Showing papers in "Nepal Medical College journal in 2011"

Long term effect of monosodium glutamate in liver of albino mice after neo-natal exposure.

Abstract: Mono Sodium Glutamate (MSG) is a naturally occurring excitatory neurotransmitter. It is extensively used as a food additive and flavoring agent for its UMAMI taste. Simultaneously it is being implicated for varied pathological condition like obesity, gonadal dysfunction, learning difficulty etc. It produces oxygen derived free radicals and metabolized in liver. Neonate mice are sensitive and suffer from adverse effects. Present work was undertaken to study the long term effects on histology of liver following MSG injection in neonates. The changes in the liver parenchyma of 75 days old mice showed variable changes. Areas around central vein were most affected. The liver cords were disrupted, dilated sinusoids, prominent Kupffer cells with accumulation of particulate matter.There were inflammatory cells around central vein. The hepatocyte cell membrane were disrupted, cytoplasm vacuolated, nucleus were pyknotic. Even the normal looking cells showed depletion of PAS +ve material in the cytoplasm.The long term effect on histology showed moderate and patchy hepatocellular damage.

Prevalence of intestinal worm infestations among school children in Kathmandu, Nepal.

Abstract: Intestinal worm infestation is one of the major childhood health problem in Nepal. This study was done to assess the prevalence of intestinal worm infestations among school children aged 6-16 years in a public high school in Kathmandu Nepal. A total of 142 stool samples from healthy students were collected and reported following formol-ether concentration technique. The overall prevalence of intestinal worm infestation was found to be 17.6% (Boys = 22.0% vs girls = 13.5%). Children aged 6-8 years were found to be highly infected with intestinal worms (21.4%) followed by 9-12 years old (18.6%). Those between 13-16 years of age were significantly less infected (10.7%) compared to others (p < 0.05). Ova/cysts of intestinal parasites detected include Trichuris trichiura (32.0%), Ascaris lumbricoides (20.0%), Hymenolepis nana (16.0%), hookworm (8.0%) and 24.0% cases showed mixed parasitic infections.

Clinical and Bacteriological profile of urinary tract infection in children at Nepal Medical College Teaching Hospital

Abstract: The aim of this study was to study the clinical and bacteriological profile of urinary tract infection (UTI) in children. This was a prospective study of 40 culture positive cases of UTI in children who attended pediatric outpatient department of Nepal Medical College Teaching Hospital. UTI was more common in female (65.0%) than in male (35.0%). Half were in the age group 1- 5 years. Fever was the most common presentation (65.0%) followed by abdominal pain (42.5%), decreased appetite (37.5%) and dysuria (37.5%). Escherichia coli was the most common (67.5%) bacterial isolate followed by Klebsiella sps (20.0%) and Proteus sps (10.0%). E. coli was 100 % sensitive to nitrofurantoin. E. coli was also highly sensitive to ofloxacin, cefotaxim and amikacin (94.0%). Klebsiella was 100 % sensitive to ciprofloxacin and amikacin. Greater degree of resistance was seen to ampicillin, cotrimoxazole and nalidixic acid.

A study of sexual dimorphism in permanent mandibular canines and its implications in forensic investigations.

Abstract: Teeth are well preserved after death and they exhibit remarkable sexual dimorphism Hence, they provide excellent materials for forensic investigations intended for identification of sex Present study was undertaken on permanent mandibular canines of 90 male and 90 female subjects of age group 17-23 years The mesiodistal width for right and left mandibular canines and intercanine distance were measured Subsequently, canine index was calculated for both sides Significant sexual dimorphism was found in all parameters except intercanine distance All the results were compared with previous studies and discussed in the light of genetic, evolutionary and metabolic reasons for sexual dimporhism

Association between maternal body mass index and the birth weight of neonates.

Abstract: Birth weight (BW) is an important determinant of infant's well being. Several factors such as mothers' genetic characteristics, socio-cultural, demographic, behavioral factors, prepregnancy body mass index (BMI), gestational weight gain (GWG) etc contribute to birth weight. This study assesses the anthropometric measurement of ethnic Nepalese women belonging to Sherpa/Tamang community and Brahmin/Chhetri community and the neonatal outcome in this population. A retrospective study was done in singleton pregnant women of Sherpa/Tamang and Brahmin/Chhetri community who delivered baby in Nepal Medical College and Teaching Hospital from April 2007 to March 2008 to examine the association between the maternal Body Mass Index (BMI) and the gestational weight gain among the two ethnic communities and the birth weight of newborns. Among 206 Sherpa women who met the eligibility criteria, the mean BMI of Sherpa/Tamang community was 23.53 +/- 2.28 which was statistically higher than the Brahmin/Chhetri community (21.6 +/- 2.32). Among Sherpa/Tamang community, the mean gestational weight gain was 12.8 +/- 3.4 kg and the mean birth weight was 3460 +/- 410 grams. Similarly among Brahmin/Chhetri community, mean gestation weight gain was 10.3 +/- 3.1 kg and the mean birth weight was 2960 +/- 340 gm. Maternal BMI, gestational weight gain and birth weight of the newborn was significantly higher in Sherpa/Tamang community and the Increasing BMI and the gestational weight gain was found to have strong association with the birth weight of the newborns among this ethnic community.

