Showing papers in "Nepal Medical College journal in 2006"

Study of depression among geriatric population in Nepal.

Abstract: Depression is one of the commonest psychiatric disorders among the elderly patients attending the outpatient department of the tertiary care hospital. The consequence of unrecognized and untreated depression in the elderly population may include excessive use of health care services, decreased treatment compliance and increased morbidity and mortality related to underlying medical illness and from suicide. The aim of the study is to estimate the prevalence of depression according to Geriatric Depression Scale (GDS) and to find out the association of GDS with ICD-10 Diagnostic Criteria for Research (ICD-10 DCR) among older adults in the Nepalese population. A study group of 100 elderly patients aged 65 years and above were randomly selected from the psychiatry, medicine and general practice outpatient departments of Tribhuvan University Teaching Hospital, Nepal. MMSE scale is administered and the patients scoring more then 24 were administered the GDS and clinical diagnosis was made according to ICD-10 DCR. 53.2% of the samples were found to experience depressive illness according to GDS which includes 34.2% of mild and 19% of severe depression. 83.3% of the patients diagnose with probable depression with GDS were also diagnose clinically with ICD-10 DCR (p<0.001). This study concludes that significant number of elderly patients attending OPD of tertiary care hospital suffers from depression and GDS is a reliable tool to screen depression in the Nepalese patients.

Retrospective analysis of stroke and its risk factors at Nepal Medical College Teaching Hospital.

Abstract: Stroke is a major public health burden worldwide and is responsible for a large proportion of disability; and ranks third in the causation of morbidity and mortality. This disease although regarded as a disease of old age, it is not uncommon in younger population in developing countries.. A retrospective study of cerebro-vascular accidents (stroke) managed at Department of Medicine, Nepal Medical College Teaching Hospital during the period of 1st April 2000 to 31st March 2005 was done to study demographics and risk factors. Cases of TIA were not included in the final analysis of the data due to uncertainty of diagnosis and lack of imaging (CT scan). The collected data was analyzed using data analysis software SPSS (version 12). We identified 72 cases of stroke excluding TIA. The mean age at which patients in this study experienced their first ever stroke was 61.7 yrs (SD 14.9 yrs). The commonest presenting complaints in our study population were weakness of limbs (90.3%), slurring of speech (33.3%), altered mental status (29.8%), deviation of angle of mouth and headache (22.2%) each and urinary incontinence (13.9%). Vomiting, dizziness, fever, personality changes, seizure, tingling sensation of limbs were uncommon clinical presentation and were present in 15.28% of cases. Risk factors were smoking (58.3%), hypertension (47.2%), alcohol (41.4%), atrial fibrillation (12.5%) and diabetes mellitus (11.1%). To conclude, stroke in countries like Nepal is a public health problem. The clinical presentations and risk factors are in agreement with other studies. The low mean age of stroke patient reflects demographic feature of this region.

Ocular morbidity among children studying in private schools of Kathmandu valley: A prospective cross sectional study.

Abstract: A prospective cross sectional study of students of two private schools was done and students were screened in detail. A total of 1816 students aged 5 to 16 years were evaluated, out of which 52.8% were males and 47.2 % were females. Among the total, 65.8% had no ocular abnormalities and 34.2% had some form of ocular disorders. Refractive error was the commonest problem seen accounting for 21.9% out of total, followed by infective disorders, which accounted for 7.2%, 3.5% of them were noted to have Orthoptic problem including various types of strabismus, 2.2% were color blind, 2.6% were found to have various other disorders. The prevalence of refractive error among private school children seems to be higher. Color blindness also seems to be prevalent among these children. This kind of school screening would help in detecting the eye problems timely and thus would reduce the ocular morbidity as well as prevent children from going blind unnecessarily.

Intestinal parasitosis among the elderly people in Kathmandu Valley.

