Showing papers in "Asian Journal of Medical Sciences in 2019"

Burden of multidrug resistant respiratory pathogens in intensive care units of tertiary care hospital

Abstract: Background: Lower respiratory tract infections are one of the most common infections among the patients in Intensive Care Units (ICUs). Admission in ICUs and use of life supporting devices increase the risk of infection with multidrug resistant pathogens. Aims and Objectives: This study was aimed to determine the prevalence and antibiograms ofthe bacterial pathogens causing lower respiratory tract infectionsamong patients of ICUs. Materials and Methods: A total of 184 specimens from patients admitted in ICUswith lower respiratory tract infections were included in this study. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques. Carbapenamase detection was performed by modified Hodge test method.Detection of metallo beta lactamase (MBL) was tested by imipenem and imipenem/EDTA disc. Detection of Klebsiellapneumoniaecarbapenamase (KPC) was performed by imipenem and imipenem/phenyl boronic acid. Results: Out of 184 samples, 131 showed significant growth of bacterial pathogens. Acinetobacter species (42.6%), Staphylococcus aureus (16.9%) and Pseudomonasaeruginosa(13.9%)were the three most common isolates. Out of 22 imipenem resistant isolates of Acientobacter species, 9 were KPC producer, 4 were MBL producers and 3 isolates were positive for MBL and KPC both. Among the Acinetobacter species, 5.1% isolates were resistant to tigecycline and colistin. One isolate of Pseudomonas aeruginosa was positive for MBL. Conclusions:High prevalence of multidrug resistant bacteria in ICUs was recorded. Gram negative bacilli were predominantly associated with LRTI among ICU patients;Acinetobacterspecies being most common isolate. Detection of carbapenamase among the Acinetobacterand emergence of tigecycline resistancelimits the therapeutic options.Regular monitoring of such resistant isolates would be important for managing infection control in critical units.

Post-Traumatic Stress Disorder among Emergency Medical Services Personnel: A Cross-sectional Study

Abstract: Background: Post-Traumatic Stress Disorder is characterized by directly experiencing traumatic events or witnessing, learning, or repetitively experiencing the details of these events. High risk occupations (i.e., EMS personnel) frequently encounter traumatic eventscoping with events exceeding the range of human experiences. Regional lack of studies necessitated the need to report the prevalence of PTSD among healthcare providers in Saudi Arabia (SA). Aims and Objective: To explore the prevalence of PTSD among EMS personnel. Materials and Methods: This a descriptive cross-sectional study at King Abdul Aziz Medical City (KAMC), Riyadh, SA among 110 paramedics, emergency medical technicians (EMT), and ambulance drivers who were conveniently selected for this screening. Post-Traumatic Stress Disorder Checklist, the Civilian version, (PCL-C) was used to screen the participants, and cut-off point was 30-35. PTSD symptoms (present & absent) was considered as outcome measure. Results: Total of 110 participants were contacted, 74 (67%) agreed to participate. Around half of the participants were EMT (52%). Total number of screened individuals is 52, 14 (26.9%) had positive screening, of those, EMT had higher proportion than paramedics (32% vs 20.8%). Conclusion: This report is the first PTSD prevalence among healthcare providers in SA. The results showed that 26% of EMS personnel had positive screening for PTSD. Attention should be directed toward this issue by regular psychological evaluation and implementing psychological rehabilitation programs for EMS personnel. The study reflects only one center in the city, thus generalization would not be inappropriate.

A study on distribution and gender wise predilection of lip print pattern

Abstract: Background: Lip prints are considered as very useful and are to be important forms of transfer evidence like finger prints. Studies have shown that even lip prints are unique for an individual and hence have the potential for personal identification. Aims and Objectives: To correlate the distribution of lip print pattern and its gender wise predominance. Material and Methods: The study comprised of 100 Nepalese medical students (50 males; 50 females). A photographic method was adopted rather than the old traditional lipstick method. The photographed lip prints were transferred into a computer to identify the character/lip print pattern. Statistical analysis was done using the SPSS (version 23.0) software package and Chi-square test was applied to evaluate the existence of correlation of lip print pattern with gender. Results: Type- II lip print pattern was frequently observed in all the four quadrants of both the sexes. This was followed by in order Type-I’>Type-I> Type-IV and Type-III lip patterns. There was a difference in gender wise distribution of lip prints. Conclusion: Further specific population based and gender specific studies on lip prints with larger sample size are required for comparison of lip prints with gender, so that a database could be created and used for representing sex differentiation.

