Showing papers in "Nepal Medical College journal in 2007"

The prevalence of type 2 diabetes mellitus and impaired fasting glucose in semi-urban population of Nepal.

Abstract: The increase in life expectancy in developing countries and as a result of increasing obesity and other life style changes, the global incidence of type 2 diabetes mellitus (T2DM) is increasing. The purpose of this study was to investigate the prevalence of T2DM and impaired fasting glucose (IFG) in semi-urban population of Nepal and to compare the prevalence between men and women and among different age groups. A total 740 adults (286 men and 454 women) aged 21 to 94 years (men +/- SD; 45.6 +/- 15.6 years) were included. The prevalence of T2DM and IFG was 9.5% and 19.2% in the whole population. Prevalence of T2DM was higher in men (11.8%) then in women (7.9%), similarly IFG was noted higher in men (25%) then in women (15.4%0). The prevalence of T2DM and IFG was seen to be increased with age in the whole population. Among women, the prevalence of T2DM and IFG was 2.9% and 12.8% in 21 to 40 years age group, 9.7% and 13.8% in 41 to 60 years age group and 15.4% and 27.7% in > 60 years age group. Among men, it was 4.7% and 22.6% in 21 to 40 years age group, 13.3% and 30.5% in 41 to 60 years age group and 23% and 17.3% in > 60 years age group. To conclude, the overall prevalence of T2DM and IFG increases with age. Prevalence of IFG is highest among middle age men where as the prevalence of T2DM is highest among older men.

Initial exploratory observational pharmacology of Valeriana wallichii on stress management: a clinical report.

Abstract: Valeriana wallichii , an Indian medicinal plant, has been on trial for its role in stress disorders in hospital based clinical set-up. Hamilton’s Brief Psychiatric Rating Scale (BPRS) was used and thorough clinical investigations were carried out to screen the subje cts. Thirty-three subjects (20 male and 13 female; average age 34.2 years) were medicated with the plant extra ct in a fixed dose regime (500 mg/capsule, twice da ily, p.o. after meal). They were thoroughly investigated clinically and using standard questionnaires based on different psychological rating scale at baseline (d ay 0), mid-term (day 30) and final (day 60). The observations exhibited that, V. wallichii not only significantly (p<0.001) attenuated stress and anxiety, but also significantly (p<0.001) improved depression an d also enhanced the willingness to adjustment. Nevertheless it did not alter memory, concentration or attention of the volunteers. The results sugges t that V. wallichii may be useful in the treatment of stress related d isorders in human and may be a promising antistress agent in near future.

Study of anaemia in pregnancy and its outcome in Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

Abstract: Anaemia is the commonest problem in pregnancy in developing countries. It is defined by WHO as haemoglobin level less than 11 grams % in pregnancy. It is divided in to three degree mild degree (9.0-10.9 gm%), moderate degree (7.0-8.9 gm%) and severe degree(< 7.0 gm%). It carries a lot of threats to the mother as well as baby. This is a hospital based retrospective study done in Nepal medical college, teaching hospital (NMCTH) of Nepal among the women who came for regular antenatal check up and delivered in the same hospital as well. Total of 863 cases were recorded as complete record out of which 368 were anaemic and 495 were nonanaemic. The prevalence of anaemia was 42.6%. The birth weight, Apgar score at the time of birth, prevalence of preterm delivery and IUFD were more common in anaenic group than in nonanaemic group.

Prevalence of and factors associated with diabetic retinopathy among diabetics in Nepal: a hospital based study.

