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Hypoglycemia is characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status or sympathetic nervous system stimulation. Glucose levels

Primary hypoadrenalism(Addison’s disease) refers to glucocorticoid deficiency occurring in the setting of adre­nal disease(mostly due to autoimmune adrenalitis), whereas secondary hypoadrenalism arises because of deficiency of ACTH(mostly due to pituitary disease) . A major distinction between these two is that mineralocorticoid deficiency invari­ably accompanies primary hypoadrenalism, but this does not occur in secondary hypoadrenalism because only ACTH is de­ficient; the renin-angiotensin-aldosterone axis is intact and in primary hypoadrenalism skin pigmentation is always present due to increased ACTH secretion(unless of short duration) but it is absent in secondary hypoadrenalism. Addison’s disease or primary adrenocortical failure was first described by English physician Thomas Addison, who found it in six patients with adrenal tuberculosis in 1855(1). Addisonian crisis is a potentially fatal condition associated mainly with an acute defi­ciency of the glucocorticoid cortisol and, to a lesser extent, the mineralocorticoid aldosterone. This is a rare condition with an estimated incidence in the developed world of 0.8 cases per 100,000 and prevalence of 4 to 11 cases/100,000 population. Despite optimised life-saving glucocorticoid replacement and mineralocorticoid-replacement therapy, it is life threatening if overlooked(2-3). Hypothyroidism may mask the addison’s disease so in patients with panhypopituitarism and autoim­mune polyglandular syndrome type 2 thyroxine replacement without adequate steroid replacement may precipitate acute addisonian crisis. Journal of Chitwan Medical College 2013; 3(4); 54-56 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9557

Static magnetism and thermally activated magnetic relaxation were investigated in granular FePt films (20 nm-200 nm thick) with random magnetic anisotropy through hysteresis loop, torque curve and magnetization time dependence measurements. While the magnetism of thicker film (200 nm thick) is dominated by a single switching of the ordered L10 phase, thinner film (20 nm) displays a double switching, which is indicative of the presence of the disordered cubic phase. The pronounced behavior of double switching in thinner film suggests that the film grain boundary is composed of soft cubic magnetic phase. The magnetic relaxation study reveals that magnetic viscosity S of the films is strongly dependent on the external applied field and exhibits a maximum value (12 kAm) around the switching field and a vanishing behavior at low (1 kOe) and large (12 kOe) fields. The activation volume of the thermal switching was found to be much smaller than the physical volume of the granular structure due to the incoherent rotation mode of the magnetization reversal mechanism, which is established to be domain wall nucleation.

Thyroid nodules are often followed up with serial ultrasound imaging. Doubling time is well established in the evaluation of lung nodules. We examined whether benign and malignant thyroid nodules exhibit differences in doubling time.This retrospective, IRB-approved study included patients with nodules aspirated between January and June 2012 (benign), and January 2012 to December 2014 (suspicious or malignant), no interval thyroidectomy, and two ultrasound examinations longer than 180 days apart. Diameters and morphology were assessed by a single observer, demographics recorded, and doubling time calculated. Area under the receiver operating characteristic curve was derived. Society of Radiologists in Ultrasound criteria were used to determine aspiration appropriateness initially and after follow-up.59 patients with 61 nodules were included. Statistically significant between-group differences exist for sex, solidity, echogenicity, and microcalcifications, with no significant differences in doubling time, age, days between studies, vascularity, or mean diameter. Benign nodules' doubling time was 340 to 7134 days (mean, 2196; median, 1593), with 9 nodules that decreased in size. Malignant nodules' doubling time was 451 to 17182 days (mean, 3940; median, 2137), with 7 nodules that decreased in size. Using a threshold of 1100 days, sensitivity and specificity of doubling time to predict malignancy are 19.0% and 86.7%, respectively. Area under the receiver operating characteristic curve is 0.39. Follow-up imaging resulted in 6 additional benign and 0 additional malignant nodules meeting criteria.There is no significant difference in benign or malignant nodules' doubling times, and a decrease in nodule size is nonspecific. These findings challenge the underlying rationale for routine imaging follow-up of thyroid nodules.