Evaluation of blood groups in patients with anti TPO positive

Abstract: Background: In studies, ABO blood group system has been shown to be associated with type 2 diabetes mellitus, chronic renal failure, gestational diabetes mellitus, postpartum depression, coronary artery disease, Crohn’s disease as well as various cancer types such as stomach, breast, skin cancers and rheumatologic diseases. Aims and Objective: The relationship between anti TPO positivity and ABO blood group system is aimed to be investigated by using blood groups which are the product of genetic structure and easy to identify by considering the relationship between anti TPO positivity and blood group. Materials and Methods: 4312 patients with determined blood groups were included among the patients, who were admitted to the internal medicine outpatient clinics of our hospital between January 2, 2017 and May 28, 2019 and were screeened for thyroid antibodies with thyroiditis susceptibility. Results: The most common blood group was A in both anti TPO positive and anti TPO negative patient groups.The rate of those with O blood group was 2.65% higher in anti TPO positive group than anti TPO negative group. B blood group was found to be 4.87% higher in anti TPO negative group than anti TPO positive group (p:0.148). Conclusion: In conclusion, it was found that O blood group may be a risk factor for anti TPO positivity and B blood group is much lower in anti TPO positive ones. However, it is obvious that more comprehensive prospective multicentered clinical and experimental studies are needed to establish the relationship between blood groups and autoimmune diseases, especially autoimmune thyroiditis.

Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

Abstract: Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow. Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children. Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al. Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022). Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

Menstrual Hygiene: Practice and Challenges Among Adolescent girls of a Private School of Urban Nepal

Abstract: Background: Menstrual health hygiene management (MHM) is the basic right of every female. In developing countries like Nepal, this right is less understood or utilized. Parental and family influences and hence the societal influences plays vital role in behavioral change. In urban sector, the girls studying in the private schools are mostly from privileged background. So there is a need to observe the pattern of practices among private school girls which reflects the scenarios in privileged urban sector. Aims and Objectives: This study is to explore the practices and challenges for menstrual health hygiene management among adolescent girls of a Private school in Urban Nepal. Material and Methods: A cross sectional study was conducted in a private school selected purposely in the month of April and May 2019. Girls from grade seven and above were included in the study. Results: All the girls were aware about the process of menstruation. The practices and believes were influenced by their family and facilities provided to them rather knowledge gained at school. All the participants prefer to use disposal pads and 6.3% of participants reported that they use both pads and reusable cloths. Most girls did not change the pads at school (56.2%). All the participants reported that they were hesitant to take help from teachers due to awkwardness. Conclusions: Practices of the individuals is influenced by family beliefs. Again, adolescents spend many hours daily in schools. So strict measures to implement facility in schools for MHM should be taken.

Brain electrical activity during bench press weight training exercise

Abstract: Background: Weight training is one type of exercises which some people interest. When the body has a physical exercise with enough intensity, it can produce a positive effect on brain function by changing amplitude of electroencephalographic activity. Aims and Objective: The purpose of this investigation was to examine a more comprehensive range of the electroencephalographic activity including delta, theta, alpha, beta, and gamma brainwaves during bench press weight training exercise. Materials and Methods: Electroencephalographic activities were recorded with nine participants by using the commercial lightweight electroencephalographic device, NeuroSky Mindwave Mobile, both before and during bench press weight training exercise. Results: The present study was conducted to find out how bench press weight training exercise effected to human brainwave. The electroencephalographic activity could be recorded during bench press weight training. The findings of the present study documented increase in beta and gamma brainwaves during bench press weight training exercise. This electrophysiological changes could represent the rearrangement of different systems as a consequence of exercise. Conclusion: This bench press weight training might significantly alter the intense exercise. Future studies may want to examine how these changes in electroencephalographic activity influence or are associated with changes in cognition, affect and/or perception during/after bench press weight training exercise. The impact of peripheral physiology on electroencephalographic activity of bench press weight training exercise also needs to be examined.

An antioxidant activity of Cinnamonum tamala improves histopathological alterations and biochemical parameters in alloxan induced diabetic rats

Abstract: Background: Diabetic mellitus is a multifactorial disorder associated with its devastating consequences has assumed epidemic proportion. Diabetes mellitus (DM) is a global health problem and the incidence of DM is increasing at alarming rate all over the world. Many Indian medicinal plants have been reported to possess potential antidiabetic activity and could play important role in the management of diabetes with less adverse effects. Aims and Objectives: The main objective of this study was to focus on the anti-diabetic activity of Cinnamomum tamala, with special reference to its curative and protective role in alloxan induced diabetic rats. Attempts were further made to study the antioxidant properties of C. tamala leaves. Materials and Methods: The diabetic rats were administered orally with the aqueous leaves extracts of Cinnamonum tamala (250 mg/kg) for 30 days. The results were compared with standard drug Tolbutamide. Result: The alloxan treated diabetic control rats showed a significant increase in the plasma glucose, glycosylated hemoglobin (HbA1C), glucose-6-phosphatase, aldolase, LDH, ALT, AST, ALP and GGT activity, freeradicals formation with a concomitant decrease in glycogen content in the liver and serum insulin level and phosphoglucoisomerase and hexokinase activity in tissues as compared to normal control rats. Oral administration of C. tamala extract for 30 days showed significant result as compared to Tolbutamide and diabetic control rats. Conclusion: On the basis of above findings it can be concluded that extracts of C. tamala to alloxan induced diabetic rats showed significant positive changes in the biochemical and histopathological parametersrelated to carbohydrate and protein metabolism.

