the use of double angled screw plate configuration for successful outcome in patients with neglected fracture neck of femur. Valgus osteotomy is also technically easy operation in hands of average trauma surgeon with the use of a fixed angle plate and hip screw.DOI: http://dx.doi.org/10.3126/kumj.v11i2.12491 Kathmandu University Medical Journal Vol.11(2) 2013: 147-151
A Cross-Sectional Comparison of Drinking Patterns, Alcohol Use and Related Medical Morbidities in a Secondary Versus Tertiary Setting
Authors: Risal A , Tharoor H
Published: May 2015

Background Alcohol Dependence exists in different spectrums at different settings and associated with various medical morbidities, disability and health care utilization costs. Objectives To study the drinking patterns, alcohol use disorders and alcohol related medical morbidities in patients diagnosed with Alcohol Dependence Syndrome (ADS) and attending out / in-patient psychiatry services at secondary and tertiary care centre. Methods A cross-sectional comparative study was done among the patients diagnosed with ADS attending psychiatry services at District hospital, Udupi and Kasturba Hospital, Manipal. Serial sampling was done. Patients having any other psychiatric illnesses were excluded. The two groups were compared in relation to socio-demographic variables, drinking related variables, patterns of drinking and alcohol related medical morbidities identified. Results Significant differences in some socio-demographic parameters among the patients from the two different treatment centers were found with secondary level hospital (N=50) having more illiterate, laborers and below the poverty line population in comparison to the tertiary level hospital (N=75). Maximum frequency of gastro-intestinal morbidities was seen in both the hospital population, irrespective of the patterns of drinking. Conclusion Alcohol use disorders and alcohol related medical morbidities show some variations in their presentations in the different treatment centers. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12492 Kathmandu University Medical Journal Vol.11(2) 2013: 152-157
Education: The Key to Curb HIV and AIDS Epidemic
Authors: Bhatta DN , Aryal UR , Khanal K
Published: May 2015

Overwhelming impact has been established among different aspects and burden of incurable HIV and AIDS is increasing day-by-day globally. The aim of this article is to discuss the potential benefits and strengths of an education system in the absence of remedy and help to develop future strategies. Education has great impact on HIV and AIDS and vice-versa. An education plays a vital role to curb the transmission of HIV and AIDS thorough capacity building, provides information, reduces vulnerability, empowerment, improve life skill, maintain equity, reduce dependence, stigma, and discrimination, where are abundance foundations for HIV infection. HIV and AIDS has role for devastation of education system and level which has great impact on productivity, economic growth, demand, supply and daily life of human being. Low and middle income countries needs to be improve recording and reporting systems related to impact of HIV and AIDS on education. By analyzing preceding evidences, policy makers or governance feels to reformulate policies relating to education and health. Evidence based policy and program will be more useful to address distressing squall of epidemic. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12493 Kathmandu University Medical Journal Vol.11(2) 2013: 158-161
Fenestration of Axillary Vein by a Variant Axillary Artery
Authors: Hadimani GA , Desai SD , Bagoji IB , Patil BS
Published: May 2015

Variations of venous pattern in the arm are common. In this case report, we present a variation of axillary artery and vein. During routine educational dissections of axillary region, it was observed that a fenestrated axillary vein was perforated by a variant axillary artery in right arm of an old male cadaver. The axillary artery which was fenestrated through axillary vein had only two branches arising from its second part and no branches from its remaining distal parts. The branches are thoraco-acromial (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the subscapular, circumflex scapular, posterior circumflex humeral and lateral thoracic arteries. We propose to name this artery as collateral axillary arterial trunk. The course of this collateral axillary arterial trunk and its branches and also clinical significance of this variation are discussed in the paper. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12494 Kathmandu University Medical Journal Vol.11(2) 2013: 162-164
Return of Visual Acuity to Normal in Old Age
Authors: Misra A
Published: May 2015

Changes occur in our body through out life. Decreased visual acuity is probably the most common effect of age-related anatomical and neurological changes in the eyes and the visual pathway. However, this case is an exception as at the age of 75 years, his power of accommodation has returned to normal. The improvement in accommodation and visual acuity is hard to explain. Likely explanations given need to be further investigated. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12495 Kathmandu University Medical Journal Vol.11(2) 2013: 165-167
Terminal Bifurcation of the Right Testicular Vein and Left Testicular Arterio-Venous Anastomosis
Authors: Nayak BS , Rao KGM , Shetty SD , Sirasanagandla SR , Kumar N , Guru A
Published: May 2015

The testis is the organ upon which the survival of the human species depends. Abnormalities of testicular vessels may lead to loss of gametogenesis and hormone production. Reported here is a case of bilateral variations of the testicular vessels observed in a male cadaver during the first year MBBS dissection classes. The right testicular vein bifurcated into two veins just before its termination and both the branches terminated into the inferior vena cava. The left testicular artery arose from the abdominal aorta just above the level of origin of the inferior mesenteric artery. There was an arterio-venous anastomosis between the left testicular vein and the left testicular artery. The arterio-venous anastomosis might be functionally important as it can change the quality of the blood entering the testis. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12496 Kathmandu University Medical Journal Vol.11(2) 2013: 168-170
A Multidisciplinary Approach in Treating a Patient with Unilateral Cleft Alveolus
Authors: Das D
Published: May 2015

