bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of cardiovascular events with glycosylated haemoglobin in diabetic patients
Authors: Deo RK , Karki P , Sharma SK , Acharya P 
Published: April 2009

Background: In persons with diabetes, chronic hyperglycemia (assessed by glycosylated hemoglobin level) is related to the development of microvascular disease; however, the relation of glycosylated hemoglobin (HbA1c) to macrovascular disease is less clear. Objective: To study the association of cardiovascular events (CVE) with glycosylated haemoglobin in diabetic patients. Design: Case control study Setting: B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal Materials and methods: Fifty diabetic patients with recent cardiovascular events: myocardial infarction (MI) or stroke was included in the study. There were 25 patients of myocardial infarction and 25 patients of stroke. Fifty diabetic patients without cardiovascular events were taken as control. Results: After adjustment for age, smoking, body mass index, systolic blood pressure and total cholesterol at baseline, level of HbA1c was statistically significant (p = 0.017) among patients with CVE. For MI, level of HbA1c was statistically significant (p = 0.018) while for stroke, level of HbA1c was not significant (p = 0.694). Mean blood glucose also predicted CVE and MI but not stroke in this study (p values = 0.006, 0.006 and 0.670 respectively). Fasting and postprandial plasma glucose was statistically significant in CVE (p values = 0.024 and 0.019 respectively). Urine protein was statistically significant for CVE, MI and stroke (p values = 0.000, 0.032, 0.032 and OR 4.571 (95% CI: 1.963- 10.646), 2.667 (95% CI: 1.043-6.815), 2.667 (95% CI: 1.043-6.815) respectively. Limitations: Sample size was limited due to time constraint and limited resources. Cases with peripheral artery disease were not included in the study. Conclusion: Glycosylated haemoglobin is associated with cardiovascular events and myocardial infarction but not stroke. Key words: Glycosylated Haemoglobin, Cardiovascular event, Myocardial infarction, Stroke doi: 10.3126/kumj.v6i4.1739 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 476-485
Histopathological study of solitary nodules of thyroid
Authors: Khadilkar UN , Maji P 
Published: April 2009

Objective: To determine the incidence of various thyroid disorders manifesting as Solitary Thyroid Nodule and also to evaluate the histomorphology of the lesions. Materials and methods: Hundred specimens of Solitary Thyroid Nodules were studied for gross characteristics, microscopic features, age and sex incidence. Results: Of the 100 cases of Solitary Thyroid Nodules, 66% were non neoplastic and 34% were neoplastic. Among the neoplasms, 21% were malignant and 13% were benign. The age incidence ranged from 20-50 years for non neoplastic lesions and 20-40 years for neoplasms. A female preponderance was seen for both non neoplastic and neoplastic conditions. The solitary nodules involved the right side of the thyroid more commonly than the left. Involutional colloid nodule was the predominant type of solitary nodule (52%). Among the malignant neoplasms, papillary carcinoma was the commonest solitary nodule (13%). One case each of hyalinising trabecular adenoma, columnar cell variant of papillary carcinoma and medullary carcinoma unusually presenting as solitary nodules were encountered in the present study. Conclusion: Histomorphologic evaluation of Solitary Thyroid Nodules presenting without a background setting of multinodular goiter is challenging and mandatory as the diagnoses ranges from the common non neoplastic lesions like involuting nodules to the rare neoplastic conditions like medullary carcinoma. Key words: Solitary Thyroid Nodule morphology, involuting nodule, medullary carcinoma doi: 10.3126/kumj.v6i4.1740 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 486-490
Delayed replantation: Can it be a success?
Authors: Parolia A , Kundabala M , Shetty N , Manuel ST 
Published: April 2009

This case report describes delayed replantation of an avulsed maxillary central incisor in a 17-year-old male patient following an injury on fall one day earlier. Avulsed maxillary right permanent central incisor was replanted back into the socket after extra-oral root canal treatment. One year follow up showed validity of treatment, with no evidence of resorption in the replanted tooth. Key words: Replantation, Maxillary central incisor, Resorption doi: 10.3126/kumj.v6i4.1742 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 497-501
Is there a link between problem-based learning and emotional intelligence?
Authors: Evans P 
Published: April 2009

A brief description of problem-based learning is given and reference is made to the difficulties in demonstrating its value in terms of ‘accumulated knowledge' with respect to the literature. The author suggests that problem-based learning may be a suitable curriculum component for developing a student's emotional intelligence. Key words: Emotional intelligence, medical undergraduate, problem-based learning doi: 10.3126/kumj.v7i1.1756 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 4-7
Development of medical education in Nepal
Authors: Dixit H 
Published: April 2009