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.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.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), HbA1c6.5(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), HbA1c6.5 (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.Tessellated fundus was observed as decreased risk for the development of diabetic retinopathy and maculopathy.

Emission inventories from mobile sources have traditionally been obtained through computational modeling. This method, however, has intrinsic shortcomings in that the factors used incorporate only a limited amount of real-world observations. The agreement between model predictions and measurements has often been poor. Recently, a fuel-based method ofobtaining on-road emissions inventories has been developed. This technique calculates emission f in grams of pollutant per unit of fuel used (kg, gallons or l) from remote sensing measurements. Combining these factors with fuel use data, available from tax records, results in a fuel-based emission inventory. This method for obtaining emission inventories is very economical and an ideal alternative for locations lacking the resources to develop an emissions model. We have used this routine to calculate CO, HC and NO on-road running exhaust emissions inventories for the Denver Metropolitan area during several years when the enhanced I/M program has been in place. These calculations indicate a continually decreasing inventory over the 6 yr study period. The calculations are also compared with results from the recent MOBILE6 model. The modeled inventories are 30–70% higher, 40% lower, and 40–80% higher for CO, HC and NO, respectively. r 2002 Elsevier Science Ltd. All rights reserved.

The irreversible characteristics of the magnetization and the switching mechanism have been investigated in granular FePt films with L10 phase prepared by sputtering on a polymer substrate. The films display an extremely large magnetic anisotropy with a random distribution of the magnetization easy axis. The magnetic instabilities and the irreversible magnetization are found to be controlled by domain wall, which is responsible for the magnetization reversal. Through remanence curves and ΔM plot, the nature of magnetic interactions was revealed to be positive exchange coupling.

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.

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 < 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 < 0.000) and after 1 week, OR = 6.77; 95 % CI = 1.28 - 35.76, p < 0.006). Conclusion: Corneal edema following phacoemusification surgery in diabetic eyes is likely to be more frequent than in non-diabetic eyes. Nepal J Ophthalmol 2013; 5(10): 230-234 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8734

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.IMRT, dose calculation algorithms, Anisotropic Analytical Algorithm (AAA), Pencil Beam Convolution (PBC), Varian's Eclipse treatment planning system.

One application of the unique capability of magnetic resonance (MR) imaging for characterizing soft tissues is in the specific detection of lipid. Adipose tissue may be abundant in the body, but its presence in a lesion can greatly limit differential diagnostic considerations. This article reviews MR imaging fat detection techniques and discusses lesions in the abdomen and pelvis that can be readily diagnosed by using these techniques. Traditional fat detection methods include inversion-recovery and chemically selective fat-suppression pulse sequences, with the former being less sensitive to field heterogeneity and less tissue specific than the latter. Chemical shift-based sequences, which exploit the inherent resonance frequency difference between lipid and water to depict intracytoplasmic fat, have great utility for evaluating hepatic steatosis and lesions such as adrenal and hepatic adenomas, hepatocellular carcinoma, focal lipomatosis of the pancreas, and adrenal cortical carcinoma. The signal from large amounts of fat can be suppressed by using a narrow radiofrequency pulse for selective excitation of fat protons (ie, fat saturation imaging), a technique that increases image contrast resolution and highlights lesions such as contrast-enhancing tissue, edema, and blood products. This technique is especially useful for evaluating renal angiomyolipomas, adrenal myelolipomas, ovarian teratomas, and liposarcomas. MR spectroscopy is a promising method for quantifying absolute liver fat concentration and changes in hepatic triglyceride content during treatment. New and evolving techniques include magnetization transfer and modified Dixon sequences. A solid understanding of these techniques will help improve the interpretation of abdominal and pelvic imaging studies.

