Showing papers in "Nepal Medical College journal in 2014"

Prevalence of intestinal parasitic infections among public school children in a rural village of Kathmandu Valley.

Abstract: Intestinal parasitic infections (IPI) are one of the most prevalent infections in humans residing in developing countries and its burden is high among school aged children. This cross-sectional study was conducted to determine the prevalence of intestinal parasitic infection and types of intestinal parasites in rural public school children of Nepal. It included students from Nursery to Class X of a rural public school located in the northeast part of the Kathmandu Valley, Nepal. Among the 194 participating children, prevalence of intestinal parasitic infection was found as 23.7%; (28.2% for boys; 20.2% for girls). Amongst the infected children, single and mixed parasitic infection was detected in 43 (93.5%) and 3 (6.5%) children respectively. Among protozoan parasites, Giardia lamblia was the most common (58.6%) whereas Hymenolepis nana was the most common (21.7%) among the helminths. Statistically different prevalence of intestinal parasitic infection was observed among children aged above 10 years and children aged below 6 years as well as 6 to 10 years. Gender-wise, there was no statistical difference in prevalence of intestinal parasitic infection. This study suggests the need of health education program in schools along with regular screening of intestinal parasites and treatment for effective management of the intestinal parasites among school children in Nepal.

Effects of intrathecal fentanyl as an adjunct to hyperbaric bupivacaine in spinal anesthesia for elective caesarean section.

Abstract: Hyperbaric bupivacaine is the most common drug used in spinal anesthesia for caesarean section. The aim of this study was to compare the effects of adding fentanyl to intrathecal bupivacaine on the onset and duration of spinal anesthesia and its effect on mother and neonate. Seventy healthy parturients with singleton pregnancy scheduled for elective cesarean section were randomly allocated to receive subarachnoid block with 0.5% bupivacaine heavy 2.4 ml (Group A) or fentanyl 20 microgram (0.4 ml) added to 0.5% bupivacaine heavy 2 ml (Group B). Blood pressure, heart rate, respiratory rate, oxygen saturation, along with characteristics of spinal block were assessed throughout the surgery and in the postoperative ward until the patient requested for analgesia. It was found that duration of sensory block was prolonged in fentanyl group (p < 0.05). Duration of complete analgesia (97 ± 8.23 minutes vs 153 ± 7 minutes; p value = 0.00) and effective analgesia (134 ± 5.6 minutes vs 164 ± 9; p value = 0.00) were also found to be prolonged in Group B. There was not much difference in the occurrence of side effects in both the groups. Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.

Cystoscopic bladder biopsies: a histopathological study.

Abstract: Urothelial carcinoma is the most common tumor of the bladder and is a major cause of morbidity and mortality. Cystitis constitutes an important source of clinical signs and symptoms. In this study 31 cystoscopic biopsies subjected for histopathological examination were taken. The study was conducted in the department of Pathology of Nepal Medial College Teaching Hospital over a period of two years (October 2012 to September 2014). The mean age of the patient undergoing cystoscopic biopsy was 61.3 years, most of the patients being elderly male. 51.6% cases were clinically malignant. The most common histopathological diagnoses were cystitis (29%) and non invasive papillary urothelial carcinoma, low grade (29%). 58% are neoplastic lesions. 51.6% of the case was malignant lesions on histopathology. Among the malignant lesion of urinary bladder 93.7% were urothelial tumor and 6.3% were glandular neoplasm (adenocarcinoma, signet ring cell). There was no detrusor muscle in 33.3% cases of urothelial tumor to assess the muscle invasion. 26.7% cases of urothelial tumor shows muscle invasion. Histopathological study of cystoscopic biopsy helps in early detection of tumor and its management.

Status of iron, oxidant and antioxidants in chronic type 2 diabetes mellitus patients.

Abstract: Diabetes mellitus is a common health problem of the world. Iron may be a part of the cause of the disease and its complications. Iron is a trace element which produces reactive oxygen species (ROS) participating through Fenton reaction and that ROS may be a cause to produce oxidative stress and further diabetic complications. The study aims to access the iron and its effect in producing oxidative stress in type 2 diabetic patients. Serum iron, total iron binding capacity (TIBC) and percentage transferrin saturation are calculated as the index of iron. Malondialdehyde (MDA) is estimated as index of oxidant and vitamin C, vitamin E are measured as index of antioxidants. This is a case control study conducted in the department of Biochemistry in collaboration with department of Medicine at B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. 52 chronic type 2 diabetes mellitus patients and 52 age and sex matched normal healthy controls were included in the study. Plasma iron, TIBC, percentage transferrin saturation were found (89.14±30.50 μg/dL), (266.78±48.80 μg/dL), (36.61±14.31 %) in diabetic cases as compared to (83.98±24.19 μg/dL), (279.08±40.23 μg/dL), (31.05±10.98 %) of healthy controls. A signifi cant increase in MDA level (6.35±1.52 nmol/ml in cases and 4.18±1.12 nmol/ml in controls, p<0.001) and signifi cant decrease in vitamin C (0.85±0.19 mg/dL in cases and 1.28±0.21mg/dL in controls, p< 0.001) and vitamin E (0.85±0.25 mg/dL in cases and 1.34±0.38mg/dL in controls, p<0.001) were observed.

