Showing papers in "Nepal Medical College journal in 2005"

The beneficial effect of yoga in diabetes.

Abstract: Twenty NIDDM subjects (mild to moderate diabetics) in the age group of 30-60 years were selected from the out patient clinic of G.T.B. hospital. They were on a 40 days yoga asana regime under the supervision of a yoga expert. 13 specific Yoga asanas < or = done by Type 2 Diabetes Patients included. Surya Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana, Bhastrika Pranayama, Pashimottanasana, Ardhmatsyendrasana, Pawanmuktasana, Bhujangasana, Vajrasana, Dhanurasana and Shavasana are beneficial for diabetes mellitus. Serum insulin, plasma fasting and one hour postprandial blood glucose levels and anthropometric parameters were measured before and after yoga asanas. The results indicate that there was significant decrease in fasting glucose levels from basal 208.3 +/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl. The exact mechanism as to how these postures and controlled breathing interact with somatoendocrine mechanism affecting insulin kinetics was worked out. A significant decrease in waist-hip ratio and changes in insulin levels were also observed, suggesting a positive effect of yoga asanas on glucose utilisation and fat redistribution in NIDDM. Yoga asanas may be used as an adjunct with diet and drugs in the management of Type 2 diabetes.

Effect of early mother-baby close contact over the duration of exclusive breastfeeding.

Abstract: This is a prospective study involving ninety-two lactating mother- infant pairs in the first six months of birth. They were followed-up up to six months for various perinatal factors determining the duration of exclusive breastfeeding. Early postpartum mother-baby skin-to-skin contact had a powerful influence (P<0.001) over the duration of exclusive breastfeeding up to 4-6 months and was found to be more significant than early initiation of breastfeeding (P<0.05). Mode of delivery did not have any significant effect (P<0.5) over the duration of exclusive breastfeeding. Thus health care centers can easily adopt a policy to allow few minutes of early postpartum mother-baby skin-to-skin contact and early initiation of breastfeeding to all vaginal as well as caesarian deliveries to promote breastfeeding.

Antibiogram pattern of isolates from UTI cases in Eastern part of Nepal.

Abstract: The present study was conducted to study antibiogram pattern of isolates from urinary tract infection (UTI) cases at a referral hospital in Eastern Nepal. Of the total 2,799 of urine samples studied, 720 (25.7%) were positive for some kinds of bacterial agents. Escherichia coli was most predominant organism (59.0%) followed by Klebsiella sp. (12.6%), Pseudomonas aeruginosa (6.9%), Acinetobacter sp. (5.9%), Enterococcus sp. (4.2%) and others (2.6%). Antimicrobial susceptibility testing was done by Kirby-Bauer's disc diffusion method following National Committee for Clinical Laboratory Services (NCCLS) guidelines. Most strains of Esch. coli and Klebsiella sp. were resistant to Ampicillin and Ciprofloxacin. Ps. aeruginosa and Acinetobacter sp. showed relatively higher resistance to Aminoglycosides. These organisms were often multidrug resistant. Ps. aeruginosa showed 68.0% resistance to even Ceftazidime. For Enterococcus sp. Nitrofurantion and Gentamicin were the drugs of choice. Of the all antimicrobial agents tested, Ciprofloxacin showed most disappointing result.

A study on anterior clinoid process and optic strut with emphasis on variations of caroticoclinoid foramen.

Abstract: This study presents the incidence of carotico-clinoid foramen, dimensions of the anterior clinoid process and optic strut in dry skulls to provide a guide to neurosurgeons in surgical approach especially to anterior part of cavernous sinus. Thirty-five dry skulls were used. Basal width, length, thickness of anterior clinoid process and thickness of optic strut was measured. Morphology of carotico-clinoid foramen was also studied. The average length, basal width and thickness of the anterior clinoid process on right side were 10.74 +/- 2.37 mm, 10.83 +/- 1.20 mm, 5.13 +/- 1.03 mm and left side were 9.91 +/- 1.50 mm, 11.0 +/- 1.12, 5.33 +/- 0.96 mm. Average thickness of optic strut was 3.79 +/- 0.88 mm on right side and 3.61 +/- 0.78 mm on left side. Out of 70 sides in thirty five skulls examined, carotico-clinoid foramen was observed in 14 (20.0%) cases. Out of which complete foramen was in 3 (right side, 4.3%), partial in 8 (6 right, 2 left, 11.4%) and contact in 3 (left side, 4.3%) respectively. Comparison with other races and differences between right and left sides were also discussed. The present study was done to obtain dimensions of anterior clinoid, optic strut, their anatomical variants and incidence of caroticoclinoid foramen in location population. This study will help the surgeons to plan their approach to this area and thus will make the surgical procedure safer

Factors associated with intestinal parasitic infection among school children in a rural area of Kathmandu Valley, Nepal.

