Testis-specific actin-like 7A (ACTL7A) is an indispensable protein for subacrosomal-associated F-actin formation, acrosomal anchoring, and male fertility

Formation of the acrosome during spermiogenesis is an essential process for creating fertilization-competent sperm. Of the numerous aspects required for acrosome biogenesis, adherence of the acrosomal outer membrane to the nuclear surface is mediated by the subacrosomal perinuclear theca. However, the cellular dynamics and congruent functions pertaining to these acrosomal anchoring factors are not well understood despite many of them being implicated as potential causes for human male infertility. Actin-like 7A (ACTL7A) is one such factor for which deleterious polymorphisms have recently been shown to cause human male infertility. It is thought that acrosomal attachment is coordinated by cytoskeletal associations between the acrosome and nucleus via the acroplaxome. To further illuminate the mechanistic underpinnings of ACTL7A for essential acrosome associations, in this study, we investigated its dynamic localization in the developing germline, molecular associations with other cytoskeletal components, and the cellular consequences of ablation. Our intracellular localization data show ACTL7A to be dynamically present within the nucleus and subacrosomal space and later associated with postacrosomal regions of developing spermatids. Through the generation of an Actl7a knock-out mouse model, we consistently observed disruption of acrosomal biogenesis with abnormal migration of the acrosomal granule and peeling acrosomes during spermatid elongation. Significantly, we found a complete loss of subacrosomal filamentous actin (F-actin) structures in knock-out spermatids suggesting a regulatory role for subacrosomal F-actin. Considering our reported data together with existing literature, we propose a mechanistic model explaining the essential role of ACTL7A for acroplaxome-associated F-actin, acrosomal attachment integrity, and male fertility.

Emergence Time and Sequence of Primary Teeth in a Sample of Nepalese Children

Background Primary teeth emergence is an important milestone in children and timing of emergence varies among populations. Objective To determine the emergence time and sequence of primary teeth in a sample of Nepalese children visiting Dhulikhel Hospital. Method A descriptive cross-sectional study was conducted in children of 5 months to 4 years visiting Dhulikhel Hospital. The emergence of incisal tip to incisal margin for incisors and canines, cusp tip to occlusal margin of molars visible were recorded along with age in months and gender. Descriptive statistics was done to calculate the mean age of emergence of each tooth with standard deviation. Unpaired t-test was used to assess the difference between the mean age of emergence of teeth between right and left sides and between boys and girls. Result The first teeth to emerge was mandibular central incisor at the age of 9.37 ± 1.42 months and the last one was maxillary second molar at the age of 32.91 ± 6.39 months. There was no significant difference in the mean emergence time between the maxillary and mandibular jaws, between right and left sides of jaws and between boys and girls except for primary maxillary right central incisor and mandibular right second molar which was found to be emerged early in girls. Conclusion The emergence time and sequence of primary teeth observed in the present study can be used as a baseline data for the children of Kavre district.

Translation and Validation of Oral Health-Related Early Childhood Quality of Life Tool for Nepalese Preschool Children

Background Early childhood caries (ECC) in preschool children debilitate their quality of life affecting oral function, appearance and social well-being. A tool for measuring oral health-related quality of life for preschoolers may help in making clinical decisions and assist policy makers in planning and management of health programs in the country. Objective To translate oral health-related early childhood quality of life (OH-ECQoL) tool into Nepali language and test its validity and reliability. Method OH-ECQoL was translated into Nepali language by two Nepalese professional translators which was back translated by professional English translator. This was sent to three independent advisors to see the appropriateness of translation. Pilot testing was done in 20 parents and questionnaire was finalized after needed corrections. Final version was introduced to the 118 parents of children aged 24- 71 months. Caries status was recorded for all children participating in the study. Concurrent, construct, discriminant validity and internal consistency reliability, test -retest reliability were evaluated. Result OH-ECQoL scores and perception of parents for general and oral health of their children was significant (at 0.01 level). There was significant difference in OH-ECQoL scores between no ECC and severe ECC groups and moderate and severe ECC groups (at 0.05 level). There was also a significant correlation between child impact section and family impact section (at 0.01 level). Cronbach's alpha was 0.891 demonstrating good internal consistency. Intra class coefficient was 0.963 suggesting excellent testretest reliability. Ninety-one (77.1%) children had severe ECC and 40(33.9%) parents were from upper middle class. Conclusion The Nepali version of OH-ECQoL is a valid and reliable tool for assessing the oral health-related early childhood quality of life in children of Nepal.