Dental caries status and oral health practice among 12-15 year old children in Jorpati, Kathmandu.

Abstract: Oral health is an essential component of health throughout life. There has been a decline in dental caries and periodontal disease in developed countries which can be attributed to the implementation of preventive programmes but in developing countries dental diseases are still on the rise. Therefore this cross sectional study was carried out to assess the prevalence of dental caries and oral hygiene practices among 12 to 15 years old children. Self administered close ended questionnaires were used to assess the oral hygiene practice. The overall dental caries prevalence was 58.3% and the mean DMFT score was 1.2 (± 1.79) and the deft score was 0.6 (± 1.24). Majority of the children (84.1%) presented with the practice of brushing their teeth once everyday using tooth brush and toothpaste. Regular dental check up was very poor (5.6%) but 77.4% reported that they visited a dentist in case of pain or presence of stains in the teeth. Females (63.4%) and children studying in higher secondary class (74.2%) showed a "good" level of oral hygiene practice than males and children in secondary class respectively. Children having "good" practice presented with "low" dental caries severity. The utilization of dental services was poor in the children, therefore highlighting the necessity to implement preventive programmes is important which would help in reducing the incidence of the dental caries as well as aiding in prompt treatment of dental caries at its initial stages.

Serum uric acid level in normal pregnant and preeclamptic ladies: a comparative study.

Abstract: Preeclampsia is a serious pregnancy complication characterized by hypertension, proteinuria with or without pathological edema. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not in preeclamptic patients. Pre-eclamptic patients admitted in Nepal Medical College Teaching Hospital from June 2012 to June 2013 were included in this study. Age matched normal healthy pregnant ladies served as control. The record of their blood pressure and serum uric acid level was evaluated. Results showed significantly high blood pressure [SBP 149.42±12.35 vs 109.00±7.93 mm Hg; DBP 96.85±8.32 vs 72.5±7.10 mm Hg], and serum uric acid level [6.27±1.37 vs 4.27±0.61 mg/dl] in pre-eclamptic patients compared to their healthy counterparts. Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia increasing its synthesis by damage and death of trophoblastic cells and proliferation. Uricemia in preeclampsia likely results from reduced uric acid clearance from diminished glomerular filtration, increased tubular reabsorption and decreased secretion. Results of the present study indicated association of elevated serum uric acid level with preeclampsia which could be used as a biochemical indicator of preeclampsia in pregnant women.

Reduced susceptibility to vancomycin in methicillin resistant staphylococcus aureus: a time for action.

Abstract: Infections by Methicillin resistant Staphylococcus aureus (MRSA) is an often encountered therapeutic challenge. The problem is accentuated by the emergence of MRSA strains which are resistant to Vancomycin, the recommended agent for the treatment of MRSA infections. We therefore carried out this study to determine the MIC values ofvancomycin for the MRSA isolated from different clinical specimens in Nepal Medical College. MICs were determined by agar dilution method. Out of the 82 MRSA isolates tested, 18 showed MIC of 2 μg/ml and 29 isolates had MIC of 1 μg/ml and 35 isolates had MIC of 0.5 μg/ml. Although none had a MIC in the intermediate or resistant zone, 18 (2.9%) had MIC in the upper limit of the sensitive zone which is a matter of concern and calls for prompt preventive actions.

Bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's Hospital Thapathali, Kathmandu.

Abstract: Neonatal Sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. Identification of the common bacteria and risk factors causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was carried out to determine the bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's hospital. A cross-sectional prospective study was conducted among neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified and antibiotic susceptibility was carried out with standard microbiological methods. Data were analysed by using SPSS. Ver. 16 software. The positive yield of blood culture was 21%. The most common isolates were Staphylococcus epidermidis, E. coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas spp. In Antibiotic susceptibility pattern Gentamycin showed the highest sensitivity to all types of isolated organisms. Vancomycin sensitivity was highest for Gram positive organism and Ciprofloxacin was most effective for Gram negative organisms isolated. Ampicillin and Amoxycillin were the least effective drug. Multiple drug resistance was observed in 77.15% of isolates. Prematurity, low birth weight and maternal pyrexia before delivery were found to be strongly associated with neonatal sepsis. Gram positive organisms were more prevalent than gram negative organisms.

