bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Interesting Case of Basal Cell Carcinoma with Raynaud’s Phenomenon Following Chronic Arsenic Exposure
Authors: Gulshan Shazia , Rahman Muhammed Jawaid , Sarkar Ranu , Ghosh Suman , Hazra Rathin 
Published: September 2018

Arsenic is commonly known to be associated with squamous cell carcinoma. Among the lesser known associations is basal cell carcinoma and even rarer is its effect on blood vessels causing peripheral vascular disease. Here we present a case of a 55 yr old man with ulceroproliferative lesions on scalp and forehead along with several hyperpigmented patches on trunk and extremities. He had symptoms suggestive of Raynaud’s phenomenon that eventually led to digital gangrene. FNAC was done which was suggestive of basal cell carcinoma. On further enquiry, he was found to reside in an arsenic endemic zone and was investigated for blood arsenic level which was elevated. Punch biopsy from different lesions from body confirmed nodular basal cell carcinoma. Presently the patient has stopped drinking water from the local tubewell. On follow-up he shows improvement of Raynaud’s phenomenon and skin lesions.Keywords: basal cell carcinoma; chronic arsenic exposure; raynaud’s phenomenon. | PubMed
Role of Eosinophils in Acute Appendicitis
Authors: Shrestha Reshmi , Shrestha Anju , Tiwari Mamata , Ranabhat Sabin , Maharjan Sushna 
Published: September 2018

Introduction: High negative appendectomy rate still prevails on conventional histologic examination. Increased mural eosinophilic infiltrate had been observed in acute appendicitis. Present study aimed to evaluate the role of mural eosinophils in clinically suspected acute appendicitis but histological normal appendix, as an indicator of acute inflammation, alone or in association with edema and to estimate the cut off value for high eosinophil count for the diagnosis of acute appendicitis.
Methods: A prospective cross sectional study was conducted on appendectomy specimens which were categorized into three groups of classical acute appendicitis, negative appendectomy and control. HandE and Giemsa stained section were studied for the presence of mural eosinophilic infiltrate, mast cells and edema.
Results: Of total 170 cases, group 1 comprised of 68 cases, group 2 consisted of 78 cases and group 3 consisted of 24 cases. Mean eosinophil and mast cell counts in the muscularis propria were significantly higher in CAA and NA categories when compared to control group. Positive association was found between high eosinophil count and edema in CAA and NA categories. Cut off value of ≥6/ mm2 for mural eosinophil count was not significantly different in between NA and control categories.
Conclusions: Increased mural eosinophils were significantly present in acute appendicitis and clinically suspected acute appendicitis but histological normal appendix when compared with control group. Sole presence of increased mural eosinophils might represent acute inflammation. However, cut off value for high eosinophil count could not be established to suggest acute appendicitis.
Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.
Patterns of Lesions in Hysterectomy Specimens in a Tertiary Care Hospital
Authors: Vaidya Sujan , Vaidya Sapana Amatya 
Published: September 2018

Introduction: Hysterectomy is one of the most common gynaecological procedures performed all over the world. The most frequent indications for hysterectomy are fibroids, abnormal uterine bleeding uterovaginal prolapse and endometriosis. The objective of this study was to present the histopathological patterns of various uterine and adnexal pathologies in the hysterectomy specimens and also to correlate its pre-operative clinical diagnosis with histopathology.
Methods: This is a two-year descriptive study of hysterectomy specimens carried out in the Department of Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all the hysterectomy specimens collected during this period was analyzed.
Results: Out of the 533 cases, fibroid was the most common indication for hysterectomy that was seen in 229 (42.94%) cases followed by uterovaginal prolapse in 101 (18.93%) cases. Leiomyoma was the most common pathology reported in 250 (46.90%) hysterectomy specimens, followed by ovarian tumours in 95 (17.82%) cases. In 17.82% (95/533) cases, no pathology was seen. Overall, the pre-operative indications in 533 cases of hysterectomy were histopathologically verifiable in 487 (91.37%) cases.
Conclusions: Though the histopathological examination correlates well with the pre-operative clinical diagnosis, a number of lesions were also encountered as pure incidental findings. Hence, it is mandatory that every hysterectomy specimen should be subjected to histopathological examination so as to ensure better post-operative management.
Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.
Risk of Periodontal Disease: Is there a Correlation with the Type of Antihypertensive Medication?
Authors: Scardina G A , Messina P 
Published: September 2018

