Showing papers in "Nepal Medical College journal in 2010"

A clinical study on the management of generalized anxiety disorder with Centella asiatica.

Abstract: Centella asiatica is reputed for its beneficial effects in various neurological disorders. The present investigation was undertaken to evaluate the role of 70% hydro-ethanolic extract of Centella asiatica (CA) on generalized anxiety disorder (GAD) in man. Hamilton's Brief Psychiatric Rating Scale (BPRS) was used to screen the subjects. Thirty-three participants (18 male and 15 female; average age 33 yrs) were medicated with the CA in a fixed dose regime (500 mg/capsule, twice daily, after meal). They were thoroughly investigated using standard questionnaires based on psychological rating scale at baseline (day 0), mid-term (day 30) and final (day 60). The scale also includes a number of direct queries about current levels of experienced stress. The observations revealed that, CA not only significantly (p<0.01) attenuated anxiety related disorders but it also significantly (p<0.01) reduced stress phenomenon and its correlated depression. CA further significantly (p<0.01) improved the willingness for adjustment and cognition. Results indicated that Centella asiatica may be useful in the treatment of GAD and may be used as a promising anxiolytic agent in near future.

Nasal carriage rate of methicillin resistant Staphylococcus aureus among at National Medical College Teaching Hospital, Birgunj, Nepal.

Abstract: Present study was conducted to assess the nasal carriage rate of methicilin resistant Staphylococcus aureus (MRSA) among patients, visitors/patient attendants and healthcare personnel at National Medical College Teaching Hospital, Birgunj, Nepal. A total of 112 nasal swabs (patients: 31, visitors/patient attendants: 61, and healthcare personnel: 20) were subjected to bacteriological investigation following standard protocol. S. aureus isolates were identified by mannitol fermentation and coagulase positivity. Antimicrobial susceptibility test was performed by Kirby-Bauer’s disc diffusion method on Muller-Hinton agar medium. S. aureus was isolated in 14 (12.5%) of participants (M: 11.3%, F: 13.6%). Highest nasal colonization rate was found among healthcare personnel (25.0%) followed by the visitors/patient attendants (13.1%) and the patients (3.2%) (P>0.05). Highest positive rate was observed in the age group d”14 years (33.3%), followed by 15 to 50 years (13.2%) and >50 years (5.6%) (P>0.05). Out of 14 S. aureus isolates, 57.1% were methicillin resistant, prevalence rate of MRSA among total subjects being 7.1%. MRSA prevalence rate were 5.6% and 8.5% in total male and female participants, respectively (P>0.05). Highest MRSA prevalence rate was among health-care personnel (10.0%), followed by visitors/patient attendants (8.2%) and the patients (3.2%) (P>0.05). All MRSA isolates were resistant to Ampicillin, followed by Cephalexin (37.5%), Ciprofloxacin (37.5%), Tetracycline (37.5%), Gentamycin (25.0%), Erythromycin (0.0%) and Vancomycin (0.0%). High rate of nasal MRSA carriage rate found in this study indicates the need for standard infection control to prevent MRSA transmission.

Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens

Abstract: Cholecystectomized specimens are one of the frequently encountered specimens in daily routine histopathological work in the pathology department. With the expectation that most of the gallbladder specimens harbor benign disease, it is at times surprising to find occult malignancy. This study aims to find out the frequency of primary gallbladder carcinoma and incidental primary carcinoma, detected during routine histological examination of gallbladder specimen that were submitted in pathology department of Nepal Medical College Teaching Hospital (NMCTH) as well as to assess the need of histopathological examination of cholecystectomy specimens. Retrospective study was done in total 668 cases of cholecystectomies specimens submitted in NMCTH histopathology department during 5 yrs of duration from Jan 2003 to Dec 2007. There were total 22 cases of primary gallbladder carcinoma and 2 cases of metastatic cholangiocarcinoma in gallbladder. The incidence rate of primary malignancy was 3.3% and was commonly found in female at 7th decade of their life. Adenocarcinomas were the most common histological type with poor differentiation and diagnosed frequently at stage IIA. The rate of incidental primary carcinoma of gallbladder was 1.4%, detected commonly at stage I. Combined preoperative and intraoperatively, only 55.0% of histologically proven gallbladder malignancies were correctly identified. Intraoperative findings of incidental carcinomas included thickened GB (3 cases), distended GB (2 cases), GB polyp (1 case) and no obvious abnormality were mentioned in 3 cases. Therefore, every cholecystectomy specimen should be examined histopathologically to detect possible incidental carcinomas.