Tuberculosis and the art of macrophage manipulation

Macrophages are first-line responders against microbes. The success of Mycobacterium tuberculosis (Mtb) rests upon its ability to convert these antimicrobial cells into a permissive cellular niche. This is a remarkable accomplishment, as the antimicrobial arsenal of macrophages is extensive. Normally bacteria are delivered to an acidic, degradative lysosome through one of several trafficking pathways, including LC3-associated phagocytosis (LAP) and autophagy. Once phagocytozed, the bacilli are subjected to reactive oxygen and nitrogen species, and they induce the expression of proinflammatory cytokines, which serve to augment host responses. However, Mtb hijacks these host defense mechanisms, manipulating host cellular trafficking, innate immune responses, and cell death pathways to its benefit. The complex series of measures and countermeasures between host and pathogen ultimately determines the outcome of infection. In this review, we focus on the diverse effectors that Mtb uses in its multipronged effort to subvert the innate immune responses of macrophages. We highlight recent advances in understanding the molecular interface of the Mtb-macrophage interaction.

Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration

Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.

Assessing the Relationship of Maternal Factors and Family Income with Early Childhood Caries: A Hospital Based Study

Background Earlychildhood caries (ECC) is a multifactorial disease. Maternal factors and family income has major influence on the caries status of children. Objective To assess the relationship of maternal factors and family income with early childhood caries among children attending Pediatric Dentistry department of Dhulikhel Hospital. Method A cross sectional study was conducted among 239 children of age 3 to 6 years attending Pediatric Dentistry department of Dhulikhel Hospital, Kavre, Nepal. Age of child, mother's occupational status,educational level and family income were recorded. Oral examination of child was done to record decayed, missing, filled teeth (dmft). Descriptive analysis was done to observe the caries experience. Chi - square test was used to assess the relationship of caries experience with occupational status, education of mother and family income. Result The mean decayed, missing, filled teeth of the children was7.04±4.10. There was no significant relationship of early childhood caries with occupational status of mother (p=0.675), education of mother (p=0.140) and family income (p=0.158). Conclusion There was no relationship of maternal factors and family income with early childhood caries when surveyed among the children visiting Pediatric Dentistry department of Dhulikhel hospital.

An Experience of Pediatric Upper and Lower Gastrointestinal Endoscopy in a Tertiary Center

Background Although upper gastrointestinal endoscopy and colonoscopy is considered to be a gold standard in the diagnosis of many pediatric gastrointestinal disorders, there is limited data about its utility from our country. This important diagnostic tool is underutilized. Objective The objective of this study is to report the common indications, endoscopic findings and complications of pediatric upper gastrointestinal endoscopy and colonoscopy in a tertiary center to increase awareness amongst pediatricians. Methods This descriptive cross-sectional study was conducted in children undergoing upper gastrointestinal endoscopy and colonoscopy for various indications in a tertiary center from November 2014 to October 2016 (24 months). Results We performed 192 endoscopies during this period. Upper gastrointestinal endoscopy 158 and Colonoscopy 34. Mean age of patients was 10.2 years (range 6 months to 16 years) and 140(72.9%) patients were under 10 years of age. Common indications of UGI endoscopy were recurrent abdominal pain (67%), acute abdominal pain (12.6%), recurrent vomiting (8.0%), upper GI bleed (4.4%), failure to thrive (3.1%) and caustic ingestion (2.5%). An abnormality was detected in 128(81%) patients. Antral gastritis (55%) was the most common diagnosis. Thirty two percent of children with RAP had chronic moderate to severe gastritis and were positive for H. pylori in Giemsa stain on histopathological examination. Common indications of colonoscopy were Lower GI bleed and chronic diarrhea. Out of 22 patients who underwent colonoscopy for lower GI bleed, 18(82%) patients had rectal polyp and underwent snare polypectomy. Out of 12 patients who were evaluated for chronic diarrhea, 7(20%) were diagnosed to have cow's milk protein allergy and 5(15%) patients had inflammatory bowel disease. An abnormality was detected in 30(88%) patients. All children received sedation/ analgesia and tolerated the procedure well. Conclusion Upper gastrointestinal endoscopy and colonoscopy are safe procedure in children. The awareness about its diagnostic and therapeutic role should be raised amongst pediatricians in developing countries. There is also a need to develop training programs of pediatric gastroenterology and pediatric endoscopic suites in developing countries so that children may benefit from this state of the art diagnostic modality.