Abstract: Present study was carried out among the elderly people (60+ years of age) from August 2005 to July 2006 in Kathmandu Valley to assess the prevalence of intestinal parasitosis in them. Stool samples were collected from 235 elderly people (122 from government elderly home, 66 from private elderly home and 47 from the households in a rural community). The samples were examined by formal ether sedimentation and Sheather's sucrose floatation followed by Kinyoun's modified Ziehl-Neelsen staining. The overall prevalence of intestinal parasites was found to be 41.7%, out of which 30.6% had multiple parasitism. The government elderly home had significantly higher parasitic prevalence (50.8%) followed by the rural community (46.8%) and the private elderly homes (21.2%) (P 0.05). There was equal infection rate with protozoa (25.8%) and helminths (27.0%). Trichuris trichiura (39.4%) and Entamoeba histolytica (19.7%) were the commonest helminth and protozoa, respectively.

Onychomycosis in eastern Nepal.

Abstract: Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.

De Ritis ratio as diagnostic marker of alcoholic liver disease.

Abstract: Patients suffering from Alcoholic Liver Diseases (ALD) are often diagnosed by spectrum of physical manifestations and laboratories abnormalities. Among biochemical abnormalities De Ritis Ratio (AST/ALT ratio) is more sensitive during any phase of the disease. This ratio is based on common tests of liver function test and can be investigated in any laboratory and is more relevant in countries like Nepal where alcohol abuse is a major cause of liver disease. Clinically diagnosed 103 ALD cases and 73 healthy controls were enrolled for the study. Selected parameters of liver function tests were analyzed by Vitalab Selectra-2 autoanalyser using Merck diagnostic kits and statistically analyzed by student "t" test. The De Ritis ratio was calculated from serum AST and ALT values and was found 2. 30:1 in patients compared to of 1.10:1 in control group. AST and ALT value showed mild to moderate elevation as it was 124.80 +/- 86.24 IU/L and 54.21 +/- 39.72 IU/L in patients compared to 35.00 +/- 23.49 IU/L and 31.48 +/- 17.79 IU/L in controls. The increase in AST and ALT level in patients was statistically significant (p or = - Glutamyl Transferase showed 425.26 +/- 36.40 IU in alcoholics compared to 70.55 +/- 27.35 IU/L in controls, a significant increase observed (p 2:1, supported by reversal of Albumin/globulin ratio facilitates the diagnosis.

Assessment of carotid artery dimensions by ultrasound in non-smoker healthy adults of both sexes.

Abstract: UNLABELLED Assessment of carotid artery lumen diameter and intima-media thickness is becoming as a surrogate marker of early evaluation of cardiovascular disease. Present study aims to describe the normal carotid dimensions in healthy adults of both sexes. A total of 123 healthy volunteers including 65 men and 58 women, aged 21 to 60 years (mean +/- SD; 35.66 +/- 8.84 years) were studied. Ultrasound study of both carotid arteries were performed with a 7.5 MHz linear array transducer. Common carotid artery lumen diameter ranged from 4.3 mm to 7.7 mm. Difference was not noted between left and right common carotid artery lumen diameter (5.78 +/- 0.57 mm and 5.86 +/- 0.66 mm), and internal and external carotid artery lumen diameter as well. Both left and right common carotid artery, internal and external carotid artery lumen diameter tended to be larger (p < 0.05) in men than women. Common carotid artery intima-media thickness ranged from 0.4 mm to 0.8 mm. Difference was not noted between left and right common carotid intima-media thickness when separately analyzed among men, women and the entire population. Difference was also not noted in comparison between men and women. CONCLUSION Common carotid artery and internal and external carotid artery lumen diameter tends to be larger in men than women among young adults. There is no difference between left and right carotid artery lumen diameter. Common carotid artery intima-media thickness is similar in comparison between left and right and both sexes.

Seasonal variation of skin diseases in Nepal: a hospital based annual study of out-patient visits.