Comparative ABO blood group and rhesus factor distribution between homogenous and heterogenous populations in South Eastern Nigeria

Abstract: Background: The ABO blood group and Rhesus (Rh) factor remain the most important blood group in transfusion medicine. Knowledge of ABO and rhesus blood group distribution within a population is indispensable for transfusion medicine, clinical and marriage counselling. Aims and Objectives: The objectives of this study were to provide data and compare the pattern of ABO and rhesus blood group distribution between a homogenous and a heterogenous population. Material and Methods: Blood was collected from 352 University students representing a heterogenous population and 235 primary school pupils in a local community representing homogenous population. The ABO and rhesus blood groups were determined using white tile and agglutination methods. Results: Among the 352 and 235 individuals studied in UNN and HFNP, blood groups O had the highest frequency with 54.80% and 51.06% respectively while blood group AB had the least frequency of 4.50% and 3.40% in UNN and HFNP respectively. Rhesus positive had the highest frequency of 88.63% and 95.33% while rhesus negative had the frequencies of 11.35% and 4.68% in UNN and HFNP respectively. Rhesus negative was highest among females in UNN 26 (7.37%) while males had the highest rhesus negative 7 (2.98%) in HFNP. In both study populations, there was no significant difference in ABO and rhesus blood group distribution between the males and females (P > 0.05). Conclusions: A homogenous population is associated with low prevalence of rhesus negative compared to a heterogenous population.

Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Abstract: Background: Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability. Materials and Methods: This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture. Result: Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups. Conclusion: Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

Parkinsonism following basal ganglia infarction in Dengue fever

Abstract: Dengue fever is an acute febrile viral illness characterized by severe headache, myalgia, arthralgia, rashes, leucopenia and thrombocytopenia. Patients may face haemorrhagic complications like gastrointestinal bleeding, intracranial haemorrhage, menorrhagia, hematomas, hematuria and massive epistaxis. Ischemic stroke in dengue fever is a rare scenario; and Parkinsonism following basal ganglia infarction in dengue fever, to the best of our knowledge, has not been reported yet.

The Spectrum of Biopsy-Proved Kidney Disease: A Retrospective Single Center Study in Erbil-Iraq

Abstract: BACKGROUND Renal biopsy is crucial to determine the pattern of the different types of renal diseases. It represents the gold standard of diagnostics for renal pathologies, including glomerular diseases, and it has an important value for the prognosis, monitoring disease progression, and planning the management protocol. AIMS AND OBJECTIVE To report the frequency of different pathological lesions affecting the kidney in patients who were admitted to our medical centre. MATERIALS AND METHODS This is a retrospective study of all patients with renal diseases who underwent percutaneous renal biopsy at the Erbil Kidney Centre for eight years (1st of January 2010 to 31st of December 2017). A total of 893 cases were biopsied and subsequently studied via histopathological examination and immunofluorescence microscopy. The study is ethically permitted by the Kurdistan Board for Medical Specialization. RESULTS The average age of the patients was 30.9 years. The most common clinical indication for biopsy included nephrotic syndrome (46.47%), acute renal failure (19.04%), chronic renal failure (15.34%), nephritic syndrome (7.39%), proteinuria alone (7.28%), and hematuria alone (4.48%). In patients with a primary glomerular disease, focal segmental glomerulosclerosis and minimal change disease were the most frequent (27.44% and 16.01%) in the younger patients (18.61±13.47 years), while membranous glomerulonephritis was more common in older patients (38.94±13.69 years). Patients with a secondary glomerular disease were mainly diagnosed with lupus nephritis, amyloidosis, and diabetic nephropathy. CONCLUSION The epitome of our study signifies that the spectrum of glomerular diseases varies based on age, sex, ethnicity, and geographical distribution. The implementation of renal biopsy proved to be a cornerstone in reaching the correct diagnosis. Future studies should implement the use of electron microscopy in conjunction with classical techniques of histopathology and immunofluorescence microscopy to diagnose equivocal cases of interest.

Comparative analysis of indices of the metabolic syndrome in patients with and without non-alcoholic fatty liver disease at a teaching hospital in Nnewi, South-East, Nigeria

Abstract: Background: Non-Alcoholic fatty liver disease (NAFLD) has become a worldwide health concern with increase in the global incidence of obesity and it is now considered the hepatic component of the metabolic syndrome. Aims and Objective: The study’s aim was to compare the indices of the metabolic syndrome in compensated chronic liver disease patients with and without NAFLD at NAUTH, Nnewi. Materials and Methods: A total of 136 consecutive patients with compensated chronic liver disease were recruited into the study. A structured questionnaire was administered to obtain relevant socio-demographic data. NAFLD was diagnosed based on clinical, biochemical, ultrasonographic and in a few histological features. The Adult Treatment Panel III criteria were used to identify patients with the metabolic syndrome. Results: Of the 136 participants recruited into the study, 52 (38.2%) fulfilled 2 or more diagnostic criteria for NAFLD with a male: female ratio of 1:1.36. The mean (SD) age of persons with NAFLD was 45.12 (±8.07) years compared to 47.49(±11.79) years for persons without NAFLD. The difference was not statistically significant (p=0.2). Body mass index (BMI), central obesity (waist circumference), fasting blood sugar, blood pressure, total cholesterol and triglycerides were significantly higher in the NAFLD group (p= <0.05) respectively. Conclusion: Indices of the metabolic syndrome were more prevalent in persons with NAFLD. It is recommended that patients with NAFLD be screened for metabolic syndrome and appropriate therapy instituted to decrease the risk of both hepatic and cardiovascular complications.