Abstract: Diabetic retinopathy is the one of the leading cause of visual impairment in world including Nepal. The objective of the study is to estimate the prevalence of and factors associated with Diabetic Retinopathy among diabetics in a Tertiary Eye Care Centre, Nepal. A hospital-based, cross sectional study, was conducted at Tilganga Eye Centre, Nepal. 371 consecutive subjects were recruited during a period of study. Ophthalmologist performed comprehensive eye examinations, which were reconfirmed by senior ophthalmologist. Diabetic Retinopathy was graded using the Early Treatment Diabetic Retinopathy Study. Total 371 consecutive diabetics were examined, mean of 57.4 years (SD 12.0) having the sex ratio of 0.72 male per female. The prevalence of Diabetic Retinopathy was 44.7% (166) with non-proliferative Diabetic Retinopathy presented 85.5% (142) and 14.5% (24) were proliferative Diabetic Retinopathy. Clinically significant macular edema was found in 19.2% (32). The age at onset of diabetes, duration of diabetes and hypertension were significantly associated with Diabetic Retinopathy (p = 0.05). The prevalence of Diabetic Retinopathy was within the range of previous studies with a high rate of proliferative diabetic retinopathy. Factors associated with diabetic retinopathy were similar to other developed countries. To prevent this condition of Diabetic Retinopathy, the coordination between physician and ophthalmologist needs to be strengthened.

Effect of methotrexate (MTX) administration on spermatogenesis: an experimental on animal model.

Abstract: An experiment was conducted to observe histomorphometric and cellular toxicity on rat testes after sixty days of methotrexate administration intraperitoneally (ip). Total 30 adult male rats were divided into one control and two experimental groups containing 10 rats in each group. Experimental groups received methotrexate in two different doses i.e 25 ig and 50 ig, whereas control one received normal saline intraperitoneally. At the end of the experiment, animals were sacrificed and testes were processed for paraffin sectioning and stained in haematoxylin and eosin. Further microscopic study of seminiferous tubules, interstitial spaces, primary spermatocytes and spermatids were carriedout. Results revealed decreased diameter of seminiferous tubules, increased interstiial spaces in experimental groups in dose dependent manner and found to be statistically significant (p < 0.05) as well as distortion of morphology of Leydig cells in experimental group. Therefore, it can be concluded that these qualitative and quantitative changes in male gonads may alter the reproductive performance of animals.

Oxidative stress in benign prostate hyperplasia.

Abstract: Benign Prostate Hyperplasia (BPH) is the common health problem in ageing male. Free radicals and reactive oxygen species (ROS) are produced more with advancement of age leads to oxidative stress. This study aims to assess Malondialdehyde (MDA), the marker of lipid peroxidation and vitaminic antioxidants e.g. alpha-Tocopherol (Toc) and Ascorbate (Asc) status in plasma of BPH patients. This is a case control study conducted in Department of Biochemistry in collaboration with Dept of Surgery, BPKIHS. Forty eight (n = 48) confirmed patients of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA, Asc and alpha-Toc were estimated. Plasma MDA level showed 4.81 +/- 1.87 nmol/ml in BPH patients compared to 3.69 +/- 1.56 nmol/ml in healthy controls (p < 0.001). There were significant decrease in plasma alpha-Toc and Asc level which were 0.85 +/- 0.12 mg/dl and 0.93 +/- 0.13 mg/dl in BPH patients compared to 1.37 +/- 0.31 mg/dl and 1.44 +/- 0.38 mg/dl in healthy controls respectively. Inverse correlation of plasma MDA with a- Toc (r = -0.09) and Asc (r = -0.51) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.

Soil transmitted helminthiasis in Kathmandu, Nepal.

Abstract: A total of 200 soil samples taken from different sites and 1,504 stool samples collected from school children (n = 188) and patients (n = 1,316) visiting the health care centres in Kathmandu Valley were included in this study. Soil samples were investigated for the presence of parasitic eggs using sucrose flotation technique. Stool samples were examined by formal-ether concentration and direct smear techniques. The contamination rate of soil with parasitic eggs and larvae was found to be 28.5% (57/ 200). The overall parasitic infection rates in school children and patients were 42.5% and 2.8%, respectively. Four types of parasites were detected from soil samples, of which Ascaris was the most common. Trichuris was most common among school children whereas Ascaris in patients. Females in both study groups had higher prevalence compared with male counterparts with significantly low rate in health care centre visiting patients (p < 0.05).

Study of low birth weight babies in Nepal Medical College.

