Showing papers in "Nepal Medical College journal in 2004"

First case of Dengue virus infection in Nepal

Abstract: Dengue virus transmitted by Aedes mosquito is one of the important cause health problems in world. Dengue fever and more severe and often fatal forms namely dengue hemorrhagic fever and dengue shock syndrome are emerging health problems in many part of the globe. No cases of Dengue virus infection have been reported from Nepal till date and for the first time, we report a case of dengue fever from Nepal.

Intestinal parasites and intra familial incidence in a low socio-economic area of Chandigarh (North India).

Abstract: A total of 550 stool samples were collected from a low socio economic population of Chandigarh (North India) and examined macroscopically and microscopically, to determine the prevalence of intestinal parasitic infections and their familial incidence. The overall prevalence rate was 19.3%. Ascaris lumbricoides and Giardia lamblia were the commonest, affecting 51 (9.3%) and 33 (6.0%), respectively. In 17 (22.7%) families the same parasite was observed to infect multiple family members, which included A.lumbricoides (in 9 families), G. lamblia (in 7 families) and H. nana (in 1 family). The results of present study indicate that there is a high prevalence of parasitic infection in the community where personal hygiene and sanitary conditions are poor and may be one of the contributing factors for transmission within the families. Intervention strategies including health education program should be designed and implemented to control parasitic infections.

Retrospective study of suicide cases admitted in Nepal Medical College Teaching Hospital.

Abstract: A retrospective study of suicide cases admitted to Emergency Department and latter admitted to Department of Medicine and followed by Department of Psychiatry, Nepal Medical College Teaching Hospital. This study covered a period of 4 yrs. i.e. from January 2000 to December 2003. During this period total 118 cases were admitted. Out of which 39 male and 58 female cases were studied. Suicide was their common motive. The most common poison was organophosphorous compounds. Age group of attempt suicide are between 15-45 yrs. Depression, post-schizophrenic depression and clear psychosocial stress were important cause of suicide in this study.

Anatomical variation in origin and course of the thoracoacromial trunk and its branches.

Abstract: The variations in origin and course of the thoracoacromial trunk (TAT) and its branches were studied in 178 cadavers during the routine dissection from the year 1982 to 2002. The TAT originated from the first part of the axillary artery (AA) in 13.4% cases of the right and 10.6% of the left axilla. The variations in origin of the branches of TAT were divided into three groups. First variation group showed deltoacromial (DA) and clavipectoral (CP) subtrunks of the TAT originating directly from the AA in majority of cases. Second group revealed clavicular branch of the TAT originating from the AA, whereas in the third group all classical branches originated directly from the AA and there was no existence of the TAT. The superior thoracic artery (STA) originated from the TAT in 16.8% (Confidence Interval, CI: 11.12-21.89) cases of the right and 6.1% (CI: 2.59-9.53) of the left axilla and the lateral thoracic artery in 39.8% (CI: 32.01-46.10) cases of the right and 29.3% (CI: 15.01-26.80) of the left axilla. The incidence of variations in origin of the TAT and its branches was found higher on right side. The knowledge of these variations is of anatomical and surgical interest. This information is useful for the surgeons dealing with the axillary region especially in case of reconstructive surgery.

Effect of Sonachandi Chyawanprash and Chyawanprash Plus--two herbal formulations on immunomodulation.

Abstract: The immunomodulatory effects of Sonachandi Chyawanprash and Chyawanprash Plus--two herbal formulations have been evaluated. Both the drugs increased the macrophage activity and their number indicating enhancement of non-specific immune response and reduction of chances of infection. Besides that both Sonachandi Chyawanprash and Chyawanprash Plus efficiently protected Cyclosporine A induced immunosuppression suggesting the immunoprotective role of the aforesaid herbal formulations.