Serum vitamin D status and biochemical parameters of asthmatic children in Sokoto Metropolis, North-western Nigeria

Abstract: Background: Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms. It is characterized by the occurrence of bronchial hyper responsiveness, airflow obstruction and an underlying inflammation. Several studies have proposed the association of vitamin D with increased incidence of asthma symptoms. Aims and Objectives: This study aimed at determining the serum vitamin D status and biochemical parameters among asthmatic children in Sokoto-Nigeria. Materials and Methods: The study population consisted of 120 subjects including 80 asthmatic children and 40 age-and sex-matched apparently healthy controls from two tertiary Hospitals in Sokoto Metropolis. Serum vitamin D, calcium, parathyroid hormone (PTH), immunoglobulin E (IgE) and magnesium were measured using standard techniques. Results: Mean serum vitamin D and magnesium were significantly (p ˂ 0.05) lower, while serum PTH and IgE were significantly higher (p˂0.001) in asthmatic children than in controls. Vitamin D insufficiency was found to be prevalent among the asthmatic children. There was no significant relationship between the low level of vitamin D and asthma severity. Conclusion: This study observed that, hypovitaminosis D and hypomagnesaemia occurred among asthmatic children, and asthma was more prone in the younger children than in their older counterpart. It is recommended that in order to avoid or limit the rate of children having asthmatic episodes, vitamin D and magnesium supplements should be used in the management of asthmatic children.

Reliability assessment of pre -post test questionnaire on the impact of a daylong clinical pharmacology workshop among medical professionals

Abstract: Background: Pretest-posttest questionnaire are often used during workshop to assess the impact of a program on the participants. However, the reliability of such data collection ‘tool’ is not often judged. There is lack of evidence supporting the authentication of such research instrument. Aims and Objective: This study was conducted to assess the reliability of prepost test questionnaire comprising MCQs, on participants attending a one-day workshop on clinical pharmacology at a teaching hospital in eastern India. Materials and Methods: Pre and post test questionnaire comprising 15 MCQs covering different aspects of ‘Good Clinical Practices’ on which several presentations were later delivered by experts were distributed to (n=42) participants in a one-day oriented workshop within stipulated time period and their feedback were collected and statistically analyzed after the workshop was over. Results: The average number of MCQs attempted in the pretest questionnaire was 12.42 and in posttest were 14.44 by the participants. The workshop participants increased their percentage of correct answer score from an average of 48.4 in pretest to a statistically significant 88.73 in posttest (p<0.0001). Conclusion: Pre/post questionnaire could be effective and reliable tools in meeting stipulated learning objectives and help in assessing the aftermath of an educational program.

Evaluation of Antidiabetic potential and Hypolipidemic activity of Coccinia indica (leaves) in Diabetic Albino rats

Abstract: Background: The whole plant of Coccinia indica is very effective in different types of diseases with fewer side effects. The leaves, roots of this plant were claimed to be useful in the treatment of diabetes mellitus based on folk medicine. The purpose of this study was to examine the antihyperglycemic effect of water extract of C. indica in alloxan diabetes rats. Aims and Objectives: The aim of this study is to find whether the conditions, hyperglyclemia and hyerlipidemia, are correlated and whether the application of the aqueous extract leads to abating these two conditions. Materials-Methods: The aqueous leaves extracts of C. indica (200 mg/kg) were administered orally for 14 days, in alloxan induced diabetic rats on Glucose, Lipid profile, Lipoproteins and Lipid metabolizing enzymes activity. Result: The aqueous leaves extract of C. indica induced significant improvement in glucose, serum Lipids, lipoproteins and lipid metabolizing enzyme activity (HMG CoA reductase, LCAT). Conclusion: The present study indicates that the extract of Coccinia indica exhibits lipid lowering, maintaining lipoproteins concentration and also improves the activities of lipid metabolizing enzyme in hyperglycemic rats leading to an increase in peripheral glucose consumption.

The FIT therapy for the treatment of musculoskeletal and neurological disorders related symptoms: A retrospective observational study

Abstract: Background: Far Infrared Waves (FIW) with frequency range among few hundreds gigahertz (GHz) and few terahertz (THz) display some positive effects on neurological and musculoskeletal disorders. Aims and Objectives: Our retrospective observational study describes the benefits observed by the administration of an infrared –trapping and focusing plaster (FIT-PATCH) in patients affected by different musculoskeletal and neurological symptoms. Materials and Methods: 100 patients were retrospectively reviewed through the Second Opinion Medical Network. Each patient sticked a FIT-PATCH every 5 days for 1 month upon the skin in the painful/inflamed area. Quality of life (QOL) assessment was evaluated by the Short Form-36 (SF-36) health survey questionnaire before starting the treatment and after the fourth week and the Visual Analogue Scale (VAS) completed the pre-post treatment subjective pain record. Results: SF-36 showed significantly improvement of the pre-post treatment scores (P < 0.03), pain score (P < 0.02), general health score (P < 0.03) and in the emotional component scores (P < 0.03). The VAS pain score was either improved (P < 0.02) after plaster administration. No side effects or allergenic skin reactions were reported along the study. Conclusions: The FIT patches improved the symptoms probably through a mechanism involving the sebaceous/sweat glands system spreading the fit irradiating infrared THz waves energy, to the surrounding tissues with both a thermal and electromagnetic putative effect.The occlusive mechanism of the patch on the skin surface increasing the local thermic gradient cannot be adequately supposed to be therapeutically effective, because the FIT patch locally applied induces haemodynamic microvascular modification, not only locally but also remote. Thus, the intrinsic chemical properties of the FIT formulation absorbs and concentrates the endogenous infrared waves amplifying and reverberating them into the underlying tissues near and far, through low-Q-factor helical antennas of the sweat glands spreading the energy all over the body. Hence, the claim is that fit basically absorbs and concentrates the endogenous infrared waves into the affected districts and accelerates symptoms recovery.

