Acute Primary Tuberculous Ulcer of Glans Penis.

Acute primary tuberculous ulcer of glans penis is a rare entity even in the endemic region. We present a 55 year old male with multiple undermined ulcers for short duration of 4 weeks with raised erythrocyte sedimentation rate, negative Mantoux test and histopathology revealed a diagnosis of tuberculous ulcer which responded well to antitubercular therapy.

Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer.

BACKGROUND AND PURPOSE: Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy. MATERIALS AND METHODS: Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method. RESULTS: A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12-1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36-0.92; P = .02) compared with the R method. CONCLUSIONS: The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.

The physical spacing between the von Willebrand factor D'D3 and A1 domains regulates platelet adhesion in vitro and in vivo.

Essentials The role of von Willebrand factor (VWF) domains in regulating platelet adhesion was studied in vivo. Multimeric VWF with spacers at the N- and C-terminus of VWF-A1 were systematically tested. N-terminal modified VWF avidly bound platelet GpIbα, causing VWD Type2B like phenotype in mice. Novel anti-D'D3 mAbs suggest that changes at the D'D3-A1 interface may be biologically relevant. SUMMARY: Background Previous ex vivo studies using truncated VWF (von Willebrand factor) suggest that domain-level molecular architecture may control platelet-GpIbα binding function. Objective We determined if this is the case with multimeric VWF in vivo. Methods Full-length human VWF ('hV') was modified with a 22-amino acid mucinous stretch at either the N-terminus of VWF-A1 to create 'hNV' or C-terminus to yield 'hCV'. This extends the physical distance between VWF-A1 and the adjacent domains by ~6 nm. Similar mucin inserts were also introduced into a human-murine chimera ('h[mA1]V') where murine-A1 replaced human-A1 in hV. This yielded 'h[mA1]NV' and 'h[mA1]CV', with N- and C-terminal inserts. The constructs were tested ex vivo and in vivo. Results Mucin insertion at the N-terminus, but not C-terminus, in both types of constructs resulted in >50-fold increase in binding to immobilized GpIbα. N-terminal insertion also resulted in greater shear-induced platelet activation, more thrombus formation on collagen, enhanced platelet accumulation and slower platelet translocation on immobilized VWF in microfluidics assays. Hydrodynamic injection-based expression of h[mA1]NV, but not h[mA1]V or h[mA1]CV, in VWF-/- mice caused profound thrombocytopenia, reduced plasma VWF concentrations, lower multimer distribution, and incessant tail bleeding that is reminiscent of von Willebrand disease type 2B. Platelet plugs were noted in the portal veins and hepatic arteries. An anti-D'D3 mAb DD3.3 that displays enhanced binding to VWF containing the N-terminal mucin insert also exhibited increased binding to wild-type VWF under shear and upon ristocetin addition. Conclusion Conformation changes at the VWF D'D3-A1 interface may be a key regulator of thrombosis in vivo. Structural features at the A1-A2 interface are likely of less significance.

Assessing the Level of Knowledge in the Preconceptional Use of Folic Acid Supplement among Primigravida Women.

Background Folic acid deficiency is one of the most common vitamin deficiencies among women of childbearing in developing countries. Folic acid intake prior to, and during, the first months of pregnancy significantly reduces the risk of fetal neural tube defects. Objective To find out the level of knowledge regarding the benefits and use of preconceptional folic acid supplements among pimigravida women. Method A hospital based cross-sectional study was conducted among 250 primigravida women attending obstetric outpatient department of Kathmandu Medical College Teaching Hospital. A pretested questionnaire was administered using systematic random sampling technique and data was analysed by SPSS version 16.0 using descriptive and inferential statistics. Result Study revealed that 10.8% respondents had good knowledge whereas, 65.6% had poor knowledge about preconceptional folic acid supplementation. 87.2% had taken folic acid at some point of pregnancy and 17.6 % of pregnant women had taken preconceptional folic acid. 21.2% had heard about folic acid supplement and 20% had known about benefits of preconceptional folic acid. 17.6% knew that it should be taken one month before conception and 16% answered that it could prevent neural tube defects. Conclusion Majority of primigravida women lack the knowledge of preconceptional folic acid. Most women planning to get pregnant are also not taking folic acid supplementation.