Immediate effect of a slow pace breathing exercise Bhramari pranayama on blood pressure and heart rate.

Abstract: The study was carried out to evaluate the immediate effect Bhramari pranayama, a slow breathing exercise for 5 minutes on heart rate and blood pressure Heart rate and blood pressure of volunteers were recorded The subject was directed to inhale slowly up to the maximum for about 5 seconds and then to exhale slowly up to the maximum for about 15 sec keeping two thumbs on two external auditory canal, index and middle finger together on two closed eyes and ring finger on the two sides of the nose During exhalation the subject must chant the word "O-U-Mmmma" with a humming nasal sound mimicking the sound of a humming wasp, so that the laryngeal walls and the inner walls of the nostril mildly vibrate (Bhramari pranayama, respiratory rate 3/min) After 5 minutes of this exercise, the blood pressure and heart rate were recorded again Both the systolic and diastolic blood pressure were found to be'decreased with a slight fall in heart rate Fall of diastolic pressure and mean pressure were significant The result indicated that slow pace Bhramari pranayama for 5 minutes, induced parasympathetic dominance on cardiovascular system

Soil contamination with Toxocara spp. eggs in the public parks from three areas of Khorram Abad, Iran.

Abstract: Toxocariasis is a parasitic zoonose caused by the infection of larval nematode Toxocara species. A total of 285 soil samples from January to March 2009 in 18 public parks were collected to test for soil contamination with Toxocara eggs. Soil samples were investigated for the present of Toxocara eggs using sucrose flotation method. Distribution of Toxocara spp. eggs in samples collected from public parks was 63.3%. The highest number of eggs recovered from 200 g of soil was 128. A total 304 eggs were recovered and 42.1% fully developed to embryonated egg stages. The contamination rate in second region in the studied areas was higher than the other regions. A similar tendency was observed in parks size, so that parks higher than 10,000 m2 were more highly contaminated. The present investigation clearly shows that public parks have been contaminated with Toxocara eggs in Khorram Abad, suggesting that care should be taken when using public parks.

Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery.

Abstract: Due to unpleasant nature and physiological consequences of postoperative pain, search of safe and effective modalities for its management has remained a subject of interest to clinical researchers. Analgesic action of lidocaine infusion in patients with chronic neuropathic pain is well known but its place in relieving postoperative pain is yet to be established. The study aimed to assess the effectiveness of perioperative intravenous lidocaine infusion on postoperative pain intensity and analgesic requirement. Sixty patients undergoing major upper abdominal surgery were recruited in this randomized double blinded study. Thirty patients received lidocaine 2.0% (intravenous bolus 1.5 mg/kg followed by an infusion of 1.5 mg/kg/h), and 30 patients received normal saline according to randomization. The infusion started 30 min before skin incision and stopped 1 h after the end of surgery. Postoperative pain intensity and analgesic (diclofenac) requirement were assessed at the interval 15 minutes for 1 hour then 4 hourly up to 24 hours. The pain intensity at rest and movement as well as the total postoperative analgesic (diclofenac) requirement were significantly lower (142.50 +/- 37.80 mg vs.185.00 +/- 41.31 mg, P<0.001) in lidocaine group. The extubation time was significantly longer in lidocaine group (14.43 +/- 3.50 minutes vs. 6.73 +/- 1.76 minutes, P<0.001). The time for the first dose of analgesic requirement was longer in lidocaine group (60.97 +/- 18.05 minutes vs.15.73 +/- 7.46 minutes, P<0.001). It can be concluded that perioperative infusion of low dose of lidocaine decreases the intensity of postoperative pain, reduces the postoperative analgesic consumption, without causing significant adverse effects in patients undergoing upper abdominal surgery.

Clinicopathological analysis of ovarian tumors--a study on five years samples.

Abstract: Ovarian neoplasms have become increasingly important not only because of the large variety of neoplastic entities but more because they have gradually increased the mortality rate due to female genital cancers. A total of 120 cases of ovarian tumors were studied at the Department of Pathology, Konaseema Institute of Medical Sciences, Amalapuram, India, during the period of March 2005 to March 2010, to find out frequency of different histological patterns of ovarian tumors at Konaseema Region. Among 120 cases, majority 86 (71.6%) were benign, but alarming number 30 (25.0%) were malignant, remaining 4 cases were borderline. The commonest histological pattern observed in the study was epithelial tumors (61.6%). The commonest benign tumor was serous cyst adenoma, while; the commonest malignant tumors were granulosa cell tumor and endometrial carcinoma. Epithelial tumors were commonest variety of ovarian tumors followed by germ cell tumors. A relatively high number of malignancies were observed in this study.