Abstract: This was a retrospective study conducted to study the newborns weigth less than 2500gm delivered in Nepal medical college in the year 2005 and 2006. The cases were studied to find out the incidence and relation of maternal age, parity, gestational age, sex, etiological factors, mode of deliveries with Low Birth Weight (LBW) babies. There were 172 patients with LBW babies out of 1517 patient. Including the 9 twin babies, there were total 181 babies with LBW. Thus the incidence of LBW babies was 11.9%. There were only 26 (15.0%) under 20 years of age. As for parity, 92 (53.0%) were primigravida and 80 (46.0%) were multigravida. There were 6 (3.5%) of the babies less than 28 weeks, 22 (13.0%) between 29 to 32 weeks, 61 (33.7%) between 33 to36 weeks, 78 (43.1%) between 37 to 40 weeks and 14 (7.7%) 41 weeks or above. The babies under 1000gm or 1000 gms were 7 (4.1%),1001-1500 gms were 15 (8.7%), 1501-2000 gms were 40 (23.0%) and 2001-2500 gins were 119 (69.2%). Male babies were 94 (52.0%) and female babies were 87 (48.0%). Caesarian section was 15.7% remaining babies were delivered vaginally. Among the risk factor for LBW babies, spontaeneous preterm labour were 61 (35.5%), intra-uterine growth restriction were 51 (29.0%), antepartum haemorrhage 10 (5.8%), twin 9 (5.2%), pregnancy induced hypertension 12 (7.0%), preterm premature rupture of labour 8 (4.7%), anomalies were 4 (2.3%) and urinary tract infection were 20 (11.6%). Other infection were Typhoid 4 (2.3%) and chest infection 2 (1.2%). Thus the incidence of LBW babies in our hospital is quite high in comparision to the Western world and primigravida has more chance of delivering LBW babies. Spontaeneous preterm labour and intra uterine growth restriction are major risk factor leading to LBW babies. Urinary tract infection also plays important role in spontaeneous preterm labour. So to reduce the prevalence of LBW babies, we should identify in early the high risk pregnancy, taking more care to primigravida, treating clinical and subclinical infection in time to prevent spontaeneous preterm labour, diagonosing and managing the intra uterine growth restricted babies in time.

Chronic pain and cost: an epidemiological study in the communities of Sunsari district of Nepal.

Abstract: The purpose of the study was to find out the preval ence of chronic pain in economically active population and associated economic loss. This cross -sectional observational study was carried out in 3 VDCs of Sunsari District involving 1730 individuals of 15-64 years age group selected by multistage random sampling. Demographic data, absence or presence of pain, site, severity, duration and relieving measures, approximate expenditure in treating pain and number of days lost due to pain were noted using a preformed questionnaire. Out of 1730 indivi duals interviewed, 882 (50.1%) had pain of which 93.7% had chronic pain (pain lasting for >3 months) . Backache (25.8%), headache (20.1%) and abdominal pain due to acid peptic disease (12.5%) w ere the most prevalent painful conditions. About 14% of individuals had severe grade pain. Female se x, age �30years, lack of formal schooling, smoking habit and dependent status were associated with hig her prevalence of pain. Almost 19% of individuals with pain were unable to go to work the previous da y. Man-days loss due to pain was 1.37 days/ month/ person in the study population. In terms of cost, p ain related losses were Nepalese Rupees (NRs)1671.89/person/year as against the per capita GDP of NRs 98,640.00 (US$1370.0). The money incurred by individuals for therapy on pain was NRs 760.15/person/year. In conclusion, probably first time, we are reporting the prevalence of chronic pa in in our communities with people having to spend significant portion of their scarce income (and cou ntry’s GDP) to treat pain, thus, highlighting it as a public health problem.

The morphology of central tympanic membrane perforations.

Abstract: The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant Hearing loss in the study was found to range from negligible to 53dB Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss

The role of super oxidized solution in the management of diabetic foot ulcer: our experience.