Curcuma longa and Boswellia serrata for Improving Functional Status in Osteoarthritis Patients: From Bench to Bedside Evidences

Abstract: Background: The management of osteoarthritis (OA) represents a real challenge. Curcumin is a highly pleiotropic molecule with an excellent safety profile.Some previous studies showed the extract of Curcuma longa and Boswellia Serrata(CB extract) is a promising potential as therapeutic interventions against OA. Aims and Objective: This study aimed to measure the effectiveness and safety of CB extract for improving functional status in patients with OA. Materials and Methods: A randomized controlled trial (RCT) in OA patients. The treatment used in this trial were CB extract (350 mg of Curcuma longa and 150 mg Boswellia Serrata) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium). Subjects were randomized to 3 different group (Group 1: CB extract and NSAID; group 2: CB extract; group 3: NSAID). Each subject would be followed up 3 times: baseline (visit I), 2 weeks after baseline (visit II), and 4 weeks after baseline (visit III). The measurement of functional status with WOMAC (Western Ontario and McMaster Universities Osteoarthitis Index). Results: There were 105 osteoarthritis patients. Seven subjects were lost to follow up and three subjects were excluded from the study due to medication side effect. Ninety-five subjects (group 1: 36; group 2: 29, group 3: 30) remained for complete analysis. Delta (Δ) WOMAC score defined as the result of subtraction between WOMAC score at visit I and WOMAC score at visit III. Group 1 showed the greatest reduction of WOMAC score after 4 weeks of treatment (ΔWOMAC = 12.08 ± 18.6). Group 3 has the least WOMAC score reduction (ΔWOMAC = 6.9 ± 16). There was no statistically different of ΔWOMAC score between groups (p = 0.367). There were no statistically different of the prevalence of AE between groups at the visit II (p: 0.119) and at the visit III (p: 0.767). Conclusion: CB extract is effective and safe for improving functional status in OA patients.

Ear Findings and Hearing analysis in cleft palate patients in Nepal

Abstract: Background: The orofacial cleft is the most common birth anomaly with a prevalence rate ranging from 1/1000 to 2.69/ 1000. The middle ear diseases are known to be associated with cleft palate, however, the prevalence and the magnitude of the condition is usually underestimated. Aims and Objectives: The purpose of this study was to find out the various exisiting ear abnormalities, to assess the middle ear function and hearing status in patients with cleft palate and confirm the existence of these manifestations and their significance. Materials and Methods: All the patients with cleft palate with or without cleft lip over a one-year duration from January to December 2018 at the teaching hospital were include after informed consent. The patients with only cleft lip were excluded. General ENT examination and Otoscopy was performed. Tympanometry and Pure tone Audiometry was done (in those above 5 years). The degree of hearing loss was categorized using the WHO guidelines. Results: Out of a total of 56 patients, there were 30(53.6%) male and 26(46.4%) female. The age range was from 2years to 31 years. The mean age was 12.8 years. Maximum number of patients were in the 10-20 years age group 29(51.8%) followed by 22 (39.3%) in the less than 10 years age group. 53 (47.3%) of 112 ears examined had dull tympanic membrane, followed by retraction of tympanic membrane in 42 (37.5%) ears. Other findings were central perforation in 5 (4.5%), bulging tympanic membrane in 2 (1.8%) and atticoantral disease in 1 (0.9%) ear. 8 (7.1%) ears had normal findings. There was one case with right ear atresia (0.9%). In Tympanometry findings, the maximum number of ears, 51 (48.1%) had type B curve, followed by 33 (31.2%) ears with type As curve. 16 (15%) of ears had type C curve. 6 (5.7%) ears had type A curve. B type curve was found more common in less than 10 years age group. A chi Square test was performed and the findings had statistically significant association. (P value: 0.03 for Right ear tympanometry ; P value: 0.043 for left ear tympanometry). In Pure tone audiometry findings of 105 ears, 72 (68.6%) ears had mild conductive hearing loss. 10 (9.5%) ears had moderate conductive hearing loss, while 1 (1%) ear had mixed hearing loss. 22 (20.9%) ears had normal hearing level. Conclusion: This study assessed the common ear problems prevalent in cleft patients, along with the hearing loss. Since, ear disease were quite common in these patients, these patients should be evaluated regularly by an otolaryngologist to detect, treat and prevent such problems in these patients so that long term morbidity could be avoided.