Uropathogens and their antimicrobial susceptibility pattern in Bharatpur, Nepal.

Abstract: Urinary tract infection is one of the common clinical condition in the patients presenting to the clinics and hospitals. Detection of common pathogens and their antimicrobial susceptibility pattern is mandatory for effective treatment. The present study was conducted to detect common pathogens of urinary tract infection (UTI) and their susceptibility pattern to the commonly used antimicrobial agents in local scenario. We conducted a retrospective study on bacteria isolated from the urine samples submitted in microbiology unit from May 2009 to October 2009 at Chitwan Medical College. Study included total 950 clean catched midstream urine samples which were processed to identify the causative agents and their susceptibility pattern to commonly used antimicrobial agents according to the CLSI guidelines. This study showed UTI is more common in young females. Out of total 950 samples, 237 (24.94%) samples grew potential pathogens causing UTI. Escherichia coli were the predominant 163 (68.77%) isolates followed by Enterobacter spp 33 (13.92%). Most of the urinary isolates showed hundred percent resistant to Ampicillin and high degree of resistance to Nalidixic acid, Nitrofurantoin, Cotrimoxazole followed by Ciprofloxacin and Gentamicin. More than 50% of common pathogens were resistant to Ceftriaxone. Uropathogens were more sensitive to Cephotaxim, Amikacin, Ofloxacin and Norfloxacin. Uropathogens resistant to 3rd generation cephalosporin are increasing. Irrational and repeated use of antibiotics is the main cause of increasing resistant organism of UTI.

Prevalence of vaginitis among pregnant women attending Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal.

Abstract: Vaginitis is the most prevalent disorder among the pregnant women The objective of this study was to find out the prevalence of common types of vaginitis among the pregnant women visiting Paropakar Maternity and Women’s Hospital in Kathmandu Among 200 pregnant women included in the study, 78 (390%) had vaginitis Of total 78 positive cases of vaginitis, 295% had candidiasis, 526% bacterial vaginosis and 13 % trichomoniasis Approximately 83% had monomicrobial infection and 167% had polymicrobial infection Vaginitis was common in the age group of 20 to 29 years (418%) and 30-39 years (400%) Ethnically, Indo-Aryans (402%) were mostly infected The infection rate was the highest among illiterate women (476%) and least among the women having education above secondary (230%) The positive infection rate was higher in women from rural area (452%) than those from urban area (373%) Nearly half of the women with agriculture occupation (484%) had vaginitis Vaginitis was common in women with third pregnancy (526%) Among 78 vaginitis cases, 53 (679%) were asymptomatic cases

Antibacterial photodynamic therapy on Staphylococcus aureus and Pseudomonas aeruginosa in-vitro.

Abstract: Photodynamic therapy (PDT) involves the use of drugs or dyes known as photosensitizers, and light source which induces cell death by the production of cytotoxic reactive oxygen species (ROS). This principle of cell death can be utilized to kill bacteria in vitro. We propose the use of blue light emitting diodes (LEDs) and Riboflavin as the light source and photosensitizer for in vitro killing of Staphylococcus aureus and Pseudomonas aeruginosa. Circularly arranged 65-blue LED array was designed as the light source to fit exactly over 7cm culture plate. Riboflavin having non-toxic properties and nucleic acid specificity was used as a photosensitizer. Clinical isolates of Staphylococcus aureus and Pseudomonas aeruginosa were used in our study. Effect of PDT on viability on these species of bacteria was compared with control samples that included: control untreated, control treated with light only and control treated with riboflavin only. Statistical analysis was done using one-way ANOVA test. PDT against Pseudomonas aeruginosa and Staphylococcus aureus was significantly (p < 0.05) effective compared to all control samples. Combination of blue LEDs and Riboflavin in PDT against these bacterial species has been successfully demonstrated in-vitro. Therefore, PDT has promising applications in the process of treating superficial wound infections.

Association of thyroid dysfunction among infertile women visiting infertility center of Om Hospital, Kathmandu, Nepal.