Permanent Teeth Emergence Time and Sequence in Children of Kavre District, Nepal

Background Population specific standards on the timing and sequence of emergence of permanent teeth are essential in planning dental care for children. There is only a single study on the emergence of permanent teeth in Nepalese children. Objective To determine the standards for permanent teeth emergence time and sequence in children of Kavre district, Nepal. Method A descriptive cross sectional study was conducted in 623 children of age 5 to 14 years from six different schools of Kavre district. The number of permanent tooth erupted except third molar was recorded along with age and gender. Data were analysed using SPSS 20.0. Descriptive statistics was used to determine the number and percentage of permanent teeth emerged at different ages and the mean age of emergence of each tooth. Student 't' test was used to determine the inter jaw differences in the mean age of emergence of each tooth. Result The study population constituted 50.7% boys and 49.3% girls of the total sample. The first tooth to emerge was mandibular first molar, whereas maxillary second molar tended to be the last to emerge in both the genders. Though in general, mandibular teeth tended to precede the corresponding maxillary teeth in emergence but significantly only mandibular central, lateral and second premolar emerged earlier than maxillary.( p ≤ 0.05) Conclusion This study can be used as a reference data for clinical and academic purpose especially for the children of Kavre district, Nepal.

Gentiana lutea exerts anti-atherosclerotic effects by preventing endothelial inflammation and smooth muscle cell migration

BACKGROUND AND AIMS

Studies suggest that Gentiana lutea (GL), and its component isovitexin, may exhibit anti-atherosclerotic properties. In this study we sought to investigate the protective mechanism of GL aqueous root extract and isovitexin on endothelial inflammation, smooth muscle cell migation, and on the onset and progression of atherosclerosis in streptozotocin (STZ)-induced diabetic rats.

METHODS AND RESULTS

Our results show that both GL extract and isovitexin, block leukocyte adhesion and generation of reactive oxygen species in human umbilical vein endothelial cells (HUVECs) and rat aortic smooth muscle cells (RASMCs), following TNF-alpha and platelet derived growth factor-BB (PDGF-BB) challenges respectively. Both the extract and isovitexin blocked TNF-α induced expression of ICAM-1 and VCAM-1 in HUVECs. PDGF-BB induced migration of RASMCs and phospholipase C-γ activation, were also abrogated by GL extract and isovitexin. Fura-2 based ratiometric measurements demonstrated that, both the extact, and isovitexin, inhibit PDGF-BB mediated intracellular calcium rise in RASMCs. Supplementation of regular diet with 2% GL root powder for STZ rats, reduced total cholesterol in blood. Oil Red O staining demonstrated decreased lipid accumulation in aortic wall of diabetic animals upon treatment with GL. Medial thickness and deposition of collagen in the aortic segment of diabetic rats were also reduced upon supplementation. Immunohistochemistry demonstrated reduced expression of vascular cell adhesion molecule-1 (VCAM-1), inducible nitric oxide synthase (iNOS), and vascular endothelial cadherin (VE-cadherin) in aortic segments of diabetic rats following GL treatment.

CONCLUSIONS

Thus, our results support that GL root extract/powder and isovitexin exhibit anti-atherosclerotic activities.

