Showing papers in "Nepal Medical College journal in 2008"

Histological pattern of ovarian tumors and their age distribution

Abstract: A female's risk at birth of having ovarian tumor sometime in her life is 6-7%. Relative frequency of ovarian tumor is different for western and Asian countries. Two third of ovarian tumors occur in women of reproductive age group. This study was done in Tribhuvan University Teaching Hospital with aim to find out frequency of different histological types of ovarian tumors and their age distribution and thus provide an institutional experience from Nepal also. One hundred and sixty one ovarian tumors, reported from April 2004 to March 2006 were included in the study. One hundred and thirty five of these tumors (83.9%) were benign and 16.1% (26/161) were malignant. Surface epithelial tumors were most common (52.2%) followed by germ cell tumors (42.2%). Mature cystic teratoma was commonest benign tumor (48.2%). Serous adenocarcinoma was commonest malignant tumor (46.2%). For all age groups, benign tumors were more common than malignant ones. Most ovarian tumors (47.2%) were seen between 21 -40 years where as most malignant tumors (73.1%) were seen above 40 years. In 1st two decades, germ cell tumors were more common than other tumors.

Effect of alternate nostril breathing exercise on cardiorespiratory functions.

Abstract: Pranayama (breathing exercise), one of the yogic techniques can produce different physiological responses in healthy individuals. The responses of Alternate Nostril Breathing (ANB) the Nadisudhi Pranayama on some cardio-respiratory functions were investigated in healthy young adults. The subjects performed ANB exercise (15 minutes everyday in the morning) for four weeks. Cardio-respiratory parameters were recorded before and after 4-weeks training period. A significant increment in Peak expiratory flow rate (PEFR L/min) and Pulse pressure (PP) was noted. Although Systolic blood pressure (SBP) was decreased insignificantly, the decrease in pulse rate (PR), respiratory rate (RR), diastolic blood pressure (DBP) were significant. Results indicate that regular practice of ANB (Nadisudhi) increases parasympathetic activity.

Awareness and practice of family planning methods in women attending gyne OPD at Nepal Medical College Teaching Hospital.

Abstract: A cross sectional descriptive study of awareness and practice of family planning methods among 200 women of reproductive age attending gynecology out patient department (GOPD) of Nepal Medical College Teaching Hospital from 14th May 2008 to 14th July, 2008 was carried out. Most of the respondents (93.0%) were aware of at least one of family planning methods out often methods, but only 65.0% had ever used it and contraceptive prevalence rate was 33.5% which was slightly higher than the national data as 28.5%. The best known method of temporary contraception was depo provera (78.0%) followed by oral contraceptive pills (74.0%) and condom (71.0%) and least known methods were vaginal foam tablets/jelly (34.0%) and natural methods (16.0%). Among permanent family planning methods, awareness about female sterilization (81.0%) was more than male sterilization (77.0%) which was in accordance with studies done in other countries. Knowledge about emergency coritraception was quite low (12.0%) as it was newly introduced in the country. Regarding current use of contraception depo provera (11.0%) was the most widely used followed by oral contraceptive pills (4.5%) and condom (4.5%). 5.5% had undergone female sterilization while only 2.5% of male partner had sterilization Knowledge of non contraceptive benefits of family planning methods was claimed by only 35.0% of the respondents, 27.0% reported awareness that condoms protect from HIV/AIDS and sexually transmitted diseases (STD) while knowledge about various adverse effects was widespread (52.5%). The most common source of information on contraception was media (55.5%), both printed and electronic. This study also observed that with increase in level of education, awareness also increased. Although most of the women were aware about the methods, they were ignorant about the details like duration of protection, return of fertility on discontinuation and non contraceptive benefits. The most common reason for discontinuation of FP methods was stated as side effects. A wide knowledge practice gap was evident in this study, which was similar to the findings of studies done in other developing countries. Improved female education strategies and better access to services are needed to solve these problems. The use of communication media suitable for the audience and adequate message is important in conducting effective family planning awareness activities. Efforts should be made to educate the public about the safety and convenience of modern, long-term, reversible methods of contraception among both healthcare professionals and the public.

Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study

Abstract: A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children’s Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.

Correlation of prostate volume with international prostate symptom score and quality of life in men with benign prostatic hyperplasia.