Serum lipid profile in patients with thyroid disorders in central Nepal.

Abstract: Thyroid dysfunction is a major public health problem among Nepalese population. Hence the study is aimed to find out the prevalence of thyroid dysfunction and to investigate the effect of it in serum lipids. Serum fT3, fT4, TSH, total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG) were measured using standardized assays. Overall thyroid dysfunction was detected in 25.7% of the study population with the higher prevalence among females. The distribution of overt hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism and subclinical hyperthyroidism were 3.7%, 14.1%, 3.3% and 4.6% respectively. There was a positive association between hypothyroidism and TC>200, LDL>130 and TG>200mg/dl; 48.4% of hypothyroid patient had hypercholesterolemia and 32.3% had hypertriglyceridemia. The mean TC, LDL and TG levels were increased progressively with the increase in the serum TSH. It was noteworthy in this study that even a slight increase in serum TSH (between 6.2-10 mIU/L) showed significant increase in serum lipid level. However there was no association among patients with hyperthyroidism and control group.

Control of coliform bacteria detected from diarrhea associated patients by extracts of Moringa oleifera.

Abstract: The aims of this study were to determine the total population of coliform bacteria in the samples collected from diarrhea associated patients from the local area of Bangladesh and to examine the antibacterial efficacy of leaf extracts of Moringa oleifera (Moringaceae) against the isolated coliform bacteria. The coliform bacteria detected in these samples by some microbial-biochemical tests such as Escherichia coli, Shigella dysenteriae, Salmonella sp., Enterobacter sp., Klebsiella pneumoniae and Serratia marcescens. The total isolation rate of coliform bacterial species was ranged from 38.01-3.51%. At the concentration of 300 ig/disc, the organic extracts of hexane, chloroform, ethyl acetate and methanol extracts of Moringa oleifera leaf exhibited a remarkable antibacterial effect against all the tested bacterial pathogens. The zones of inhibition against all the tested bacterial pathogens were found in the range of 8.0 to 23.2 mm, along with their respective minimum inhibitory concentration (MIC) values ranging from 62.5-1000 ig/mL. The results obtained in this study suggest that the extracts from Moringa oleifera leaf can be a source of natural antimicrobials with potential applications in pharmaceutical industry to control coliform bacteria.

Correlation between gestational weight gain and birth weight of the infants.

Abstract: Birth weight is an important determinant of infant's well being as low birth weight is known to increase the risk adult onset of diseases like type-2 diabetes and ischemic heart disease. Maternal weight gain is one of the most important independent predictors of infant birth weight. Institute of Medicine of the National Academics, USA has recommended that total weight gain of mothers should be according to their prepregnancy body mass index (BMI). Therefore, this study was conducted to observe the total weight gained by the pregnant women and the correlation between the weights gained by them with the birth weight of their infants. 98 women who delivered full term single baby at Patan hospital were included after taking their verbal consent. The details of the newborn and the history of the pregnant women were taken from the hospital records. The information about the family income, dietary habit, birth spacing and the type of work done by the pregnant women was obtained from the women themselves. The mean weight gain of the mothers was 9.48 (SD = 3.41) kilograms and the mean birth weight of the infants was found to be 2965.66 (SD = 364.37) grams. Multiple Liner Regression Models showed the effect of Gestational weight gain (GWG), Age and Parity on birth weight of the infant. Step-wise multiple regressions gave rise to models that showed effect of GWG and age on birth weight of the infants. This study concluded that gestational weight gain has positive linear relationship (correlation) with the birth weight of infants.

Opportunistic infections in relation to CD4 level among HIV seropositive patients from central Nepal.