Purpose Current implementations of methods based on Hounsfield units to evaluate regional lung ventilation do not directly incorporate tissue-based mass changes that occur over the respiratory cycle. To overcome this, we developed a 4-dimensional computed tomography (4D-CT)-based technique to evaluate fractional regional ventilation (FRV) that uses an individualized ratio of tidal volume to end-expiratory lung volume for each voxel. We further evaluated the effect of different breathing maneuvers on regional ventilation. The results from this work will help elucidate the relationship between global and regional lung function. Methods and Materials Eight patients underwent 3 sets of 4D-CT scans during 1 session using free-breathing, audiovisual guidance, and active breathing control. FRV was estimated using a density-based algorithm with mass correction. Internal validation between global and regional ventilation was performed by use of the imaging data collected during the use of active breathing control. The impact of breathing maneuvers on FRV was evaluated comparing the tidal volume from 3 breathing methods. Results Internal validation through comparison between the global and regional changes in ventilation revealed a strong linear correlation (slope of 1.01, R 2 of 0.97) between the measured global lung volume and the regional lung volume calculated by use of the "mass corrected" FRV. A linear relationship was established between the tidal volume measured with the automated breathing control system and FRV based on 4D-CT imaging. Consistently larger breathing volumes were observed when coached breathing techniques were used. Conclusions The technique presented improves density-based evaluation of lung ventilation and establishes a link between global and regional lung ventilation volumes. Furthermore, the results obtained are comparable with those of other techniques of functional evaluation such as spirometry and hyperpolarized-gas magnetic resonance imaging. These results were demonstrated on retrospective analysis of patient data, and further research using prospective data is under way to validate this technique against established clinical tests.

Purpose: purpose of this study is to evaluate the effect of grid size in Eclipse AcurosXB dose calculation algorithm for SBRT lung. Methods: Five cases of SBRT lung previously treated have been chosen for present study. Four of the plans were 5 fields conventional IMRT and one was Rapid Arc plan. All five cases have been calculated with five grid sizes (1, 1.5, 2, 2.5 and 3mm) available for AXB algorithm with same plan normalization. Dosimetric indices relevant to SBRT along with MUs and time have been recorded for different grid sizes. The maximum difference was calculated as a percentage of mean of all five values. All the plans were IMRT QAed with portal dosimetry. Results: The maximum difference of MUs was within 2%. The time increased was as high as 7 times from highest 3mm to lowest 1mm grid size. The largest difference of PTV minimum, maximum and mean dose were 7.7%, 1.5% and 1.6% respectively. The highest D2-Max difference was 6.1%. The highest difference in ipsilateral lung mean, V5Gy, V10Gy and V20Gy were 2.6%, 2.4%, 1.9% and 3.8% respectively. The maximum difference of heart, cord and esophagus dose were 6.5%, 7.8% and 4.02% respectively. The IMRT Gamma passing rate at 2%/2mm remains within 1.5% with at least 98% points passing with all grid sizes. Conclusion: This work indicates the lowest grid size of 1mm available in AXB is not necessarily required for accurate dose calculation. The IMRT passing rate was insignificant or not observed with the reduction of grid size less than 2mm. Although the maximum percentage difference of some of the dosimetric indices appear large, most of them are clinically insignificant in absolute dose values. So we conclude that 2mm grid size calculation is best compromise in light of dose calculation accuracy and time it takes to calculate dose.

Irreversible magnetic processes have been investigated in magnetic systems with two different anisotropy symmetries (uniaxial and biaxial) through angular measurement of the switching field, the irreversible susceptibility and the magnetic viscosity. These two systems consist of two-dimensional cobalt ferrite hetero-structures epitaxially grown on (100) and (110) MgO substrate. It is found that for uniaxial anisotropy the irreversible characteristics of the magnetization are large and display a strong angular dependence, which exhibits its maximum at the easy axis and drops quickly to vanish at the hard axis. However, for biaxial anisotropy the magnetization irreversible characteristics are considerably reduced and are less sensitive to the field angle.

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 (P0.05). 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 (P0.01), and all fast-thawed subprimals were equal or superior to 14D and 21D (P0.01) in storage and thawing purge. During retail display, the greatest purge loss occurred in fast-thawed treatments (P0.01). 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.

To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management.This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated.Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection.A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.