The first institution for training health workers started 75 years ago. Further development of teaching / learning institutions, mainly governmental started from the middle of the 20th Century. It was however with the setting up of the Institute of Medicine (IoM) under TU that training programmes for different grades of health manpower were started. The last two decades has seen an explosion of institutions involved in the training of health personnel. This is possibly because of the huge demand of human resources of health (HRH) not only in Nepal, but worldwide. Various grades of HRH are going out of the country and seeking their livelihood elsewhere. Key words: IoM, BPKIHS, PAHS, HRH doi: 10.3126/kumj.v7i1.1757 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 8-10
Indications for labour induction and predictors for failed induction at KMCTH
Authors: Rayamajhi RT , Karki C , Shrestha N , Padhye SM 
Published: April 2009

Objective: To study the incidence and indications for labour induction and study the predictors of failed induction. Materials and methods: A hospital based prospective study done over a 12 month period between 1st November 2007 to 30th October 2008. Selection criteria: Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred uterus requiring induction of labour. Results: The incidence of labour induction was 19.7%. Operative delivery was 34.6% in the study group and 27.4% in those with spontaneous onset of labour. 74.07% of the induction group required operative delivery for failed induction and 25.03% for foetal distress. The predominant indication for induction was post term pregnancy (51.28%) followed by PROM (17.3%), isolated oligohydramnios (8.97%), hypertensive disorders of pregnancy (8.33%), maternal perception of decreased foetal movements (7.69%) and others. Failed induction was higher in nulliparas (41.2%) as compared to multiparas (23.7%). Failure rate was 53.8% when maternal age >30y and 28.2% in those < 30y. Women with normal BMI had a failure rate of 25.6% compared to 36% for overweight and 44.4% for obese women. 24.1% had failed induction when Bishop score was >5 and 40.8% when Bishop score was < 5. Between 38-41 weeks pregnancy failed induction occurred in 28-31% while it was higher at 41 weeks pregnancy. The best outcome was seen when the birth weight was 2500-2900g (22.5% failures) while 72.7% had failed induction when the birth weight was >3500g. The duration of induction was >24 hours in 42.6% of women and 48.2% were in the latent phase of labour when taken for caesarean section. Conclusion: Despite the proven benefit of induction of labour in selected cases, one must keep in mind its impact on increasing the rates of operative delivery. Strategies for developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high operative delivery rates. Key words: caesarean section rate, failed induction, induction of labour. doi: 10.3126/kumj.v7i1.1760 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 21-25
Cytogenetic analysis of children with suspected genetic disorder
Authors: Shrestha U , Bhattacharya S , Bhatta NK , Jha CB 
Published: April 2009

Objectives: To analyze chromosomes in children with suspected genetic disorder and to categorize the chromosomal basis of genetic disorder Materials and methods: Thirty children were selected from the patients attending genetic clinic, Department of Pediatrics, B.P. Koirala Institute of Health Sciences presenting with dysmorphic feature, mental retardation, short stature, congenital malformations and ambiguous genitalia with age between 0-15 years. Cytogenetic analysis was carried using standard peripheral blood lymphocyte culture method and G-banding technique in Cytogenetic laboratory of Department of Anatomy, B.P. Koirala Institute of Health Sciences. Results: Chromosomal disorders were identified in 33.34% (10) of children. The most common chromosomal abnormality was Down syndrome (26.67%) followed by Turner syndrome (6.67%). Conclusion: The cytogenetic analysis of children with suspected chromosomal aberration is important to uncover the contribution of chromosomal disorder in genesis of dysmorphisms, mental retardation, short stature, sexual ambiguity and congenital malformation in children and prevent further potentially unpleasant investigation being undertaken. Key words: Chromosome, suspected genetic disorder, dysmorphic feature, mental retardation, short stature, congenital malformations, ambiguous genitalia doi: 10.3126/kumj.v7i1.1763 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 40-43
Incidence of tuberculosis in enlarged neck nodes, our experience
Authors: Maharjan M , Hirachan S , Kafle PK , Bista M , Shrestha S , Toran KC , Lakhey M 
Published: April 2009

Objectives: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Materials and methods: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Results: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. Conclusion: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region. Key words: Tuberculosis, Lymph node, Fine needle aspiration cytology, Lymphadenitis doi: 10.3126/kumj.v7i1.1766 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 54-58
The pattern of tooth loss due to dental caries and periodontal disease among patients attending dental department (OPD), Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH), Nepal
Authors: Upadhyaya C , Humagain M 
Published: April 2009