Comparative evaluation of craniofacial anthropometric measurements in Indian adult patients with and without obstructive sleep apnea: A pilot study

AIMS

The study aimed to compare the craniofacial features of North Indian patients suffering from obstructive sleep apnea (OSA) to that of normal North Indian population.

MATERIALS AND METHODS

Selected 25 North Indian subjects (age: 18-65 years) were divided into two groups (OSA group [n = 14] and non-OSA group [n = 9]) according to the results of full night polysomnographic sleep study. Body mass index (BMI), neck circumference (NC), and lateral cephalograms were recorded for each subject in both groups and total 22 parameters of craniofacial anthropometric features were measured on lateral cephalograms for each subject. The differences in BMI, NC, and craniofacial features between the OSA and non-OSA groups were compared statistically.

RESULTS

Independent sample t-test was used to compare the differences between OSA group and non-OSA group. The results showed that the BMI, NC, bulk of tongue (tongue length, tongue height, and tongue area) and length of the soft palate (PNS-U) were significantly higher in OSA group. OSA group was also found to have inferior positioning of hyoid bone (MP-H, ANS-H, PNS-H, ANS-Eb), narrower superior and middle airway space (SPAS and MAS), antero-inferior positioning of mandible (Gn-C3, ANS-Me, SNB, N-Me) and lower cranial base flexure angle (N-S-Ba).

CONCLUSION

Craniofacial features, which play an important role in the pathophysiology of OSA, differ significantly between North Indian patients suffering from OSA and normal North Indian population.

A comparative evaluation of bond strength of feldspathic porcelain to nickel-chromium alloy, when subjected to various surface treatments: An in vitro study

Purpose of the Study:

The purpose was to evaluate the effect of various surface treatments and sandblasting with different particle size on the bond strength of feldspathic porcelain with predominantly base metal alloys, using a universal testing machine.

Materials and Methods:

Totally, 40 specimen of nickel-chromium alloy were prepared in an induction casting machine. The groups divided were as follows: Group I-sandblasted with 50 μ Al₂O₃, Group II-sandblasted with 110 μ Al₂O₃, Group III-sandblasted with 250 μ Al₂O₃ and Group IV-sandblasted with 250 μ Al₂O_3, followed by oxidation and again sandblasted with 250 μ Al₂O₃. The dimensions of each specimen were adjusted so as to maintain the thickness of ceramic at 1 mm. The specimen were loaded on the assembly of the universal testing machine, and a cross head speed of 0.5 mm/min was used to apply a compressive force at the junction of metal and feldspathic porcelain. The force application continued until adhesive fracture occurred, and the readings of the load applied to that particular specimen were recorded.

Results:

The means for shear bond strength for Group I, II, III and IV were found to be (226.92 ± 1.67), (233.16 ± 3.85), (337.81 ± 16.97) and (237.08 ± 4.33), respectively. Means of shear bond strength among the groups were compared using one-way analysis of variance test. Comparison between individual groups were made with Tukey's Honestly Significant Difference post-hoc test.

Conclusion:

Different particle size and surface treatment have an important role on the bond strength of ceramic-metal interface. Greater particle size demonstrated higher bond strength.

Afatinib use in non-small cell lung cancer previously sensitive to epidermal growth factor receptor inhibitors: the United Kingdom Named Patient Programme

INTRODUCTION

Afatinib prolongs progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) who were previously sensitive to erlotinib or gefitinib. This study investigated experience of afatinib under a Named Patient Use (NPU) programme.

PATIENTS AND METHODS

Retrospective data for 63 patients were collected, including demographics, dose, toxicity and clinical efficacy.

RESULTS

Response rate and median PFS were 14.3% and 2.6months, respectively. Diarrhoea and rash were the most common toxicities; 46% of patients required a dose reduction and 41% had a dose delay.

CONCLUSIONS

Efficacy and safety in the NPU programme are consistent with the LUX-Lung 1 trial.