Nepal's economic activity is dominated by agriculture. The volume of exports is small. About a quarter of the foreign exchange earned from export is required to cover costs of imported fossil fuels. Fossil fuels supply less than 7% of total energy consumption. More than 90% of primary energy consumption is supplied by biomass resources, and forests are the major source of biomass. The sustainable fuelwood yield of forest is far less than the total consumption, which has caused severe forest denudation. Consumption of crop residues and animal dung for fuel are increasing because of fuelwood shortage. The paper outlines the consequences of biomass consumption in Nepal and past efforts at biomass resources management and indicates their effectiveness. A few major practical policy measures have been suggested to correct the situation. The experiences and measures for biomass resources management explained in this paper are expected to be useful to other countries facing a similar situation.

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 (P0.01) 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.

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.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.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 vision3/60-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).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.

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 (P0.05). In the SO, the tenderness decreased from the middle of the muscle to both ends (P0.05). The anterior sides of the long head BF and SO were tougher than their posterior sides (P0.05).The first 4 steaks of the SM were more tender than the rest of the muscle (P0.05). There was a significant tenderness increment from the middle of the AF and SR to both ends of each muscle (P0.05). The medial side of the VI was more tender than its lateral side (P0.05). The VM had its smallest shear force value at the most distal end compared with the rest (P0.05). Dry or moist heat oven roasting, as compared with grilling, significantly tenderized SO (P = 0.002) and VL (P0.0001) 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.

Introduction: Age related macular degeneration is a disorder of the macula most often clinicallyapparent affecting central vision and is one of the leading causes of blindness in the populationabove 50 years. The aim of this study is to determine clinical profi le of AMD in Nepalese presentingto a Teaching Hospital in Kathmandu.Methods: It was a hospital-based cross-sectional study. The subjects included in the study were thosepresenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospitalfrom July 2007- Dec 2007.The total number of individuals included in the study were 402 and totalnumber of eyes were 804.Results: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group withprevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-groupindividuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjectsabove 71 years. This study revealed that the prevalence of AMD in females was higher with femalepreponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/24-6/60 vision and 15% had vision 0.01).Conclusions: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College TeachingHospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically signifi cantincreased risk for AMD development in this study.Key Words: Age-related macular degeneration, blindness, Nepalese, prevalence

Purpose: To compare the percentage depth dose (PDD) computational accuracy of Adaptive Convolution (AC) and Collapsed Cone Convolution (CCC) algorithms in the presence of air gaps. Methods: A 30×30×30 cm3 solid water phantom with two 5cm air gaps was scanned with a CT simulator unit and exported into the Phillips Pinnacle™ treatment planning system. PDDs were computed using the AC and CCC algorithms. Photon energy of 6 MV was used with field sizes of 3×3 cm2, 5×5 cm2, 10×10 cm2, 15×15 cm2, and 20×20 cm2. Ionization chamber readings were taken at different depths in water for all the field sizes. The percentage differences in the PDDs were computed with normalization to the depth of maximum dose (dmax). The calculated PDDs were then compared with measured PDDs. Results: In the first buildup region, both algorithms overpredicted the dose for all field sizes and under-predicted for all other subsequent buildup regions. After dmax in the three water media, AC under-predicted the dose for field sizes 3×3 and 5×5 cm2 and overpredicted for larger field sizes, whereas CCC under-predicted for all field sizes. Upon traversing the first air gap, AC showed maximum differences of –3.9%, −1.4%, 2.0%, 2.5%, 2.9% and CCC had maximum differences of −3.9%, −3.0%,–3.1%, −2.7%, −1.8% for field sizes 3×3, 5×5, 10×10, 15×15, and 20×20 cm2 respectively. Conclusion: The effect of air gaps causes a significant difference in the PDDs computed by both the AC and CCC algorithms in secondary build-up regions. AC computed larger values for the PDDs except at smaller field sizes. For CCC, the size of the errors in prediction of the PDDs has an inverse relationship with respect to field size. These effects should be considered in treatment planning where significant air gaps are encountered.