Abstract: CD4 cells status of HIV patients provides one of the benchmarks against the progression of HIV/AIDS. Regular investigation of opportunistic infection in HIV patients is one of the major components of HIV/AIDS care and support service. Between October 2007 and May 2008, a cross-sectional analytical study was carried out in Tribhuvan University Teaching Hospital with an objective to find the relationship between CD4 level and opportunistic infections. After taking informed consent pre-structured questionnaire was filled and specimens were collected to investigate major opportunistic infections (OIs) as per standard microbiological procedure. All the information were entered into SPSS 11.5 system and analyzed. Of the 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. The age group 21-30 years was predominant (42.7%) followed by 31-40 years (42%). Oral candidiasis was found to be the predominant OIs (32.0%) followed by streptococcal pneumonia (28.7%), Salmonella infection (20.7%), cryptosporidial infection (19.3%) and tuberculosis (10.0%). Significant relationship could be established between low CD4 count (<200) and the appearance of oral candidiasis (/2=9.16, p<0.05) but no such relationship could be established regarding other OIs. So, it can be concluded that appearance of oral candidiasis is the strong evidence of advanced stage of HIV infection.

Study of fibrinogen in patients with diabetes mellitus.

Abstract: Patients with diabetes mellitus have 2 to 4 times increased risk for cardiovascular disease than non-diabetic patients. However this excess risk is not fully explained by the traditional cardiovascular risk factors (Hypertension, Hypercholesterolaemia, Smoking and Obesity) which are also associated with diabetes. Fibrinogen has been identified as an independent risk factor for cardiovascular disease and it is associated with traditional cardiovascular risk factors. This is a descriptive analytical cross-sectional study carried out in Tribhuvan University Teaching Hospital (TUTH) medical outpatient department and Medical ward from June 2005 to June 2006. A total of 120 consecutive patients were enrolled; 30 patients having Diabetes. Next 30 patients having both diabetes and coronary artery disease. Thirty patients having only coronary artery disease but no diabetes. And 30 patients (control) not having both diabetes and coronary artery disease. Fibrinogen was found to be significantly higher in patients with diabetes than control. Fibrinogen was significantly higher in diabetic patients with coronary artery disease than those patients who had only diabetes or coronary artery disease (p value<0.01).

Prevalence of methicillin resistant Staphylococcus aureus (MRSA) among skin infection cases at a hospital in Chitwan, Nepal.

Abstract: This study was carried out to see the methicillin r esistance of Staphylococcus aureus isolated from patients with skin and soft tissue infection. In this study, a total of 600 S. aureus isolates isolated from 1,334 specimens from skin and soft tissue infection were included. For the screening of methicillin resistant of S. aureus (MRSA), specimens were inoculated on lipovitellin mannitol salt agar (LMSA) and MRSA were screened by testing resistance to oxacillin in AST plate following the standard bacteriological technique. The overall pre valence of MRSA was 68.0% (408/600). MRSA infection was higher among patients above 30 years of age. TibetoBurmans had high MRSA infection rate (72.5%) than Indo-Aryans (56.8%) and the rate was significantly higher among males (75.0%) than females (63.4%) (p<0.05). MRSA isolation rate was higher from wound (76.9%), followed by purulent exudates (67.7%) and abscesses (64.1%). The high prevalence of MRSA found in this study might be due to hospital based specim en.

A morphometric study of human trachea and principal bronchi in different age groups in both sexes and its clinical implications.

Abstract: An extensive morphometric study of human trachea and principal bronchi was undertaken in the Department of Anatomy, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, on 87 specimens procured from 51 male and 36 female relatively disease free fresh cadavers from Kolkata Police Morgue. The specimens were grouped into five age groups for both sexes. The length of trachea, principal bronchi, subcarinal angle was measured in each specimen. The external transverse diameter (width), internal transverse diameter and anteroposterior diameter (depth) were recorded at two different levels of trachea (junction of upper third and middle third; middle third and lower third) and middle of principal bronchi. Then the width-depth ratio was calculated. For each component of the measurements, standard error (SE), standard deviation (SD) and test of significance were calculated using independent sample't' test and multiple comparison test. The present investigation revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters and width-depth ratio of upper and lower trachea and right and left principal bronchi and the subcarinal angle, in a same age group as well as in different age groups in both sexes. The study of these morphometric variations is of profound clinical importance as it may help the clinicians to understand the etiology of several pulmonary diseases and the surgeons to deal with resection and reconstruction of the tracheobronchial tree. This knowledge is also helpful for smooth conduction of some maneuvers like endotracheal intubation and bronchoscopic procedures.

Use of protein: creatinine ratio in a random spot urine sample for predicting significant proteinuria in diabetes mellitus.