Immediate neonatal outcome of adolescent pregnant mother at Nepal Medical College Teaching Hospital

Pregnancy in teenage period of life is often associated with maternal complications as well as preterm delivery, low birth weight babies and small for date babies. The purpose of this study was to know the immediate outcome of neonates delivered by adolescent pregnant mother at Nepal Medical College Teaching Hospital (NMCTH), Attarkhel, Kathmandu. A retrospective comparative study was carried out in 350 adolescent pregnant mother who had delivered newborn at NMCTH from April 2005 to February 2009. Data were obtained from the case record register from Archive. Prevalence of adolescent pregnancy was 11.1%. Majority of adolescent mother were aged between 17-19 years, belonging to Mongolian ethnicity, Hindu by belief and residing within Kathmandu Valley. More than 90.0% mothers were primigravida and 85.4% had complete antenatal check up (ANC). Normal vaginal delivery was the predominant mode of delivery in both group (84.6% vs 80.0%), followed by lower section caesarean section (LSCS) (14.0% vs 18.8%) and instrumental delivery (1.1% Vs 1.2%). In newborn, male outnumbered female (59.7% vs 40.3%). A reasonable number of preterm (10.9% Vs 6.3% p = 0.029), low birth weight (12.3% vs 9.1% P = 0.259) and small for gestational age babies (7.4% vs 5.1% p = 0.318)) and birth asphyxia (10.3% Vs 5.1% p = 0.009%) were found in this study. These newborns are often associated with high morbidity and mortality. Therefore, it is imperative to prevent teenage pregnancy by providing adequate access to health facilities and raising awareness about the sex and reproductive health amongst this population.

Impact of nutrition education on knowledge and haemoglobin status of hill women in Uttarakhand State of India

INTRODUCTION

This study aimed to examine the impact of the use of single vs. combination of media on nutritional knowledge and haemoglobin status of women in a rural hill area in Uttarakhand State, India.

METHODS

Women from three villages were selected randomly and divided into three groups namely, print media group (n = 59), multimedia group (n = 53) and control group (n = 111). The print media group was exposed to nutrition education through the use of calendars on anaemia for 60 days; the multimedia group was given nutrition education through a combination of media including calendars, video films, and group discussions for 60 days.

RESULTS

At pre-exposure stage, 62.7% of the women in the print media group, 67.9% of the multimedia group, and 66.7% of the control group had a low nutrition knowledge level. After exposure, the print media group and the multimedia group showed a significant rise in nutrition knowledge, with the multimedia group scoring significantly higher than the print media group. Overall, 69.1% of the women were anaemic with mean haemoglobin concentration of 10.74 +/- 0.86 g/dl. A non-significant rise in mean haemoglobin concentrations in the experimental groups was found at post-exposure stage.

CONCLUSION

Calendars and video films are effective in increasing nutrition knowledge of illiterate hill women. Use of mass media programmes of longer duration should be encouraged to combat the nutritional problems of rural communities.

Clinical profile of tuberculosis in children

Childhood tuberculosis is common in our community. The diagnosis in most cases is still based on clinical evidence alone. The present study was designed to study clinical profile, laboratory investigations and outcome of pediatric tuberculosis. A prospective study was conducted among the children admitted in Nepal Medical College from April 2007 to March 2011. The prevalence of tuberculosis was 1.5%. Pulmonary tuberculosis was common (53.7%) than extra pulmonary (46.3%) tuberculosis. BCG scar was present in 48.8%. History of tuberculosis contact was present in 36.6% and Mantoux test was positive in 39.0%. The most common symptoms were fever (75.6%), cough (63.4%) and weight loss (41.5%). Confirmed diagnosis was made (bacteriological or histological) only in 14.6%. This study supports the use of history and clinical features to diagnose childhood tuberculosis.