Caesarean delivery at Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

Abstract: This is a retrospective study conducted in Department of Obstetrics and Gynaecology. The study includes all delivery in Nepal Medical College Teaching Hospital (NMCTH) from March 09, 1997 to April 13, 2002. The objective of this study is to find out the incidence, indications, complications and fetal outcome in all caesarean deliveries. All files of caesarean deliveries were obtained from hospital records and studied. Data were collected and analysed. In 5 years period total deliveries in NMCTH were 1727. There were 163 cases of caesarean delivery with caesarean delivery rate 9.4%. Slow progression of labour, previous CS, fetal distress and breech presentation were the first four common indications of caesarean delivery in NMCTH. Regarding complication and caesarean delivery the incidence of complications was 23.9% of all deliveries. We found postpartum haemorrhage (n=27) 69.2% of all cases with complications. Few cases of wound infection and UTI also noticed in this study. Total babies born were 165 with 2 sets of twins. Three babies had APGAR score less than 3 and there were 2 neonatal death after caesarean delivery.

Study on enteric parasitosis and nutritional status of school children in remote hilly areas in Nepal.

Abstract: We examined the effect of enteric parasitosis on nutritional status of school children in remote hilly areas in Nepal. A total of 325 school children aged 6 to 19 years (boys: 214; girls: 111) who provided both blood and stool samples were included. The height (Ht) (cm), weight (Wt) (kg), age, sex, ethnic of each child were recorded. Fecal samples were examined by direct smear method in duplicate. The blood hemoglobin (Hb) was estimated by Sahli's method in the field (Nepal) whereas the serum protein (Prot), albumin (Alb), Alb/globulin ratio (A/G), serum glutamate pyruvate transaminase (SGPT), cholesterol (Chol), triglycerides (Trig), and serum iron (SI) were measured in Japan. Of the total, 201 (61.8%) had enteric parasites, predominantly the soil transmitted helminths. Ascaris lumbricoides was the most common parasite detected (72.6%) followed by hookworm (16.2%) and others. Protozoan infections were very low ( 0.05). Overall, no significant differences in levels of Hb, Prot, A/G, SGPT, Chol, Trig and SI in the parasite positive and negative children were observed (P>0. 05) but in Alb level (P<0.05). When, the levels of these parameters were compared in the age groups of <11 and 11-19 years, similar findings were observed in both the age groups. But, in the age group of 11-19 years, a significant difference was observed in Trig level (P<0.05). No differences were found in the levels of these parameters in the parasitic positive and negative children belonging to Dalits and different ethnic namely, Indo-Aryan and Tibeto-Burman, respectively.

Gender difference in socio-epidemiological factors for leprosy in the most hyper-endemic district of Nepal.

Abstract: Leprosy which has caused stigma and social ostracism for millennium is nearing elimination worldwide as a public health problem, but the leprosy burden in Nepal is still 4.4 times greater than WHO's target level of less than one case per 10,000 population. Although leprosy affects both the sexes, in most parts of the world males are affected more than females at a ratio of 2:1. The general objective of the study was to investigate the gender difference in socio-epidemiological factors for leprosy. The analytic cross-sectional study was carried out in one of the most hyper endemic district- Dhanusa district of Nepal. Stratified random sampling method was applied for the selection of the patients. Chi-square/Fisher's exact test was applied to assess statistically significant differences in values between males and females. There were 580 leprosy patients (385 male and 195 female) aged above 15 years registered for multi drug therapy between April 1, 2001 to March 31,2002 in the 16 main health centers of the district. Out of 580 patients, 273 patients (183 males and 90 females) were included in the study in order to collect the data on socio-demographics, patient's knowledge on leprosy, treatment seeking behaviour, and social problems faced by the patients. Data were collected using a structured interview schedule. The mean age of the male patients was 45.1 years (range 15-77 years) and female patients were 40.3 years (range 15-75 years). Among male patients 93.4% were married while among female patients 70.0% were married. Among male patients 51.9% were illiterate whereas 71.1% were illiterate among female patients. Most of the patients (69.6%) lived in joint family and the rest in nuclear family. Among male patients, 86.9% had good knowledge about the disease compared to 73.3% among females. This study showed that among the female patients 12.2% were facing high level of social problems, while among male patients only 4.4% were facing the same. About 15% patients had poor treatment seeking behaviors (8.2% among males and 27.8% among females). A significant gender differences among leprosy patients have been found in age distribution, educational status, marital status, caste types, family members, and overall knowledge on the general aspect of leprosy, social problems faced by the patients and treatment seeking behaviour.