Abstract: Present study was undertaken during a period of 6 months (September 2008-February 2009) to see an correlation of 24 hours urine protein estimation with random spot protein-creatinine (P:C) ratio among a diabetic patients. The study comprised of 144 patients aged 30-70 years, recruited from Kantipur hospital, Kathmandu. The 24-hr urine sample was collected, followed by spot random urine sample. Both samples were analyzed for protein and creatinine excretion. An informed consent was taken from all participants. Sixteen inadequately collected urine samples as defined by (predicted creatinine--measured creatinine)/predicted creatinine > 0.2 were excluded from analysis. The Spearman's rank correlation between the spot urine P:C ratio and 24-hr total protein were performed by the Statistical Package for Social Service. At the P:C ratio cutoff of 0.15 and reference method (24-hr urine protein) cutoff of 150 mg/day, the correlation coefficient was found to be 0.892 (p < 0.001). The area under ROC curve at different cutoffs was 0.88 at 95.0% CI. The sensitivity and specificity of the P:C ratio to detect significant proteinuria at the cutoff of 0.15 are 96.6% and 74.4%. So the P:C ratio can predict significant proteinuria in diabetic subjects, avoiding the inconvenient 24-hr urine collection but the cutoff should be carefully selected for different patients group under different laboratory procedures and settings.

The incidence of color blindness among some school children of Pokhara, Western Nepal.

Abstract: The incidence of color blindness varies from race to race and different in different geographical area. Since, there is no such report about the prevalence of color blindness in the western part of Nepal, the present study had been conducted to find out the incidence of color blindness among school children of Pokhara city, western Nepal. Participant's (n=964, 474 boys, 490 girls, age group 10 to 19 years) color vision was tested by using Ishihara chart (38 plates). Among 474 boys, 18 boys were color blind with the prevalence of 3.8%. None of girls were found to be color blind. Out of 18 color blind boys, nine, six and three boys were the victims of deuteranopia, deuteranomaly and protanomaly respectively. The incidence of color blindness were more amongst the Darji (14.3%) and Newar (9.1%) ethnic groups.

Study on the variation of branching pattern of arch of aorta in Nepalese.

Abstract: The variations of vessels arising from the aortic arch are numerous. The purpose of this study is the description of the variations on the branching pattern of arch of aorta, in order to offer useful data to anatomists, radiologists, vascular surgeons, neck and thorax surgeons in Nepalese subjects, and relating it with embryological basis. In this investigation, branching patterns of arch of aorta were studied in 85 cases of Nepali origin. Variations in the anatomical arrangements of the branches of arch of aorta in the Nepali population were as par with other populations of the world. Variations on the branching pattern of the arch of aorta were found in 17 cadavers (20.0%) of elderly Nepalese. The accurate information on this is vital for vascular surgery in the thorax, head and neck regions. Although, the variations are usually asymptomatic, they may cause dyspnea, dysphagia, intermittent claudication, misinterpretation ofradiological examinations and complications during neck and thorax surgery. These observations are precious while invading the arch of aorta and its branches by instruments, as all areas are susceptible to surgical attack.

A study of depression and anxiety in cancer patients.

Abstract: The aim of the study was to assess the prevalence of depression and anxiety in cancer patients. A cross sectional case control study design was used. Severely or terminally ill cancer patients and patients suffering from other concomitant illnesses were excluded from the study. Depression and anxiety was assessed on 50 cancer patients (cases) and on 50 healthy individuals (controls). The tools used were Structured Proforma (for recording sociodemographic details and relevant medical history), General Health Questionnaire (GHQ) and Hospital Anxiety and Depression Scale (HADS). A total of 30 (60.0%) were detected as 'cases' or having psychiatric morbidity based on a cutoff score of above 2 on 12 item GHQ. Depression was present in 28.0% of cancer patients whereas 40.0% of cancer patients had anxiety as per HADS.

Deep-seated thoracic and abdominal lesions: usefulness of ultrasound guided fine needle aspiration cytology, a 3 year experience.