Profile of acute lower respiratory tract infection in children under fourteen years of age at Nepal Medical College Teaching Hospital (NMCTH)

The purpose of this study was to find out the current pattern and prevalence of acute lower respiratory tract infections in children at Nepal Medical College Teaching Hospital in Katmandu, Nepal. A retrospective study was done in 73 children, admitted to the Pediatric ward over a period of one year from January 2010-December 2010. This study showed, 52.0% children below two years of age had acute lower respiratory tract infections, where 68.4% had pneumonia and 31.6% had acute bronchiolitis. The prevalence of infections was 58.9% in male children. The occurrence of infections was common in January and April month. Pneumonia was detected in 37.7% children with malnutrition. The most common presenting symptoms was fever observed in 90.4%, cough in 71.2% and fast breathing in 34.2% children. The WBC count was high in 47.9% children, out of which 43.8% had pneumonia and 4.1% had bronchiolitis. Increased neutrophil count in 36.9% and increased ESR in 50.7% seen in patients only with pneumonia. Chest x-ray showed, lobar pneumonia in 45.2% children where right middle zone was most commonly involved in 42.4% patients. Six (8.2%) children were diagnosed as pulmonary tuberculosis. The average duration of hospital stay was 6 days.

Clinical and bacteriological profile of urinary tract infection in children at Nepal Medical College Teaching Hospital

The aim of this study was to study the clinical and bacteriological profile of urinary tract infection (UTI) in children. This was a prospective study of 40 culture positive cases of UTI in children who attended pediatric outpatient department of Nepal Medical College Teaching Hospital. UTI was more common in female (65.0%) than in male (35.0%). Half were in the age group 1- 5 years. Fever was the most common presentation (65.0%) followed by abdominal pain (42.5%), decreased appetite (37.5%) and dysuria (37.5%). Escherichia coli was the most common (67.5%) bacterial isolate followed by Klebsiella sps (20.0%) and Proteus sps (10.0%). E. coli was 100 % sensitive to nitrofurantoin. E. coli was also highly sensitive to ofloxacin, cefotaxim and amikacin (94.0%). Klebsiella was 100 % sensitive to ciprofloxacin and amikacin. Greater degree of resistance was seen to ampicillin, cotrimoxazole and nalidixic acid.

Review of Paediatrics In-Patient at Nepal Medical College and Teaching Hospital

Introduction: This retrospective study was undertaken to analyze the disease pattern in the Pediatric ward in a Medical College. After analyzing the data, our study would emphasize on the prevention and the management modality of the most prevalent diseases in the community. Methodology: This study was carried out retrospectively for one year from January 2008 - December 2008 on the basis of age and sex and the frequency of disease according to the system involved. Results: A total number of 453 patients were admitted during the study period. There were 267(59%) male and 186(41%) female children. Less than five years age group accounted for 180(39.7%) excluding the neonate. In the study period, respiratory tract infections were the commonest cause of admission in all age group 198(43.7%), gastrointestinal including diarrhoeal diseases were 112(24.7%), enteric fever comprised of 22(5%), and other disease comprised of about 143(31.5%) of the total admissions. CNS diseases comprised of 43(9%) of which 7(16%) were meningitis and meningoencephalitis, 26(60%) of the total CNS cases were due to febrile convulsion. Respiratory diseases were found to be the major cause of morbidity in children. Conclusion: Children under five years age being the most common age group amongst all, with infection being the most predominant cause of Pediatric morbidity, the WHO/UNICEF algorithm for Integrated Management of Childhood Illness (IMCI) is specifically suited for the developing country like ours. Key words: Paediatric Inpatient; Morbidity; IMCI DOI: 10.3126/jnps.v31i1.3262J Nep Paedtr Soc 2010;31(1):25-29

Nanoionomer: evaluation of microleakage

BACKGROUND

Glass ionomer cements are widely used in pediatric practice due to their advantage of fluoride release and chemical bond to tooth structure. Adherence of the restorative material to the cavity walls is one of the most important characteristic for it to be proven as an ideal material as it prevents microleakage.

AIMS AND OBJECTIVES

This study was aimed at evaluating the microleakage of nanofilled resin-modified glass ionomer cement compared with the conventional and resin-modified glass ionomer cements.

MATERIALS AND METHODS

Standard class V cavities of size 3 mm x 2 mm x 2 mm were made on a total of 30 extracted teeth and restored with the conventional glass ionomer, resin-modified glass ionomer or nanoionomer. After thermocycling, teeth were immersed in 0.5% methylene blue dye for 24 h. They were then sectioned buccolingually. Microleakage was assessed for the occlusal and gingival walls using a compound microscope by two examiners independently.