Abstract: The aim of this study was to correlate the prostate volume with international prostate symptom score (IPSS) and quality of life (QOL). Hundred consecutive patients diagnosed as having benign prostatic hyperplasia were included. All patients were interviewed using standardized questionnaires for International Prostate Symptom Score, which include one single disease-specific quality of life question. Transabdominal ultrasonogram was used to assess the prostatic volume. Data was analyzed using the statistical package for social sciences (SPSS) for Windows. The mean age and median duration of symptom was 67.5 years and 12.0 months respectively. The mean volume of prostate was 42.5 cm3. Most of the patients had severe symptoms with mean IPSS of 23.5 and single disease-specific QOL score of 5.2. The correlation between the prostate volume and age, IPSS, and QOL score were not statistically significant except for two domains; incomplete emptying and nocturia that appear to be correlated with prostate volume. The correlation between IPSS and QOL score was strong. Similarly, correlation between QOL score and age was significant but weak. In conclusion, prostate volume had no correlation with age, symptom score, and quality of life score. So prostatic size should not be an only and important consideration; moreover, we should assess the impact of symptoms while treating the cases.

Prevalence of methicillin resistant Staphylococcus aureus in school children of Pokhara.

Abstract: Present study was carried out to find out the prevalence of methicillin resistant Staphylococcus aureus (MRSA) in school children of Pokhara city in western, Nepal. A total of 184 randomly selected children younger than 15 years were included in the study. Nasal swabs collected were subjected to standard bacteriological culture. S. aureus isolates were identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on muller-hinton agar (MHA) by modified Kirby-Bauer disc diffusion method. Out of total 184 nasal swabs, S. aureus was isolated in 31.0% (n=57). Among the isolates, 35.1% (n=20) were from male children whereas 64.9% (n=37) were from female. There was no significant sex difference in colonization of S. aureus. Out of 57 isolates, 56.1% (n=32) were MRSA. MRSA isolates indicated relatively high rate of resistance to antibiotic cloxacillin (68.7%) followed by ofloxacin (40.6%), tetracycline (15.6%), erythromycin (9.4%), ciprofloxacin (6.2%) and vancomycin (3.1%).This study showed a high prevalence of MRSA carriage in school children indicating the spread of MRSA in the community.

Prevalence of Salmonella typhi and paratyphi infection in children: a hospital based study.

Abstract: The purpose of this study was to find out the prevalence and antibiotic sensitivity pattern of Salmonella typhi and paratyphi isolated from children presenting with fever at Kanti Children’s Hospital in Kathmandu, Nepal. A total of 9,856 blood samples collected for culture during one year period (April 2007 to March 2008) were included in the study. Out of total, 235 (2.0%) were positive for S. typhi and paratyphi A. Of the total positive, 195 (83.0%) were S. typhi and 40 (17.0%) were S. paratyphi A. The growth positive rate in two genders (M: 53.2% and F: 46.8%) was not significant (P>0.05). Over two-third of cases were clustered in the age-group of 1-10 years. The occurrence of infections was common in summer months (rainy season). S. typhi was found to be most sensitive to cefotaxime (100.0%) followed by ceftriaxone (98.9%), ofloxacin (93.5%), cotrimoxazole (93.5%) and chloramphenicol (93.2%) and was least sensitive to amoxyccilin (66.7%) followed by ciprofloxacin (86.6%). S. paratyphi also was found to be most sensitive to cefotaxime (100.0%), followed by ceftriaxone (97.4%), cotrimoxazole (97.1%) and chloramphenicol (92.5%) and was least sensitive to amoxycillin (15.0%) followed by ciprofloxacin (51.3%) and ofloxacin (70.3%).

Prevalence of diabetic retinopathy following a community screening for diabetes.

Abstract: Diabetic retinopathy is a public health challenge in developing countries including Nepal and is not like other preventable or treatable causes of blindness. The aim of study was to estimate the prevalence of diabetic retinopathy following a community screening for diabetes. A community-based, cross sectional study was designed to screen for diabetes in people age > or =40 years in a semi-urban community of Kathmandu, Nepal. In those individuals with detected diabetes, a comprehensive eye examination was performed by an ophthalmologist and diabetic retinopathy was graded using a standard protocol. 1475 persons were screened for diabetes with a mean age of 54.7 +/- 12 years with sex ratio of 0.69 male per female. Thirty-four subjects were found to have impaired fasting glucose and sixty subjects had diabetes. The prevalence of diabetes mellitus was 4.1% (60) but 6.4% (94) had an abnormal blood sugar level. Fifty-seven diabetic patients visited at-Tilganga Eye Centre for ocular examination. Among examined patients, the prevalence of diabetic retinopathy was 19.3% (11). Only one person had clinically significant macular edema requiring laser therapy. The prevalence of hypertension and cataracts were the same among patients with and without diabetic retinopathy. The prevalence of diabetic retinopathy was low but one of sixteen newly diagnosed diabetics did have evidence of diabetic retinopathy. Eighty-four percent of known diabetics had never had their eyes examined for ocular complications. Community awareness and physician coordination should be emphasized to increase the eye examination rate.