Abstract: Dressing or Preparation of the diabetic foot ulcer is very essential not only to reduce or prevent inf ection but also for the preparation for definite surgery, if necess ary. Present article is about our experience in the evaluation of effectiveness of Super Oxidized Solution in local t reatment of diabetic foot ulcers. Out of 20 cases S uper Oxidized Solution helped in total healing in 8 cases, and pr epared wounds for definite cover by reducing infect ion and promoting granulations which are pre requisites for definitive surgery in remaining 12 cases.

Comparative study of cerebrospinal fluid adenosine deaminase activity in patients with meningitis

Abstract: Cerebrospinal fluid (CSF) adenosine deaminase (ADA) activity in tubercular meningitis (TBM) patients (n=20), non-tubercular meningitis (NTBM) patients (n=10) and non-tubercular non-meningitis (NTBNM) cases (n=15) were measured by the method based on Berthlot's reaction The mean CSF ADA activity in TBM (1362 +/- 845 IU/L) was found to be significantly higher as compared to NTBM (651 +/- 241 IU/ L, p<0001) and NTBNM (235 +/- 116 IU/L, p<00001) respectively The sensitivity and specificity of CSF ADA activity was 850% and 880% respectively at cut-off value of 697 IU/L to diagnose tubercular meningitis The specificity and sensitivity of CSF ADA for TBM was found to be 850% and 700% as compared to NTBM and 850% and 1000% as compared to NTBNM We propose that estimation of that ADA activity in CSF of TBM patients, using a cut off value 697 IU/L can diagnose differentially tubercular meningitis Since, most developing countries have the dubious distinction of having higher prevalence and incidence of tubeculosis and lack of well equipped laboratory services for proper diagnosis of tubercular meningitis, measurement of CSF ADA activity can be a better and reliable approach for the rapid diagnosis and management of tubercular meningitis vis a vis other types of meningitis

Mental and behavioral effects of parasitic infections: a review.

Abstract: Whether parasitic diseases-and in particular helminth infections because they are extensive and widespread--have an effect on mental functions and educational attainment is by no mean a new question. Concern about the possibility was evident in the early decades of the century, and the results of investigations designed to discover whether the effects of parasite infections had consequences on school children. Many species of helminth have been reported as causing infections in humans. Of the nematode infections, both soil transmitted helminthiasis and lymphatic filariasis are public health problem in the country. Any of these infections may result in morbidity, malnutrition, and iron-deficiency anaemia. Their possible contribution to impaired cognitive function and educational achievement is by the association between iron deficiency anaemia and malnutrition. Research on the effects of parasitic infection has focused on school-age children. Not only are these children the most vulnerable to parasitic infections--they are also the population group most likely to experience the impact of infection on cognitive function. This review paper discusses the mental and behavioral effects of parasitic infection on child's health. Infected children are less active; their behavior is said to be sluggish and both mental and physical activities and processes appear dulled and slow. A reduction in available energy is likely to cause a cascade of effects running through most aspects of the host's daily mental life and behavior.

A study of antibiotics used in adult respiratory disorders in Kathmandu and Bhaktapur.

Abstract: Respiratory tract infections (RTI) are one of the major causes of morbidity and mortality, in Nepal, because of the climate, living conditions and economic status of the people. This study was done to find out the pattern of respiratory tract infections in adults and pattern of antibiotics (AB) prescribed in them and to explore the most economical treatment of patients without compromising the quality of it. Three hospitals of Kathmandu valley and two hospitals of Bhaktapur were selected. Out of 118 patients of RTI in which AB were prescribed, 110 patients were randomly selected in this study. Among them 53.6% were male and 46.4% were female, 43.7% patients were smokers and 56.3% were non-smokers. The average costs of treatment of upper respiratory tract infections (URTI) were lower then lower respiratory tract infections (LRTI). The cost of treatment of chronic respiratory cases was highest.

Horseshoe kidney--a case report.