Aims and objectives: The aim of this study was to investigate the type of tooth usually associated with extraction due to caries or periodontal disease and its relation to age at which these were lost, among patients attending dental surgery outpatient clinic, Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH). Materials and methods: A total no of 626 patients (male-299 and female-327) attending at outpatient clinic, in the department of Dentistry, Dhulikhel Hospital were taken in over a period of six months. The details about the permanent teeth to be extracted regarding each tooth type, including age and sex of the patient, type of tooth extracted, cause of extraction were collected, causes other than dental caries and periodontal disease were excluded. Results: The highest proportion of extraction due to caries occurred between 21-30 years of age, while that of periodontal disease was between 51-60 years of age. More than 80% of teeth lost were from below 40 years of age group. Mandibular first molar was by far the most frequently extracted tooth due to dental caries followed by maxillary first molar. Maxillary teeth were lost more than mandibular teeth due to periodontal disease. Conclusion: Dental caries and periodontal disease are the two most important factors for extraction or removal of tooth. In this study dental caries is the major cause for loosing tooth among young group of people. Key words: dental caries, periodontal disease, extraction doi: 10.3126/kumj.v7i1.1767 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 59-62
Advancing neurosurgery with image-guided robotics
Authors: Pandya Shawna , Motkoski Jason W. , Serrano-Almeida Cesar , Greer Alexander D. , Latour Isabelle , Sutherland Garnette R. 
Published: April 2009

Robotic systems are being introduced into surgery to extend human ability. NeuroArm represents a potential change in the way surgery is performed; this is the first image-guided, MR-compatible surgical robot capable of both microsurgery and stereotaxy. This paper presents the first surgical application of neuroArm in an investigation of microsurgical performance, navigation accuracy, and Phase I clinical studies.
To evaluate microsurgical performance, 2 surgeons performed microsurgery (splenectomy, bilateral nephrectomy, and thymectomy) in a rodent model using neuroArm and conventional techniques. Two senior residents served as controls, using the conventional technique only (8 rats were used in each of the 3 treatment groups; the 2 surgeons each treated 4 rats from each group). Total surgery time, blood loss, thermal injury, vascular injury, and animal death due to surgical error were recorded and converted to an overall performance score. All values are reported as the mean ± SEM when normally distributed and as the median and interquartile range when not. Surgeons were slower using neuroArm (1047 ± 69 seconds) than with conventional microsurgical techniques (814 ± 54 seconds; p = 0.019), but overall performance was equal (neuroArm: 1110 ± 82 seconds; microsurgery: 1075 ± 136 seconds; p = 0.825). Using microsurgery, the surgeons had overall performance scores equal to those of the control resident surgeons (p = 0.141).
To evaluate navigation accuracy, the localization error of neuroArm was compared with an established system. Nanoparticles were implanted at predetermined bilateral targets in a cadaveric model (4 specimens) using image guidance. The mean localization error of neuroArm (4.35 ± 1.68 mm) proved equal to that of the conventional navigation system (10.4 ± 2.79 mm; p = 0.104). Using the conventional system, the surgeon was forced to retract the biopsy tool to correct the angle of entry in 2 of 4 trials.
To evaluate Phase I clinical integration, the role of neuroArm was progressively increased in 5 neurosurgical procedures. The impacts of neuroArm on operating room (OR) staff, hardware, software, and registration system performance were evaluated. NeuroArm was well received by OR staff and progressively integrated into patient cases, starting with draping in Case 1. In Case 2 and all subsequent cases, the robot was registered. It was used for tumor resection in Cases 3–5. Three incidents involving restrictive cable length, constrictive draping, and reregistration failure were resolved. In Case 5, the neuroArm safety system successfully mitigated a hardware failure.
NeuroArm performs as well and as accurately as conventional techniques, with demonstrated safety technology. Clinical integration was well received by OR staff, and successful tumor resection validates the surgical applicability of neuroArm.
Intraneural ganglia in the hip and pelvic region
Authors: Spinner Robert J. , Hébert-Blouin Marie-Noëlle , Trousdale Robert T. , Midha Rajiv , Russell Stephen M. , Yamauchi Tatsuya , Sasaki Syouzou , Amrami Kimberly K. 
Published: April 2009

Object
The authors describe their experience in a series of cases of intraneural ganglia within the hip and pelvic regions, and explain the mechanism of formation and propagation of this pathological entity.

Methods
Five patients with 6 intraneural ganglia are presented. Four patients presented with symptomatic intraneural ganglia in the buttock and pelvis affecting the sciatic and lumbosacral plexus elements. An asymptomatic cyst affecting the opposite sciatic nerve was found on MR imaging in 1 patient. The fifth patient, previously reported on by another group, had an obturator intraneural ganglion that the authors reinterpreted.

Results
All 5 intraneural ganglia affecting the sciatic and lumbosacral plexus elements were found to have a joint connection to the posteromedial aspect of the hip joint; the obturator intraneural cyst had a joint connection to the anteromedial aspect of the hip joint. In all cases, initial review of the MR images led to their misinterpretation.