Controlled programmed trial of Ocimum sanctum leaf on generalized anxiety disorders.

Abstract: Ocimumn sanctum, an Indian medicinal plant, has been on trial for its role in generalized anxiety disorder (GAD) in hospital based clinical set-up. Hamilton's brief psychiatric rating scale (BPRS) and thorough clinical investigations were used to screen the subjects. Thirty-five subjects (21 male and 14 female; average age 38.4 years) were medicated with the plant extract in a fixed dose regime (500 mg/capsule, twice daily, p.o. after meal). They were thoroughly investigated clinically and using standard questionnaires based on different psychological rating scale at baseline (day 0), mid-term (day 30) and final (day 60). The observations exhibited that, O. sanctum significantly (p<0.001) attenuated generalized anxiety disorders and also attenuated its correlated stress and depression. It further significantly (p<0.001) improved the willingness to adjustment and attention in human. Therefore, it may be concluded that O. sanctum may be useful in the treatment of GAD in human and may be a promising anxiolytic agent in near future.

Ocular evaluation in patients with chronic renal failure--a hospital based study.

Abstract: Chronic renal failure affects every organ system including eye. The aim of this study is to conduct thorough ocular examination in the patients of chronic renal failure and to analyze the findings. 119 cases were collected from Nephrology unit of Tribhuvan University Teaching Hospital between 1st June 2002 to 15th December 2003. This was a cross sectional, descriptive type of study. Sampling technique was consecutive and stratified. Severity of renal disease was classified as mild, moderate, severe and end stage renal disease. Twenty-three percent of total 238 eyes had vision < 6/18. The causes for visual impairment were maculopathy 23 eyes, cataract 14 eyes followed by proliferative diabetic retinopathy, 9 eyes. Twelve percent of total eyes had vision < 6/60. Lid edema was present in 63.0%, conjunctival pallor in 75.6% and corneal calcification in 1.6%. Retinopathy was the most important finding. Hypertensive retinopathy was present in 56 out of total 119 cases (47.1%). It was more prevalent and tended to be more severe as renal disease progressed. This was statistically significant. Diabetic retinopathy was present in 38 out of 43 diabetic cases (88.3%). Although statistically not proven, more severe grades of diabetic retinopathy were detected with increasing severity of the renal disease. There was one case of bilateral serous detachment of the retina relating to chronic renal failure. In this study, 47 out of 56 cases of hypertensive retinopathy and 19 out of 38 cases of diabetic retinopathy were detected for the first time, thus showing the importance of ocular evaluation of the patients of renal insufficiency.

Fungal infections of the eye - laboratory diagnosis and treatment

Abstract: Infections of the eye give rise to severe ocular morbidity and blindness include keratitis, orbital cellulites, endophthalmitis and dacryocystitis. Corneal blindness, in developing countries is predominantly associated with infections. In India, nearly 30-35% of all culture positive infectious keratitis are caused fungi. Laboratory diagnosis mainly depends upon proper collection and transport of clinical specimens. In fungal keratitis, corneal scraping is the ideal sample, but occasionally corneal biopsy or anterior chamber aspirate may also be needed. Corneal scraping is usually by Kimura spatula, under a slit lamp examination, after anaesthetizing the cornea with topical anaesthetic like 0.4% proparcaine. Corneal biopsy is done by a minor trephining and AC aspirate using a sterile tuberculin syringe. In case of endophthalmitis, 150-200 il of aqueous humour is collected. Vitreous fluid (500-1000 il), however, is collected by pars plana vitrectomy onto sterile tuberculin syringe, the needle is then fixed to a sterile rubber bung after expelling air from the syringe. The collected sample is immediately transported to the laboratory. Swabs from the regurgitating lacrimnal sacs and wound aspirate/swabs are the ideal specimens for dacryocystitis and orbital cellulites, respectively. These samples are cultured onto SDA slants following standard procedures. The main draw back of culture is its long incubation time (5 to 14 days), though it is indispensable from the view point of the specificity. Direct examination (KOH wet mount, Gram's, Giemsa or calcofluor fluorescent staining methods) of the specimen, however, is quick and immensely helpful for ophthalmologist. The newer rapid methods, such as molecular techniques are also available and the management of patients can be according to the results obtained. With the advent of novel antifungal agents such as newer azoles and cell wall acting antifungals like echinocandins, the clinician has the wider option of selecting the therapeutic modality. In the event of the increasing reports of in vitro drug resistance to much frequently used azoles, polyenes and 5-fluorocytosines, clinical applicability of the newer antifungal agents seems to be quite promising.