The Effects of Chronic Kidney Disease on Liver Function Tests: The Laboratory Interpretation Perspective

Abstract: The aim of the study was to determine the levels of routinely measured liver function tests such as liver enzymes (AST, ALT, ALP, GGT & LDH), serum proteins (albumin and total) and serum bilirubins in patients with Chronic Kidney Disease (CKD). Clinical management of CKD involves frequent laboratory monitoring of liver function tests. It is therefore important to understand the levels of these biochemistry parameters in both healthy individuals and those with CKD for easier and accurate interpretation. A cross-sectional study of two groups of study subjects including patients with CKD and control group was used. A total of 180 subjects with CKD were recruited for the study plus another 200 healthy subjects who served as the control group and were recruited from among blood donors. About 2.0 mL of venous blood specimen was removed from each patient and from control subjects. Levels of the enzymes Aspartate Transaminase (AST), Alkaline Phosphatase (ALP), Alanine Transaminase (ALT), Gamma Glutamyl Transferase (γ-GT) and Lactate Dehydrogenase (LDH) were measured. Levels of serum protein and bilirubin were also determined in the two groups of study subjects. The Kolmogrov-Smirnov test was used to test the data for normality. The data obtained was parametric in nature and was tabulated as a mean and standard deviation. Parametric method of data analysis was used. Descriptive statistics used included parameters of location and parameters of dispersion. Means differences between investigated groups (control and chronic kidney disease patients) were assessed by ANOVA and post ANOVA statistical analysis. There were statistically significant differences (p<0.05) in the levels of serum protein and liver enzymes between patients with CKD and control group but no significant differences in the levels of serum bilirubin (p>0.05). The results suggest that those patients with CKD exhibited low levels of AST and ALT while the levels of ALP, GGT, and LDH were relatively higher. The levels of serum proteins were relatively lower in patients with CKD as compared to the control group. There is, therefore the need for a keen interpretation of liver function tests in patients suffering from CKD.

Cross-sectional study of pattern of Dyslipidemia and Prevalence of Atherogenic Diabetic Dyslipidemia in newly detected Diabetic patients

Abstract: Background: India has seen an ever increasing number of diabetic patients and in turn rise in cardiovascular diseases. Many studies have shown diabetic patients to have dyslipidemia, with certain common patterns early in the disease. Aims and Objective: The current study was done to identify pattern of dyslipidemia and prevalence of ADD in treatment naïve diabetic patients. Material and Methods: Fasting lipid profile was analysed in treatment naïve diabetic patients at a tertiary care teaching hospital. Various factors influencing the results were analysed statistically. Results: Prevalence of dyslipidemia was 89.2%, whereasatherogenic diabetic dyslipidemia was seen in 34.2% and raised non-HDL cholesterol in 73.3%. Conclusion: Our study showed a high prevalence of dyslipidemia in newly diagnosed diabetics indicating the importance of screening for dyslipidemia in newly diagnosed cases and implementation of timely lipid lowering therapy to prevent CVD. It also highlights the importance of pattern of dyslipidemia called Atherogenic diabetic dyslipidemia and raised Non-HDL cholesterol in diabetic patients.

Device closure of ventricular septal defect: Initial experience in Nepal

Abstract: Background: Device closure is an attractive alternative in the management of Ventricular Septal defect (VSD). Aims and Objective: The aim of the study was to access the safety and early outcome of VSD device closure at Shahid Gangalal National Heart Centre, Nepal. Materials and Methods: The study was single center, retrospective study. All the VSD cases who were attempted for VSD device closure during December 2016 to February 2019 were included. Catheterization laboratory records for VSD type and size, Device type and size were retrospectively reviewed. Hospital records were reviewed for in-hospital complications. Results: Sixty-one VSD cases were attempted for device closure. VSD was successfully closed in 55 (90.1%) patients. The mean age of the patient was 11.1 years. Twenty-nine (52.7%) were female and 26 (47.3%) were male. Perimembranous VSD in 49 (89 %) and muscular VSD in 6 (11 %) patients. The size of VSD ranged between 2 and 12mm (Mean 5.4mm). The VSD was closed with Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer muscular VSD occluder and Memopart PDA device in 24 (43.7%), 26 (47.3%), 4 (7.2 %) and one patient (1.8%) patients respectively. The postoperative complications were insignicant residual leak across device in 2 (3.6%) patients, mild pericardial effusion in one (1.8%) patient. None of the patient had new onset tricuspid regurgitation, aortic regurgitation and complete heart block. One patient developed Right bundle branch block, one developed Left bundle branch block, one developed Junctional rhythm. There was no mortality. Conclusion: VSD device closure can be safe and effective if patients are selected properly.