Abstract: We studied predisposing factors of enteric parasitic infections in school children [n=340 (Boys: 177 and Girls: 163)] in a rural area in Kathmandu Valley, Nepal. Fecal samples were examined by formal-ether concentration technique. A total of 71.2% children had parasite. Altogether nine types of parasites were recovered; Trichuris trichiura was the commonest one followed by hookworm and others. A structured questionnaire regarding various predisposing factors was used. No significant differences in the infection rate between the sexes, age groups ( or = 15 years) and family sizes ( or = 6) were observed (P>0.05). The positive rates were significantly low in children with the history of taking antihelminthic drugs in the past six months (P 0.05) and children from farming family (P>0.05). No difference in the infection rate was found in children having different types of toilet facility: open-field defecation, pit latrine and modern toilet at their houses (P>0.05). Slightly higher positive rate was associated with drinking water from Kuwa (shallow well) compared to natural spout, piped water and Khola (river) (P>0.05). Children were infected despite of their awareness regarding the safe water and geophagy.

Variations in branching pattern, shape, size and relative distances of arteries arising from arch of aorta.

Abstract: Hundred aortic arches were studied in adult cadavers (aged 40-70 years) for variations in the origin of branches at arch of aorta in situ and for observing the lumenal diameters and relative distances between the adjacent branches. Usually described three branches arising at arch of aorta were observed in 77.0% specimens. Two branches arising from arch of aorta, having different branching pattern were observed in 12.0%:--(i) BC trunk; left brachiocephalic which divided into right common carotid and right subclavian (ii) common origin of BC and LCC; LSC. (iii) common origin of BC and LCC; common origin of LSC and left vertebral. While, four branches were observed in 11.0% showing separate openings:--(i) BC; LCC; LV; LSC (ii) BC; thyroid ima; LCC; LSC (iii) BC, mediastinal; LCC; LSC. At the lumenal surface of the arch of aorta the lumenal openings showed a similar pattern corresponding to the arterial branches on the external surface. These openings were oval in shape in 90.0% with the mean maximum anteroposterior diameters being greater than the mean maximum side-to-side diameters (p < 0.001), while they were elliptical in 10.0%. The BC artery showed largest size followed by LSC and then LCC in most of the branching patterns (p< 0.001). The mean transverse distances between adjacent lumenal openings of these branches were significantly greater than the mean vertical distances (p < 0.001). Approximation of LCC to BC trunk was seen in 10.0% specimens. These observations may be important while invading the arch of aorta and its branches by instruments, as all areas are now susceptible to surgical attack.

Utility of specific IgG4 response in saliva and serum samples for the diagnosis and follow up of human neurocysticercosis.

Abstract: This study was aimed to analyze the Ig subtypes and IgG1 and IgG4 subclass responses to crude soluble extract (CSE) antigen and Ag B of Cysticercus cellulosae in pre and post treatment (PT) saliva and serum samples for the diagnosis and follow-up of neurocysticercosis (NCC) patients. Saliva and serum samples collected from 55 patients (15 highly suggestive of NCC clinically and radiologically, 10 hydatidosis, 10 other helminthic infections, 10 tubercular meningitis, 10 neurological disorders other than NCC), 15 normal healthy subjects and 10 NCC patients at 1, 3 and 6 months following albendazole therapy were analyzed for specific IgG, IgG1, IgG4, IgM and IgA antibody responses by ELISA. With the use of CSE Ag, the rank orders in saliva for sensitivity was IgG (71.4%) > IgG1 (68.2%) > IgG4 (65.2%) > IgM (57.7%) > IgA (55.5%) and specificity IgG1 = IgA (93.2%) > IgG = IgG4 = IgM (91.6%) while in serum, sensitivity was IgG (78.9%) > IgG1 (71.4%) > IgG4 (68.2%) > IgA (65.2%) > IgM (62.5%) and specificity IgG1 = IgG4 (90.2%) > IgA (85.9%) > IgG (83.3%) > IgM (82.1%). With the use of Ag B in saliva, the sensitivity was IgG (65.2%) > IgG1 = IgG4 (62.5%) > IgM = IgA (55.5%) and specificity with the use of saliva was IgG1 = IgG4 = IgM (94.8%) > IgG (93.2%) > IgA (91.6%) while with serum the sensitivity was IgG = IgG1 (68.2%) > IgG4 (65.2%) > IgA (62.5%) > IgM (57.7%) and specificity was IgG1 (93.2%) > IgG4 = IgM (91.6%) > IgA (90.2%) > IgG (87.3%). Comparative analysis of antibody responses in patients with single Vs multiple CT scan lesions indicated higher sensitivity in multiple lesion patients. Antibody responses in PT samples indicated that the undetectable IgG4, IgM and IgA responses in saliva samples correlated well with the CT scan reports while in serum samples, responses persisted longer. In conclusion, this study indicated that due to the lower sensitivity of IgM and IgA responses in pretreatment samples, detection of IgG4 subclass in saliva to either CSE Ag or AgB may serve better marker in the NCC follow-up.