Introduction: The purpose of this study was to evaluate the effects of long-term oral antihypertensive treatment using centrally acting sympatho-inhibitory drugs (clonidine) and beta-blockers (metoprolol) on capillary microcirculation in the labial and periodontal mucosa.
Methods: Sixty subjects were recruited for the study: 20 patients affected by hypertension in treatment with centrally-acting sympatho-inhibitory drugs (64.28 ± 11.78 years); 20 patients in treatment with beta-blockers (62.03 ± 9.84 years) and 20 healthy subjects (62.06 ± 6.72 years). We use the videocapillaroscopic technique to evaluate in vivo the microcirculation of the labial mucosa corresponding to the lower lip and of the periodontal mucosa corresponding to the central superior incisor.
Results: Capillaroscopy revealed a significant increase in the length, diameter, tortuousity and density (P <0.05) of capillaries in patients affected by hypertension in treatment with centrally acting sympatho-inhibitory drugs, while beta-blockers had a lower effect on the labial and periodontal microcirculation compared to the healthy population.
Conclusions: The capillaroscopic has revealed substantial modifications of the oral microcirculatory pattern in hypertensive patients in treatment with centrally-acting sympatho-inhibitory drugs than with beta-blockers.
Keywords: Hypertension, antihypertensive drug, oral videocapillaroscopy.
Diagnosis Delayed but not Denied - Sheehan’s syndrome
Authors: Thyagaraj Vijayeshree , Kumar MJ Vinod 
Published: September 2018

Sheehan’s syndrome is a rare complication of postpartum hemorrhage. With advancement in obstetric care, Sheehan's syndrome has become uncommon except in developing countries. Here, we report a patient with Sheehan’s syndrome who escaped diagnosis for 22 years and presented with life threatening complications. This patient also had certain unusual features of Sheehan’s syndrome like pancytopenia and renal failure. A high index of suspicion is necessary in diagnosing such patients.
Keywords: pancytopenia; renal failure; Sheehan syndrome.
Facilitation of free residential training inside the country – The fundamental health service responsibility of the Government and its regulatory body
Authors: Bhattarai Madhur Dev 
Published: September 2018

For optimum Peripheral Health Service and implementation of various Vertical Public Health Programme Services, network of public Rural and Urban Health Centers with trained Specialists in General Practice (GP) is essential. Later such Specialist GPs will thus fulfill both comprehensive training and experience required for Health Management and Planning Service in the centre. About 40%-50% of all Residential Trainings and Specialists are required in GP. There are further up to 100 to 150 possible specialties in which remaining doctors can be trained for Specialty Health Services. Though free Residential Training has numerous advantages, its shortage inside country is the bottleneck to provide above mentioned Health Services. Planning for health service delivery by at least trainee residents under supervision or appropriately trained specialists guides Residential Training’s regulations. Fulfillment of objective training criteria as its core focus is the concept now with the major role of Faculty as supervising residents to provide required service in the specialty and simultaneously updating themselves and their team for Evidence-Based Medicine practice. Similarly the need of Ambulatory Health Service and joint management of in-patients by specialists in hospitals has changed unit and bed divisions and requirements for Residential Training. Residents, already the licensed doctors, are thus providing required hospital service as indispensable part of its functional hierarchy for which they need to be paid. With such changing concepts and trends, there are some essential points in existing situation to facilitate free Residential Training inside country. For Government doctors, relevant amendment in their regulation is accordingly required.
Keywords: ambulatory care; general practice; health service; hospitalist; medical council; medical
education; public health; regulatory body; research; residential training.
Effect of Gender and Body Weight on Postprandial Glucose and Lipid Metabolism in Adults with Type 2 Diabetes
Authors: Diaf Mustapha , Khaled Boumediene Meghit , Habib Houari Hadj , Belbraoued Slimane 
Published: September 2018

Introduction: The magnitude of the healthcare problem of type-2-diabetes increases according to its association with several risk factors for cardiovascular diseases such as obesity and dyslipidemia.
Methods: This study took place in the north-western region of Algeria. We aimed to assess the effect of body weight and gender on postprandial lipid and glucose in type-2-diabetes patients. 93 diabetic patients (age 55.65±13.81 years) were studied. Anthropometric parameters and body mass index (BMI) were measured. Fasting and postprandial (PP) glucose and lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apo A-I and apo B) profiles were evaluated.
Results: There were a positive correlation between postprandial glucose and BMI in women (r2 = 0.041). Negative correlation with BMI was noticed for PP TG in both males (r2 = 0.011) and females (r2 = 0.021). A significant difference (p= 0.019) was observed for PP HDL-c in women (0.39 ± 0.10 g/L vs. men 0.33 ± 0.12 g/L) and also for PP apo A-I (women: 1.33 ± 0.27 g/L vs. men: 1.09 ± 0.34 g/L; p= 0.0003). According to gender and weight groups, our results indicated that female gender and overweight are associated with elevated PP HDL-c and PP apo A-I levels. However, obesity in women is related to high concentration of PP TG.
Conclusions: The present study suggests that gender difference and weight classes are important factors that contribute to determining the postprandial responses, both for glucose and lipids, in type 2 diabetic patients.
Keywords: gender difference; postprandial dyslipidemia; type 2 diabetes; weight groups.
Clinico-microbiological Profile and Visual outcome in Traumatic Endophthalmitis following Pars Plana Vitrectomy at a Tertiary Eye Care Centre of Nepal
Authors: Thapa Raba , Paudyal Govinda 
Published: September 2018