Epidemiological and bacteriological profile of burn patients at Nepal Medical College Teaching Hospital.

Abstract: This study was conducted to know the epidemiological and bacteriological profile of burn patients at Nepal Medical College Teaching Hospital. The charts of 50 burn patients admitted in department of surgery were reviewed retrospectively. All the epidemiological characteristics, mode of injury, time taken to reach hospital and involved body surface areas were noted. The charts were also reviewed for bacterial isolates from burn wounds and its sensitivity pattern for various antibiotics. Data was analyzed using the statistical package for social sciences (SPSS) for Windows. The mean age of patients was 31.8 years with male: female ratio of 1.3:1. Half of the patients were from Kathmandu. Fifty two percent of patients directly came to our hospital while rests were referred from other hospitals. The average time taken to reach hospital was 11.3 hours. Those patients who were referred from outside the valley took longer time (p=0.002). Flame burn was the leading cause for injury (66.0%) followed by scald burn (16.0%), electric burn (14.0%) and acid burn (4.0%). Staphylococcus aureus (28.0%) was the commonest organism isolated from wound swab culture. Others were Klebsiella (16.0%), Pseudomonas (13.0%), Proteus (13.0%) and E.coli (13.0%). No growth was noted in 17.0% of patients. During the treatment, 14.0% of patients died and 4.0% left against medical advice. Remaining patients were discharged after complete recovery. Body surface area involvement was found to be a significant predictor of mortality (p<0.001) and the length of hospital stay was significantly low for them (p=0.05).

Prevention of hypotension during propofol induction: a comparison of preloading with 3.5% polymers of degraded gelatin (Haemaccel) and intravenous ephedrine.

Abstract: The present study compared the efficacy of preloading with colloid "Haemaccel" with vasoconstrictor (intravenous ephedrine sulphate) in preventing hypotension during propofol induction. This prospective, randomized study included 120 patients of Amercan Society of Anaesthesiologists (ASA) physical status I and II ageing 21 to 50 years of both gender coming for routine surgery. Patients were randomly allocated into three groups with 40 patients in each. Group A (control) did not receive any study medication, group B received Haemaccel (10 ml/kg intravenously over 10-15 minutes) and group C received injection ephedrine (0.2 mg/kg iv) prior to induction of anaesthesia. Propofol (2.5 mg/kg iv) was used for induction of anaesthesia. Heart rate and blood pressure were recorded before induction (baseline) and then every minute for 5 minutes after administering propofol. Anaesthesia was continued with standard technique thereafter. Hypotension was defined as fall in systolic blood pressure more than 20% from the basal value. The incidence of hypotension in Haemaccel (23.1%) or ephedrine group (22.5%) was significantly less than the control group (67.5%, P<0.01). We conclude that though preloading with colloid (Haemaccel) or prior injection of sympathomimetic (ephedrine) are not fully efficacious in preventing hypotension caused by propofol induction, both decrease the incidence in significant number of patients with heart rate less than baseline value in the colloid group.

Lipid profile of adult Nepalese population.

Abstract: Dyslipidemia is one of the major risk factors of coronary artery disease. Present study was aimed to find out the lipid profile of non-diabetic adult Nepalese population (n = 454; M: 180 and F: 274; Mean age: 42.8+/-15.5 years). The mean +/- SD (mg/dl) level of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 184+/-50.7, 147.4+/-79.9, 111.9+/-42.0 and 45.0+/-11.7, respectively. All lipid levels except LDL were higher among 41 to 60 years age group while LDL was higher among participants aged >60 years. Desirable TC level ( or =240 mg/dl) and very high TG (> or =500 mg/dl) and LDL (> or =190 mg/dl) were found in 8.8%, 2.6% and 5.8% of participants, respectively. Higher HDL level (40 mg/dl) was seen in 60.0% of the total population. Higher percentage of women than men (65.3% vs 52.2%) had >40 mg/dl HDL level. Nornal lipid profile (TC 40 mg/dl) was seen in 26.7% of participants, and was higher in females (32.1%) than in males (18.3%). The overall mean cholesterol level was within normal limit. Mean LDL level showed increasing trend with age and about one fourth of participants had normal lipid profile.

Role of serum C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in Nepalese population.