Study on koilocytosis, X-chromatin and HSV-2 in cervical smears in Nepal.

Abstract: A total of 1,106 cervical smears were studied during a one year period from Feb 1999 to Feb 2000. Majority of the lesions were Inflammatory smears constituting 91.0%, Cervical intraepithelial neoplasia [CIN] and Squamous cell carcinoma [SCC] cervix constituted 8.0% and 1.0% respectively. The percentage of different grades of CIN being CIN I 85.0%, CIN II 9.0% and CIN III 6.0%. Thirty cases were taken as a study group. The commonest age group for CIN was 31-40 years 80.0% and for carcinoma cervix above 50 years 63.0%. The most common risk factors were marriage before 20 years of age 80.0% and a low socio-economic status 70.0%. The common presenting feature in CIN was pain lower abdomen 88.0%, followed by whitish discharge per vagina 60.0%. Similarly in carcinoma cervix pain lower abdomen 80.0% followed by weight loss 60.0% were the common presenting symptoms. Koilocytic change was seen in 42.1% of the cases of CIN I. The incidence of X-chromatin positivity gradually decreased as the lesion advanced, the p-value between CIN I and CIN II [p=<0.02], CIN I and CIN III [0=0.00] and between CIN III and Carcinoma cervix [p=<0.004] being significant. An association with Herpes simplex virus-2 [HSV-2] was seen in 11.0% cases of CIN I, 33.0% cases of CIN IIl and 40.0% cases of carcinoma cervix with a gradual rising antibody titre of 1:2 in CIN I, 1:7 in CIN III and 1:7 to 1:9 in carcinoma cervix respectively.

Ocular manifestations in diabetes mellitus: an experience at Nepal Medical College Teaching Hospital.

Abstract: A prospective study was conducted at Nepal Medical College Teaching Hospital from March to June 2004 to find out the ocular manifestations of diabetes mellitus. A total of 120 patients were included. Diabetic retinopathy was the predominant finding, with non proliferative diabetic retinopathy accounting for 46.5% and proliferative diabetic retinopathy for 0.8%. In anterior segment diseases cataract accounted for 38.3%.

Status of serum ferritin and folate levels amongst young women in a rural community of Haryana, India.

Abstract: A community based cross sectional study was conducted amongst young married non-pregnant women aged 18 years or more from six randomly selected villages in Ballabhgarh block, district Faridabad, Haryana state. Data was collected on socio-demographic profile and obstetric parameters utilizing a pre-tested semi-structured questionnaire. The non-pregnancy status of the women was confirmed by inquiring about the last menstrual period. Serum ferritin and folate levels were assessed utilizing the ELISA and the RIA method, respectively Serum ferritin and folate levels less than 15.0 and 3 ng/ml were considered as indicator of poor iron and folic acid stores, respectively. The dietary intake of iron, folic acid and calories was assessed utilizing the 24-hour dietary recall methodology. Almost 63.8 and 27.7 % of the women had poor serum ferritin and folate levels. The mean dietary intake of iron, folic acid and calories was 14.8+/-7.7 mg, 49.2+/-20.1 microg, and 1564+/-411 kcal, respectively. There was an inadequate intake of food as revealed by their calorie intake that was 83.4% of the recommended dietary allowances. Only 6.9 and 7.8 % of the women were consuming iron and folic acid more than 75.0 % of the recommeded dietary allowances (RDA) Women with dietary intake of calories less than 50.0 % of the RDA had a lower serum ferritin level compared to the women who had a higher calorie intake. It was also revealed that there was a decreasing trend in serum folate levels with poor socio-economic status. Young rural women had poor serum ferritin and folate levels in the community studied, possibly due to poor dietary intake of food and thereby iron and folic acid. Distribution of iron and folic acid tablets may be recommended to young women of reproductive age group.