Classification of brain processing indicators in financial officers

Abstract: Background: Arthur F. Carmazzi discovered new way of identifying the human brain’s clarity based on the foundations of genetic neurosciences. The specific terminology of “Ambiguity Relief” was used to refer to the human brain’s processing that supports evaluating information to relate new context to existing knowledge, simplifying ideas, making decisions, and problem solving into actionable elements. Aim and Objective: This study identified the relationship between brain processing indicator and communication of financial officers in Thailand by using the Colored Brain Communication Inventory. Materials and Methods: Fifty participants were involved in this study. All participants were assessed by using the Colored Brain Communication Inventory developed by Arthur F. Carmazzi. Results: All participants were thirty-one males (62%) and nineteen females (38%). There were eleven persons worked as Manager, considered 25%. Nine participants worked as Director and seven participants worked as Deputy Director and Senior Manager were about 18%, 14%, and 14%, respectively. Five participants worked as Senior Director were in the amount of 10% of all the participants while two participants worked as Senior Officer and Officer were 4% and 4%, respectively. Of the fifty participants, the highest number of 28 participants (56%) were reported as Green Brain Processing while 12 participants (24%) were reported as Purple Brain Processing. The less of 7 participants (14%) were reported as Red Brain Processing while only 3 participants (6%) were reported as Blue Brain Processing, respectively. Conclusion: This study is the first study to explore the effects of brain processing indicator and communication on the leadership and working environment by using Colored Brain Communication Inventory tool in Thailand. By adopting conceptual and hypotheses of Colored Brain model, any awareness by participants might help their team members adopt a cooperation attitude instead of trying to change others beyond their own processes which creating frustration on both sides.

Assessment of lipid abnormalities and Cardiovascular Risk indices in Type 2 Diabetes Mellitus

Abstract: Background: Incidence of cardiovascular events is increased to two to four times among diabetic patients when compared with non-diabetic. Dyslipidaemia in diabetes is major risk factor for cardiovascular events. Atherogenic indices have been used as major laboratory measures in clinical practice to assess cardiovascular risk. Recent studies, have shown that non-high-density lipoprotein cholesterol and other atherogenic indices is like or better than LDL-C alone in the prediction of CVD incidence and mortality. Aim and Objectives: The aim of this study is to assess the lipid abnormalities with cardiovascular risk using atherogenic coefficient (Ac), Cardiac Risk Ratio (TC/HDLc and LDLc/HDLc), TG/HDLc and Non- HDL in diabetes patients. Materials and Methods: A cross-sectional descriptive study conducted at Bir hospital (tertiary care center) Nepal. Patients diagnosed as diabetes with age 30 years or above were selected in this study during a period of 1 yr. Results: The mean age of the patients enrolled was 55.08±1.11 (34-81) year with male (52 %) to female (48%) ratio is 1.08:1. In this study the mean Non HDLc was 165.24±43.40 mg/dl (65-323) and AC was 4.0±1.09. The finding of AC was slightly higher in female compare to male i.e mean ±S.D 4.07±1.31 and 3.94±1.15. This study show the strong correlation of Non HDLc with total cholesterol (r=.990, p=0.000), LDLc(r=.602,p=0.000),TG (r=.411,p=0.000), LDLc/HDLc (r=.580,p=0.000),TC/HDLc ((r=.866,p=0.000), TG/HDLc (r=.390,p=0.000) and AC (p=0.866). Conclusion: The association between abnormal lipid levels and cardiovascular risk is evident among patients with diabetes mellitus. In this study there is the correlation with FBS, Non HDL-c cholesterol, Cardio risk ratio, TG/HDLc, Atherogenic coefficient. Hence Non-HDL cholesterol and Atherogenic indices proves to be more sensitive and a better predictor of cardiovascular events in diabetes patients.

Stress reduction by Phochong chanting indexed by Thai Stress Test

Abstract: Background: Stress is traditionally defined as either a bodily or mental tension resulting from factors that tend to alter an existent equilibrium or the process of appraising events of assessing potential responses, and of responses which may include not just physiological but also cognitive and behavioural changes. Aims and Objective: The purpose of this study was to examine the stress reduction after listening to Phochong chanting. Materials and Methods: Forty participants were participated in this study. They were divided into two groups; the control group who saw a spot on computer screen while listening to Phochong chanting for 10 minutes, and the target group who saw the Buddha image while listening to Phochong chanting for 10 minutes. The Thai Stress Test was used as a tool to examine the stress reduction. Frequency, percentage, mean, and standard deviation were used for descriptive data analysis. Paired sample t-test was also used to compare between before and after listening to Phochong chanting. Results: The percentage of participants in the target group who felt ‘excellent mental health’ was 20.0% and only 10% for the control one. The 55.0% in the target group felt ‘normal mental health’ while 45.0% was for the control one. About 25.0% of the target group felt ‘mild stress’ while 45.0% was in the control one. However, no participant showed ‘sever stress (stressful)’ in this study. The Thai Stress Test has adequate reliability, adequate construct validity, and sufficient discriminant power. Conclusion: By listening to Phochong chanting would help the stress level reduction.