Antimicrobial susceptibility and internalization of Salmonella Typhimurium in vacuum-tumbled marinated beef products.

As the incidence of multidrug resistance (MDR) Salmonella enterica serotype Typhimurium is increasing, data regarding the antimicrobial interventions and pathogen internalization in marinated meat products are important. This study evaluated the antimicrobial intervention and internalization of Salm. Typhimurium in marinated beef sirloin steaks. Beef bottom sirloin flaps (IMPS #185A; USDA Select) inoculated (108  log10  CFU ml-1 ) with Salm. Typhimurium were sprayed (lactic acid (4%) and buffered vinegar (2%)) prior to vacuum-tumbled marination (0·35% sodium chloride and 0·45% sodium tripolyphosphate) for 30 min. Pathogen presence after antimicrobial spray, vacuum-tumbled marination, and translocation was determined by direct plating on Xylose Lysine Deoxycholate (XLD) agar with tryptic soy agar (TSA) overlay. The data imply varied internalization and antimicrobial susceptibility pattern of Salm. Typhimurium in marinated meat. Lactic acid (4%) spray (P < 0·0001) and buffered vinegar (2%; P < 0·0001) reduced surface populations of Salm. Typhimurium on inoculated beef sirloin flaps prior to vacuum marination. However, lactic acid treated sirloin flaps had greater reductions (~2 log10  CFU cm-2 ) than buffered vinegar when compared with control prior to vacuum marination. However, the translocation of Salm. Typhimurium following vacuum marination was not influenced (P < 0·333) by the application of a surface organic acid spray prior to marination. SIGNIFICANCE AND IMPACT OF THE STUDY: As detailed in the Federal Register FSIS final rule (9 CFR part 317), vacuum-marinated, vacuum-tumbled meat products are not designated as 'mechanically tenderized'. As such, the internalization and potential survival of Salmonella spp. in marinated beef products is a major concern. These results highlight the internalization of pathogens in vacuum-tumbled meat products and emphasize the importance of considering these products as nonintact. Similarly, these data confirm the efficacy and utility of interventions prior to vacuum-tumbled marination. Further research is needed to identify additional strategies to mitigate internalization and translocation of pathogens into vacuum-marinated meat products.

Visual Outcome after Treatment with High Dose Intravenous Methylprednisolone in Indirect Traumatic Optic Neuropathy.

BACKGROUND: Traumatic optic neuropathy is an acute injury of the optic nerve due to trauma. It is an ocular emergency, requiring early treatment though there is no proven standard treatment protocol for the condition. Various studies have shown improvement in vision after intravenous steroids, but not statistically significant. Studies have revealed even optical decompression surgery is not the ultimate treatment because of no significant improvement of vision. Our study aims to assess visual outcome after high dose (1 gram) of intravenous methylprednisolone in cases with indirect optic neuropathy. METHODS: This was a non-randomized interventional study carried out in Kathmandu Medical College Teaching Hospital from May 1st 2013- June 1st 2014. RESULTS: There were 10 cases with indirect traumatic optic neuropathy included in the study. Four cases received IV methylprednisolone and six cases were observed without steroid treatment. Traumatic optic neuropathy was observed more in males[8 (80%)]with higher number in age group 21-30 years old. The visual recovery after intravenous steroid treatment was rapid and beneficial in cases with vision better than Non Perception of Light (NPL), even in cases presented 4 days after the trauma. CONCLUSIONS: There was rapid and beneficial improvement in visual acuity after high dose of intravenous steroid treatment in cases with indirect traumatic optic neuropathy with vision better than Non Perception of Light (NPL).

Internalization and thermal susceptibility of Shiga toxin-producing Escherichia coli (STEC) in marinated beef products.

This study evaluated the internalization and cooking susceptibility of seven individual Escherichia coli (STEC) serogroups in surface-inoculated (10(5)log CFU/cm(2)) and vacuum tumbled marinated (30 or 60 min) bottom sirloin steaks. After storage for 14 days (0 to 2°C), flaps were cooked to various endpoint temperatures (55, 60, 65, and 71°C) for evaluation of pathogen survival by direct plating or rapid PCR based detection (BAX®). Direct plating of cooked samples yielded no enumerable plates. The data indicate varied internalization, translocation, and heat susceptibility patterns among serogroups. Using the rapid PCR based detection method O26, O103, and O111 were detected in flaps after cooking to 55 and 60°C, while O157:H7 survived in flaps cooked to 60 and 65°C. However, STEC O145 was the only serogroup that survived in all cooking temperatures. Serogroup O121 was not detected by plating or PCR in any cooked products. Intriguingly, STEC serogroups can be internalized during marination and the internalized pathogens vary in thermal susceptibility.