Epidemiological survey of intestinal parasitic infections of diarrhoeal patients in Nepal and Lao PDR.

Abstract: Intestinal parasitological survey was conducted to clarify the distribution of intestinal parasites in Nepal and Lao Peoples' Democratic Republic (Lao PDR) from 2001 to 2003. A total of 401 diarrheal fecal specimens were collected from patients aged one to 75 years (250 from Nepal and 151 from Lao PDR). The specimens were examined using the formalin-ether sedimentation (FES) and sucrose centrifugal flotation (SCF) techniques. Nine species (3 Nematoda, 1 Cestoda, and 5 Protozoa) of parasites were recovered from Nepal, whereas seven species (3 Nematoda, 1 Trematoda, and 3 Protozoa) from Lao PDR. Of the parasites detected, (14.4%) was the most common in Nepal, and was Opisthorchis viverrini (29.8%) in Lao PDR. Infection rates were markedly different among age groups in both countries; higher rates were observed in age groups of 10-29 years than in 0-9 years group. Scanning electron microscopic observation revealed that trematoda eggs recovered from Lao PDR were identified as O. viverrini, which could not be done by a light microscope.

Effect of temperature on phagocytic activity of neutrophils.

Abstract: The effect of temperature on phagocytic activity of neutrophils has been evaluated. Freshly collected heparinised blood samples from young healthy volunteers were incubated with heat killed Staphylococcus aureus at 37 degrees C, 38 degrees C, 39 degrees C and 40 degrees C for 20 minutes. Some of the neutrophils engulfed some heat killed bacteria. Then the blood smears were prepared and stained by Leishman's stain. Engulfed bacteria within the neutrophils stained intensely were observed and counted to find out the phagocytic index and avidity index of the neutrophils. It was found that phagocytic index increased significantly at 38 degrees C and 39 degrees C in comparison to that of at 37 degrees C but did not show significant increase when incubated at 40 degrees C. It seems that contractile elements responsible for the movement of the neutrophils through the formation of pseudopod is more activated at higher temperature (38 degrees C and 39 degrees C) in comparison to that of at normal body temperature (37 degrees C). Temperature higher than 39 degrees C may cause impairment in enzyme function responsible for assembly and disassembly of actin and myosin filaments in the cell causing decreased movement and decreased rate of formation of psudopod resulting in decreased phagocytic activity.

Study on urinary bladder stone cases at Okhaldhunga Hospital, Nepal. 1988--1994.

Abstract: A retrospective study on urinary bladder stones among the patients seeking treatment in Okhaldunga Hospital was carried out for six calendar years from 1988 to 1994. Forty-six cases of bladder stones were identified during that period. Among them, 43 patients' records were studied (93.0%) in subsequent analysis. Ninety-seven percent were male with mean age 11.53+/-6.9 years. The number of children are significantly higher in 0-9 years of age (p<0.01). The symptoms lasted more than 2 years with the most common presenting symptoms dysuria (86.0%) and poor flow of urine (41.8%). The average hospital stay was 8.7 days. The majority of cases (78.5%) had undergone cystolithotomy without any complications. The study also showed that the majority (97.0%) of urinary bladder stone cases were successfully managed at a rural hospital like Okhaldhunga.

Detection of diarrheagenic viruses from diarrheal fecal samples collected from children in Kathmandu, Nepal.