RESULTS

Nanoionomer demonstrated the least microleakage, with a mean score of 1.3, compared with the resin-modified glass ionomer (score of 3.2) and conventional glass ionomer cement (score 2.6).

CONCLUSION

Nanoionomer exhibited adequate resistance to microleakage and thus may prove better than conventional or resin-modified glass ionomers.

Perinatal mortality audit

Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. A retrospective study of perinatal indices was conducted among 816 births delivered during the period of 1 year from April 2007 to March 2008 in Nepal Medical College. There were 11 still births and 11 early neonatal deaths. Breech presentation with stucked head and respiratory distress syndrome in preterm babies are the common causes for perinatal mortality. Within the Wigglesworth's classification; group 1, 3 and 4 are the common groups of perinatal death. The 76.5% of perinatal deaths and 100% of early neonatal deaths were low birth weight babies. Similarly 72.5% of perinatal death and 82% of early neonatal death were preterm babies. The perinatal mortality was 26.9/1000 births, comparable to other studies, but still emphasis should be given to upgrade the neonatal care. The efforts should be made for regular antenatal checkups and improvement of neonatal care.

Impact of the impact factor in biomedical research: its use and misuse

The impact factor was created in the biomedical research field in order to measure a journal's value by calculating the average number of citations per article over a period of time. It was initially developed to help libraries decide which highly-cited journals to subscribe to. However, at present, it is being misused to judge the quality of a researcher or medical scientist as well as the quality of the work done. It contains serious sources of errors and flaws, resulting in strong biases against culture- and language-bound medical subspecialties. The present article is aimed to highlight the impact of the impact factor in the biomedical research, as well as its use and misuse.

Accuracy of DCE – MRI in predicting response in patients treated with taxane based neoadjuvant chemotherapy

Abstract #5120

Background: Neoadjuvant chemotherapy for locally advanced breast cancer is an established treatment option. Several studies have shown DCE-MRI scanning to be the most accurate investigation to assess response to EC chemotherapy. Recent trials have shown that addition of Taxanes increases the overall response rate and the rate of breast conserving surgery. Taxanes act by inhibiting angiogenesis in the tumour and this could potentially affect the quality of the post treatment scan images as DCE-MR scan and cause inappropriate decisions regarding the required surgery.
 Aim: To compare the accuracy of DCE-MR scan in identifying residual disease in patients treated with FEC (Fluoro uracil, Epirubicin, Cyclophosphamide) vs EC (Epirubicin, Cyclophosphamide) followed by Taxane.
 Methods: Patients treated with primary chemotherapy who subsequently underwent breast conserving surgery were identified from a prospectively maintained database. Clinical details including chemotherapy regimes, pre and post chemotherapy MRI data, number of surgical procedures and histological parameters of the excised specimen were obtained.
 Results: A total of 121 patients treated with primary chemotherapy were identified. Of these, 76 were treated with FEC or EC based chemotherapy and 45 were treated with EC+Taxane. DCE-MRI was significantly less accurate (p<0.05) when predicting the size of residual disease in the Taxane group.
 
 Conclusion: DCE MR scan is not as accurate for quantifying size of residual disease in patients treated with taxane when compared with patients treated with traditional FEC/EC based primary chemotherapy. This should be considered when planning surgery after neoadjuvant therapy.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5120.

Pseudocyesis

Pseudocyesis - a clinical syndrome seen in non-psychotic woman, known since the time of Hippocrates. Pseudocyesis has a psychological basis in which a woman's wish for pregnancy is essential to their identity and self-esteem. Normally, pseudocyesis is seen in women who desperately want to become pregnant, especially those with longstanding infertility. Basically, the treatment of Pseudocyesis is to help these patients recognize the illness and to educate and counsel them. Here is the case of pseudocyesis in which there is no history of long standing infertility. This case is rare and liable to be missed.