Emerging opportunistic protozoa and intestinal pathogenic protozoal infestation profile in children of western Nepal.

Abstract: Intestinal parasitic infestation continues to be of public health importance in many tropical and subtropical countries for their high prevalence and effects on the morbidity in the population. This 5-year hospital-based retrospective analysis was aimed to find out the intestinal protozoal parasitic profile in 1790 pre-school and school-going children visiting the hospital with gastrointestinal illness. Giardia lamblia was the most prevalent pathogenic protozoan intestinal parasite (73.4%), followed by Entamoeba histolytica (24.4%). Interestingly, "newer" opportunistic pathogens like Cyclospora cayetanensis (1.0%) and Cryptosporidium sp. (1.0%) were detected from immunocompromised children below 2 years of age as a result of vertical transmission, which is alarming for a country like Nepal at the stage of 'concentrated epidemic' of HIV infection.

Central neural blocks: a quality assessment of anaesthesia in gynaecological surgeries.

Abstract: Quality of anaesthetic care can be improved only after identifying the factors contributing to patients' discomforts and dissatisfaction. The purpose of this prospective observational study was to assess the quality of central neural blocks in terms of physiological alterations and undesired events and to find out modifiable factors associated with patients' discomforts and dissatisfaction. Total 204 female patients (ASA I and II) undergoing gynaecological surgeries received either of the subarachnoid block (SAB), combined spinal epidural anaesthesia (CSEA) or lumbar epidural anaesthesia (LEA) depending on the nature of the procedure. Intra-operative and immediate post-operative physiologic alterations and undesired effects, surgeons' rating of the operation condition and patient satisfaction (using 10 cm visual analogue scale) and acceptability of the technique were analyzed. Out of 204 patients, hypotension, bradycardia and nausea occurred in 45.1%, 17.6% and 14.7% respectively. Fifty-six (27.4%) patients experienced discomforts whereas 10.8% had tolerable pain and 4.9% patients required conversion to general anaesthesia. The main causes of discomfort in these patients were inability to move lower limbs in 35.7% and discomfort in the upper limbs in 32.1% of patients. Operating conditions were suboptimal and unacceptable in 3.9% and 4.3% of patients respectively. The mean patient satisfaction VAS score was 8.2 +/- 1.3 and patient acceptability was 90.2%. Significant failure or unacceptability (approximately in 10.0%) along with a high incidence of preventable discomforts demand improvement in preoperative patient education, intra-operative care and liberal uses of sedation to improve the quality to bring the acceptability closer to 100.0%.

Microbiology of dacryocystitis among adults population in southern Australia.

Abstract: Retrospective study on microbiology of dacryocystitis cases in adults was carried out at the Royal Victorian Eye and Ear Hospital (RVEEH). Sixty-four consecutive cases seen between March 2000 and June 2003 were included. Seventy-nine organisms were isolated from the sixty-six samples (1.2/specimen). Aerobic or facultative bacteria were recovered in 76 (96.2), fungi from two specimens (2.5%). And anaerobic bacteria from only one specimen (1.3%). Staphylococcus aureus (27), was most common followed by Pseudomonas aeruginosa (6), Proteus mirabilis (4), Hemophilus parainfluenza (4) and H. influenza (4). Fifty-four samples showed single organism while 12 samples showed multiple organisms. Overall, Gram-positive organisms were predominating (54.4%) over Gram negative (41.8%) organisms. The current bacteriology of lacrimal duct obstruction in the population served by the RVEEH should be taken into account while selecting first line antimicrobial treatment for dacryocystitis and in prophylaxis in lacrimal drainage surgery.