Conclusions
To the authors' knowledge, these are the first cases of intraneural ganglia demonstrated to have a connection to the hip joint. This finding at a rare site provides further evidence for the unifying articular (synovial) theory for the formation of intraneural ganglia and reveals a shared mechanism for their propagation. Furthermore, understanding the pathogenesis of these lesions provides insight into their successful treatment and their recurrence.
Comparative Oxidative Stability of Fatty Acid Alkyl Esters by Accelerated Methods
Authors: Moser Bryan R. 
Published: April 2009

AbstractSeveral fatty acid alkyl esters were subjected to accelerated methods of oxidation, including EN 14112 (Rancimat method) and pressurized differential scanning calorimetry (PDSC). Structural trends elucidated from both methods that improved oxidative stability included decreasing the number of double bonds, introduction of trans as opposed to cis unsaturation, location of unsaturation closer to the ester head group, and elimination of hydroxyl groups. Also noticed with EN 14112 was an improvement in oxidative stability when a larger ester head group was utilized. Methyl esters that contained ten or less carbons in the fatty acid backbone were unacceptable for analysis at 110 °C (EN 14112) due to excessive sample evaporation. With respect to PDSC, a correlation was noticed in which the oxidation onset temperature (OT) of saturated fatty esters increased with decreasing molecular weight (R2 0.7328). In the case of the monounsaturates, a very strong inverse correlation was detected between molecular weight and OT (R2 0.9988), which was in agreement with EN 14112. Lastly, a strong direct correlation (R2 0.8759) was elucidated between OT and oil stability index (OSI, EN 14112, 80 °C). The correlation was not as strong (R2 0.5852) between OSI obtained at 110 °C and OT.
In vivo non‐enzymatic repair of DNA oxidative damage by polyphenols
Authors: Tan Xiaorong , Zhao Chenyang , Pan Jing , Shi Yimin , Liu Guoan , Zhou Bo , Zheng Rongliang 
Published: April 2009

AbstractThe non‐enzymatic repair of DNA oxidative damage can occur in a purely chemical system, but data show that it might also occur in cells. Human hepatoma cells (SMMC‐7721) and human hepatocyte cells (LO2) were treated with 200 μM H2O2 for 30 min to induce oxidative DNA damage quantified by amount of 8‐OHdG and degree of DNA strand breaks, without inducing enzymatic repair. The dynamics of enzymatic repair activity quantified by unscheduled DNA synthesis, within 30 min after removal of H2O2 enzymatic repair mechanism has not been initiated. However, pre‐incubation with low micromolar level polyphenols, quercetin or rutin can significantly attenuate DNA damage in both cell lines, indicating that the polyphenols did not work through an enzymatic mechanism. Unscheduled DNA synthesis after removal of H2O2 was also markedly decreased by quercetin and rutin. Combined with our previous studies of fast reaction chemistry, the inhibitory effect of polyphenols have to be assigned to non‐enzymatic repair mechanism rather than to enzymatic repair mechanism or antioxidant mechanism.
Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess
Authors: Ryan Jesse T. , Preciado Diego A. , Bauman Nancy , Pena Maria , Bose Sumit , Zalzal George H. , Choi Sukgi 
Published: April 2009

ObjectiveControversies remain regarding the management of orbital cellulitis (OC). The objective of this study was to examine the outcomes of patients admitted to our institution for orbital cellulitis during a 7‐year period.Study DesignCase series with chart review.SettingTertiary referral pediatric hospital.Subjects and MethodsCharts of 465 consecutive OC admissions were reviewed for presentation, imaging, medical and surgical treatment, and outcome.ResultsOf these patients, 189 were treated in the emergency room and 276 were admitted. CT scan was performed on 240 patients. Subperiosteal abscess (SPA) was noted in 68 patients. Of these, 47 were treated medically and 21 had surgery. Surgical patients were older (8.3 vs 6.2 years, P = 0.039), had larger abscesses (>10 mm, P < 0.001), required a longer admission (10.2 vs 6.6 days, P < 0.001), and had higher temperatures on admission (38.0°C vs 37.3°C, P = 0.03).ConclusionThe majority of small SPAs as diagnosed on CT scans in younger children can be successfully treated medically. Surgery, however, should be considered for a worsening clinical examination. Our findings confirm those of previous reports on this clinical entity.
On p–valent starlike functions with reference to the Bernardi integral operator
Authors: Kumar Vinod , Shukla S.L. 
Published: April 2009

Let (A, B) denote the class of certain p-valent starlike functions. Recently G. Lakshma Reddy and K.S. Padmanabhan [Bull. Austral. Math. Soc. 25 (1982), 387–396] have shown that the function g defined bybelongs to the class (A, B) if f ∈ (A, B). The technique used by them fails when c is any positive real number. In this paper, by employing a more powerful technique, we improve their result to the case when c is any real number such that c ≥ −p(1+A)/(1+B).