The influence of beef quality characteristics on the internalization and thermal susceptibility of Shiga toxin-producing Escherichia coli (STEC) in blade-tenderized beef steaks.

The risk of Shiga toxin-producing Escherichia coli (STEC) survival in blade-tenderized beef is a concern for beef processors. This study evaluated the internalization and post-cooking survival of individual STEC serogroups (O157:H7, O26, O45, O103, O111, O121, and O145) in blade-tenderized beef steaks with different quality traits. Strip loins representing four combinations of USDA Quality Grade (Choice or Select) and pH category (High pH or Normal pH) were inoculated (10(6)logCFU/cm(2) attachment) with individual STEC serogroups before storage (14 days), blade tenderization, and cooking (50, 60, 71, or 85°C). Serogroup populations on raw steak surfaces and internal cores were determined. Rapid-based methods were used to detect the internal presence of STEC in cooked steaks. Internalization and post-cooking survival varied among STECs. All serogroups, except O45 and O121, were detected in the internal cores of steaks cooked to 50°C, while O103, O111, and O145 STEC were detected in steaks cooked to 50, 60, and 71°C.

The power of torque magnetometry: defect induced switching in hexaferrite nano-structures.

The presence of magnetic heterogeneities in ferromagnetic systems can reduce their performances in applications such as data storage media and permanent magnets. The detection and the full characterization of these heterogeneities is difficult especially when they are present in a very low concentration within ferromagnetic systems. Here, torque magnetometry is applied to investigate the magnetism of heterogeneities in two-dimensional hexaferrite structures. The study was conducted on a two-dimensional BaFe12O19 structure with decoupled nano-platelets grown on oxidized silicon buffered with ZnO. Measured torque curves reveal anomalous effects manifested by the presence of reversible and hysteretic kinks at large and low magnetic fields respectively. These kinks represent the contribution of magnetic heterogeneities to the global anisotropy of the film in addition to the two-fold symmetry of the major perpendicular anisotropy component. The heterogeneities consist of two types of nano-metric crystallites with the same magnitude of anisotropy as the major magnetic phase, but tilted about -74° and 74° from the normal to the film plane. These results are supported by various types of material characterization (SEM, XPS, XRD, MFM and VSM) and are well reproduced with a simple theoretical model that replicates the symmetry, switching and the easy axes alignment of the heterogeneities magnetization.

Diabetic retinopathy in tessellated fundus.

BACKGROUND: Duration of diabetes, poor control, age of the patient, frequent hypoglycemia, hypercholesterolemia, over-weight, smoking, alcohol, renal failure and pregnancy have all been suggested as factors which may influence the onset of diabetic retinopathy. However, there are cases without retinopathy in spite of duration of 30 to 40 years of diabetes and presence of one or other above mentioned risk factors, suggesting role of local factors to prevent angiopathy.Our study aims to assess whether tessellated fundus is a protective factor for diabetic retinopathy. METHODS: This was hospital based descriptive study. The patients included in the study were 40 years and above having diabetes for 10 years and beyond. Diabetic retinopathy was graded following Early treatment Diabetic retinopathy Study. RESULTS: Tigroid fundus was negatively associated with diabetic retinopathy (OR 0.49 with 95% confidence interval 0.21-1.11) and maculopathy (OR 0.43 with 95% confidence interval 0.15-1.3). Age 40-50 years (OR 0.67 with 95% confidence interval 0.24-1.83), female gender (OR 0.71 with confidence interval 0.31-1.61), HbA1c <6.5(OR 0.36 with confidence interval 0.99-1.31) and duration 10-15 years of onset of diabetes (OR 0.58 with confidence interval 0.22-1.37) was negatively associated with diabetic retinopathy in tigroid fundus diabetics. Age 40-50 years (OR 2.12 with confidence interval 0.43-10.5), female gender (OR 2.51 with confidence interval 0.38-10.88), HbA1c<6.5 (OR 3.12 with confidence interval 0.59-16.58) and duration 10-15 years of onset of diabetes (OR 1.5 with confidence interval 0.1-18.54) was positively associated with retinopathy in non-tigroid fundus. CONCLUSIONS: Tessellated fundus was observed as decreased risk for the development of diabetic retinopathy and maculopathy.