Abstract: Three hundred twenty patients were subjected to ultrasound guided fine needle aspiration cytology (FNAC) over a 3 year period (April 2006 - March 2009). These included liver (125 cases), lung (81 cases), abdominal and mediastinal lymph nodes (29 cases), ovary (14 cases), omentum (12 cases), pancreas (10 cases), kidney (10 cases), mediastinum (8 cases), gall bladder (8 cases) etc. The aim of this study was to evaluate the overall utility of ultrasonographic guided FNAC in the diagnosis of abdominal and thoracic lesions. In 264 cases (82.5%), FNAC was diagnostic with commonest diagnosis being malignant neoplasm (70.0%). 14 cases (4.4%) were suspicious of malignancy and remaining 42 (13.1%) cases either didn't reveal diagnostic material or they were inconclusive. In liver, Metastatic adenocarcinoma is the commonest tumor, while in lung; the commonest lesion is non-small cell carcinoma. Benign neoplasm (3.1%) and non neoplastic lesion (9.4%) were also diagnosed by FNAC. Rare sites like oesophagus and duodenum were also aspirated. Complication rate was too low (0.9%) in this study. USG guided FNAC, in conjunction with clinico-radiological parameters are accurate and safe in diagnosing deep-seated mass lesions in the thorax and abdomen.

Loading dose versus standard regimen of magnesium sulphate in eclampsia - a randomized trial

Abstract: Eclampsia is one of the leading causes of maternal mortality and morbidity around the world. Magnesium sulphate is used as primary agent in the treatment of seizure in eclampsia. Its dosage and frequent painful injection makes it a difficult drug for the patient. This study was carried out in one of the biggest referral centre of Nepal to study the suitability of different dosage schedule for our patient. A randomized controlled trial was carried out in the Obstetric Unit of BP Koirala Institute of Health Science (BPKIHS) over the span of 1.5 years. A total of 80 eclamptic women were randomized to receive either standard Pritchard Regimen (loading and maintenance) or Loading dose of magnesium sulphate. Both groups were evaluated for recurrence of seizures and outcomes. There were no recurrent seizures in standard regimen group. There were 2 patients with recurrent seizure in loading dose group. (p=0.184) Loading dose of magnesium sulphate is a good alternative for standard Pritchard regimen. It avoids multiple painful injections of magnesium Sulphate.

Public perception about drinking jar water and its bacteriological analysis.

Abstract: The consumption of jar water has been increasing consistently in these days. To improve such water quality and supply, information is needed to assess water contamination in a variety of community, including those that rely primarily on unimproved distributed sources of drinking water. This study was done to assess the public perception on drinking jar water and assessment of drinking jar water distributed in Kathmandu Valley which was conducted in the Department of Microbiology, Amrit Science Campus, Thamel, Kathmandu during the period of Aug 2009 to Dec 2009. A total 57 water samples of different drinking jar water having different brand names were proceed using standard protocols and analyzed for the presence of total coliforms and fecal coliforms. All identified fecal coliforms isolates from different water samples were subjected to in-vitro antimicrobial susceptibility test by Kirby-Bauer disc diffusion method. In order to know the perception of people in drinking jar water, semi structured questionnaires were made and purposively selected for the study in 525 populations who were using jar water for drinking purpose. Most population rated their drinking jar water good but found to be highly concerned with the quality. Among total water samples, 91.2% (n=52) were found contaminated with total coliforms and 59.6% were with fecal coliforms. During the study, 117 isolates of enteric bacteria were isolated, of which 33.3% (n=39) were Escherichia coli followed by other gram negative bacteria. Similarly, out of 58 fecal coliforms isolates, 43.1%, 39.6%, 12.2% were E. coli, Klebsiella spp, and Enterobacter aerogens. Of those fecal coliforms, all were sensitive to antibiotic ciprofloxacin and resistant to ampicilin. The finding indicates that jar water is not safe for drinking purpose without treatment.

Anomalous formation of the circulus arteriosus and its clinico-anatomical significance.

Abstract: Circulus arteriosus (Circle of Willis) is an anastomotic ring which unites the internal carotid and vertebrobasilar systems. It slows down the blood before it reaches the brain and helps in collateral circulation. Anatomic study reveals the variation in the pattern and calibre of vessels which make up the circulus arteriosus. The greatest variation in calibre occurs in the posterior communicating artery. The posterior cerebral artery is divided into three portions by the posterior communicating artery; these are- P 1 , P 2 , and P 3 . Three basic configurations of the posterior communicating artery has been described; foetal, transitional and adult. In foetal configuration: the diameter of the P 1 segment of posterior cerebral artery is less than the diameter of posterior communicating artery so that the blood supply to the occipital lobes is mainly via the internal carotid arteries. Thirty five circulus arteriosus of the formalin embalmed brains were studied during the period of three years. Posterior cerebral and posterior communicating arteries were traced from their origins to terminations. It is revealed that in 8.6% of cases the formation of the circulus arteriosus was anomalous. The calibre of the pre communicating (P 1 ) segment of posterior cerebral artery was smaller than the posterior communicating artery. It appeared that the posterior cerebral artery is the continuation of posterior communicating artery, thus the branch of the internal carotid artery. Anomalies of the formation of circulus arteriosus leads to stroke. The neurosurgical importance of this study lies during the exposure of the region for different purposes. Knowledge of the vascular variations will increase the success of the procedure.