Abstract: The aim of this study was to determine whether there was seasonal variation in skin diseases amongst dermatology out-patients in Nepal. A retrospective study was done of all new out-patients visiting a single dermatologist, at the Om Hospital and Research Center, Kathmandu, Nepal. The study population comprised all new patients visiting the dermatology out-patient department, between January and December, 1999. Data were obtained from the hospital out-patient records and analyzed. The total number of patients with skin diseases was 1746 (Males-793; Females-953). Majority (28.6%) of the visits was in spring and the three most common diagnoses included fungal infections, acne and melasma. All skin diseases showed statistically significant seasonal variation. It is clear that occurrence of certain skin diseases in Nepal show a significant seasonal trend.

Percutaneous transvenous mitral commissurotomy.

Abstract: Two hundred patients underwent Percutaneous transvenous mitral commissurotomy (PTMC) from January 2003 to July 2004. Seventy four percent of the patients were female. Age ranged from 10 years old to 61 years and mean age was 29 years. Twenty three percent of the patients were under 21 years of age. Atrial fibrillation was present in 32.0% of the cases. Mean mitral valve area increased from 0.90cm2 (+/- 0.14) to 1.82cm2 (+/- 0.21) (p = 0.018). Left atrial mean pressure decreased from 21 mmHg mean to 7 mmHg. Subjective improvement was reported in 98.0% of the patients immediately after the procedure. There was no mortality during the hospital stay or within the first month of the procedure. Significant mitral regurgitation of grade 3 was noted in 5 patients. Two developed severe mitral regurgitation. The complications were negligible. One had systemic embolisation during the procedure which recovered over a period of time. One developed deep vein thrombosis which recovered after treatment.

Stroke: a case series study in Nepal Medical College Teaching Hospital.

Abstract: Stroke is a major public health burden worldwide. Prevention programme are essential to reduce the incidence of stroke and to prevent the all but inevitable stroke epidemic, which will hit our population (developing countries) hard as our population age and adopt lifestyle of the more developed countries. In this study we have tried to find the clinical characteristics of the stroke patients admitted in NMCTH and the commonest risk factors and its magnitude in our population. In these retrospective clinical case series study, we included the cases which were admitted in NMCTH over the past 2 years (from 1st April 2003 to 31st march 2005). All these patients were confirmed cases of stroke (CT scan was done in all these cases). Clinical profiles of all these patients were studied and analyzed using SPSS 11.0 version software. Seventy two patients were diagnosed as having cerebrovascular accident. The mean age of the patients having stroke in our study was 61 years. The commonest symptom was unable to move one side of the body (90.0%), other common symptoms were slurring of speech (33.0%), loss of consciousness (29.0%), headache (23.0%) and deviation of mouth (22.0%). 70 patients (97.0%) had 2 or more than 2 symptoms (i.e. multiple symptoms). Smoking (61.0%), hypertension (60.0%) and atrial fibrillation (8.0%) were the commonest modifiable risk factors, while increased age (mean 61 years) was the commonest nonmodifiable risk factor. Ischemic stroke (68.0%) was common than hemorrhagic (32.0%) stroke. In this study we found that smoking and hypertension was the commonest risk factor in our study group. Atrial fibrillation (8.0%) and diabetes mellitus (8.0%) were among the less common risk factors, whereas alcoholism and hypercholesterolemia were negligible in our study population. Multiple clinical features are common with unable to move the one side of the body being the commonest. The commonest form of stroke detected in our study group was ischemic type which is comparable to the study done in the past. Despite of these findings a bigger epidemiological study is needed to generalize this view over our community.

Knowledge, attitude and practices of mothers regarding home management of acute diarrhoea in Sunsari, Nepal.