Gemcitabine twice weekly as a radiosensitiser for the treatment of brain metastases in patients with carcinoma: a phase I study

Conventional treatment for brain metastases (BM) is whole-brain radiotherapy (WBRT). Efficacy is poor. It might be increased by a potent radiosensitiser such as gemcitabine which is believed to cross the disrupted blood–brain barrier. Primary objective of this study was to determine the maximum tolerated dose (MTD) of twice weekly gemcitabine given concurrently with WBRT. Patients with BM from carcinoma were included. The dose of WBRT was 30 Gys (10 daily fractions). Gemcitabine was given 2–4 h prior to WBRT on days 1 and 8 for the first cohort of patients and then on days 1, 4, 8 and 11. Starting dose was 25 mg m⁻², escalated by 12.5 mg m⁻² increments. At least three patients were included per level. Dose limiting toxicity (DLT) was defined as grade 4 haematological or grade ⩾3 nonhaematological toxicity. A total of 25 patients were included; 74% had a PS 1 (ECOG). In all, 23 had non-small-cell lung cancer, six colorectal, four breast, two renal cell and one oesophageal carcinoma. A total of 92% had concurrent extracranial disease. Six had single BM, 13 had two or three BM and six multiple. Up to 50 mg m⁻² (level 4) no DLT was observed. At 62.5 mg m⁻², one out of six patients developed DLT (thrombocytopenia-bleeding). The next dose level (75 mg m⁻²) was abandoned after grade 4 bone marrow toxicity (fatal neutropenic sepsis) was seen in one out of two patients. So that the dose of 50 mg m⁻² will be taken forward for further study.

Re-treatment of a lung tumour using a simple intensity-modulated radiotherapy approach

We present a lung tumour case where, although the proximal spinal cord had already reached its dose tolerance, re-treatment was indicated. Minimization of the cord dose was defined as the main constraint for this case, however additional dose to the heart was considered. A simple (4 field) intensity-modulated radiotherapy (IMRT) treatment which proved superior to the standard conformal plan was developed using the Computerized Medical Systems (CMS) XiO treatment planning system. The IMRT plan was found to be superior to the conventional conformal plan regarding tumour coverage. It provided 100% saturation of the planning target volume (PTV) by the 95% isodose cloud, whereas the latter only provided 77% coverage. A step and shoot delivery using 10 intensity levels was developed and subsequently delivered for this patient. We considered it to be a routine application of IMRT and an important example of how it can offer benefit in individual and appropriate cases where conventional treatment is inadequate.

Studies on the electrochemical performance of glucose biosensor based on ferrocene encapsulated ORMOSIL and glucose oxidase modified graphite paste electrode

The electrochemical performance of a new glucose biosensor is reported. The glucose biosensor is developed using glucose oxidase (GOD) and ferrocene encapsulated palladium (Pd)-linked organically modified sol-gel glass (ORMOSIL) material incorporated within graphite paste electrode. The ORMOSIL material incorporated within graphite paste electrode behaves as an excellent electrocatalyst for the oxidation of enzymatically reduced GOD. The electrochemical behavior of new glucose biosensor has been examined by cyclic volammetry and amperometric measurements. The bioelectrocatalysis of ORMOSIL embedded within graphite paste as a function of storage time and varying concentration of ORMOSIL is reported. The initial amperometric response on glucose sensing is recorded to be 145 microA at 15% (w/w) concentration of the ORMOSIL which is decreased to 20 microA at 5% of the same keeping GOD concentration constant. The variation of electrochemical behavior of the ORMOSIL embedded within graphite paste as a function of time has also been studied based on cyclic voltammetry. The voltammograms showing the reversible electrochemistry of ORMOSIL encapsulated ferrocene is changed into a plateau shape as a function of time, however, the electrocatalytic behavior is still retained. The practical usability of new glucose sensor has been compared with earlier developed glucose sensor. The sensitivity, response time and linearity of the new glucose biosensor are found to be excellent over earlier reported glucose biosensor. The amperometric response, calibration curve and practical applications of new glucose sensor are reported.