Long term effects of monosodium glutamate on spermatogenesis following neonatal exposure in albino mice--a histological study

Abstract: Monosodium glutamate (MSG), popularly known as Azinomoto has been in use since long as a flavour enhancing substance. Its widespread use has also earned it a bad name as hazardous for human health. It has been incriminated to cause wide range of effects comprising retinal degeneration, metabolic disorders, endocrinal disorders including reduced fertility rate in both male and female experimental mice and rats following neonatal exposure. However there are many contradicting views too regarding the above effects which have prompted us to undertake the present study. In our study seven newborns of Swiss Albino mice were injected subcutaneously with MSG (2 mg/gm ofbody wt. in a dilution 40 mg of per ml. of distilled water) on completion of 2nd, 4th, 6th, 8th and 10th day of life. Similar number of controls were injected with same volume of distilled water. Testes were obtained through dissection on completion of 75 days of life. 5 micron thick sections were cut, stained by H.E. and Heidenhain's Iron Haematoxylin and studied under light microscope. It was observed from the quantitative analysis of the seminiferous tubules that there was increase in the number of the pachytene stage of primary spermatocyte in the experimental group as compared to that of the control animals of corresponding age.

A study of ocular morbidity of patients attending a satellite clinic in Bhaktapur, Nepal.

Abstract: A community based retrospective study was conducted in the satellite clinic of Nepal Medical College Teaching Hospital at Jhaukhel VDC of Bhaktapur, from March 2007 to February 2008. A total of 395 patients were examined, where males comprised of 135 patients (32.9%) and females 265 patients (67.1%). The common ocular diseases observed in this study were refractive errors 22.5%, age related cataract 17.5%, extra ocular diseases like conjunctivitis 14.9%, conjunctival degenerations 10.8%.

Reasons underlying the extraction of permanent teeth in patients attending Peoples Dental College and Hospital.

Abstract: Extraction of permanent teeth is common in Nepal. The study was undertaken to determine the causes and pattern of missing permanent teeth among patients attending Peoples Dental College and Hospital (PDCH) and to see if there is any association between variables like socio economic status, patient education level, dental visit and extraction of permanent teeth. A prospective cross sectional survey was carried out in patients attending the Department of Oral Surgery in PDCH between August 2006 and October 2006. The data was collected by trained clinician through clinical examination and using semi- structured questionnaires. Computer software SPSS 15 was used for statistical analysis. In age groups 30 years, 55.6% periodontal disease was the most common reason for extraction of teeth. Distribution by type of teeth and dental disease was highly significant where. Dental caries was the reason for extraction of first permanent molar. Distribution by education level and visit to dentist was highly significant. About 93.1% of the people who were illiterate visited the dental surgeon while in pain and 76.0% of the university level graduates visited the dentist while in pain. Caries and its sequel remain the most important cause of tooth loss throughout adult life along with periodontal diseases at later stages.

Color vison deficiency among medical students: an unnoticed problem.

Abstract: Color vision deficiency, most of the time remains an unnoticed problem; although it is not very rare. The faculty of appreciation of color is essential for our smooth daily activities. Unfortunately, even many doctors do not know the severity of their color vision deficiency and tend to assume it as slight, and a few, as in the general population, do not know about their disability. Some common difficulties reported by medical practitioners and medical students were in recognizing- widespread body color changes (pallor, cyanosis, jaundice, rashes, erythema of skin), colorful charts, slides, test-strips for blood and urine, body products: blood or bile in urine, faeces, sputum, vomit, microscopy, mouth and throat conditions, impressions presented in the Ishihara chart, titration end-points, tissue identification (surgery) etc. The present study was undertaken to evaluate the presence of congenital color vision deficiencies among the medical students. The study was carried out among the 1st and 2nd year medical students of Nepal Medical College and Teaching Hospital (n= 120) with the help of Ishihara chart, that was shown to all participants. They were asked to read the impressions in the color chart. The impression perceived by a person with normal color vision was different from the impression perceived by a person with color vision deficiency. It was noted that, among the study population (n=120) 5.83% of the volunteers were color weak. Amongst the color-deficient volunteers, 57.0% were protanopic while 43.0% were deuteranopic. Medical students must be made aware of their congenital color vision deficiency and its effects on their work. Screening will enable the student and later the doctor to become aware of limitations in their powers of observation and devise ways of overcoming them; the patient will be protected from harm and litigation may be avoided when doctors have adapted their practice to their deficiency. Medical students and physicians must be screened for color vision deficiency and advised about it so they can take special care in clinical practice.