Abstract: In Nepal, 45,000 children less than five years age die due to diarrhoea annually. Home management of diarrhoea is the hallmark of control of diarrhoeal diseases program in Nepal, which also aims to increase the correct use of Oral Rehydration Solution (ORS) by mothers, so mothers play a great role in the reducing the morbidity and mortality of children. The aim of the study was to assess knowledge, attitude and practices of the mother regarding home management of acute diarrhea in their children. The list of 330 children on Plan 'A' treatment was prepared at 11 peripheral health institutions of Sunsari district. Their identification data were recorded by health workers. The mothers were interviewed by the same health worker at the time of home visit after 24 hrs to know the improvement in the child and also preparation and use of ORS. Majority (97.6%) of the mother had information about ORS and also its usefulness in the management of dehydration due to diarrhea. Fifty percent mothers could make ORS properly and gave ORS to their children ideally (after each stool). The correct preparation and ideal use of ORS have not reached in proper way to the mothers of Sunsari district. Use of ORS definitely lowers the mortality due to dehydration, an effect that can clearly be seen in the short term. Intervention such as increasing women's literacy, improving basic sanitation and health care services, and raising the general nutritional status of the population can only be expected to decrease the diarrhoeal diseases morbidity and mortality in long term.

A profile of ectopic pregnancy at nepal medical college teaching hospital.

Abstract: A retrospective study of ectopic pregnancy at Nepal Medical College Teaching Hospital between January 2001 to June 2006 was carried out to determine incidence, demographic features, clinical presentation, duration at presentation and treatment, and the management protocol. A total of 36 cases of ectopic pregnancy were treated giving the incidence of ectopic pregnancy of 10.2/1000 deliveries and 7.3 /1000 pregnancies. The mean age is 30.1 years (range 23-45 years) and the mean parity is 1.2 with nulliparous at 49%. The mean gestational age is 6.9 weeks (range 5-11 weeks). Among the ethnicity, Mongolians constituted at 54.6%. The commonest risk factors present were infertility (33.3%), previous ectopic pregnancy (16.7%), pelvic inflammatory disease (13.9%) and tubal surgery (13.9%). The commonest symptoms at presentation are abdominal pain (94.4%), amenorrhea (72.2%) and abnormal vaginal bleeding (58.3%); and commonest signs were abdominal tenderness (91.7%), adnexal tenderness (72.2%) and cervical excitation (50.0%). The mean time from symptom to treatment was 176.58 hours and mean time from admission to treatment was 12.88 hours. Ectopic pregnancy was correctly diagnosed clinically in 85.0% patients including 42.5% (12/36) of ruptured ectopic pregnancy. Abdominal ultrasound and urinary â-hCG tests (ELISA test) were additional diagnostic tools. Sixty one percent (22/36) presented in subacute condition. Two cases (5.6%) were presented late causing diagnostic problem and more morbidity like anaemia, blood transfusion, adhesion needing major operations. Salpingectomy is the mainstay of treatment. Only one case has conservative surgery. Late presentation and ruptured ectopic pregnancy is associated with increased morbidity and mortality. High index of suspicion and early recourse to laparotomy save the life from this obstetric disaster.

Evaluation of anti-inflammatory activity of Calotropis gigantea (AKANDA) in various biological system.

Abstract: To evaluate the effect of Calotropis G in various experimental animal models. The anti-inflammatory activity was evaluated using carrageenin-induced kaolin -induced rat paw oedema for acute and cotton-pellet granuloma, adjuvant-induced arthritis model for chronic inflammation. Antipyretic activity was carried out using yeast induced pyresis method. Phenylquinone--induced writhing method in mice was used for analgesic activity. Test compounds exhibited variable anti-inflammatory activity and peak activity of the test compounds were reached at 2 h. Alkaloid fraction possesses comparatively high initial anti-inflammatory activity. The residual anti-inflammatory activity of alkaloid fraction of Calotropis G suggest either a greater protein binding nature of the compound there by providing a slow released pool of active drug molecule in the system or non available of possible bioactive metabolites to retain the activity profile relation.