Any type of aesthetic correction in dental practice is always a challenging task, especially when it is complicated with cleft lip and alveolus. Careful examination and correct decision making at early stage of treatment and multi disciplinary approach is always necessary for long term success. This paper described a multidisciplinary approach in managing a 19-year-old female patient with unilateral cleft alveolus impacted maxillary canine , missing lateral incisor and hypoplastic central incisor by surgical , orthodontic and prosthodontic means. The impacted canine was surgically exposed and orthodontic traction given to bring it into the normal alignment. The missing lateral incisor was replaced by a fixed bridge with a ceramic gingival fixed prosthesis to manage alveolar cleft. At the same time the hypoplastic defect of central incisor was hidden by the full coverage retainer used for the bridge abutment on the tooth. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12497 Kathmandu University Medical Journal Vol.11(2) 2013: 171-174
Burning Mouth Syndrome: An Enigmatic Disorder
Authors: Javali MA
Published: May 2015

Burning mouth syndrome (BMS) is a chronic oral pain or burning sensation affecting the oral mucosa, often unaccompanied by mucosal lesions or other evident clinical signs. It is observed principally in middle-aged patients and postmenopausal women and may be accompanied by xerostomia and altered taste. Burning mouth syndrome is characterized by an intense burning or stinging sensation, preferably on the tongue or in other areas of mouth. This disorder is one of the most common, encountered in the clinical practice. This condition is probably of multifactorial origin; however the exact underlying etiology remains uncertain. This article discusses several aspects of BMS, updates current knowledge about the etiopathogenesis and describes the clinical features as well as the diagnosis and management of BMS patients. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12498 Kathmandu University Medical Journal Vol.11(2) 2013: 175-178
Gender-Based Violence: A Crucial Challenge for Public Health
Authors: Sanjel S
Published: May 2015

This article attempts to summarize the situations of gender-based violence, a major public health issue. Due to the unequal power relations between men and women, women are violated either in family, in the community or in the State. Gender-based violence takes different forms like physical, sexual or psychological/ emotional violence. The causes of gender-based violence are multidimensional including social, economic, cultural, political and religious. The literatures written in relation to the gender-based violence are accessed using electronic databases as PubMed, Medline and Google scholar, Google and other Internet Websites between 1994 and first quarter of 2013. The keywords such as gender-based violence, women violence, domestic violence, wife abuse, violence during pregnancy, women sexual abuse, political gender based violence, cultural gender-based violence, economical gender-based violence, child sexual abuse and special forms of gender-based violence in Nepal were used for internet search. As GBVs remain one of the most rigorous challenges of women’s health and well-being, it is one of the indispensable issues of equity and social justice. To create a gender-based violence free environment, a lot works has to be done. Hence, it is suggested to provide assistance to the victims of violence developing the mechanism to support them. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12499 Kathmandu University Medical Journal Vol.11(2) 2013: 179-184
How I Do It? Endoscopic Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty
Authors: Shrestha BL
Published: May 2015

DOI: http://dx.doi.org/10.3126/kumj.v11i2.12500 Kathmandu University Medical Journal Vol.11(2) 2013: 185-187
Community Based Medical Education – Necessity Realization and Practice
Authors: Koju R
Published: May 2015

DOI: http://dx.doi.org/10.3126/kumj.v11i3.12501 Kathmandu University Medical Journal Vol.11(3) 2013: 189-190
Study on Developmental- Behavioural Pediatrics Training Experiences of Pediatricians and Pediatric Trainees Working in Nepal
Authors: Rimal HS , Pokharel A , Saha V
Published: May 2015

Background There are growing concerns about developmental, behavioural, social and emotional wellbeing of children throughout the world. A huge gap exists between the instructions provided on medical disciplines and on areas of Developmental- Behavioural Pediatrics (DBP) during pediatric training in our region. Objective This study aims to evaluate the Developmental –Behavioural pediatrics (DBP) training experiences of pediatricians and pediatric trainees during their post graduate training in pediatrics. Methods Questionnaires were sent to the pediatricians / trainees and data was analyzed using SPSS software. Result More than 56 % of respondents were satisfied in 10 out of 11 medical disciplines where as more than 56% were unsatisfied in 10 out of 11 developmental behavioural pediatrics disciplines. This Study has demonstrated that between 50-60 % of pediatricians did not see the cases of ADHD, Learning difficulty and family dysfunction for a period of three months prior to the survey which are relatively common conditions. Even in post graduate training nearly 66 % of pediatricians were unsatisfied with their instructions in DB pediatrics. Conclusion Pediatricians working in Nepal have difficulties in addressing the issues of developmental pediatrics, raising a question about the need to review the curriculum of post graduate training in Pediatrics. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12502 Kathmandu Univ Med J 2013; 43(3):191-195