An overview of reproductive health of women in Bajhang district.

Abstract: Reproductive health is not merely an absence of disease or disorder, rather it is a condition in which reproductive process is accomplished in a state of complete physical, mental and social well being according to WHO. Reproductive morbidity encompasses obstetric morbidity including conditions during pregnancy, delivery and the post-partum period; and gynecological morbidity including conditions of the reproductive tract such as reproductive-tract infections, cervical cell changes, genital prolapse, malignancies and infertility. The first step towards achieving the needs of women as consumers and providers is to do baseline research so that the nature and magnitude of the problem is assessed. Bajhang is one of the poorest, most deprived and remotest districts in the Far Western development region of Nepal. The status of all women is very low and their situation is very difficult. This study was conducted during a gynecological camp for a period of six days from 10th-15th March, 2003, in the district hospital of Bajhang at Chainpur. All women who attended the gynecological camp were included in the study. The 6 days period, total 530 women had attended the camp. Among them 273 (51.5%) had gynecological problems. Uterovaginal prolapse was the leading morbidity found in 97 women (18.3%) followed by subfertility (14.2%) and reproductive tract infections(13.9%). Only 22.0% women were using family planning methods. This study shows that a large number of women are seeking help for gynecological problems, hence emphasizing the importance of research in this area. Such studies have a pronounced impact in settings where no information on gynaecological morbidities exists and where there is an absence of consensus on the extent of such morbidity. This study not only gives us a baseline data about the most prevalent gynaecological problems in the remote area, it may help us in planning future reproductive health programs also.

Knowledge, attitude and practice (KAP) study on diabetes mellitus among Nepalese diabetic patients.

Abstract: Present study was carried out to understand the knowledge, attitude and practices (KAP) regarding diabetes mellitus (DM) among the diabetic patients attending a diabetic education programme. Results showed that the majority of patients had correct knowledge regarding diabetic diet, three-fourths of them were subjected themselves to blood sugar checking at good intervals and almost all were under regular contact with physicians. This study might help in implementation of diabetic education programme giving more emphasis among older and younger groups of patients and encouraged the patients to have more contact with concerning physicians, so that complications that occurring at early stage of disease could be prevented.

Study of prevalence of hypertension in Chronic Obstructive Pulmonary Disease patients admitted at Nepal Medical College and Teaching Hospital.

Abstract: A retrospective study of 237 cases of Chronic Obstructive Pulmonary Disease (COPD) patients admitted in medical ward of Nepal Medical College Teaching Hospital (NMCTH) was performed to find out the prevalence of hypertension in such COPD subjects. The prevalence of COPD amongst the total number of patients admitted at NMCTH medical ward was 17.3%. Prevalence of COPD was more after the onset of middle age, the peak was found to be at the age of 60-69 years. Out of these COPD subjects, 98 patients (37 patients were known case of hypertension) had hypertension. Thus prevalence of hypertension was 41.3% in COPD subjects studied. Prevalence increased with age after the age of 50 years and the highest prevalence was at the age of 60-69 years which directly correlates with the prevalence of COPD. The prevalence of hypertension in COPD patients was significantly higher than the normal population that may reflect COPD itself as a risk factor for developing hypertension. A larger and detailed study is needed to confirm such finding.

Cancer: determinants and progression.

Abstract: Cancer is the combination of uncontrolled cellular proliferation and immortality. It is a multi-step disease with a multi-factorial etiology. The determinants of cancer are many and varied including genetic predisposition, environmental influences, infectious agents, nutritional factors, hormonal and reproductive factors, radiation etc. However, the extent of the genetic involvement and their interaction with environment in tumorigenesis is still elusive. The six essential alterations in cell are proposed which determines the transition from normal cell to malignant. It includes--self-sufficiency in growth signals, insensitivity to growth-inhibitory (antigrowth) signals, evasion of programmed cell death (apoptosis), limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis. Nevertheless, the last two decades have seen rapid improvements in understanding the complex molecular mechanisms underlying tumorigenesis, yet the quest for unraveling the mystery is not over. Further study in this area is indispensable that could hold the promise of increasing our understanding of cancer etiology and possible preventive strategy.

Salmonella bacteraemia in Pokhara: emergence of antibiotic resistance.