Hypertension in Primary Open Angle Glaucoma.

INTRODUCTION: The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . METHODS: It was cross-sectional case-control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). RESULTS: Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. CONCLUSIONS: Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

Corneal edema after phacoemulsification surgery in patients with type II diabetes mellitus.

INTRODUCTION: Corneal edema delays early visual recovery after phacoemulsification surgery in diabetes mellitus. OBJECTIVE: To compare corneal edema of eyes in patients with type II diabetes mellitus and in non-diabetics after phacoemusification surgery. MATERIALS AND METHODS: A hospital-based, retrospective study involving 96 eyes that underwent phacoemulsification surgery for immature cataract at the Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal was carried out. Evaluation was performed of 33 eyes in patients with diabetes mellitus (diabetic group) and of 63 eyes in patients without diabetes mellitus (non-diabetic group). All diabetic patients had controlled blood glucose for at least one week prior to the surgery. The operated eye was examined before surgery and on one day, one week, and one month after surgery. Intraocular pressure was measured on each visit. MAIN OUTCOME MEASURES: The findings of post-operative corneal edema and visual acuity between the diabetic and non-diabetic groups were studied and compared. RESULTS: There was no difference clinically in any pre-operative corneal examination between the diabetic and non-diabetic groups. The corneal edema after surgery was significantly higher in the diabetic group than in the non-diabetic group (p less than 0.001). The number of patients with corneal edema one day and one week after surgery was significantly higher in the diabetic group than in the non-diabetic group (after 1 day, OR = 62.5; 95 % CI = 15.31 - 255.11, p less than 0.000) and after 1 week, OR = 6.77; 95 % CI = 1.28 - 35.76, p less than 0.006). CONCLUSION: Corneal edema following phacoemusification surgery in diabetic eyes is likely to be more frequent than in non-diabetic eyes.

Verification of dose calculation algorithms in a multi-layer heterogeneous phantom using films.

UNLABELLED: The development of advanced radiation treatment techniques such as intensity modulated radiation therapy (IMRT) and volumetric intensity modulated arc therapy (VMAT) require more accurate dose calculation algorithms within the treatment planning systems (TPS) considering that the human body is composed of tissues of widely differing radiological properties and the characteristics of a therapeutic radiation treatment beam along a heterogeneous path will be different. The objective of this study was to evaluate the accuracy of 2D-isodose distributions predicted by pencil beam convolution algorithm (PBC) and anisotropic analytic algorithm (AAA) in a heterogeneous slab phantom composed of media equivalent to air, water and bone density. The measurements were done by using the films at multiple depths in the phantom for open field sizes 5 × 5 cm2 and 10 × 10 cm2. The results from this study indicated that the AAA had better agreement with the measurement compared to PBC for both the test field sizes at all selected depths; however, the limitation of AAA in predicting doses within and beyond low-density medium was observed, especially for a smaller field size (up to 32.7% and 34.0% for AAA and PBC, respectively). Furthermore, discrepancies up to -4.8% for AAA and -14.6% for PBC was seen in the high-density medium as well. Dose prediction errors by the AAA and PBC were more pronounced for a smaller test field size, especially in the low-density medium. KEYWORDS: IMRT, dose calculation algorithms, Anisotropic Analytical Algorithm (AAA), Pencil Beam Convolution (PBC), Varian's Eclipse treatment planning system.

The effects of freezing and thawing rates on tenderness, sensory quality, and retail display of beef subprimals.