Age at menarche of subpopulation of Nepalese girls.

Abstract: The present study was carried out to explore the mean age at menarche of school going girls of Western Nepal Pokhara and to determine the factors influencing age at menarche. The data was collected from five schools located within the Pokhara Valley of Western Nepal. Only the students who had experienced menarche were included in the study. Verbal consent was obtained after explaining the objectives of the study; the students were interviewed for personal and family details and information obtained was recorded. The age at menarche was found to be 12.69 +/- 0.95 years. The mean age at menarche of those attending community schools was significantly higher than that of those attending private schools (12.85 +/- 0.87 vs 12.41 +/- 0.99 years). The mean age at menarche was found to be delayed with increase in number of family members and more siblings. The mean age at menarche of the vegetarians was higher than that of non-vegetarians (12.82. +/- 0.81 vs 12.68 +/- 0.95 years).

Assessment of kidney stone and prevalence of its chemical compositions.

Abstract: Kidney stone analysis is the test done on the stone which cause problems when they block the flow of urine through or out of the kidneys. The stones cause severe pain and are also associated with morbidity and renal damage. There is also no clear understanding on the relative metabolic composition of renal calculi. Hence, the study is aimed to find out the chemical composition of it which can guide treatment and give information that may prevent more stones from forming. The study was carried out on the stones that had been sent to the department of Biochemistry (n = 99; M = 61; F = 38; Mean age: 33.6 +/- 14.4 years) Approximately 98.9% of stones were composed of oxalate, 95.9% of Calcium, 85.8% of phosphate, 62.6% of Urate, 46.4% of Ammonium and very few percentages of Carbonate.

Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

Abstract: World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

Effect of Pueraria tuberosa tuber extract on chronic foot shock stress in Wistar rats.

Abstract: The present study was undertaken to explore the protective effects of tuberous root extract of Pueraria tuberosa on chronic foot shock stress (CS) induced physiological, neurobehavioral and neuropathological alterations. Male Wistar rats (120-150 g) were divided into seven groups, consisting of ten animals in each. Group I served as normal, group II as positive control, while group III-VII as test drug treated. P tuberosa tuber extract (PTE) was given to rats of groups III-VI at the doses of 50, 100, 200 and 400 mg/kg respectively, while group VII treated with Withania somnifera rhizome extract (WSE) (100 mg/kg) as reference drug. Group II (stress control) received only equivalent volume of distilled water (0.5 ml/100 g) orally. All the drugs were given orally once/day for 14 consecutive days. The last dose was given 1 h before study. Simultaneously, all the animals (except group I) were subjected to 1 h of foot-shock (2 mA) through a grid floor for those 14 days in a standard conditioning chamber with the escape route closed [Chronic stress (CS)]. Thereafter, the rats were placed on open-field and plus maze apparatus for studying the behavioral patterns of them, and the anxiolytic effects of the putative drug. Sexual activities of the animals were also studied. Finally, the animals were sacrificed and their ulcer formation in gastric mucosa was noted. Weights of adrenals and spleen were also taken. Further, plasma corticosterone levels were estimated spectroflurometrically. Results indicated that, CS significantly altered the behavioral patterns, decreased the sexual urge and activities, damaged the gastric mucosal layers, enhanced plasma corticosterone levels and increased adrenal glands and spleen weights. PTE and WSE showed significant anxiolytic activity, protected the gastric mucosa, lowered plasma corticosterone level (indicating HPA axis inhibition) and negated the hypertrophy of adrenals and spleen. PTE also enhanced the sexual urge and activities in animals exposed to chronic stress. The findings suggest significant anxiolytic and anti-stress properties of PTE, confirming the clinical efficacy of the plant mentioned in Ayurveda (Indian system of traditional medicine).