Abstract: Diarrhea causing viruses (Rotavirus. Adenovirus and Norovirus) were investigated in diarrheal fecal samples collected from children in Kathmandu, Nepal in Janury 2004 using both real time PCR and immuno-chromatogaphic techniques. Of the total 12 diarrheal samples investigated, 8 (66.7%) were positive for Rotavirus, 1 (8.3%) was positive for Adenovirus and none was positive for Norovirus (Norwalk like virus). The Adenovirus positive sample was also positive for Rotavirus. Similar results were obtained by immuno-chromatographic technique. All of Rotavirus detected belonged to Group-A. Results indicated that immuno-chromatographic technique was equally good in the detection of diarrhea causing viruses in fecal samples. Furthermore, it was simple, cost-effective and less time consuming (15 minutes) compared with the PCR. Immuno-chromatographic technique, therefore, appeared to be useful for rapid diagnosis of viral gastroenteritis in developing countries like Nepal.

Evidence for HIV-2 infection in Nepal.

Abstract: Assessment of the presence and prevalence of HIV-2 antibodies in patients attending the Universal College of Medical Sciences Teaching Hospital, Bhairahawa, western Nepal was done. A total of 1534 patients sera were screened for the presence of HIV-1 and HIV-2 antibodies from March 2000 to May 2003. A total of 3 (0.2%) patients were found to be sero-positive for HIV-2 antibodies. Out of the above three patients, 1 (0.1%) was infected with HIV-2 only and the remaining 2 (0.1%) were infected with HIV-1 and HIV-2 both. This evidence of the presence of HIV-2 presence implicates serious outcomes as HIV-2 has not been reported from hospital patients in Nepal.

Study of cases of hypertension admitted at Nepal Medical College Teaching Hospital.

Abstract: Hundred cases of hypertension admitted to medical ward at Nepal Medical College and Teaching Hospital were studied and analysed. They constituted 9.4% of the total admitted patients in the medical ward. Association of hypertension with other diseases is highlighted. Thirty two percent of these hypertensives were diabetic and 22.0% of hypertensives also had Chronic obstructive airway disease (COAD). Different types of complications of hypertension seen in the studied subjects are mentioned. Only 19.0% of hypertensives had their blood pressure controlled and the rest were uncontrolled hypertensives.

Multisystem involvement of microfilaria in a HIV positive patient.

Abstract: A 35-year-old HIV positive male presented with dyspnoea and chest pain was diagnosed having acute pericardial and pleural effusion. Microfilaria was detected from blood as well as from the pericardial and pleural fluid and from urine. CD4 count was 123 cells microl. The patient was receiving treatment with antiretroviral therapy and Cotrimoxazole for last 4 months. The patient had no opportunistic infection and no symptoms suggestive of filarial infection in the past. This is for the first time we are reporting high microfilarial load (1000/ml) from blood in HIV positive patient, where microfilaria was also demonstrated from the pericardial and pleural fluid and from urine.

Bilateral sternales in relation to body of sternum.

Abstract: The sternalis muscle on the manubrium sterni and its communication with sternocleidomastoid has been reported by many workers as unilateral or bilateral in both the sexes. The present report deals with bilateral sternales below the angle of sternum in a male cadaver during routine dissection. The proximal attachment of the muscle was from the manubriosternal joint on either side, right being broader than left and was found to be overlapping the lateral part of sternum and adjoining pectoralis major muscle. The muscle was running downwards and laterally and was attached on the cartilage of 6th and 7th ribs appearing to be continuous with rectus abdominis muscle. The muscle was found to be innervated by branches of the corresponding intercostal nerves of these spaces. The sternalis if present could be used for reconstructive surgical operations on the breast.

Evaluation of rapid diagnostic methods for pediatric viral diarrhea using samples collected in Nepal and Japan.