Abstract: Infertility is one of the medial, social and psychological burdens in this part of world. Thyroid dysfunction can lead to menstrual disturbance, anovulatory cycles, and decreased fecundity. Proper management of thyroid dysfunction canresult restoration of normal fertility. Therefore it is very important to screen thyroid abnormalities among women with infertility. This study aimed to determine association of thyroid dysfunction among infertile women. This study comprises total of 735 primary infertile women with age ranging from 20 to 35 years. Blood samples were collected and subjected for estimation of thyroid hormones. Out of 735 cases 547 (74.4%) were euthyroid. 56 (7.6%) have primary hypothyroidism, 31 (4.2%) have primary hyperthyroidism, 87 (11.8%) have subclinical hypothyroidism, and 8 (1.1%) have subclinical hyperthyroidism.

Asymptomatic bacteriurea among pregnant women visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal.

Abstract: Urinary tract infection is the commonest bacterial infection in pregnancy. The overall incidence is 5.0-10.0% of all pregnancy. During pregnancy bacterial growth is favoured by increased urinary content of glucose, aminoacids and other nutrients. Other factors responsible for infection are basically related to hormonal effect and mechanical factors. Prolonged stasis of urine in urinary bladder favours growth of micro organism, relaxation of vesico-ureteric junction leads to reflux of urine from bladder to ureter and later up to renal pelvis and later can affect the renal parenchyma affecting the function of kidneys. In addition, some maternal defense mechanism are less effective during pregnancy. Bacteriuria either asymptomatic (5.0%) or symptomatic is common in pregnancy, if left untreated, asymptomatic bacteriuria will lead to acute pyelonephritis in 20.0-30.0%. This may result in abortion, premature delivery, low birth baby and even still birth. About 12.0% of antenatal admission are sepsis due to pyelonephritis. Keeping in mind that UTI in pregnancy leads to increase in maternal morbidity as well as neonatal morbidity and mortality. In this prospective study all asymptomatic consecutive antenatal women were included 200 from each trimester with total of 600 in number to see the incidence in different trimester, most prevalent organisms and it's sensitivity. They were followed up till delivery to see the incidence of asymptomatic bacteriurea in different trimester and its outcome in terms of type of delivery, baby weight, apgar score given at the time of birth and hospital admission for morbidity.

Study of parasitic infection among children of Sukumbasi Basti in Kathmandu valley.

Abstract: Keeping in view of heavy burden of intestinal parasitosis, present study was done to find out the prevalence of intestinal parasitic infection in children (aged <16 years) of Sukumbasi (people living without land ownership) Basti (community) in Kathmandu Valley. A total of 279 stool samples collected in clean, dry and screw capped plastic container were firstly examined for the presence of adult worm and/or segments of worms. Samples fixed in 10% formal-saline were then examined microscopically after concentration by formal-ether sedimentation technique. Overall parasite positive rate was 43.3% (121/279) with no significant difference in two genders (Boys: 48.3%, 73/151; Girls: 37.5%, 48/128) (p=0.07). Altogether 11 species of parasites were detected. Of them Giardia lamblia was most common followed by Entamoeba histolytica, Trichuris trichiura and others. Positive rate was higher in Tibeto-Burman (55.0%, 77/140) and the least in Indo-Aryan (25.4%, 27/ 106) (p=0.01) ethnic groups. Children taking anti-parasitic drug in last six months had significantly low positive rate (25.4%, 15/59) than others (48.2%, 106/220) (p=0.002). Results of this study suggestive of periodic administration of anti-parastic drugs and need for improvement of sanitary/hygienic practice.

Signet ring cell carcinoma of the gallbladder: a case report.

Abstract: Carcinoma of the gall bladder is the most common biliary tract tumor with higher incidence in females and increasing age The risk is significantly higher in cholelithiasis Signet ring cell carcinoma is a rare form of mucinous adenocarcinoma and has a worse prognosis Early diagnosis is rare We report a case of signet ring cell carcinoma of the gall bladder in a 70 years old female patient The gross finding was yellowish white mass measuring 4 x 35 cm on cut surface of the gall bladder along with thickened wall Histopathological examination of the specimen shows the sheets of signet ring cells with lateral spread through the lamina propria and large amount of extracellular mucin There was metastasis in the retroperitoneum and mesenteric lymph node The tumor was stage IV (according to TNM staging) Patient died 20th post operative day Since very few cases have been reported, information regarding the behavior and prognosis of gall bladder carcinoma is limited However it has been seen that stage III and IV carcinoma usually have worse prognosis

Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal.