Abstract: Various diagnostic modalities have been reported to influence the negative appendicectomy. C-reactive protein (CRP), an acute phase reactant, may improve the accuracy of diagnosing acute appendicitis. The present study was undertaken to evaluate the utility of CRP as a diagnostic tool among patients clinically suspected to have acute appendicitis. The role of total leukocyte (WBC) count was also studied. A total of 145 diagnosed cases of acute appendicitis were studied over a period of one and half years. CRP was raised in 91 cases and was normal in 54 cases. The sensitivity and specificity of CRP estimation in diagnosing appendicitis was 74.8% and 66.7% respectively and the sensitivity and specificity for total WBC count was 78.6 and 54.8% respectively. The present study suggests that we cannot rely wholly on CRP or on WBC count for operative decision. Clinical judgment is still the best modality for the diagnosis and operative management of acute appendicitis. It seems wiser to use active observation, which should identify most patients with non-specific pain and reserve operation for those who need it most.

Hisopathological spectrum of glomerular disease in nepal: a seven-year retrospective study.

Abstract: We analyzed 137 cases of renal biopsies at the Department of Pathology from 2001 to 2007. The average age was 30.6 years (range, 13-72) for males and 32.9 years (range, 11-75) for females. The male to female ratio was 1.6: 1. The most common clinical syndromes for performing renal biopsy were nephrotic syndrome (81.6%) followed by asymptomatic urinary abnormalities (5.8%), nephritic syndrome (3.6%), hypertension (2.9%), chronic kidney disease (2.2%), acute renal failure (2.2%), cirrhosis (0.7%) and transplant rejection (0.7%). The major glomerular diseases in descending order of frequency were membranous glomerulonephritis (MGN; 42.3%), membranoproliferative glomerulonephritis (MPGN; 21.9%), minimal change disease (MCD; 10.2%), focal segmental glomerulosclerosis (FSGS; 8.0%), IgA nephropathy (2.9%), post infectious glomerulonephritis (GN) (2.2%), chronic GN (2.2%), tubulointerstitial nephritis (TIN; 1.5%), lupus nephritis (1.5%), focal proliferative GN (1.5%), C1q nephropathy (1.5%), amyloidosis (1.5%) and other minor form of glomerular diseases (2.8%). The pattern of glomerulonephritis in our study is different from the reports of other developing countries. It could be due to various races and altered environmental condition. The information obtained from these results can be used as baseline data for making efficient research in Nepalese population in the future. The higher frequency of MGN and MPGN among Nepalese in comparison with other developing countries deserves further evaluation.

Anesthetic consideration in downs syndrome-a review

Abstract: Downs syndrome constitutes to be the most common chromosomal disorder. Patients with Downs's syndrome are posted for several surgeries including dental procedures and even for facial reconstruction. They are associated with several congenital anomalies in different organ system. There is also increased incidence of atlanto axial instability and risk of spinal cord injury. These children are susceptible to infection and they are also considered to be hypersensitive to the effect or atropine. These all factors modify the anesthetic implication and also anesthetic management in these cases. We have highlighted all these factors and reviewed the anesthetic implication of these child posted for several procedures under anesthesia.

Evaluation of different tests for detection of Staphylococcus aureus using coagulase (coa) gene PCR as the gold standard.

Abstract: A total of 288 staphylococcal specimens isolated from different clinical specimens were selected for the evaluation of tests used to detect Staphylococcus aureus. The coagulase (coa) gene PCR was preformed, which confirmed 288 specimens as S. aureus and 51 specimens as coagulase negative staphylococci (CONS). All the specimens were subjected to slide coagulase test, Slidex Staph plus test and tube coagulase test. Sensitivity, specificity, positive predictive value and negative predictive values of were calculated using coa gene PCR as gold standard for the detection ofS. aureus. The tube coagulase test showed very good sensitivity (98.7%), specificity (98.1%), PPV (99.5%) and NPV (94.4%) than other methods. Slidex Staph plus test showed fairly good sensitivity and specificity. Slide coagulase test has good specificity but poor sensitivity. Therefore we recommend that tube coagulase test be done routinely for the detection ofS. aureus in microbiology laboratory.

Practices on immediate care of newborn in the communities of Kailali district.