Abstract: We undertook a retrospective hospital based study of 2,354 blood culture specimens from June 2000 to May 2003 in order to determine the isolation rates of Salmonella species and their antibiotic susceptibility patterns in western Nepal. Blood samples were cultured and identification of Salmonella species. and their antibiotic susceptibility testing were done as per standard protocol. Of the total 114 (4.8 %) yielded Salmonella species. Of them 76 (66.7%) Salmonella typhi and 38 (33.3%) S. paratyphi A. S. typhi was found to be the predominant species each year. Higher proportion of Salmonella bacteraemia was seen in adults, with a clearcut male to female preponderance (1.8:1). Monsoons enhanced the risk of acquiring enteric fever. There is also a rise in the number of multi-drug resistant strains in and around Pokhara Valley, with 40.7% S. typhi and 5.2% S. paratyphi A showing resistance to two or more antibiotics. These isolates were primarily resistant to the first line drugs namely Ampicillin, Chloramphenicol and Cotrimoxazole but susceptible to third generation Cephalosporins. Appearance of multi drug resistance poses considerable threat of increased morbidity and mortality in this region. This emphasizes the need for prudent use of antimicrobials.

Intervention studies on rational use of drugs in public and private sector in Nepal.

Abstract: In developing countries, inappropriate, inefficient and ineffective use of pharmaceuticals have resulted into the poor health and medical cares for the community people. For improving the situation, various interventions have been tested and proved effective in different settings. In Nepal also, various strategies have been tested and found effective to improve the prescribing and dispensing practices. This paper has examined the process and results of different studies. The educational intervention, the training has not been effective in improving the prescribing practices but has limited effect on dispensing practices in the public sector. However, it becomes effective in improving prescribing practices if combined with a managerial intervention e.g. peer-group discussion. In private sector, training alone is effective in changing the drug recommendation practices of retailers. But none of interventions have been found to be effective in improving dispensing practices. After examining the effectiveness of different interventions, training combined with peer-group discussion is recommended for piloting in all Primary Health Care (PHC) outlets of a district to improve the prescribing practices. For improving the dispensing practices in both public and private sector, additional studies have to be carried out using different strategies.

Study of serum lipid profile in type 2 diabetic patients attending KMCTH.

Abstract: The study was aimed at identifying the association between two major risk factors for coronary artery disease (CAD), namely, type 2 diabetes and hyperlipidemia. Hyperlipidemia has a ocumented causative relation with CAD, but the major risk associated with diabetes may be due to the associated hyperlipidemia. Lipid profiles of 30 patients with type 2 diabetes were taken and a detailed clinical workup done, including estimation of the body mass index (BMI). The study revealed that dyslipidemia is very common in type 2 diabetics and the most common abnormality seen was increased serum triglyceride levels (73.3%). The next common abnormality was decreased serum high-density lipoprotein cholesterol (HDL-C) levels and increased serum low-density lipoprotein cholesterol (LDL-C) levels, both seen in 66.7% patients respectively. A high total serum cholesterol levels was seen in 46.7% patients. Forty percent of the patients examined were on the overweight side, 16.7% being overtly obese. Thus the study, despite having small number of patients, clearly shows the association between type 2 diabetes and hyperlipidemia, which may influence the mechanism by which type 2 diabetes is associated with increased CAD risk.

Oxidative stress and antioxidant status in cancer patients and healthy subjects, a case-control study.

Abstract: Since raised oxidative stress (OS) or weak antioxidant defence or both are considered to be important players in multimechanistic pathogenesis of cancer, the present study was undertaken to evaluate their possible involvement in the pathogenesis of this disease in the local population. Levels of plasma vitamin C, vitamin E, total antioxidant activity (TAA) and thiobarbituric acid reacting substances (TBARS) as a marker of OS were measured in 20 cancer patients (Mean age 63.1 + 9.3 yr.) and 20 age, sex and socioeconomically matched healthy subjects (Mean age 63.7+7.8 yr.). Significantly low level of vitamin C (p <0.001), vitamin E (p <0.001) and TAA (p <0.003) were observed in cancer patients, whereas OS was significantly increased in patients as compared to control (p <0.003). Smokers had significantly lowered TAA and significantly raised OS than non-smokers, in both case and control groups. Tobacco chewer patients had raised OS as compared to control. This study supports the thesis that OS is a risk factor in carcinogenesis and that smoking, an established risk factor in cancer, at least partly appears through it.