Trend of blood group distribution among the different ethnic groups of Kathmandu Valley.

Abstract: This study was undertaken to find out the trend of blood group distribution (ABO and Rh) among the 1310 Nepalese attended in Tribhuvan University Teaching Hospital and Nepal Medical College Teaching Hospital Kathmandu. The frequency of distribution of A, B, AB and O was 28.5%, 27.3%, 8.7% and 35.5% respectively. Only 0.8% of them were found to be Rh (-) ve. In this population of study, O (+) ve blood group was found to be predominant among the Brahmins, Magars and Gurungs. A (+) ve blood group was predominant among the Chhetris, and B (+) ve among the Sherpas and the Lamas.

Intestinal parasitic infections among HIV seropositive and high risk group subjects for HIV infection in Nepal.

Abstract: Present study was carried out to find out the prevalence of intestinal parasites in HIV seropositive (HIV+) subjects and high risk group (HRG) for HIV infection in Nepal. A total 196 (HIV+: n = 112; Age: 16-52 years and HRG: n = 84; Age: 16-39 years) individuals were included. Stool specimens were examined by direct smear, formal-ether sedimentation, Sheather's sucrose floatation and Kinoyun modified Ziehl-Neelsen methods. Overall prevalence of intestinal parasites was 35.7% (70/196) (26.7% in HIV+ subjects and 47.6% in HRG subjects). Trichuris trichiura was the commonest parasite in HIV+ subjects (50.0%), whereas hookworm was most common among HRG subjects (56.8%). There was an association of parasitic infections with the gastrointestinal tract symptoms in both the study subjects. Tibeto-Burmans study subjects had marginally higher prevalence than Indo-Aryans study subjects (P > 0.05). Multiparasitic infections were relatively more common among HIV+ subjects (7.2%) in comparison to HRG subjects (4.8%). Similarly the protozoan infections were relatively higher in HIV+ subjects (4.5%) compared with HRG subjects (1.2%). The opportunistic protozoa Cryptosporidium parvum was detected only in 5.2% HIV+ subjects.

Assessment of proteinuria as a marker of nephropathy in type 2 diabetes mellitus.

Abstract: This is a cross sectional hospital based study carried out at Om Hospital and Research Center Kathmandu, Nepal. In the study, 200 diabetic patients attending the hospital were taken as the subjects and we evaluated the urinary albumin excretion and other biochemical parameters (such as creatinine, total cholesterol, HDL cholesterol, LDL cholesterol), blood pressure and body mass index (BMI). Among these 200 patients with type 2 diabetes mellitus (DM), 52.0% were having high blood pressure. The proteinuria was present in 23.0% of the overall subjects but when it is categorized in hypertensive and non-hypertensive group, 30.7% of the diabetic patients with hypertension were having proteinuria. It has been found that males were having higher prevalence ofproteinuria (53.8%) than female (17.6%). There was significant difference in systolic blood pressure, diastolic blood pressure in nephropathy and without nephropathy group. Thus the nephropathy or the incidence of proteinuria was associated with obesity, high diastolic blood pressure and male sex. These data suggest that control of diabetes; hypertension should decrease the risk for proteinuria thus decreasing end stage renal disease (ESRD) and mortality from ESRD.

Retinoblastoma in Nepal: a clinical profile of 30 cases.