Spectrum of radiological presentations among the patients of intracranial metastasis

Abstract: Background: Brain metastasis has been the most common primary intracranial space occupying lesion (ICSOL) in adult patients.The main systemic malignancies presenting with high tendency to invade brain parenchyma are –lung, breast, melanoma, renal and colon cancers etc. Aims and Objectives: To study the various radiological presentations in cases of intracranial metatstasis. To assess the radiological presentations to differentiate metastasis from other differential diagnosis. Materials and Methods: The present cross sectional study was carried out amongst 32 patients who had been visited tertiary care hospital in Kolkata with radiological features and histopathology suggestive of metastatic lesion. Results: The mean age of the subjects was 46.56 years and the maximum number of cases presented in 5th and 6th decades of life. CT Scan showed 75% patient had metastatic lesion appearing hyperdense on plain study and 25% had lesion hypodense on plain CT Scan. On T1 weighted images- In 75% of patient the metastatic lesions were hypointense to brain parenchyma and in 12.5% they were isointense and 12.5% they were hyperintense.T2 weighted images- In 62.5% of patient the metastatic lesions were hyperintense to brain parenchyma and in 25% patients they were isointense and in 12.5% they were hypointense. Contrast Images – 37.5% of patients had homogenous enhancement and 50% had heterogeneous enhancement and 12.5% had ring shaped enhancement. In Biopsy about 75% the metastatic lesion turned out to be metastatic carcinoma. Conclusion: A thorough and systematic approach to radiological investigation is crucial for proper identification of intracranial metastatic lesions.

Relationship between Anthropometric indices, serum Leptin and Respiratory function in Myanmar male adult subjects

Abstract: Background: The role of leptin in respiratory function has been studied in specific respiratory disease. A little is known about the association of serum leptin level and respiratory function parameter in healthy subjects. Aims and Objectives: This study aimed to investigate the relationship between anthropometric indices, serum leptin and respiratory function in Myanmar male adult subjects Material and Methods: A community- based cross-sectional comparative study was carried out in 101 apparently healthy male adult subjects of age 18-45 years. All participants were categorized by anthropometric indices into non- obese (body mass index: BMI < 25 Kg/m2 and obese subjects (BMI > 30 Kg/m2). Differences in respiratory function parameter and serum leptin level were compared across the group. Spirobank II spirometer was used to measure respiratory function (FEV1, FVC, FEV1/FVC, PEFR and FEF25-75%). Serum leptin level was investigated by enzyme-linked immunosorbent assay. Results: The percentage of predicted value of all respiratory function parameters of obese group was significantly lower than that of non-obese group (p <0.05). All respiratory function parameters were significantly and negatively correlated with body mass index (BMI) and waist circumference (WC). Median and interquartile range of serum leptin level in the obese group was 5.8(3.5-9.1) ng/mL and it was significantly higher than that of non-obese group [1.9(1.1-3.1) ng/mL, p <0.001]. Serum leptin level was significantly and negatively correlated with respiratory function parameters (FVC, FEV1/FVC, PEF and FEF25-75%). Conclusion: Respiratory function declined with increasing anthropometric indices might be due to increased serum leptin level considered as systemic inflammatory effect of body.

Severe Ovarian Hyperstimulation Syndrome despite low dose stimulation in Polycystic Ovarian Syndrome

Abstract: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. There is cystic enlargement of the ovaries along with fluid shift from the intravascular compartment to the third space due to increased capillary permeability and ovarian neoangiogenesis. Severe OHSS is uncommon and the condition can be fatal. Low-dose gonadotropin protocols have been introduced to reduce the risk of OHSS in patients with polycystic ovary syndrome (PCOS). The patient being reported had PCOS and developed severe OHSS despite low dose gonadotropin stimulation; which is a rare scenario.

Retrospectively analysis of Pathological features of 1047 cases of Thyroid Nodules

Abstract: Background: In recent years, the incidence of thyroid cancer is on the rise, almost become one of the fastest-growing malignant tumor, especially in women. The reasons of the incidence of thyroid, is not only the use of detection means. The relationship between clinical pathological characteristics and prognosis of thyroid is controversial. Aims and Objective: One thousand forty seven cases of thyroid nodule (thyroid nodules, TN) were retrospectively analyzed, to study the distribution of TN and its clinical pathological features. Materials and Methods: Clinicopathological data of 1047 cases TN were retrospectively studied, from Chengde Medical College Affiliated Hospital and (10.2017 to 08.2018) Chengde County Hospital (01. 2016 to 08.2018), χ2 test is used to analyze the relationship between clinical pathologic factors and lymph node. Results: In 1047 cases of TN, nodular goiter 50.62%, Hashimo-to’s thyroiditis 3.34%, thyroid carcinomas 32.28%,thyroid adenoma 10.12%, toxic nodular goiter 0.29%. The lymph node metastasis positive rate washigher in <45 years of age and tumor diameter >1 cm of the thyroid carcinoma patients. Gender, whether single had no relation with occurrence of neck lymph node metastasis. Conclusion: The lymph node metastasis positive rate is higher in <45 years of age and tumor diameter greater than 1 cm of the thyroid carcinoma patients.

A reversible hypocalcemic dilated cardiomyopathy caused by primary hypoparathyroidism

Abstract: Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of one or both ventricles. Affected patients have impaired systolic function and may or may not develop overt heart failure (HF). Prognosis is generally poor without heart transplantation. We experienced a case of a 10-year-old child with dilated cardiomyopathy (DCM) accompanied by undiagnosed primary hypoparathyroidism. In our case,aggressive management of hypoparathyroidism significantly improved the manifestations of DCM. The case presentation highlights the importance of considering hypoparathyroidism as a cause of reversible myocardial dysfunction.