Abstract: The congenital anomalies of kidney are important as they may cause renal failure in middle age group. Horseshoe kidney is the most common fusion anomaly. It has been said to occur in every 400 births and is seen in approximately 1 out of 300 pyelographies. A horseshoe kidney was observed in a thirty-two yea r old male in the archives of the Department of Anato my, PGIMER, Chandigarh. The kidney was placed at lower level as compared to its normal position. The lower poles were fused to form the isthmus opposit e to the L4 vertebra. There was no extra renal anomaly. Relation of structures in hilum was normal on righ t side while on left side pelvis was anterior to vein and artery. The right and left renal arteries arose as usual as lateral branches of the aorta just below the level of superior mesenteric artery. Two accessory renal arteries originated from the ventral aspect of aorta just ab ove the isthmus. Right kidney was drained by three renal veins directly into the inferior vena cava while th e left kidney was drained by a renal vein which had three tributaries outside the hilum. The right kidney ap peared normal under the light microscope while in t he left kidney, glomeruli were decreased and glomerular space appeared more. Some of the glomeruli appeared atrophied and filled with eosinophilic material. Th e horseshoe kidney has been estimated to be occurri ng in 0.2% of the general population and is more common in men.

An evaluation of musculoskeletal disorder and socioeconomic status of farmers in West Bangal, India.

Abstract: Rice cultivation contains several tasks and workers were compelled to adopt some harmful and awkward posture during performing those tasks. These type repetitive jobs may be related to occupational health hazards like musculoskeletal disorder (MSD). In the present investigation different MSD related problems of the workers have been assessed and also identify the socioeconomic status of the farmers considering the issues of community health development. In this connection a simple and easily applicable questionnaire technique has been apply in the agricultural field during performing rice cultivation tasks. The results showed that a large number of workers could not complete their primary education (33.0% to 43.0%) and remained below the poverty line (91.3%). From the MSD assessment lower back problem was prevalent (48.8%) among the workers when all rice cultivation tasks were consider together, but it was extremely prevalent in reaping job (92.0%) and transplantation job (84.0%). It was concluded that MSD among the workers might be related to the stressful work posture, long duration jobs, nature of jobs and use of ill-fitted hand tools. So, some free-hand exercise, proper work-rest scheduled and awareness program may be helpful for reducing the MSD and proper handling of hand tools.

An evaluation of training of teachers in medical education in four medical schools of Nepal.

Abstract: Effective teaching is a concern of all teachers Therefore, regular teachers' training is emphasized globally B P Koirala Institute of Health Sciences (BPKIHS), a health science deemed university situated in eastern region of Nepal has an established Medical Education unit which attempts to improve teaching-learning skills by training faculty members through organizing regular medical education training programs The aim of the present study was to assess the effectiveness of 3-day training workshop on "Teaching-learning methodology and Evaluation" held in four different medical colleges of Nepal The workshop was targeted at middle and entry level of health profession teachers who had not been previously exposed to any teacher's training program The various components, such as teaching-learning principles, writing educational objectives, organizing and sequencing education materials, teaching-learning methods, microteaching and assessment techniques, were incorporated in the workshop A team of resource persons from BPKIHS were involved in all the four medical institutions The collection data had two categories of responses: (1) a questionnaire survey of participants at the beginning and end of the workshop to determine their gain in knowledge and (2) a semi-structured questionnaire survey of participants at the end of workshop to evaluate their perception on usefulness of the workshop The later category had items with three-point likert scale (very useful, useful and not useful) and responses to open-ended questions/ statements to document participants general views The response was entered into a spreadsheet and analyzed using SPSS The result showed that all participants (n = 92) improved their scores after attending the workshop (p < 0001) Majority of respondents expressed that the teaching-learning methods, media, microteaching and evaluation techniques were useful in teaching-learning The workshop was perceived as an acceptable way of acquiring teaching-learning skills but 394% participants expressed that the duration of the workshop was too short The overall impression about trainers was very positive Therefore, regular organization of such workshops with addition of new advances in medical education would be highly beneficial to improve teaching learning skill of medical teachers

Serum nitrite level and adenosine deaminase activity is altered in visceral leishmaniasis.