Abstract: We evaluated real time PCR, ELISA and immunochromatography (ICG) test systems for detection of diarrheagenic viruses (Rotavirus, Adenovirus and Norovirus) in pediatric diarrheal fecal samples collected in Kathmandu, Nepal (n = 23) and in Kobe, Japan (n = 25) in summer of 2004. Of the 23 samples collected in Nepal, one (4.3%) was positive for Rotavirus and two (8.7%) for Adenovirus whereas six out of 25 samples (24.0%) collected in Japan were positive for Norovirus. Of the Japanese samples, 11 (44.0%) showed diarrheagenic bacteria (Campylobacter jejuni, Salmolella enteritidis) while six (26.1%) samples from Nepal showed parasites like Ascaris lumbricoides, Giardia intestinalis, Trichuris trchiura and Vampirolepis nana. Viral pathogens were not common during summer season in both Nepal and Japan. Real time RT-PCR was found to be relatively more sensitive compared with ELISA for Norovirus. However, immunological methods are simple and less time consuming (three hours for ELISA, 15 minutes for ICG) and appeared to be useful for rapid diagnosis of viral gastroenteritis especially in developing countries.

Transbronchial needle aspiration in the diagnosis of respiratory diseases.

Abstract: Thirty-three patients were subjected to transbronchial needle aspiration during the routine diagnostic bronchoscopy. Of the 17 patients with submucosal diseases, Transbronchial needle aspiration (TBNA) had a yield of 88.2% as against 81.2% for bronchial biopsies, 54.5% for bronchial brush smears and 41.1% for bronchial aspirates. TBNA also had a good yield in endobronchially visible growths. Nine patients had mediastinal or hilar lymph nodes as evident in contrast enhanced CT scans. TBNA was attempted from eight lymph node sites in six patients with bronchogenic carcinoma and was positive for malignant cells from four of these sites, while normal lymphoid cells were obtained from the other four sites. TBNA could also diagnose the disease from the left hilar lymph node in one patient with sarcoidosis, an extra tracheal bronchogenic carcinoma in another patient and an extra bronchial metastasis in yet another patient where conventional bronchoscopic techniques failed. TBNA was found to be a safe, cost effective and valuable diagnostic tool in the diagnosis of pulmonary diseases.

Bilaterally anomalous formation and distribution of posterior cord of brachial plexus.

Abstract: Posterior cord (PC) is formed by the union of posterior divisions of upper, middle and lower trunks. During routine dissection variations in the formation and distribution of PC and its branches were observed on both the sides. These variations were: i) prefixed brachial plexus on left side ii) PC on both the sides was formed by the union of posterior divisions of only the upper (C5, 6) and middle (C7) trunks while the posterior division of lower (C8, T1) trunk joined the radial nerve directly and also gave contribution by two roots to left thoracodorsal nerve iii) length of PC varied on both the sides; on right side it was 4cm while on left side it was 1.5cm long. iv) upper subscapular nerve on right side arose from PC far proximal to other branches and on its course communicated with lower subscapular nerve before distributing to subscapularis while on left side it arose from posterior division of the upper trunk (C5, 6) only. v) on left side nerve to teres minor arose directly from axillary nerve trunk instead of arising from its posterior branch. The axillary nerve on both the sides divided into terminal branches before entering the quadrangular space of arm instead after traversing the quadrangular space. vi) the branches of radial nerve, which normally arise in the radial groove, arose in the axilla on both the sides. So in cases of trauma or injury of arm some of these branches may be spared.

Analysis of mastalgia cases presented at Manipal Teaching Hospital, Pokhara, Nepal.

Abstract: Breast pain (Mastalgia) is a common cause of anxiety among women and frequently leads to a primary care clinic for consultation. This study has been designed to study about mastalgia cases presented at Manipal Teaching Hospital, Pokhara. A total of 221 female patients with breast pain presented at outpatient department of surgery from Jan 2000 to Dec 2001 were enrolled in this study. Overall 36.8% presented with cyclical mastalgia and 43.1% with noncyclical mastalgia. Nonhormonal therapy like reassurance, breast support, reduction in dietary fat intake, VitE, Vit B6 was preferred for initial therapy of mastalgia as it was found to be associated with improvements of cyclical mastalgia and good compliance. Non cyclical mastalgia mostly presented with breast lump and ended with excision of lump.

Making unsafe abortion safe: medical method.