Choroidal effusion following laser peripheral iridotomy for the treatment of angle closure glaucoma in a patient with nanophthalmos.

Abstract: We report a case of Nanophthalmos with choroidal effusion and retinal detachment following a peripheral laser iridotomy for the treatment of angle closure glaucoma. Angle closure glaucoma was diagnosed in the right eye of the patient after finding an elevated intraocular pressure and narrow angles on gonioscopy. The glaucoma was treated by lowering the intraocular pressure medically followed by laser peripheral iridotomy. The first day after a laser peripheral iridotomy, choroidal effusion was noticed that was followed by an exudative retinal detachment within a week. The medical and laser therapies for the lowering of intraocular pressure for the treatment of angle closure glaucoma in patients with nanophthalmos can be associated with choroidal effusion, retinal detachment and loss of vision.

Analysis of clinical factors affecting the restenosis following percutaneous coronary intervention.

Abstract: Coronary heart disease (CHD) is a leading cause of morbidity and mortality across the world. Percutaneous coronary interventions (PCI) including angioplasty and/or stenting have revolutionized the effect management of ischemic syndromes in CHD and their symptoms. However, the superimposition of iatrogenic mechanical injury (PCI procedure) on coronary atherosclerosis initiates restenosis that may complicate the patient's clinical course like recurrence of angina, myocardial infarction and cardiac insufficiency. In order to study the possible association of clinical risk factors on the incidence of restenosis; clinical predictors were determined in 98 patients (81 males and 17 females) who all undergone follow-up coronary angiography within 8.2 months after PCI. The mean age was 59.7years (40-80years). 83 patients had recurrence of angina however 15 patients had no symptoms at the follow up. The multivariate analysis of the clinical predictors demonstrated that a significant higher risk of restenosis after PCI was found in patients with hyperlipidemia p<0.05, [RR=1.311(1.018-1.687)]. Longer the history of hyperlipidemia the angina recurrence time is shorter. Besides restenosis is also closely related to male patients (p<0.10). Finally, this study strengthens evidence that restenosis following PCI is higher in patients with hyperlipidemia, and longer the history of hyperlipidemia the recurrence time of angina is shorter.

Influence of moonlight on the birth of male and female babies

Abstract: Effects of full moon and no moon on the birth of male and female offsprings were studied in Indian Couples of the age group 20 to 40 years. It was observed that 42 wives who were conceived within 24 hours of ovulation at full moon gave birth of 40 male and 2 female babies. On the other hand 40 women conceived on the day of ovulation 3 days prior to full moon gave birth of 13 male and 27 female babies. But only 5 women conceived on no moon, all of them gave birth of female babies. It was also observed that vaginal pH of the ovulated women during full moon was alkaline (pH 8.7 +/- 0.4) while pH was weak acidic in women ovulated 3 days prior to full moon and no moon (pH 6.4 +/- 0.5; 6.2 +/- 0.5). The basal body temperature (BBT) was increased 0.7 degrees F to 1.3 degrees F during the ovulation period when compared with women during the absence of ovulation. But there is an increase in temperature 0.5 degrees F more in women ovulated in full moon than no moon. Together, these results indicate that alkaline vaginal fluid medium and more rise of BBT during full moon favour conception of male [corrected] babies. This method gives the couple more chance of having male child if conception occurs in the day of ovulation in full moon and having female child if conception occurs in no moon.

Excessive weight gain after pregnancy in urban areas: one important area to prevent diabetes.

Abstract: Diabetes has been found to be common in people, including the women of child bearing age, in urban Nepal. There is a custom of feeding the women with foods rich in calories and fats, as much as possible, after delivery. Weights of 200 women of urban Kathmandu before the first pregnancy and 6 months and 1 year after delivery were studied. The mean + SD of weights before pregnancy, six months after delivery and one year after delivery were 51.3 + 4.9, 67.2 + 6.3 and 63.4 + 6.4 respectively. Similarly, the mean + SD of body mass index (BMI) before pregnancy, six months after delivery and one year after delivery were 21.3 + 1.8, 27.9 + 2.5 and 26.7 + 2.8 respectively. The average increases in weight and BMI six months after delivery were 15.9 kg and 6.6; the increases from the basal values were statistically significant (p<0.01). Six months later the average increased weight and BMI decreased by 3.8 kg and 1.2 respectively. Thus, the average increases in weight and BMI one year after first pregnancy were 12.1 kg and 5.4; the increases from the basal values were statistically significant (p<0.01). The women seemed to have difficulty in losing weight gained. In view of the problem of overweight, the custom of excess feeding after delivery seems required to be discouraged in urban areas to prevent subsequent gestational and type 2 diabetes in women and the population.