Abstract: To determine the clinical profile of retinoblastoma and to provide baseline data for further studies on this subject. Prospective evaluation of 30 consecutive patients with retinoblastoma admitted at the B. P. Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal, between October 1998 and July 2000 was carried out. Age, sex, laterality and time from onset of symptoms to diagnosis (lag time) were noted. Ancillary tests were undertaken to rule out metastasis. Male to female ratio was 1.1:1 and the median age of presentation was 3.1 years. Of 30 cases, 23 (76.6%) had unilateral involvement. Leukocoria was the presenting sign in 13 cases (43.3%) and fungating mass in 10 cases (33.3%). In 11 (36.7%), the latency period from onset of symptoms to diagnosis was 6-12 months. In bilateral cases, advanced disease was treated surgically and the fellow eye was treated with cryotherapy, photocoagulation and chemotherapy. Histopathological examination of 21 (70.0%) enucleated/exenterated cases revealed a poorly differentiated type of retinoblastoma. This is the first study of retinoblastoma from Nepal. Early diagnosis of this disease when it is localized to the eye is important to salvage the life of the child. An informational program directed toward the public in general, as well as careful screening of any white pupillary reflex by the pediatrician and/or primary health worker will encourage and support early diagnosis.

Serum concentration of testosterone, epididymal mast cell population and histamine content in relation to sperm count and their motility in albino rats following H2 receptor blocker treatment.

Abstract: H2 receptor blocker treatment over a period of 2 weeks had been found to cause significant reduction in epididymal tissue mast cell population and tissue histamine content in caput, corpus and cauda regions in albino rats. There was also a highly significant fall of serum testosterone level and sperm count in these segmental fluids collected by micropuncture. The motility of sperms was also greatly reduced and the number of abnormal spermatozoa was found to be increased, the increase being highly significant in the caudal segment. In view of histamine being involved in steroidogenic activity, it appears that reduction in epididymal tissue histamine content following H2 receptor blocker treatment had caused low availability of testosterone to the tissues and thereby the reduction in sperm count and their motility. Increase in number of abnormal sperms particularly in the caudal epididymis is likely to be due to malformation and increased destruction of sperms, because of alteration in epididymal environment due to fall in serum testosterone concentration.

Epigastric mass in a young girl: trichobezoar. Imaging diagnosis.

Abstract: A 16-year old girl presented with a history of abdominal pain, lump in epigastrium since one year. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. Upper GI endoscopy showed a large intragastric mass composed of hair. The CT scan showed a gastric mass extending to the duodenum. She was managed by surgical removal. A large gastric trichobezoar extending upto the jejunum was found. This case highlights the characteristic radiological appearance on barium, ultrasound and computed tomography of a bezoar within the stomach and a trichobezoar with a long tail extending upto the jejunum without intestinal obstruction is unusual.

Kikuchi-Fujimoto disease: a rare cause of cervical lymphadenopathy.

Abstract: Kikuchi-Fujimoto Disease (KFD) is a self-limiting, necrotizing, histiocytic lymphadenitis (NHL) of unknown etiopathogenesis. So far in Nepal not a single case of this disease in the cervical region leading to progressive inspiratory stridor has been reported till date. Here a case of 26 years old Nepalese house wife suffering from this disease, which is histopathologically proved as KFD with complete recovery is presented.

Overview of cases and prevalence of jaundice in neonatal intensive care unit.

Abstract: This study was undertaken to know the pattern of jaundice prevalent among the babies admitted at the Neonatal Intensive Care Unit (NICU) of the B. P. Koirala Institute of Health Sciences (BPKIHS). A total of 293 neonates including 201 (68.6%) males and 92 (31.4%) females were admitted over a period of one year (15th June 2001 to 14th June 2002). Prematurity (30.0%), birth asphyxia (29.0%), neonatal septicemia (25.9%) and respiratory distress (23.9%) were the most common reasons for admission to the NICU. There were 42 cases of neonatal jaundice, among which babies born to primigravidae (59.5%), exceeded those born to multigravidae (40.5%). Pathological jaundice was found in 64.3% of the admitted cases of neonatal jaundice. Prematurity (33.3%) and neonatal septicemia (25.9%) were the most common causes of pathological jaundice, while prematurity with neonatal septicemia (14.8%), ABO incompatibility (11.1%), Rh incompatibility (7.4%) and prematurity, neonatal septicemia and ABO incompatibility combined (7.4%) accounted for the remaining cases of jaundice. A more detailed study related to the pathogenesis of jaundice among neonates is needed for the prevention of this disease in them.