Abstract: Immediate proper care of newborn is vitally important for survival, growth and development of a baby. Despite several studies conducted in Nepal about maternal and child health care practices, little is known about factors that determine behaviors related to immediate care of newborn. Identification of behavioral determinants for immediate care of newborn in Kailali district was objective of the study. This formative research was conducted in 6 purposely selected Village Development Committees (VDCs) of Kailali. Altogether 17 Focused Group Discussions (FGDs) were conducted with 106 parents. To triangulate the findings, 58 in-depth interviews were conducted with various individuals. Most people are unaware of importance of immediate care of newborn and many unsafe behavior do exist such as common use of untrained attendants, unsafe cord care, immediate bathing of baby. Most of the existing practices are based on deep-seated traditional beliefs. Some used Clean Home Delivery Kit (CHDK) and a few had used knife to cut the cord. All had tied stump with thread and applied mustard oil to prevent infection. The use of CHDK was high in the Tharu group with surprisingly low among Brahmin/Chetri. Yet! This research showed willingness on the part of the community to learn and change harmful practices. Almost all had similar opinion that survival of a baby is with in their control. As child is the center of love of all and targeting a child many behaviors and practices could be changed. The next step would be to prioritize the behaviors that need to be targeted for change and spread key messages for behavior change.

Complex regional pain syndrome (CRPS) type-1 following snake bite: a case report.

Abstract: The pathophysiological mechanism and clinical course of complex regional pain syndrome (CRPS) type-1 still remain ill defined. Both the treatment and the prediction of the outcome of the treatment are difficult. Abnormal neurohumoral and inflammatory mechanisms have been implicated in its causation usually following trivial noxious event in an extremity. However, to the best of our knowledge CRPS type-1 following snakebite has not been reported yet in the literature. We here report a case of an aggressive CRPS type-1 following a mountain pit viper bite, locally known as Gurube (Ovophis monticola monticola) in a 55-year-old lady. The clinical condition responded well to the therapy with serial sympathetic blockade of the limb with local anaesthetics, non-steroidal antiinflammatory analgesic, antiepileptic, antidepressant and physiotherapy. Our experience in managing this patient and associated pathophysiology in development of CRPS type-1 are discussed.

Role of systemic anticoagulation in patients undergoing vascular access surgery.

Abstract: The role of per-operative systemic heparin to improve primary patency rate of vascular access surgery is controversial. The aim of this study was to assess the risk and benefit of systemic heparin during creation of vascular access for hemodialysis in patients with chronic renal failure. Patients undergoing creation of side to end radio-cephalic arteriovenous fistula over distal forearm for hemodialysis were prospectively randomized into two groups. First group received 5000 IU of intravenous heparin during surgery whereas second group did not receive any anticoagulation. Post-operative complications and outcome of surgery were compared between the two groups. Among 50 patients, 25 received heparin and 25 did not. Although there was no significant difference in operative times between these two groups (p = 0.24), early post-operative bleeding complication was more common in patients receiving heparin (p < 0.01). The primary 6-week patency was 96.0% for patients receiving heparin and 92.0% for those not (p = 0.46). Thus per-operative systemic anticoagulation during vascular access surgery is associated with increased incidence of bleeding complication and offers no benefit in terms of primary patency

Age and sex related variations in corpus callosal morphology.

Abstract: There is no unanimity in literature on sexual dimorphism or on age related morphophometric changes in the Corpus Callosum (CC) For comprehensive data 44 preserved human brains (22 male and 22 female) and 30 MRI scans from North-west Indian population were studied Morphometric measurements of the CC and its subregions were taken at the midsagittal level in both the groups and subjected to statistical analysis The only CC parameters which showed sexual dimorphism were (a) larger CC length in males in the MRI group, (b) the distance between the splenium and superior colliculus was more in males in preserved brains and (c) The distance between the genu and the fornix was more in older males than older females Age related changes included (a) In males the distance between the genu and the fornix (in both the groups) was more in the older age group while the maximum width of the anterior half of the CC body was more in the younger age group (preserved brains) and (b) In females the height of the CC and the minimum width of the CC were more in the older females (preserved brains) No sexual dimorphism was observed in most of the CC parameters studied, including the splenium Age related thinning of the anterior half of the CC in males could possibly be related to atrophic brain changes more common in males than females

Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic.

Abstract: Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. Most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology have been reported and are useful in cytological detection of bancroftian filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The objective of the study was to investigate importance of cytology in diagnosis of filariasis in lesions clinically anticipated to be of neoplastic and to review the cytomorphology of bancroftian filaria and its association with neoplasm. This is a retrospective study carried out in cytology department of Tribhuvan University Teaching Hospital. 14 cases of cytological specimen out of 4291 (0.3%) showed microfilaria; 12 cases were from FNAC from different sites and 2 cases were from pleural fluid. 2 cases showed ova in addition to microfilaria and one of them in addition showed fragment of adult worm. Microfilaria in 4 cases of FNAC and one case of pleural fluid were associated with malignant cells.