Abstract: One hundred and five (72 males; 33 females) consecutive patients who met the inclusion criteria were studied. The mean age of the patients was 49.06 +/- 11.27 years (range 23-73 years). Ninety patients were adult cirrhotics (age > or = 35 yrs) and the remaining 15 patients were young (age < or = 35 yrs). Ninety out of 105 patients were having alcohol related cirrhosis. The commonest presenting symptoms were abdomen distension (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and jaundice (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics). The most common presenting signs were ascites (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and icterus (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics), followed by loss of body hair (73.3% vs. 71.1% in young and adult cirrhotics respectively) and spider naevi (46.7% vs. 61.1% in young and adult cirrhotics respectively). Sixty percent of young cirrhotics and 52% of adult cirrhotics were in Child's grade C at the time of presentation. Most of the deaths were seen in Child's grade C of liver disease. Alcoholic cirrhosis is common in the eastern part of Nepal. Cirrhosis is not uncommon in younger age group. Abdomen distension and jaundice were most common clinical presentations. Most patients were in Child's grade C and most deaths were due to hepatic failure.

Salmonella enterica serovar Paratyphi A: an emerging cause of febrile illness in Nepal.

Abstract: With an aim to evaluate the isolation rate and antibiotic susceptibility pattern in Salmonella enterica serovar Typhi and S. Paratyphi A, 656 blood samples collected from clinically diagnosed enteric fever patients at National Public Health Laboratory, Nepal during January through December 2008 were processed. Isolates were identified by standard microbiological procedures including serotyping. Antibiotic susceptibility testing was performed by disc diffusion method and minimum inhibitory concentration (MIC) to ciprofloxacin, ofloxacin and nalidixic acid was determined by agar dilution method following CLSI guidelines. Altogether 59 isolates of S. Typhi (49.15%) and S. Paratyphi A (50.85%) were recovered. A total of 80% isolates were resistant to nalidixic acid with S. Paratyphi A (93%) showing significantly higher resistance (P<0.05) compared to S. Typhi (66%). The nalidixic acid resistant S. Paratyphi A strains required significantly higher MICs (P<0.001) to quinolone (MIC expressed as mean±SD for nalidixic acid 477.87±87.02µg/mL, ofloxacin 1.8±0.63µg/mL, ciprofloxacin 0.62±0.3µg/mL) compared with that of S. Typhi (nalidixic acid 173.18±72.03µg/mL, ofloxacin 0.43±0.11µg/mL, ciprofloxacin 0.25µg/mL). Increased MIC of fluoroquinolone (FQ) is of particular concern in emerging strains of S. Paratyphi A as exposure to these drugs fuels up further development of full FQ resistant populations. Use of FQs as the first-line drugs for empirical therapy and management of enteric fever in areas where these strains are prevalent is questionable and requires an urgent review.

Prevalence of extended spectrum beta lactamase (ESBL) production in gram negative isolates from pyogenic infection in tertiary care hospital of eastern Nepal.

Abstract: Emergence of extended spectrum beta lactamase (ESBL) producing isolates has important clinical and therapeutic implications. A high prevalence of ESBL production among multidrug resistant gram negative isolates has been reported in literature from various clinical samples. Since ESBL detection is not done on a routine basis, its prevalence is not known till date. Thus the present study was undertaken to determine the prevalence of ESBL production in gram negative isolates from pyogenic infection. A total of 300 gram negative bacilli isolated from the pus samples were identified phenotypically and antimicrobial activity was determined. ESBL detection among the isolated organisms was done by Phenotypic confirmatory disc diffusion technique recommended by CLSI. Of the 300 isolates, majority were Escherichia coli; (107) followed by Acinetobacter species; (55), Pseudomonas species; (44), Klebsiella pneumoniae; (32), Proteus mirabilis; (26), Enterobacter species; (25), Citrobacter species; (9) and others; (2). The prevalence of ESBL producing organisms was found to be 54 (18%); amongst which Escherichia coli was 29 (53.7%), Klebsiella pneumonia (14.8%), Proteus mirabilis 7 (12.9%) and others 4 (7.4%). Multidrug resistance were found in 92.6% of ESBL producers. Forty two were resistant to all the three third generation cephalosporins. The continuous surveillance of the ESBL producing isolates is necessary to make aware about the correct treatment regimens and good infection control practices.

Factors predicting the success of a trial without catheter in acute urinary retention secondary to benign prostatic hyperplasia.