Purpose: The purpose of this study it to evaluate the dose to medium vs. dose to water reporting mode of AcurosXB algorithm in Eclipse TPS for lung SBRT Methods: Five lung SBRT cases previously calculated with AAA algorithm have been chosen for this study. All high density materials within the body were contoured and assigned HU values. The plans were then recalculated with AcurosXB algorithm using both dose to medium (AXM) and dose to water (AXW) modes. DVHs were then calculated to quantify the differences in dosimetric indices. Also, plan differences (AXW-AXM) and (AXW-AXM) were computed to observe the regions where maximum dose differences occur within the body. Results: For the same plan normalization, the MU variation between the plans was within ±0.5%. All dosimetric indices of target were within ±0.5% except maximum dose to 2cm (D2-Max) from the target. D2-Max was consistently higher with AXW plan with a value as high as 2.71%. All the dosimetric indices for both ipsilateral and contralateral lung appear to be within ±1% on average without any clear trend. Likewise, dosimetric indices for heart and Esophagus appear well within ±1% on average. The maximum dose to spinal cord was recorded consistently higher with dose to water reporting mode with an average of 2.2% (range 1.40% to 4.63%). Also, the plan difference (AXW-AXM) consistently produced higher maximum dose difference 8.94% (range, 4.2% to 12.4%) as opposed to 2.82%(range, 2.8% to 3.8%) from plan difference (AXM-AXW). Conclusion: It appears that dose reporting mode in AcurosXB algorithm has insignificant effects in dosimetric indices for SBRT lung. The only significant difference observed was the maximum dose difference within the body which may not be clinically important. This may be due to the fact that AcurosXB algorithm transport the particles in medium regardless of dose reporting mode chosen.

Magnetization reversal in epitaxial cobalt ferrite films grown on (110) MgO substrate has been investigated through angular studies of hysteresis loop and DCD remanence curve. The angular dependences of the coercivity and the switching field of these films strongly deviate from those typically known for coherent and incoherent rotation modes. However, the best fit for these angular curves suggests that domain wall nucleation is the appropriate mode for the magnetization reversal in these hetero-structures.

Sheehan’s syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, that generally occurs after an intra- or postpartum bleeding episode characterized by massive hemorrhage and hypovolemic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with a relatively early diagnosed Sheehan’s syndrome associated with amenorrhoea and secondary hypothyriodism complicated by postpartum hemorrhage. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8444 Journal of Chitwan Medical College Vol.3(2) 2013 49-50

Remote sensing of light duty vehicle on-road tailpipe exhaust has been used to measure on-road mass emissions of automobile fleets in Denver for 13 years and in two other U.S. cities for 5 years. Analysis of these fleets shows that newer automobiles, during a period of fairly constant new car standards, have become continually less polluting independent of measurement location. Improving emissions control technology spurred by federal regulations is thought to have brought about these trends.

Purpose: The purpose of this study is to validate Eclipse Electron Monte Carlo (Algorithm for routine clinical uses. Methods: The PTW inhomogeneity phantom (T40037) with different combination of heterogeneous slabs has been CT-scanned with Philips Brilliance 16 slice scanner. The phantom contains blocks of Rando Alderson materials mimicking lung, Polystyrene (Tissue), PTFE (Bone) and PMAA. The phantom has 30×30×2.5 cm base plate with 2cm recesses to insert inhomogeneity. The detector systems used in this study are diode, tlds and Gafchromic EBT2 films. The diode and tlds were included in CT scans. The CT sets are transferred to Eclipse treatment planning system. Several plans have been created with Eclipse Monte Carlo (EMC) algorithm 11.0.21. Measurements have been carried out in Varian TrueBeam machine for energy from 6–22mev. Results: The measured and calculated doses agreed very well for tissue like media. The agreement was reasonably okay for the presence of lung inhomogeneity. The point dose agreement was within 3.5% and Gamma passing rate at 3%/3mm was greater than 93% except for 6Mev(85%). The disagreement can reach as high as 10% in the presence of bone inhomogeneity. This is due to eclipse reporting dose to the medium as opposed to the dose to the water as in conventional calculation engines. Conclusion: Care must be taken when using Varian Eclipse EMC algorithm for dose calculation for routine clinical uses. The algorithm dose not report dose to water in which most of the clinical experiences are based on rather it just reports dose to medium directly. In the presence of inhomogeneity such as bone, the dose discrepancy can be as high as 10% or even more depending on the location of normalization point or volume. As Radiation oncology as an empirical science, care must be taken before using EMC reported monitor units for clinical uses.