Abstract: In this study we sought to determine if there is al teration in nitric oxide (NO) production and adenos ine deaminase (ADA) activity among patients with visceral leishmaniasis (VL) and the effect of four weeks of chemotherapy on these levels. Fifty-three VL patien ts diagnosed clinically and by direct demonstration of the LD bodies in the bone marrow smear were studied. They were treated with Sodium Stibogluconate and sampled at the baseline and four weeks. Forty-three healthy indivi duals coming from the same endemic area were taken as control. Total nitrite (NO 2 - and NO 3 - ) as an index of NO production and ADA activity was measured spectrophotometrically. Serum nitrite level decreas ed significantly in patients as compared to the hea lthy individuals but significantly increased following 4 weeks of chemotherapy. Conversely, Increased ADA activity was observed in the beginning of treatment and decr eased significantly with successive 4 weeks of chemotherapy. It seems a negative correlation between NO level an d ADA activity. This result indicates parasite indu ced evasion of NO and activation of T lymphocytes during immunopathogenesis of VL. Therefore, assessment of NO metabolites may be useful marker in the evaluation of the effector mechanism of macrophages and clinic al manifestation of patients.

Prevalence of refractive error in mentally retarded students of Kathmandu Valley.

Abstract: Mental retardation also known as 'mentally handicap' means a delay or insufficient development of mental capacities. The prevalence of mental retardation in Nepal is 4.1%. Vision being the best sense for their education and daily activities, a cross-sectional and descriptive study was conducted to find out the refractive error among the students in the schools for mentally retarded people. A total of 134 clinically diagnosed cases of mentally retarded students from three different schools of Kathmandu Valley were examined. Distance visual acuity was taken with the help of Cat Ford Vision Drum, SG chart and Kay Picture Test method but first preference was given to SG chart. Cyclo-retinoscopy and fundus examination under mydriasis were done in all the cases. Examination revealed that more than half of the examined had one or more ocular disorders with refractive error being the most common type of ocular morbidity followed by ocular motility disorders. Refractive errors were found in 34.4% in which the most common type of refractive error was simple hypermetropia. In conclusion refractive error was seen commonly among mentally retarded people of Kathmandu Valley.

Antibiotic susceptibility pattern of urinary isolates in Imphal (Manipur), India.

Abstract: The present study was conducted to detect aerobic causative agents of urinary tract infection (UTI) and their antibiogram pattern. This study was carried out in the Department of Microbiology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. A total of 1,109 clean catched midstream urine samples were collected, out of which 459 (40.4%) samples grew potential pathogens causing UTI. Escherichia coli were the predominant 334 (72.8%) bacterial pathogen followed by Klebsiella species 66 (14.4%), non lactose fermenters 19 (4.1%), Pseudomonas species 16 (3.5%) and others. Most of the strains of E. coli were resistance to Ciprofloxacin whereas sensitive to Aminoglycoside. Most of the urinary isolates showed high degree of resistance to Tetracycline, Norfloxacin and Cotrimoxazole. Gentamycin was the drug of choice for most of the strains.

Histopathologic diagnosis of lymph node biopsies.

Abstract: This is a retrospective study of biopsies of lymph nodes received in the department of pathology, Nepal Medical College (NMC), from January 2004 to December 2005. Total number of lymph node biopsies during the two year period was 55, out of which 56.0% cases were females and 44.0% were males with M:F 1:1.29. Most common cause of lymphadenopathy was tuberculosis and most common group of lymph node was cervical lymph nodes. Metastatic deposits were seen in only six cases. So, like other developing countries, in our country also, tuberculosis is the leading cause for lymphadenopathy.

Diagnosis of subcutaneous cysticercosis in fine needle aspirates: a study of 10 cases.

Abstract: The objective of this study is to document the value of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of subcutaneous cysticercosis. Aspirates smears of 10 cases of subcutaneous swellings were studied over a period of 1 year between January 2004 and January 2005. The subcutaneous swellings were presented at different sites like cheek, neck, forearm, arm, chest wall and abdominal wall. In none of these cases was cysticercosis considered as diagnostic possibility. The characteristic cytomorphological features of parasitic tegument, parenchymatous portion, presence of epithelioid cells, giant cells and inflammatory cells in cytological smears help diagnose the cases of subcutaneous cysticercosis. Biopsy confirmation was possible in 5 cases, of which, two cases showed parenchymatous portion of the parasite. FNAC provides safe and rapid tool for diagnosis of subcutaneous cysticercosis. In endemic areas, cysticercosis should be considered one of the differential diagnosis of the subcutaneous swellings.