Abstract: Trial without catheter (TWOC) is a common practice in acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) although it is not successful in all patients. We conducted this study to identify the factors predicting the success or failure of TWOC in this subset of patients. Sixty-four patients with first episode of AUR secondary to BPH were enrolled in this study. These patients were given tamsulosin 0.4 mg daily for 3 days and TWOC was performed. Baseline international prostate symptom score (IPSS), residual volume of urine drained after catheterization (RU), prostate size (PS) and intravesical prostatic protrusion (IPP) by transabdominal ultrasound were recorded. TWOC was successful in 28 (43.75%) and failed in 36 (56.25%) patients. Discriminant analysis was done to evaluate the predictive factors. IPP, IPSS, PS and RU were found to predict the outcome of TWOC. A prediction model, using cut off values, was derived using receiver operating characteristic curves (ROC). A cut-off value of 8 mm for IPP detected failures with specificity of 89% and success with a sensitivity of 92% with area under ROC (AUROC) of 0.98. Similarly cut-off values of 16 for IPSS (specificity 84%, sensitivity 81%, AUROC = 0.90), 40 gm for PS (specificity 73%, sensitivity 84%, AUROC = 0.89); and 800 ml for RU (specificity 82%, sensitivity 64%, AUROC = 0.81) were derived. IPP, baseline IPSS, PS and RU can predict the outcome of TWOC. Among these factors, IPP is the most accurate in predicting the success of TWOC.

Acute appendicitis in elderly patients: a challenge for surgeons.

Abstract: The classic symptoms of acute appendicitis are seldom seen in the elderly patient. More subtle symptoms and the more virulent pathologic course allow the disease to progress rapidly and insidiously. This leads to delayed hospitalization, diagnosis and treatment. The high incidence of concomitant diseases and the multiplicity of differential diagnostic possibilities in this age group are also factors. The aim of this study is to compare the results of appendicitis operated at Lumbini Medical College, Pravas, in patients younger than 60 and patient elder than 60 years of age. All patients aged 60 years and older who underwent appendectomy for appendicitis between January 2008, and December 2011, were studied and compared with the patients who were younger than 60 years of age. All the operations were performed by consultant surgeons at Lumbini Medical College, Pravas, Tansen. Preoperative USG was done in all the cases. Preoperative antibiotics were given in all the cases. All patients underwent appendectomy as an emergency basis. The results were compared with regard to age, sex, pre-operative evaluation, operative duration and findings, postoperative course, duration of hospital stay, and mortality rate. There were 50 patients in group 1 and 150 patients in group 2 who met the inclusion criteria. The mean age (64 years for group 1 and 28 years for group 2), sex, preoperative suggestion of appendicitis (group 1, 35 [70%] of 50 patients; group 2, 135 [90%] of 150 patients), and duration of the preoperative hospitalization over 24 hours (group 1, 1 patients [20%]; group 2, 30 patients [20%]) were similar in both groups. Laparoscopy was used in (group 1, 5 patients [10%]; group 2, 6 patients [4%] and associated with no significant difference in the duration of hospitalization, frequency of appendiceal perforation or abscess, occurrence of complications, or mortality. The length of operating time was more in the first group. The mean hospital stay was 5.3 in group 1 and 2.2 in group 2 (p < 0.05). Also duration of Hospital stay was 9.5 days for perforated appendicitis and 5.4 for non perforated appendicitis in both group (p < 0.05). Advanced age adversely affects clinical diagnosis, the stage of the disease and the outcomes. Late presentation, delayed diagnosis, presence of perforation and co-morbidities are associated with poor outcome from surgery.

A study of ovarian cyst in a tertiary hospital of Kathmandu valley.

Abstract: Ovarian cysts are an extremely common gynecological problem. Majority of ovarian cysts are benign with few cases being malignant. This is a retrospective study of all the cases of ovarian cysts operated in a tertiary hospital (Kathmandu Medical College, KMC) from January 2006 to December 2008. In this 3 years duration, 102 cases (2.0%) were of ovarian cyst out of the total histopathological specimen processed in pathology department. The mean age of presentation was 38years. Ovarian cysts (27.5%) were more commonly seen in the age group 21- 30 years. Bilateral ovaries were involved in 19 cases (18.6%). Among these ovarian cysts, 89 cases (87.3%) were benign and 13 cases (12.7%) were malignant. The most common type of ovarian cyst was serous cystadenoma (40.2%) followed by mature cystic teratoma (15.7%). Metastasis to ovary was seen in 6.9% (7 cases). The most common metastasis was adeno carcinoma from gastro intestinal tract (4 cases). Other metastases to ovary were 2 cases from endometrioid adeno carcinoma of endometrium and 1 case from Non Hodgkin's Lymphoma of small intestine.

Extended spectrum â-lactamase producing multidrug resistant clinical bacterial isolates at National Public Health Laboratory, Nepal.