Microalbuminuria among type-2 diabetes mellitus patients in Pokhara, Nepal.

Abstract: Microalbuminuria is considered to be an early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The aim of this study was to see the prevalence of microalbuminuria in type 2 diabetic patients and assess its association with cardiovascular risk factors among them. A total of 143 type 2 diabetic patients with the mean age of 56.06 +/- 1.08 years were analysed. The prevalence of microalbuminuria and overt proteinuria was 45.5% and 11.2%, respectively. Prevalence of microalbuminuria in female was marginally higher than in male (p > 0.05). Subjects with microalbuminuria had significantly higher blood pressure (p 0.05). High prevalence of microalbuminuria in diabetic patients and its positive association with blood pressure and altered lipid profile suggests that screening for microalbuminuria is essential for intervention and prevent further complications like end stage renal disease and cardiovascular diseases.

Chronic kidney disease 5 on hemodialysis in Nepal Medical College Teaching Hospital.

Abstract: Chronic Kidney Disease (CKD) 5 is defined when glomerular filtration rate (GFR) is <15.0 ml/min/1.73m2. Though nephrology service was started in Nepal as early as in 1970, we do not have data regarding CKD 5 patients till date. So this study is being undertaken to know the epidemiological profile and etiology of CKD 5 patients attending hemodialysis (HD) unit of Nepal Medical College Teaching Hospital. This is a prospective study which was carried out in HD unit over a period of one year. CKD 5 patients having GFR of <15 ml/min/1.73m2 under HD were included in the study. Among 100 patients included in the study 57 were male and mean age of the study population was 46.9+/-17.9 years. Most common cause of CKD 5 in the study was hypertension (54.0%); other causes included diabetic nephropathy (18.0%), idiopathic (13.0%) and glomerulonephritis (6.0%). Fifty percent of patients were from outside Kathmandu Valley. Around 20.0% of the study population is on regular follow up while 45.0% were lost to follow up. Twenty percent of the patient underwent transplantation and 15.0% of the study population died. Majority of patients were anemic (85.0%). Correction of anemia was done with blood transfusion in 88.0% and only 12.0% received erythropoietin. Hypertension was the leading cause of CKD 5; majority of patients (45.0%) discontinued hemodialysis most probably due to economical constrain; blood transfusion was the main modality of treatment of anemia.

HELLP syndrome--a pregnancy disorder with poor prognosis.

Abstract: HELLP syndrome is a pregnancy-specific disorder defined by hemolysis, elevated liver enzymes and low platelet count that is found in parturients, more frequent in older multiparas. It is frequently associated with severe preeclampsia or eclampsia, but can also be diagnosed in the absence of these disorders. The etiology of HELLP syndrome is unknown, and the pathogenesis of this disorder (including the hepatological manifestations) is not fully understood. The most widely accepted hypotheses are: a change in the immune feto-maternal balance, platelet aggregation, endothelial dysfunction, arterial hypertension and an inborn error of the fatty acid oxidative metabolism. Hepatic involvement occurs by intravascular fibrin deposition and hypovolemia. Serum LDH and platelet count are the two most important clinical tools for disease assessment. LDH reflects both the extent of hemolysis and hepatic dysfunction. Maternofetal complications cause a 7.0-70.0% perinatal mortality rate and a 1.0-24.0% maternal mortality rate. The recognition of HELLP syndrome and an aggressive multidisciplinary approach and prompt transfer of these women to obstetric centers with expertise in this field are required for the improvement of materno-fetal prognosis.

Single burr hole drainage for chronic subdural haematoma.

Abstract: Chronic subdural haematoma is a common neurosurgical condition and surprisingly surgical treatment ranges from twist drill craniostomy to more radical membranectomy. However, the outcome is generally favourable with appropriate therapy. This retrospective study is aimed at analyzing the result of single burr hole drainage of such haematoma under local anaesthesia over a period of fifteen years. There were a total of 365 patients ranging from 6 months to 89 years with the mean age of 60 years. Recurrence of haematoma was noted in 17 (4.6%) patients and majority of them (65.0%) were managed by aspiration through the previous burr hole. Favorable outcome was noted in 98.6% patients. Those with adverse outcome were in coma preoperatively. This study suggests that single burr hole drainage under local anaesthesia is sufficient in the majority of patients and outcome was favorable even in the elderly provided they presented before lapsing into coma.

Pediatric and neonatal tetanus: a hospital based study at eastern Nepal.