Knowledge attitude and practice (KAP) study regarding facts for life.

Abstract: This knowledge attitude and practice (KAP) study was done in the married women of age 18-38 years in Jorpati and Gokarna village development committees of Katmandu district to evaluate the knowledge of "Facts for Life". There were 510 married women involved in this study. Altogether 28 questions were asked to each of them regarding the "Facts for Life". It includes the following five subjects: Safe motherhood, Childhood Immunization, Childhood diarrhea, Acute Respiratory Infection (ARI) in childhood and hygiene. There was a significant increase in knowledge about hygiene and knowledge regarding childhood immunization than diarrhea, ARI and Safe motherhood. Results showed that the overall knowledge was at 62.8%. This shows that still more attention is needed to Nepalese women.

Vaginal hysterectomy vs abdominal hysterectomy.

Abstract: This was a prospective study, conducted to analyze the intraoperative complications, postoperative morbidities and complications between abdominal and vaginal hysterectomy. This study was carried out on 100 patients (50 cases abdominal and 50 cases vaginal hysterectomy), in Services Hospital, Lahore in the year 2002 from April to December. Among the intraoperative observation, the mean duration of surgery of abdominal hysterectomy was 96.8 min and that of vaginal was 89 min (p=0.0192). The mean blood loss in abdominal hysterectomy was 311 ml and that in vaginal hysterectomy was 244ml (p=0.0017). Postoperatively febrile morbidity was seen in 10 (20.0%) cases of abdominal hysterectomy group and 6 (12.0%) of vaginal hysterectomy group. Wound infection was the main cause for febrile morbidity in abdominal hysterectomy group where as urinary tract infection was the main cause for febrile morbidity in vaginal hysterectomy. There was one case of bladder injury and 1 case of ureteric injury in abdominal hysterectomy group while none in vaginal hysterectomy group. There were 2 (4.0%) cases of postoperative haemorrhage in abdominal hysterectomy group and none in vaginal hysterectomy group. Vault infection occurred in 2 (4.0%) cases of both the groups. Two (4.0%) cases of paralytic ileus, 2 (4.0%) cases of chest infection and 1 (2.0%) case of rectal muscle hematoma were seen in abdominal hysterectomy group. Overall 39 (78.0%) cases of abdominal hysterectomy and 1 (32.0%) case of vaginal hysterectomy had complications (p=0.0002). This study showed that vaginal hysterectomy was associated with less intraoperative complications and postoperative morbidities and complications as compared to abdominal hysterectomy.

First case of cutanous leishmaniasis in Nepalese patient.

Abstract: Visceral Leishmaniasis (VL) is a serious disease caused by Leishmania donovani (LD) complex and prevalent in the temperate and tropical zones of the earth. VL, endemic in the southern plains of the 14 districts in the Terai region of Nepal, is considered a major public health problem. Cutanous leishmaniasis (CL) is prevalent mainly in the tropics and subtropics, affects nearly 1.5 million people worldwide. No reported cases of CL have been identified in Nepal until now. We report the first case of CL in a Nepalese patient.

Spectrum of stones composition: a chemical analysis of renal stones of patients visiting NMCTH.

Abstract: A general observation of clinicians suggests that the prevalence ofurolithiasis is fairly high in Kathmandu but so far no systematic study has been undertaken here to explore the etiopathogenesis of disease in this region. In this preliminary communication, we present herewith the qualitative composition of 47 renal stones collected from surgical patients admitted to NMCTH over a period of 13 months (July 2005 to July 2006). All stones were of mixed type. Calcium was present in all stones. Oxalate, phosphate and uric acid were present in 95.7%, 87.2% and 34.0% patients respectively. The probable composition, as construed from analysis, suggests that calcium oxalate stones are predominant. Strikingly, the prevalence was very high in e"20 yrs age group.