Introduction: Endophthalmitis is a potentially devastating ocular complication of perforating eye injury where prompt intervention can save some vision. This study aims to explore the clinico-microbiologic profile and visual outcome following pars plana vitrectomy (PPV) in traumatic endophthalmitis.
Methods: This is a retrospective interventional case series study conducted at a tertiary eye care centre of Nepal. A total of 49 consecutive cases (49 eyes) of endophthalmitis following PEI, who underwent PPV from January 2007 to June 2010 were included in the study.
Results: Mean age was 14.7 years (S.D. 14.27). Twenty seven patients (55%) were of age group below 10 years. Male to female ratio was 2.75:1. Mean duration of presentation was 8.9 days. Nineteen eyes (36.73%) had injuries with wooden sticks, followed by injury with metallic objects in 16 patients (32.56%). PEI involving zone I was found in 31 eyes (63.25%). The retained intraocular foreign body was found in seven patients (14.2%). The post operative vision improved in almost 24 cases (49%) with visual recovery of 20/200 and better in six cases (12.24%). The vitreous culture was positive in five cases (12.8%) with predominant streptococcus pneumonia in four cases (10.25%).
Conclusions: Children were the mostly affected group with males outnumbering females. Wooden sticks and metallic objects were the commonest insulting agents. Despite the late presentation and predominant zone I injury, eye could be salvaged in majority with visual recovery of 20/200 and better in six cases (12.24%).Keywords: endophthalmitis; intra-ocular foreign body; perforating eye injury; vitrectomy .
Effect of Physical Exercise on some Hematological Parameters in Female Athletes in Bangladesh
Authors: Alam Tanbira , Shirin Lubna , Rahman SM Niazur , Alam Tanjeda , Habib Nasrin , Umar Badar Uddin , Banna Quazi Rubayath , Begum Rokeya 
Published: September 2018

Introduction: Long term physical training has been considered to adversely affect the performance of athletes especially the females. It may be due to the iron depletion caused by hemolysis or hemodilution results from plasma volume expansion. This study aims to assess the effect of heavy exercise on hemoglobin concentration and some other hematological parameters in female athletes.
Methods: This cross sectional study was carried out in the Department of physiology, Dhaka Medical College, Dhaka, from July 2010-June 2011. A total number of 105 females (70 athletes and 35 non athletes) between 15-25 years of age were recruited. The 35 apparently healthy female non athletes were taken as control (Group-A) and 70 female athletes comprise the study group (Group-B). According to sporting category, Group-B was further subdivided as B1:Runners and B2:Cyclists. Hemoglobin percentages (Hb %), red blood cell (RBC) concentration, packed cell volume (PCV), serum iron, serum ferritin and total iron binding capacity (TIBC) were measured in fasting state after two months training. Statistical analysis was done by using SPSS/ win.15.0 for comparison between the groups, using student’s unpaired “t” test.
Results: Mean Hb%, RBC, PCV, iron and ferritin level were significantly (P<0.001) lower in athletes than those of control group. Within the study groups, runner’s serum iron and ferritin level were lower than cyclists. TIBC significantly (P<0.001) rose in Group-B2 in comparison to Group-A.
Conclusions: The current study showed that intense physical exercise leads to early stages of Hb%, RBC, PCV, iron and ferritin depletion which might compromise the health and performance of athletes.
Keywords: exercise; hemoglobin; packed cell volume; serum iron.
Frontalis Sling Operation using Silicone Rod Compared with Autogenous Fascia Lata for Simple Congenital Ptosis
Authors: Sthapit Purnima Rajkarnikar , Saiju Rohit , Limbu Ben 
Published: September 2018