Abstract: A prospective hospital based study of childhood (<15 yrs) and neonatal tetanus cases from July 2004 – May 2006 was done to study the demography, clinical features and outcome of pediatric and neonatal tetanus cases at BPKIHS. During the study, 24 cases of tetanus were admitted from 9 districts including 5 neonatal tetanus. Among children with tetanus, 31.5% received 3 doses of DPT and 10.5% received TT vaccine as tetanus prophylaxis. In 16.0% children there was no recognizable injury preceding the disease. Otitis media preceded tetanus in 16.0%. All neonatal tetanus cases occurred following umbilical sepsis. Despite their mothers receiving 2 doses of TT during pregnancy, 2 neonates developed tetanus. A neonate delivered in hospital also developed neonatal tetanus. Average incubation period was 7.7 days and average onset time was 16.9 hours. Short onset time predicted the favorable outcome (p= 0.005). Generalized tetanus cases were 75.0%, neonatal tetanus 21.0% and cephalic tetanus 4.0%. Generalized spasm was present in all cases. Common autonomic dysfunctions were fever, tachycardia and hypotension. Respiratory failure, aspiration pneumonia, rhabdomyolysis and seizure were common complications. Only one case received Intensive Care Unit (ICU) care. Survival rate was 21.1% for childhood tetanus and 40.0% for neonatal tetanus. Respiratory failure was the cause of death in majority. Study finds tetanus as an important disease in eastern Nepal, with substantial morbidity and mortality, primarily affecting the unvaccinated and inadequately vaccinated individuals. Despite lack of adequate resources, we can still manage tetanus cases with comparable outcome to other case series reported in the literatures.

Tuberculosis co-infection in HIV infected persons of Kathmandu.

Abstract: Tuberculosis is itself a major Public health problem in Nepal and the emergence HIV further complicated the issue. A cross-sectional analytical study was conducted Between January 2004 and August 2005, with a general objective to determine the Tuberculosis co-infection status in HIV/AIDS cases of Nepal. Altogether 100 HIV infected persons visiting different Voluntary counseling and testing centers (VCT) and HIV/AIDS care centers located in Kathmandu valley were enrolled in the study. Investigation of tuberculosis was done by standard method prescribed by WHO using sputum specimen. Among 100 HIV infected cases, 66 (66.0%) were males and 34 (34.0%) were females. Majority of the HIV cases were in the age group 21-30 (60.0%) followed by 3140 (31.0%). Tuberculosis was detected in 23 cases with highest prevalence in the age group 21-30 years (65.2%). No significant relationship could be established between gender and TB (c2 =0.83, p>0.01).Significant relationship was established between smoking/alcoholic habit and the subsequent development of tuberculosis (c2 = 7.24, p<0.05 for smoking habit; c2=4.39, p<0.05 for alcoholic habit at 1 degree of freedom). Among 22 culture positive isolates the predominant was Mycobacterium avium complex (40.9%) followed by M. tuberculosis (27.3%), M.kansasii (18.2%), M. fortuitum (9.1%) and M. chelonae (4.5%). Among the 23 cases of tuberculosis, 22 cases were diagnosed by cultural technique of which 4 cases were smear positive while the remaining one case was diagnosed by direct microscopy although it was culture negative. Smear negative Tuberculosis is found to be alarmingly higher in HIV positive individuals of productive age group. The disease significantly higher in smokers and alcoholics.

Detection of individuals prone to develop hypertension in their future life.

Abstract: Hypertension is a global burning health problem. Early detection of proneness to hypertension may help an individual to lead a healthy life by altering the life style (by diet restriction, exercise etc.). Subjects at high risk of future hypertension e.g. the persons of hypertensive family and / or having high resting heart rate etc. show blood pressure hyper-responsiveness to stress. Elevated blood pressure due to sympathetic stimulation prevailed longer time in susceptible persons. In the present study sympathetic stimulation exerted through cold pressor test (hand immersion up to the wrist in 4 0 C water) resulted in elevation of blood pressure and heart rate in all young male normotensive individuals (age 18-35 years, n=72). Nevertheless, blood pressure and heart rate returned to baseline, following 5 minutes of withdrawal of the stressor, in case of volunteers from normotensive families. On the other hand, the subjects whose parents, either or both were reported to be hypertensive showed elevated diastolic blood pressure even after 5 minutes of withdrawal of the said stressor— indicating that the autonomic nervous system in them was not competent enough for lowering the diastolic pressure quickly to baseline as observed in the volunteers from the normotensive families. The present study revealed that the young subjects who showed greater and prolonged responsiveness to diastolic blood pressure due to sympathetic stimulation through cold pressor test are prone to develop hypertension in future.