Abstract: WHO reported 13.0% of maternal deaths are related to unsafe abortion in developing world. To improve this, medical method of abortion has been in clinical use for over a decade. The antiprogestogen mifepristone followed two days later by a prostaglandin analogue is registered as a medical alternative to surgical termination of early intra uterine pregnancy. Since registration of medical method, research has continued to improve the medical abortion. Multicentre trials have shown that 200 mg of mifepristone orally and 800 ug of misoprostol vaginally results in a higher complete abortion percentage (95.0%). The gold standard method at present is 200 mg mifepristone orally followed by 800 ug ofmisoprostol vaginally 48 hrs later gives 95.0 to 97.0% success rate. With much improvement and efficacy more women accept medical method for abortion with higher satisfaction and provide more privacy to women especially where social stigmas are attached to induced abortion. Use of drug is safe and non-invasive and training is simple and complications are minimal. This is important in developing world where limited trained personnels are available to perform surgical evacuation. The disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion and fear of uncertainty and side effects. The termination of pregnancy is legalised in Nepal now, these medicines could be made available in market.

Influence of radish consumption on urinary calcium oxalate excretion.

Abstract: The study was undertaken to observe the effect of radish on urinary calcium oxalate excretion. Early morning midstream urine (MSU) samples collected from 36 subjects were analyzed continuously for a period of 14 days for the presence of calcium oxalate crystals. Of these, 21 cases were of renal stone and 15 were normal subjects. The subjects were advised to consume self-selected diet for a week and radish containing diet along with their self-selected diet for consecutive week. The study reveals that radish containing diet caused increased excretion of calcium oxalate compared to the self-selected diet and the crystals count in the urine were significantly higher in both genders. The difference between males and females was found to be insignificant indicating that there is no gender biasness on urinary calcium oxalate excretion. This study is first of its kind as literature search reveals no such study have been carried out earlier.

Study of type 2 diabetes mellitus cases at Nepal Medical College Teaching Hospital.

Abstract: A total of 110 cases attending diabetic clinic at Nepal Medical College Teaching Hospital were studied. Associated risk factors and co-morbid conditions were analyzed. Among them 63.6% have systolic BP more than 130 mm of Hg and 24.5% have diastolic BP more than 85 mm of Hg reflecting hypertension as most common co-morbid condition. Various complications of diabetes in studied subjects are highlighted. Eighty percent of patients have fasting blood sugar more than 110 mg% and 93.0% have post-prandial blood sugar more than 140 mg% reflecting poor overall glycemic control despite the use of medication.

Prevalence of Aeromonas in different clinical and water samples with special reference to gastroenteritis.

Abstract: A hospital based study was carried out in the Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine with the aim to initiate the isolation and identification of Aeromonas spp. from the stool samples of gastroenteritic patients and to determine the prevalence of Aeromonas spp. in other clinical samples and water. Altogether 293 samples were investigated that include 172 stool samples, 60 pus/wound swabs, 20 body fluids and 41 water samples. The samples were collected and processed by standard microbiological techniques in order to isolate Aeromonas. Ampicillin blood agar (20 microg/ml) was used as selective medium for the isolation of Aeromonas. The specimen prevalence rate of Aeromonas spp. in stool was found to be 5.2% and the A. hydrophila (55.5%) was the predominant species followed by A. caviae (33.3%) and A. sobria (11.1%) in the stool samples. Likewise, 3.3% of pus sample showed positive growth of A. hydrophila. Aeromonas was not detected in any of the body fluids. Aeromonas spp. were isolated from 58.5% of water samples obtained from different hospitals. The commonest species was A. hydrophila (62.5%) followed by A. caviae (20.8%) and A. sobria (16.7%). In vitro susceptibility testing showed that the aminoglycosides and fluroquinolones were the effective antibiotics against Aeromonas. It was found that 88.9% of Aeromonas spp. isolated from stool samples were sensitive to gentamicin, 77.8% to ciprofloxacin, norfloxacin, tetracycline and ceftriaxone and 66.6% to nalidixic acid whereas cent percent Aeromonas spp. from water samples were sensitive to gentamicin, ciprofloxacin, norfloxacin, tetracycline and ceftriaxone and 75.0% to nalidixic acid. The enteric Aeromonas isolates were more resistant to antimicrobial agents than the water isolates.