Treatment of inferior patellar pole avulsion fractures with pole resection and patellotibial cerclage wire.

Abstract: The ideal treatment for avulsion fractures of the inferior pole of the patella has not yet been identified. The options include internal fixation of the pole fragment and resection of the avulsed fragment along with the repair of patellar ligament to the patella. The purpose of the present study was to evaluate the result of pole resection with repair of patellar ligament with augmentation by patellotibial cerclage. We retrospectively studied 13 of patients who had operative treatment of an avulsion fracture of the inferior patellar pole by pole resection with trans-osseous suture fixation of the tendon to the patella and reinforcement of ligament patella with patellotibial cerclage wire. Thirteen patients who had had pole resection were followed for an average of 3 years. The average patellofemoral score (maximum, 100 points) was 88.8 points. Normal patellar height was found in thirteen patients. In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by transosseous suture fixation of the tendon to the patella and patellotibial cerclage after pole resection. The present study indicates that patellotibial cerclage can provide better clinical results and avoid prolong postoperative immobilization.

Intranasal midazolam Vs ketamine as premedication in paediatric surgical procedure for child separation and induction.

Abstract: In children pre-anaesthetic medications are frequently administered as pharmacological adjunctions to help alleviate the stress and fear of surgery as well as to ease child parental separation and promote a smooth induction. Oral, rectal, intravenous and intramuscular route has been used; however each route has its disadvantage. Pre-anaesthetic medication administered intranasal for avoidance of painful injection have made it a convenient way to pre-medication. To evaluate the efficacy of intranasal administered Midazolam 0.2 mg/kg and Ketamine 5 mg/kg respectively. Total 50 patients of ASA I and II of age group 1- 7 years, mean age 3.88 +/- 1.26 and 4.56 +/- 1.21 were included in group I and group II respectively, and Scheduled for elective surgery. Mean time of separation was 17.12 +/- 1.21 in-group I and 15.68+11.62 in group II with P value < 0.001 and 0.322, shows significant difference during time of separation from parents and no significant difference for i.v. line insertion in both groups.

Utility of phenotypic dermal indices in the detection of Down syndrome patients.

Abstract: Down syndrome (DS) is the most common cause of mental retardation. The frequency of DS patients is about 1:800 and is mainly because of the presence of extra copy of chromosome number 21. Dermatoglyphic has been well established as a diagnostic aid in number of diseases having hereditary basis. Dermatoglyphic data was obtained by the use of ink and prints on a paper, from 15 cytogenetically confirmed patients of Down syndrome attending to the genetic clinic at BPKIHS. The data were correlated and compared with equal number of controls. Dermatoglyphic prints were used to evaluate the variation in the fingerprint patterns, the presence of simian crease and the difference in 'atd' 'dat' and 'adt' angles between the control and the DS patients. The results showed that both the 'atd' and 'adt' angles differed significantly from the control group. The dactylography study revealed higher incidence of loops and lower incidence of whorls in the DS patients as compared with the controls. This method is non-invasive and cost effective. The observed changes in the 'atd' and 'adt' angles plus the fingerprint patterns in the dermatoglyphic study proved that this simple technique could be a valuable tool for selecting patients of DS for cytogenetics analysis.

Polymorphonuclear leukocyte function in type-2 diabetes mellitus patients and its correlation with glycaemic control

Abstract: Infection is an important cause of morbidity and mortality in diabetic patients. Chronic hyperglycaemia impairs host defense mechanism such as cell mediated immunity, polymorphonuclear leukocyte (PMNL) function, antibody formation etc. PMNL serves as bodies first line of defense against various infections. The present study was undertaken to establish a correlation between impaired PMNL function, blood glucose levels and its improvement with good glycaemic control with glibenclamide and glimepiride, with special reference to parameters such as respiratory burst and O2(-) and H2O2 production by diabetic neutrophils.