Abstract: Extended Spectrum â-lactamase (ESBL) producing multidrug resistant bacteria complicate therapeutic management and limit treatment options. Therefore, detection of ESBL-producing multidrug resistant (MDR) pathogens has a paramount importance. Between April 2009 and January 2010, a prospective study was carried out in National Public Health Laboratory with an objective to determine the status of ESBL producing MDR bacterial isolates from different clinical samples. Identification of the isolates was done by standard microbiological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening among MDR isolates was done using Ceftriaxone, Aztreonam, Cefotaxime, Ceftazidime and Cefpodoxime followed by confirmation using MASTDISCS TM ID ES²L Detection Discs (CPD10). Data analysis was done by SPSS 16 software. Of the 314 bacterial isolates from 1601 different clinical specimens, 199 (63.4%) were MDR. Cefotaxime was found the reliable screening agent for ESBL detection with sensitivity and positive predictive value of 98.6% and 76.4% respectively. Sixtey nine (62.7%) isolates of the 110 tested MDR isolates were ESBL positive with at least one of the Combined Disk (CD) Assays. Escherichia coli (80%) was the major ESBL producer followed by Klebsiella pneumoniae (5.8%). A statistically significant relationship was found between increasing spectrum of drug resistance and ESBL production (p<0.05). Thus it is concluded that a higher rate of ESBL production prevail among MDR clinical bacterial isolates underscoring the need for routine ESBL detection in clinical laboratories.

Comparison of Acute Physiology, Age, Chronic Health Evaluation III score with initial Sequential Organ Failure Assessment score to predict ICU mortality.

Abstract: Critically ill patients are provided with highest level of monitoring, care and treatment in Intensive Care Unit (ICU), which is very expensive and consumes many hospital resources. Various scoring systems have been developed to predict outcome in ICU patients so as to help physicians to prioritize patient admission and management. The objective of this study was to compare Acute Physiology and Chronic Health Evaluation (APACHE) III score with initial Sequential Organ Failure Assessment (SOFA) score to predict ICU mortality. Hundred seventeen patients admitted consecutively in ICU were enrolled. APACHE III and initial SOFA score of individual patients were calculated based on worst values in first 24 hours of admission. Outcome was recorded as survivors or non survivors in ICU. Both the scores were significantly higher in non survivors (p<0.001). A positive and strong correlation was seen between the scores with Spearman’s rho correlation coefficient of 0.866 (p<0.001). Discrimination for APACHE III and initial SOFA score was good with area under ROC curve of 0.895 and 0.879 respectively. Cut off point with best Youden index was e" 61 for APACHE III and e" 8 for initial SOFA score. ICU mortality differed significantly above and below cut off points (p<0.001). Hosmer Lemeshow test showed initial SOFA score to have better calibration than APACHE III score. Initial SOFA score is comparable to APACHE III score for mortality prediction in ICU and so can be helpful for better utilization of limited resources in ICU.

Clinical profile of tuberculosis in children.

Abstract: Childhood tuberculosis is common in our community. The diagnosis in most cases is still based on clinical evidence alone. The present study was designed to study clinical profile, laboratory investigations and outcome of pediatric tuberculosis. A prospective study was conducted among the children admitted in Nepal Medical College from April 2007 to March 2011. The prevalence of tuberculosis was 1.5%. Pulmonary tuberculosis was common (53.7%) than extra pulmonary (46.3%) tuberculosis. BCG scar was present in 48.8%. History of tuberculosis contact was present in 36.6% and Mantoux test was positive in 39.0%. The most common symptoms were fever (75.6%), cough (63.4%) and weight loss (41.5%). Confirmed diagnosis was made (bacteriological or histological) only in 14.6%. This study supports the use of history and clinical features to diagnose childhood tuberculosis.

Antimicrobial efficacy of metapex (calcium hydroxide with iodoform formulation) at different concentrations against selected microorganisms--an in vitro study.

Abstract: The objective of this study was to assess, in vitro, the effectiveness of several concentrations of Metapex (0.22 gm/ml, 0.022 gm/ml, 0.0022 gm/ml) in the elimination of selected microorganisms. Different concentrations of Metapex were prepared by dissolving it in ethanol (99.9%) Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Plates were incubated aerobically for Enterococcus faecalis (E. Faecalis) and Candida albicans (C. albicans), anaerobically for Bacteroid fragilis (B. fragilis) and Propionibacterium acne respectivally. A zone of inhibition was recorded for each plate and the results were analysed statistically. There was significant reduction in the size of zone of inhibition against P. acne, as the concentration of metapex decreases. At lower concentrations of metapex there was no zone of inhibition observed against E. Faecalis, C. Albicans and B. Fragilis. The result of this study suggested that Metapex is a potent antimicrobial agent at higher concentration.

Profile of acute lower respiratory tract infection in children under fourteen years of age at Nepal Medical College Teaching Hospital (NMCTH).