Comparison of needle biopsy with pleural fluid analysis for the evaluation of pleural lesions.

Abstract: A total of 60 pleural biopsies were received at Nidaan Clinic, Kathmandu during the period of two years from January 2000 to December 2002. The age of the patient ranged from 8 years to 82 years. Male: female ratio seen was 3:1. The most common lesion was found to be chronic nonspecific; pleuritis seen in 50.0% cases followed by tuberculous pleuritis in 36.7% cases, metastatic adenocarcinoma in 8.3% cases, metastatic small cell carcinoma in 3.3% cases and anaplastic large cell carcinoma in 1.7% cases. 63.3% cases of chronic nonspecific pleuritis showed transudative pleural fluid effusion. None of the cases of tuberculous pleuritis had transudative pleural effusion. 2 cases (40.0%) of metastatic adenocarcinoma had transudative pleural fluid effusion which suggests the need to perform pleural biopsy in all the cases of transudative pleural effusion whether encountered for malignancy or not.

A study on efficacy of lamivudine therapy in decompensated cirrhosis of liver due to chronic hepatitis B virus infection.

Abstract: The prognosis of decompensated cirrhosis of liver resulting from chronic Hepatitis B Virus (HBV) infection is poor and liver transplantation is the only established mode of treatment. The benefits of treatment with interferon are outweighed by serious side effects and risks of fatal exacerbation of disease activity. Lamivudine rapidly reduces hepatitis B viral DNA in serum to undetectable levels. The purpose of this study was to evaluate effectiveness and safety of Lamivudine treatment in patients with advanced and end stage liver disease caused by Hepatitis B. This was a prospective observational study in which a total of 45 patients, 39 (87.0%) male and 6 (13.0%) female who had viral activity and child pugh score e" 8 were given Lamivudine 100 mg orally once daily. Among them 30 patients completed at least 6 months of therapy, majority (27 patients) showed improvement in liver function with decrease in serum ALT from mean (+/- SD) 118.8 +/- 106.5 to 50.2 +/- 57.1 U/L (p < 0.001), decrease in serum bilirubin from 73.9 +/- 80.5 to 44.7 +/- 62.9 micromol/l (p = 0.129), increase in serum albumin from 26.2 +/- 4.2 to 33.2 +/- 3.4 g/l (p < 0.05), decrease in prothrombin time from 8.3 +/- 4.0 to 3.9 +/- 2.9 seconds prolonged (p < 0.05) and reduction in child pugh score from 11.0 +/- 1.7 to 7.0 +/- 1.3 (p < 0.001). Seroconversion was found in 5 (11.1%) patients on Intention to treat analysis. Among the seroconverted group, 1 (2.2%) patient also lost HBsAg. Six (13.0%) patient had procore mutant virus, 2 (4.4%) of them showed virological response. Therefore, total 7 (15.5%) patients showed virological response by intention to treat analysis. We conclude that inhibition of viral replication with Lamivudine results in a significant improvement of liver function in patients with decompensated cirrhosis of liver due to HBV infection.

Comparative evaluation of hexokinase isoenzyme typing and antigen detection for differentiation of Entamoeba histolytica and Entamoeba dispar.

Abstract: Entamoeba histolytica, the causative organism of invasive amebiasis is a potential pathogen, while asymptomatic infection is caused by E. dispar. Differentiation of the species is not possible on the basis of morphological characters by microscopic examination. In the present study an attempt has been made to differentiate E. histolytica from E. dispar in 45 isolates obtained from culture and direct stool samples respectively on the basis of hexokinase isoenzyme analysis and Tech Lab ELISA. A 100% correlation was found between these two techniques. However, Tech Lab E. histolytica antigen detection test was found to be both rapid and technically simple. Its use in diagnosis and epidemiological studies is recommended.