Perforation of oesophagus and aorta by an unusual migratory fish bone: case report.

Abstract: This report describes a migratory fish bone which was not found during 1st surgery causing perforation to the superior part of the arch of aorta. The patient presented with feeling of something stucked in her throat after eating fish subsequently followed by progressive excruciating pain in the neck. During 2nd surgery the fish bone was found to have migrated from the superior aspect of the arch of aorta to the anterolateral aspect of the arch of aorta after piercing the aortic lumen. We report a case of migratory fish bone which was not found during 1st surgery. The clinical examination of the throat revealed no foreign body. The CT scan of the neck and upper thorax demonstrated a 1cm linear foreign body part of which had perforated into the superior part of the arch of aorta with mediastinal hematoma. The most likely cause was a fish bone. The patient's condition slowly deteriorated, median sternotomy and exploration of mediastinum then followed. Unfortunately no fish bone was found and only mediastinal hematoma was discovered. After the first operation the patient condition did not improve and repeat CT scan of the neck and upper thorax was done 3 days later. A similar foreign body has now moved from the superior aspect of the arch of aorta to the anterolateral aspect of arch of aorta. Exploration was done again and this time the fish bone was found.

Profile of blindness in Nepal: a hospital based study.

Abstract: A hospital based prospective study was conducted at B P Koirala Lions Center for Ophthalmic Studies to determine the causes of blindness. A total of 701 patients were enrolled for this study during a one and a half year time period. Four main diseases in the order of prevalence--cataract, corneal diseases, trauma and posterior segment diseases--were identified as the major causes of blindness. The prevalence of blindness increased with age and showed a male preponderance. Cataract and corneal diseases were the leading causes of bilateral blindness and unilateral blindness respectively.

Retrospective study of chest wall tumors at a cancer hospital in Nepal.

Abstract: Primary and metastatic tumors of both soft tissues and bony skeleton, and primary tumors of adjacent organs invading the chest wall constitute chest wall tumors. A retrospective review of all the patients with chest wall tumors was done at BP Koirala Memorial Cancer Hospital (BPKMCH). Primary tumors of breast were excluded. Surgical treatment consisted of wide local excision (WLE). Chest wall reconstruction, if needed, was achieved by a muscular flap +/- prolene mesh +/- omental transposition. Thirty one patients were treated in the period from October 1999 to October 2003. Age of the patients varied from 3 years to 72 years (mean age--38 years). Presenting complaint was mass in 96.8% and pain in 48.4% cases. The mass was 5 cm or less in 34.4%, from 5 to 10 cm in 32.3%, and more than 10 cm in 32.3% cases. The lesions were located in sternal region, anterior, lateral, posterior, and vertebral chest wall in 6.5%, 32.3%, 41.9%, 16.1% and 3.2% respectively. WLE was done in 29 cases. Chest wall reconstruction using both muscular flaps and prolene mesh (15x15 cm) was done in 8 cases. In three of them, where concomitant wedge resection of the lung was done, omental transposition was added. In rest of the cases, primary closure, muscular/myocutaneous flap or skin grafting was done. Minor complications were observed in 31.0% cases, which were managed conservatively. Two patients received adjuvant radiotherapy and four patients--adjuvant chemotherapy. There were no postoperative deaths. The rate of malignancy was 48.4%.

Disposition of muscularis propria and nerve elements in the lip of the ileocaecal valve.

Abstract: The presence of a valve and the concept of a functional sphincter at the ileocaecal junction have been debated in the literature. Twenty four specimens of ileocaecal organ complex including 10cm of ileum and colon were obtained from cadavers from the Departments of Anatomy and Pathology, PGIMER, Chandigarh. 5 micron thick longitudinal sections from the upper lip of the ileocaecal valve were stained with Hematoxylin and Eosin and Silver stain. Sections of the ileum and colon from 5 ileocaecal organ complexes were also prepared and similarly stained. All the sections were viewed under the light microscope. The muscle bundles constituting the muscularis propria in the ileocaecal valve were arranged in two rows and were tapering in size from the base to the apex. The disposition of the muscle fibres was not uniform in all the specimens. The muscle fibers could be traced up to the upper, middle and lower third of the valve in 8 (33.3%), 14 (58.3%) and 2 (8.3%) specimens respectively. Silver stain of these sections revealed large numbers of nerve elements distributed within the submucosa and muscularis propria. The density of nerve elements in the ileocaecal valve was similar in all the sections irrespective of the extent of the muscularis propria and was comparable to the density of nerve elements in the muscularis propria and submucosa of the ileum and colon. The present study shows that the ileocaecal valve has a well developed muscularis mucosa and a proportionate component of the nerve elements.