Abstract: The purpose of this study was to find out the current pattern and prevalence of acute lower respiratory tract infections in children at Nepal Medical College Teaching Hospital in Katmandu, Nepal. A retrospective study was done in 73 children, admitted to the Pediatric ward over a period of one year from January 2010-December 2010. This study showed, 52.0% children below two years of age had acute lower respiratory tract infections, where 68.4% had pneumonia and 31.6% had acute bronchiolitis. The prevalence of infections was 58.9% in male children. The occurrence of infections was common in January and April month. Pneumonia was detected in 37.7% children with malnutrition. The most common presenting symptoms was fever observed in 90.4%, cough in 71.2% and fast breathing in 34.2% children. The WBC count was high in 47.9% children, out of which 43.8% had pneumonia and 4.1% had bronchiolitis. Increased neutrophil count in 36.9% and increased ESR in 50.7% seen in patients only with pneumonia. Chest x-ray showed, lobar pneumonia in 45.2% children where right middle zone was most commonly involved in 42.4% patients. Six (8.2%) children were diagnosed as pulmonary tuberculosis. The average duration of hospital stay was 6 days.

Molecular mechanism of multi-drug resistance in Shigella isolates from rural China.

Abstract: Diarrhoeal diseases and enteric infections are major causes of morbidity and mortality in the developing countries. Shigellosis was sixth in the rank of death caused by infectious disease in China. Present study assess the patterns of antimicrobial susceptibility and mutations in marA genes of Shigella isolates and its association. One hundred isolates of Shigella spp were tested to evaluate the antimicrobial susceptibility and mutation of marA through PCR-SSCP. The antimicrobial resistance profiles were: Amoxicilline-clavum (85%), Nalidixic acid (100%), Piperacilline (100%), Ciprofloxacin (25%) and Polymixin B (1.1%). S. flexneri isolates were more resistant than those ofS. sonnei to Amoxicilline-clavum (96.6% versus 0.0%, P<0.001) and Ciprofloxacin (27.3% versus 8.3%, P=0.141). S. flexneri isolates were more resistant than those of S. sonnei to three or more antimicrobial agents (96.6% versus 8.3%, P<0.001). Overall mutation rate in marA was 19%. Nucleotide sequencing showed mutations in three positionsycodon 6 ( Delation of C), 319 (Ala Gly) and 374 (Addition of C). The mutation of marA may play a minor role and other mechanisms may contribute to the drug resistance of Shigella spp.

Prospective study of application of biological communication (cybernatics) in management of chronic low back pain--a preliminary report.

Abstract: To observe the effects of application of cybernetics (theories of communication). This is an open level prospective study, involving patients with chronic low back pain of more than 3 months. Assessment were done before the start of therapy and after the completion of therapy every day for consecutive 6 days of treatment protocol. A total of 8 patients were enrolled (4 male, 4 female). The Visual Analogue Scale (VAS) was used to assess pain, Oswestry Disability Scale (ODI) was applied for scoring disability. ODI was scored at the start of treatment on 1 st day and at the end of the treatment on 6 th day. Mean VAS reduced from 8.12 to 6.93 after 1 st day, which was also statistically significant (p<.01) .This trend continued and there was very significant reduction (p<.001) of VAS in the end when means were compared with pretreatment value. Mean Oswestry disability index reduced from 49.875 to 18.44 at the end of treatment which was statistically very significant (p <0.001). There were significant improvements in all the outcome measured after Scrambler therapy.

Ocular manifestations in diabetes, a hospital based prospective study.

Abstract: Diabetes adversely affects the visual status of elderly persons, lowering their quality of life. Since the incidence of diabetes is increasing in urban Nepal, the present study investigated the ocular status in 128 diabetes patients. The ocular complications of diabetes mellitus are numerous including retinopathy, cataract and others. The ocular evaluations were done including visual acuity, refraction and anterior and posterior segment evaluation. Among 128 diabetes, only 26 patients (20.31%) had some degree of retinopathy; with 13.28% having non proliferative diabetic retinopathy and 7.03% with proliferative diabetes retinopathy.

Morphological and morphometric features of scaphoid bone in north eastern population, India.

Abstract: A study was performed to analyse the morphometry and morphological variants of adult scaphoid bone in Sikkimese population of North Eastern India. The study included 100 dry human scaphoid bones. The bones which had previous signs of fracture were excluded. The morphometric parameters were measured with vernier caliper of 0.02 mm accuracy; the circumferences were measured by placing a thread around them and measuring its length. A magnifying lens was used to observe the number of foramina. From our observations, 22 (44%) of the left scaphoid were having conical shape and 28 (56%) were pyramidal in shape. On the right side, 36 (72%) had conical shape and 14 (28%) were pyramidal. All the bones had waist, except one right sided scaphoid (2%) in which the waist was absent. The scaphoid had main dorsal sulcus in 63% of cases, 29% had two dorsal sulci and 6% had Y shaped sulci. The dorsal sulcus was absent in 3 cases (1 on left side and 2 on the right side). All the scaphoids had a minimum of one foramen in the main dorsal sulcus and 92% had more than one foramen. The present study has provided the additional information on morphology and morphometry of adult human scaphoid bones in north eastern population, India. We believe that the data obtained from the present study are important for the hand surgeons and radiologists. The details obtained will also be helpful for the morphologists and clinical anatomists.