Unusual venous drainage of face: a case report.

Abstract: Facial region has enormous blood supply. The maxillary vein, facial vein and superficial temporal vein are chief venous draining channels. There are numerous reports of unusual venous system of face, in the present case, retromandibular vein divides into anterior and posterior division soon after its formation, external carotid artery lying lateral to retromandibular vein, formation of common venous channel between internal jugular vein and anterior jugular vein where facial, lingual and submental vein drain.

Helicobacter pylori associated gastroduodenal problem among the Nepalese.

Abstract: Present study was undertaken during a period of eighteen months (April 2001 to October 2002) to see an association of Helicobacter pylori with the gastric problems among the Nepalese. This study comprised of 203 subjects (Males: 154 and Females: 49) aged 21 to 71 years with gastric problems. The biopsy samples taken from the stomach and duodenum using endoscope were tested for the presence of H. pylori by in-house rapid urease test (RUT) and culture. Representative samples were also tested by PCR. Of the total 203, 60 (29.5%) were RUT positive. Marginally high RUT positive rate was observed in males compared with females (P>0.95). Same was true with ethnic group with a marginally higher positive rate among Tibeto-Burmans compared with Indo-Aryans (P>0.05). Age-wise, higher incidence (34.4%) was observed in the age group of 36 to approximately 50 years followed by over 50 years (29.0%), and 21 to approximately 35 years (24.4%) (P>0.05). Both RUT and culture positive rate increased with the severity of the problem. RUT results were confirmed also by PCR. All RUT positive patients were given a full course of new triple therapy (combination of two antibiotics: Clarythromycin and Amoxycillin and a proton-pump inhibitor: Omeprazole) for two weeks followed by extended monotherapy with Omeprazole for up to six weeks. Of the total, 168 (82.7%) patients were available for follow-up and all of them showed an improved condition with negative RUT.

Evaluation of serum erythropoeitin response to anaemia in macroalbuminurics of diabetic and non-diabetic etiologies.

Abstract: This case-control study was undertaken in 75 subjects categorized into 3 equal groups (A: diabetic subjects with macroalbuminuria, B: non-diabetic subjects with macroalbuminuria and C; control subjects). Serum erythropoietin (EPO) was estimated and analyzed in relation to hemoglobin levels in the three groups. The Pearson's coefficient (r) for hemoglobin and log natural EPO was significant for groups A (0.01), B (0.05) and C (0.01). Linear regression analysis of hemoglobin and log natural EPO showed significant differences between the study and control groups; however no significant difference could be demonstrated amongst the study groups. Hence, it was concluded that an inadequate EPO production occurs in renal failure, which accounts for the anaemia and diabetes does not confer an additional discrepancy in this mechanism over non-diabetic macroalbuminuria.

Ganglioneuroma of pelvis--an unique presentation in a young man.

Abstract: Ganglioneuromas presented as a pelvic tumor around the pelvic organs is a rare entity. A case with unusual presentation is reported. Young man of 18 years old presented with a complaint of lower abdominal mass increasing in size for last 3 years. It was treated with partial resection for debulking purpose after the conformation during surgery with frozen section. Debulking surgery with preservation of organ functions is feasible in these slow growing tumors for better quality of life.

Reverse line probe assay for the rapid detection of rifampicin resistance in Mycobacterium leprae.

Abstract: Mutations in the rpoB gene of 40 biopsy isolates of Mycobacterium leprae were analyzed by reverse hybridization-based line probe assay after PCR, and nine distinct single-nucleotide substitutions were found. Among them, a 3-nucleotide substitution was found in two, and 2-nucleotide substitutions were found in seven isolates. This is a new finding of multiple mutations in a single point of the rpoB gene for rifampicin resistance. This investigation demonstrates that the pattern of mutations in the rpoB gene for rifampicin resistance in Nepal involves more variety.