The objective of this study was to evaluate processing methods for frozen beef subprimals; the effects of freezing and thawing rates on tenderness, sensory properties, and retail display were evaluated. There were 6 treatments: fresh, never frozen 14 d wet aged (14D); fresh, never frozen 21 d wet aged (21D); blast frozen-fast thawed (BF); blast frozen-slow thawed (BS); conventionally frozen-fast thawed (CF); and conventionally frozen-slow thawed (CS). All frozen beef subprimals were aged for 14 d before freezing. Three beef subprimal cuts, rib eye roll (n=90), strip loin (n=90), and top sirloin butt (n=90), were used with 3 replications of 5 samples per treatment per week (total of 9 wk, n=270). Blast freezing occurred by placing spacers between the boxes of meat on pallets at -28°C with high air velocity for 3 to 5 d. Conventional freezing occurred with boxes of meat stacked on pallets and placed in a -28°C freezer with minimal air movement for at least 10 d. Fast thawing of subprimals (to an internal temperature of -1°C to 1°C) occurred by immersion in a circulating water bath (<12°C) for 21 h, and slow thawing of subprimals occurred over a 2-wk period by placing individual subprimals on tables at 0°C. Steaks (2.5 cm thick) were cut from the longissimus thoracis (LT), longissimus lumborum (LL), and gluteus medius (GM) for Warner-Bratzler shear force (WBS), trained sensory evaluation, and retail display. For LL and GM beef steaks, frozen treatments were equal or lower in WBS values to 14D and 21D beef steaks. No differences were detected in WBS among the treatments applied to GM beef steaks (P=0.08). There were no differences in sensory tenderness among the LL, LT, and GM (P>0.05). All LL and LT beef steaks had approximately 4 d to 40% discoloration, and all GM steaks had over 3 d to 40% discoloration. Steaks from the LL and LT began to discolor at about 3 d, and the GM began to discolor after 1 d. For all beef subprimals, purge loss during storage and thawing was significantly greater for the slow-thawed subprimals (P<0.01), and all fast-thawed subprimals were equal or superior to 14D and 21D (P<0.01) in storage and thawing purge. During retail display, the greatest purge loss occurred in fast-thawed treatments (P<0.01). Overall, freezing rate did not affect purge loss, and neither freezing nor thawing rates had significant meaningful effects on WBS, and sensory properties were comparable with fresh, never-frozen subprimals.

Evaluation of performance, carcass characteristics, and sensory attributes of beef from finishing steers fed field peas.

Whole field peas were fed at 0, 10, 20, and 30% of DM to 139 yearling steers (British cross; 409 ± 31 kg of initial BW) for a 119-d finishing period. Carcass data and Choice grade strip loins (n = 98) were collected from a commercial abattoir in Lexington, Nebraska. Consumer sensory and Warner-Bratzler shear force analyses were performed on 2.5-cm strip steaks. No differences (P ≥ 0.17) were observed in final BW, ADG, DMI, and G:F of steers. Likewise, no differences (P ≥ 0.23) were observed for HCW, LM area, fat thickness at the 12th rib, yield grade, and marbling scores. However, KPH responded quadratically to increasing dietary amount of field peas (P = 0.02). Regarding the sensorial analysis, feeding peas linearly increased subjective tenderness (P < 0.01) and led to a quadratic response of overall like ratings (P = 0.01) and flavor like ratings (P = 0.12). Feeding peas did not alter (P ≥ 0.64) juiciness, but decreased shear force values linearly when quantities were increased (P = 0.02). These data suggest that feeding peas does not affect steer performance or carcass characteristics differently from dry-rolled corn, but does improve objective and subjective tenderness, overall desirability, and flavor of beef. Field peas could be fed to cattle and give positive attributes to the quality of the meat up to 30% inclusion in the diet.

Mapping of intramuscular tenderness and muscle fiber orientation of muscles in the beef round.