Dysphagia as a presenting symptom in a case of dermatomyositis and occult gastric malignancy

Abstract: A case of dermatomyositis in a 64 yrs old male with occult gastric malignancy is presented along with a brief review of literature.

Sleep apnoea syndrome in Nepal.

Abstract: Sleep apnoea syndrome is a well recognized entity. Sleep studies of diagnosed patients with sleep apnoea were analyzed to understand the clinical profiles of Nepalese patients with this disorder. Eighty nine patients were diagnosed to have sleep apnoea syndrome during the period of 15 months starting from November 2003. All these patients were subjected to a detailed clinical evaluation including symptoms, presence or absence of other risk factors and co-morbidities, general physical and systemic examination and relevant investigations before performing polysomnography. Clinical profiles of patients who were confirmed to have sleep apnoea syndrome with apnoea hypopnoea index (AHI) more than five were included in the study. Forty one patients (46.1%) were found to have mild disease (AHI 6-20), 22 patients (24.7%) had moderate disease (AHI 21-40) and 26 patients (29.2%) were found to have severe disease. The common symptoms were snoring, excessive daytime sleepiness, frequent awakenings, nocturia, and choking spells during sleep. Obesity was found to be the most important risk factor associated with sleep apnoea. Males having collar size more than 16 inches and females with collar size more than 14.5 inches were found to have an increased risk to develop this problem. Hypertension (66.3%), chronic obstructive pulmonary disease (43.2%) and cardiac diseases (19.1%) were the common co-morbidities associated with this disorder. Sleep apnoea syndrome is not an uncommon problem in Nepalese population. It could be the cause of various cardiovascular problems and may complicate patients with chronic obstructive pulmonary disease.

Otosclerosis--do we have a viral aetiology?

Abstract: The etiology of otosclerosis remains an enigma though there are evidences suggesting a viral involvement. This study aimed to find out the relationship between viral infections and otosclerosis. Twenty two patients with otosclerosis and 10 healthy controls were included in the study. IgM antibodies to varicella zoster virus (VZV), measles, rubella, human cytomegalovirus (HCMV) and herpes simplex virus (HSV) were detected using micro ELISA. Paul Bunnel Davidsohn test was performed to rule out Ebstein Barr virus (EBV) infection. Overall, 5(22.7%) patients showed antibodies to one or more viruses. IgM antibodies against measles and VZV could be demonstrated in 4(18.1%) and 1(4.5%) patients respectively. None of the samples were found to be positive for HSV, HCMV, rubella and EBV antibodies. Controls were negative for all the viruses tested. The difference in seropositivity between the patient and control group was not statistically significant (p>0.05). Thus, this study suggests that otosclerosis is not commonly associated with a systemic viral infection.

Perception of final-year medical students about skills attainment in a new medical school of Nepal.

Abstract: The competence of clinical and procedural skills possessed by medical students on graduation have received considerable importance in recent years. This questionnaire-based study was conducted at B.P. Koirala Institute of Health Sciences, Dharan, Nepal with an aim to assess the perception about clinical and procedural skills attainment by final-year medical students in a new medical school of Nepal. Fifty-nine final year MBBS students were interviewed using a set of questionnaire related to the experience gained by the students in relations eight clinical and twenty procedural skills. The perception about the level of attainment was good for most of the clinical skills and for few procedural skills, for example, using an auroscope and ophthalmoscope. The level of attainment was very poor in inserting the flatus tube, aspirating pleural and ascitic fluids, performing lumbar puncture, administering enema and giving subcutaneous injection. The perceived confidence in giving intravenous injection, inserting venflons, catheterizing urinary bladder, performing ambu bag and mask ventilation, proctoscopy and suturing of superficial wound was greater than the level of practical experience. The practical experience was more in doing venesection but the perceived confidence was poor in it. The final year medical students had mastered most of the clinical skills but not all procedural skills equally. Those skills in which they are not competent must be acquired during internship. Training in these skills needs to be reinforced by establishing a skill laboratory.