This paper primarily deals with the distribution, and engineering and geotechnical properties of fine grained soils in the Kathmandu Valley. Not much studies have been done on these soils in the past except at some engineering construction sites such as bridges and heavy buildings. Very little data are available on the engineering and geotechnical properties of soils of the valley (IOE, 1983a, 1983b, 1986a, 1986b, 1986c; Koirala et al., 1993; Sadaula, 1993; Shakya, 1987; Soil Test, 1990a, 1990b). The authors conducted detailed laboratory studies on the soils of the Thapathali and Ratnapark areas in the central part of the Kathmandu Valley and the results are presented and discussed. An attempt is also made to broadly evaluate the soil conditions of the valley based on the available data from previous studies conducted by various agencies. The soils of the Kathmandu Valley are mainly produced by weathering of rocks within its watershed boundary. They are in most part lacustrine and fluvial in origin and composed of clayey, silty, sandy and gravely sediments. The maximum thickness of the sediment is found in the central part (550 m at Bhrikutimandap) and southern part (>457m at Harishidhi) of the valley. The engineering properties, basically the index properties such as grain size, natural moisture content specific gravity, Atterberg limits; and the mechanical properties such as penetration resistance, cohesion, unconfined compressive strength, compressibility as well as angle of shearing resistance of fine grained soils were determined and found to vary considerably both in horizontal and vertical directions. The bearing capacity and settlement values of the soils were also determined. It is commonly found that most of the buildings in the Kathmandu Valley are founded on isolated or strip types of foundations and the foundation depth is between 1 and 1.5 m. The study of soil properties of the Kathmandu Valley indicates that the heavy loaded structures should be founded on either raft, mat or pile types of foundation.

Purpose: Different breathing maneuvers typically Result in slightly different tidal volumes that can lead to changes in alveolar recruitment. Recently, there has been tremendous interest in utilizing 4D‐CT based measurements of regional ventilation for treatment planning and treatment assessment. In this work, we wanted to demonstrate the effect of different breathing maneuvers on fractional regional ventilation (FRV) extracted using 4D‐CT. Methods: In this work, we evaluate the effect of different breathing maneuvers: a) free‐breathing (FB), b) audio‐visual assistance (AV), and c) active breathing control (ABC), on FRV. We measured these changes using a 4D‐CT based technique that quantifies changes in CT characteristics of the pulmonary parenchyma. Five subjects were imaged using 4D‐CT during a single session under 3 different breathing maneuvers. 4D‐CT images were used to extract fractional regional ventilation by applying a ‘mass correction’ that is estimated using the ratio of the global inhale‐mass and end‐exhale mass. A subtraction of the corrected images is performed by spatially matching the images at each phase of the respiratory cycle using a deformable image registration algorithm in Insight Toolkit. A distribution of the fractional regional ventilation values is used to estimate a ratio of tidal volume to functional residual capacity. Results: Increased fractional regional ventilation is observed in all the subjects when they were breathing using the ABC maneuver. Statistically significant difference (p=0.079) in fractional regional ventilation was observed when we compared the means for the FB and ABC breathing maneuvers. These global differences were also reflected on a regional level when we compared the fractional regional ventilation maps. Conclusions: This is the first study to report that breathing pattern changes can significantly impact the recruitment of alveoli resulting in marked changes in the fractional regional ventilation.

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 film 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. Key words: Vernal keratoconjunctivitis; Tearfilm; IgE level; Type I hypersensitivity reaction; Type IV hypersensitivity reaction. DOI: 10.3126/kumj.v7i2.2700 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 104-108