A study on evalution of antidepressant effect of imipramine adjunct with Aswagandha and Bramhi.

Abstract: Depressive disorders increase the risks of self-harm or even suicide in patients Indigenous drugs are being tried to treat such patient along with conventional antidepressant drugs This study was planned to investigate the antidepressant action of Ashwagandha and Bramhi and also to confirm its efficacy in the behavioural despair animal model of depression Normal saline as control (5 ml/kg), Imipramine as standard (16, 32, 64 mg/ kg) and Ashwagandha (50, 100, 150 mg/kg), Bramhi (20, 40, 80 mg/kg) as test drugs were introduced to the albino rats weighing between 200-250 gm for 2 weeks, 1 hr before electric shock in Learned helplessness test (LHT) and swimming in Forced swimming test (FST) Effects of individual drugs as well as their combination were evaluated Avoidance response, escape failure and immobility period in case of Imipramine and Ashwagandha showed highly significant (p < 001) result on individual use There was no significant result in case of Bramhi used alone except in escape failure and immobility period (FST), where at higher doses it showed significant (p < 001) result But combination of Bramhi and Ashwagandha in low doses with low dose of Imipramine gave a highly significant result (p < 001) in all the parameters Ashwagandha had significant antidepressant action, but Bramhi had not when used alone Combination of these two indigenous drug with Imipramine showed high efficacy in animal model

Poisonings at Nepal Medical College Teaching Hospital

Abstract: Poisoning is an increasingly common social problem in Nepal. Studies on poisoning in semi urban areas of Nepal are minimal. Here we, present a prospective study of poisoning in semi urban area of capital, Kathmandu lasting for six years duration. Altogether there were 354 cases of various poisoning, admitted in Nepal Medical College Teaching Hospital from Baisakh 2062 (April 16, 2005) to Chaitra 2067 (April 15, 2011). Male: Female ratio was 135:219 (1:1.6) and Age +/- SD was age 29.3 +/- 13.8 years. Age group (20-29 years) comprised of 138 patients (38.9% followed by < 20 years age group (92, 25.9%). Brahman/ chhetri (150, 42.4%) and Mongolian (146, 41.2%) ethnic groups were the main sufferers of poisoning, followed by newars (41, 11.6%) patients. Deliberate self harm was the cause for poisoning in maximum number of patients (156, 44.1%), followed by depression (64, 18.1%) and accidental poisoning (42, 11.9%). Organophosphorus (152, 42.9%), medicines (71, 20.1%), and rodenticide poisoning (38, 10.7%) were common poisons. Metacid (Methyl parathion) (46, 15.5%) was the most popular brand of poisoning agent used in Nepal for suicidal purpose. The over all mortality rate of poisoning in general was 7.1% with organophosphorus poisoning topping the list (19, 12.5%). We also present mad honey poisonings in a small group of 9 (3.2%) patients with M:F 8:1, age 26.5 +/- 8.8 years. Due precaution should be undertaken during their management as some of them may go into cardiopulmonary arrest and should not be considered benign when more than 5 tablespoonful wild honey is consumed.

Different pharmacological solutions in intracanal irrigation.

Abstract: Irrigation of root canals during endodontic therapy is an important step. Sodium hypochlorite (NaOCl), hydrogen peroxide (H2O2), chlorhexidine (CHX) and normal saline are commonly used intracanal irrigants to disinfect and clean the root canals. This prospective study was set to observe the efficacy of normal saline (0.9% NaCl) irrigation with sequential irrigation of 3% H2O2, 5.2% NaOCl and 0.9% NaCl. A total number of 228 dental patients were screened and 104 patients fulfilling the inclusion criteria were enrolled for the endodontic therapy of mature permanent teeth for the period of one year. Two treatment groups were constituted in which patients were randomly allocated equally in each treatment group. Post-obturation pain, swelling, analgesic use and eight weeks post-obturation radiological evaluation of the patients were carried out as the measurement of clinical and radiological success of the endodontic treatment. No statistically significant differences were observed in the measured treatment outcomes between two groups. However, studies involving larger sample size and longer post-obturation follow up are recommended for the further either confirmation or rejection of present findings.