Rapid differentiation of Mycobacterium tuberculosis and Mycobacterium leprae from sputum by polymerase chain reaction.

Abstract: Differentiation of M tuberculosis and M leprae by polymerase chain reaction (PCR), when acid-fast bacilli (AFB) were present in sputum from patients at Anandaban hospital, was carried out. Thirty sputum samples microscopy positive for AFB were collected and were subjected to culture. Bacterial DNA was extracted and PCR was performed using primers specific for Mycobacterium tuberculosis and Mycobacterium leprae DNA. Twenty samples were from patients with clinical TB and 10 from patients with clinical leprosy. Fifteen of the TB samples were positive in both TB PCR and culture, among the reminders four were TB PCR negative and one was positive for TB PCR. All TB samples were negative for leprosy PCR. Of the leprosy samples, five were TB PCR and culture positive, and negative for leprosy PCR. The remaining five samples were negative for both TB PCR and culture but positive in leprosy PCR. Five often clinical leprosy samples were positive for tuberculosis. This indicates that AFB in the sputum of leprosy patients might be M. tuberculosis or M. leprae. Thus PCR can be used for rapid differentiation of M. tuberculosis and M. leprae present in sputum where AFB microscopy is inconclusive.

Study habits and attitude of medical students of basic sciences.

Abstract: Study habits and attitude for learning of Basic Medical Sciences amongst 133 students of first and second year MBBS course were analyzed (through questionnaires). The study revealed that the most of the students desired to be physicians to serve the patient/society. They preferred to learn more through self study (48.0%) and lecture classes (43.0%), less through group discussion (8.0%) and PBL (1.0%). Only 5.0% use to surf the internet regularly for their study matter and 79.0% students had never consulted any medical journals.

Ectopic partial intrahepatic gall bladder with cholelithiasis – A rare anomaly

Abstract: The study was aimed to view the developmental anomalies of gall bladder (GB) in Nepalese cadavers. Forty GBs were studied for any anomalies during routine cadaveric dissection at the Department of Anatomy, Manipal College of Medical Sciences, Nepal. The study found that the congenital anomalies of GB are very rare. Only one case of ectopic partial intrahepatic GB with cholelithiasis was observed, which to our knowledge is the first reported case in Nepal. Awareness of GB anomalies is important to surgeons, radiologists, and clinicians in general. An ectopic partial intrahepatic GB can make cholecystectomy hazardous, when indicated.

Role of serum fibrinogen in patients of ischemic cerebrovascular disease.

Abstract: Fibrinogen is an independent risk factor for coronary events in population-based studies and inpatients with coronary heart disease, but there is an uncertainty about its prediction for stroke, particularly in secondary prevention. In view of this uncertainty, study was conducted to establish the role of serum fibrinogen in ischemic stroke. Fifty six patients with acute ischemic stroke of less than 7 days duration were recruited for the study. Fourty two age and sex matched candidates served as control. Baseline characteristics and blood pressure were recorded at admission to hospital. Computer tomography head was done in all patients as per protocol. Sampling took place in the early morning (7-9 AM) using all necessary precaution and serum fibrinogen was measured by method of Clauss. Statiscal analysis was performed using student t test and fisher exact test. In present study, mean plasma fibrinogen in patients group was 326.45 mg/dl, which was significantly higher than control group (202.23 mg/dl) (p<0.001). Mean plasma fibrinogen level in lacunar infarct and non-lacunar infarct did not differ significantly (307.47 mg/dl Vs. 333.19 mg/dl). Smoking was found to be a significant predictor of fibrinogen with 36.7% predictability whereas other parameters (risk factors for ischemic stroke) had little or no predictable value regarding serum fibrinogen. After adjustment for other possible ischemic stroke risk factors; plasma fibrinogen levels was found to be still significantly high in patients as compared to controls (p<0.001). Mean plasma fibrinogen level between patients who survived and who expired does not differ significantly. Present study concluded that fibrinogen is a powerful predictor of ischemic stroke though it does not predict the type and prognosis of stroke.