Introduction: To evaluate the cosmetic results and recurrence of unilateral frontalis sling surgery using a silicone rod compared with autogenous fascia lata in cases of simple congenital ptosis.
Methods: This is a retrospective comparative study of 59 patients who underwent a frontalis sling operation for congenital ptosis. Patients were divided into two groups according to the sling material used; an autogeneous fascia lata (fl) group (n = 24) and a silicone rod group (sl) (n = 35). Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the difference between the Margin Reflex Distance of both eyelids and graded as good if the difference in two eyes was ≤1mm and poor if it was 2mm or more. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category.
Results: At postoperative day seven and 30, MRD of both the groups were good but on three months follow-up MRD of silicon rod group dropped, however it was not statistically significant .Lid contour was good in both the groups, however, lid symmetry was poor in two cases of fascia lata at three months follow-up. Repeat surgery for poor outcome was done in 8.6% of cases in silicon rod and 8.3% of fascia lata group.
Conclusions: The frontalis sling operation using either a silicone rod or autogenous fascia lata showed equally good cosmetic results and lower recurrence rate at three months follow up.
Keywords: congenital ptosis; fascia lata; frontalis sling surgery; margin reflex distance; silicone rod.
Screening for Oral Cavity Cancer: A 1-year Experience of a Regional Hospital in Taiwan
Authors: Chi Tzu-Hang , Yuan Chien-Han , Chen Rong-Feng 
Published: September 2018

Introduction: The purpose of this study was to analyze the risk factors affecting precancerous lesions, and cancer of oral cavity, and to assess efficacy of visual screening for oral mucosal lesions.
Methods: The medical records of patients older than 30 years of age with history of habitual cigarette smoking or betel quid chewing that received screening for oral mucosal lesions between January 2012 and December 2012 were retrospectively reviewed. The patients' age, gender, risk factors, screening findings, and histopathology results of biopsy were included for further analysis.
Results: A total of 1341 patients were enrolled in this study. There were 1080 males and 261 females ranging from 30 to 96 years of age, with a mean age of 53.9±13.6 years. After screening, 226 (16.9%) were found to be positive of oral lesions. Among these 226 patients, 69 (30.5%) underwent biopsy under local anesthesia, and the histopathology showed malignancy in 13 (5.8%). All of the confirmed malignant cases were squamous cell carcinoma. Among them, 12 received further staging examination and one was lost to follow-up resulting in unknown stage. The early stage oral cavity cancer (stage I and II) accounted for 84.6% (11/13).
Conclusions: The detection rate of early stage oral cavity cancer in our study was reasonable. Therefore, visual screening for oral cavity cancer is recommended for patients with habitual cigarette smoking or betel quid chewing.
Keywords: betel quid chewing; cigarette smoking; oral cavity cancer; screening.
Effect of Dexamethasone and Pheniramine Maleate in Patients Undergoing Elective Laparoscopic Cholecystectomy
Authors: Shrestha Binod Bade , Karmacharya Mikesh , Gharti Binod Babu , Timilsina Bishowdeep , Ghimire Pradeep 
Published: September 2018

Introduction: Laparoscopic cholecystectomy is elective surgical procedure for uncomplicated gallstone disease and gallbladder polyp. The objective of this study was to assess the efficacy of Dexamethasone and Pheniramine hydrogen maleate on reducing stress response and pain after surgery in patients undergoing laparoscopic cholecystectomy.
Methods: After obtaining approval from the institutional ethics committee and written informed consent, 120 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study from Sep 2103 to Aug 2014 at Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Patients were randomized to receive either 8mg/2ml of Dexamethasone + 45.5/2ml Pheniramine hydrogen maleate (treatment group, n= 60) or 5 ml of normal saline (control group, n=60) 90 minutes before skin incision.
Results: There was a reduction of total bilirubin, C-reactive protein value and Visual Analogue Score (VAS) in treatment group as compared to control group (p <0.05).
Conclusions: Use of Dexamethasone and Pheniramine hydrogen maleate prior to surgical skin incision helps to reduce both postoperative pain and acute physiological stress.
Keywords: C - reactive protein; dexamethasone; laparoscopic cholecystectomy; pheniramine hydrogen
maleate.
Construction and Validation of a Women’s Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal
Authors: Bhandari Tulsi Ram , Dangal Ganesh , Sharma P Shankara , Kutty V Raman 
Published: September 2018

Introduction: Women’s autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women’s autonomy with relevance to developing countries.
Methods: We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women’s autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation.
Results: The new scale was strongly supported by Cronbach’s Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale.
Conclusions: The new scale is a reliable tool for assessing women’s autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.
Keywords: maternal health care; scale construction and validation; women’s autonomy measurement.
Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital
Authors: Thapa Lekhjung , Pokhrel Baburam , Shrestha Asis , Pradhan Manohar , Bhandari Tirtha Raj , Shrestha Shakti , Poudel Ramesh Sharma , Poudel Raju 
Published: September 2018

Introduction: Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal.
Methods: A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20.
Results: The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043).
Conclusions: Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.
Keywords: deficiency; nepal; stroke; vitamin D.