Intramuscular tenderness variation and muscle fiber orientation of beef M. adductor femoris (AF), M. biceps femoris (BF), M. gracilis (GL), M. pectineus (PT), M. sartorius (SR), M. semimembranosus (SM), M. semitendinosus (SO), M. vastus intermedius (VI), M. vastus medialis (VM), and M. vastus lateralis (VL) were investigated. The USDA Choice boxed beef subprimals were purchased and aged for 14 d from boxed date. The AF, BF, GL, PT, SR, SM, SO, VI, VM, and VL (n = 10 each) were fabricated from subprimals. Crust-frozen AF, BF, SO, SM, and VL were cut into 2.54-cm steaks perpendicular to the long axis and grilled (71 degrees C). The PT, SR, VI, and VM were grilled (71 degrees C) as whole muscles, whereas the GL was grilled after cutting into anterior and posterior regions. Grilled muscles were cut into equal size sections perpendicular to long axis of muscles. Location-specific cores were prepared from each steak/section, and Warner-Bratzler shear force (WBSF) was measured. The muscle fiber orientations of BF, PT, and VI were bipennate, SR and SO were fusiform, and AD, SM, VL, GL, and VM were unipennate. The overall mean WBSF values for BF, SO, AF, SM, PT, SR, GL, VI, VM, and VL were 5.62, 4.86, 4.18, 4.90, 3.76, 4.44, 4.75, 4.78, 4.24, and 6.53 kg, respectively. Based on WBSF values, PT was tender, BF and VL were tough, and VM, VI, SM, GL SR, AF, and SO were intermediate. The first 2 proximal steaks of long head BF were more tender than the rest (P < 0.05). In the SO, the tenderness decreased from the middle of the muscle to both ends (P < 0.05). The anterior sides of the long head BF and SO were tougher than their posterior sides (P < 0.05).The first 4 steaks of the SM were more tender than the rest of the muscle (P < 0.05). There was a significant tenderness increment from the middle of the AF and SR to both ends of each muscle (P < 0.05). The medial side of the VI was more tender than its lateral side (P < 0.05). The VM had its smallest shear force value at the most distal end compared with the rest (P < 0.05). Dry or moist heat oven roasting, as compared with grilling, significantly tenderized SO (P = 0.002) and VL (P < 0.0001) muscles. There were no significant WBSF value differences along the PT and between anterior and posterior regions of the GL. Based on WBSF ratings, PT, SR, VM, GL, and VI could be merchandized as single muscle steaks or medallions and the first 2 to 4 steaks of long head BF, SM, and AF could be marketed as premium-quality steaks. This detailed information on intramuscular tenderness and muscle fiber orientation variations of the round muscles could be used in a value added strategy for the beef round.

Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA.

BACKGROUND: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. OBJECTIVE: To determine level of immunoglobulin E (IgE) in the tear fi lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). MATERIALS AND METHODS: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme - linked immunosorbent assay (ELISA). RESULTS: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p=0.72). CONCLUSION: There was high concentration of tear IgE level observed in VKC.

A pattern of age-related macular degeneration.

INTRODUCTION: Age related macular degeneration is a disorder of the macula most often clinically apparent affecting central vision and is one of the leading causes of blindness in the population above 50 years. The aim of this study is to determine clinical profile of AMD in Nepalese presenting to a Teaching Hospital in Kathmandu. METHODS: It was a hospital-based cross-sectional study. The subjects included in the study were those presenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospital from July 2007- Dec 2007.The total number of individuals included in the study were 402 and total number of eyes were 804. RESULTS: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group with prevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-group individuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjects above 71 years. This study revealed that the prevalence of AMD in females was higher with female preponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/246/60 vision and 15% had vision <3/60-PL. Our study revealed statistically significant increased risk for AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though the Odds ratio (OR) was statistically insignificant (p=>0.01). CONCLUSIONS: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College Teaching Hospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically significant increased risk for AMD development in this study.

HELLP syndrome--a pregnancy disorder with poor prognosis.

HELLP syndrome is a pregnancy-specific disorder defined by hemolysis, elevated liver enzymes and low platelet count that is found in parturients, more frequent in older multiparas. It is frequently associated with severe preeclampsia or eclampsia, but can also be diagnosed in the absence of these disorders. The etiology of HELLP syndrome is unknown, and the pathogenesis of this disorder (including the hepatological manifestations) is not fully understood. The most widely accepted hypotheses are: a change in the immune feto-maternal balance, platelet aggregation, endothelial dysfunction, arterial hypertension and an inborn error of the fatty acid oxidative metabolism. Hepatic involvement occurs by intravascular fibrin deposition and hypovolemia. Serum LDH and platelet count are the two most important clinical tools for disease assessment. LDH reflects both the extent of hemolysis and hepatic dysfunction. Maternofetal complications cause a 7.0-70.0% perinatal mortality rate and a 1.0-24.0% maternal mortality rate. The recognition of HELLP syndrome and an aggressive multidisciplinary approach and prompt transfer of these women to obstetric centers with expertise in this field are required for the improvement of materno-fetal prognosis.