Retrospective study of spinal cord injury patients admitted to spinal injury rehabilitation center, Sanga, Banepa, Nepal.

Abstract: Spinal cord injury is a serious problem that affects many facets of an individual's life. This was a retrospective study which included data from all patients admitted to the Spinal Injury Rehabilitation Center (SIRC), Sanga with spinal injuries over a 4 year period between January 2008 and January 2011. The overall objective of the study was to determine the epidemiology of spinal injury patients admitted at the center. Socio-demographic details, mechanism of injury, level of injury, ASIA score and length of hospital stay of the subjects were recorded and analyzed. An incremental pattern was observed in the number of spinal injury patients attending SIRC. In the year 2008, 81 patients of spinal injury were recorded which increased to 122 in 2011. A total of 381 spinal injury patients were included in the study out of which a majority, 73.50% were male, 30.45% belonged to the 21-30 years age group and 23.10% belonged to the 31-40 years age group. A majority of Spinal injury patients, 189 (49.60%), were from the Central region followed by 89 (23.36%) from the Western region. Fall from height (68.24%) was the predominant cause of spinal injury followed by road traffic accident (18.63%). In the study, 213 subjects (55.91%) had ASIA A scoring and thoracic injury (49.34%) was most common followed by lumbar injury (29.66%), cervical injury (17.84%) and sacral injury (3.15%). About Two-fifths (40.42%) of the spinal injury patients were conservatively managed whereas three-fifths (59.58%) underwent surgery and length of stay of patients ranged from 2 to 305 days. This study shows that the young adults, predominantly males in their most productive years of life, are prone to traumatic spinal cord injury which results in personal and family tragedies along with socioeconomic burden to the nation. Thus, recognizing the pattern of traumatic spinal cord injuries, relevant etiological factors and identification of high-risk groups is necessary in designing better methods of prevention.

Diagnostic yield of pleural biopsy in exudative pleural effusion

Abstract: To know the diagnostic role of pleural biopsy in determining underlying etiological causes of exudative pleural effusion. A total of 47 patients, aged 16-104 years with mean age of 47.36 years, of either sex, with exudative pleural effusion underwent closed pleural biopsy with Abram's needle in standard way. Average 4-6 biopsy specimens were obtained from each patient, which were sent for histopathological examination. In this study, 47 cases of exudative pleural effusion were included, among them 26 (55.31%) cases were male and 21 (44.69%) were female with mean age 47.36 years. Cough was reported by 42 (89.36%) cases, expectoration 28 (59.57%), hemoptysis 3 (6.38%), breathlessness 27 (57.44%), wheezing 3 (6.38%), chest pain 38 (80.85%) and fever by 30 (63.82%) cases. Out of 47 cases, 28 (59.57%) cases had a positive yield, whereas in 19 (40.43%) cases the result was nonspecific inflammation. Out of 28 (59.57%) cases with positive yield 21 (44.68%) were found to have granulomatous inflammation and 10 (21.28%) cases were malignant. Among malignant pleural effusion, 4 cases were squamous cell carcinoma; 3 small cell carcinoma; 1 case adenocarcinoma and 1 case found to have mesothelioma. Tuberculosis and malignancy are the two most common causes of exudative pleural effusion in our set up. Pleural biopsy is a safe, simple and well validated diagnostic tool that helps us to differentiate between malignancy and tuberculosis.

Evaluation of intradermal vaccination at the anti rabies vaccination OPD

Abstract: Rabies is a virtually 100% fatal acute viral encephalitis caused by an RNA virus belonging to family Rhabdoviridae and genus Lyssavirus. The virus can infect all warm blooded animals. The disease is transmitted to humans by the bite, lick or scratch of an infected animal. More than 99% of all human rabies deaths occur in the developing world. It is preventable with timely and proper usage of modern immunobiologicals (vaccines and immunoglobulins). Once exposure occurs, modern prophylaxis entails immediate wound care, local infiltration of rabies immune globulin and parenteral administration of modern cell culture vaccines in multiple doses. The annual medicinal (vaccines and other drugs) cost for animal bite treatment is Rs. 2 billion approximately (2004). The objective of the present study is to evaluate the performance of the Intradermal (i.d.) route visa vis the Intramuscular (i.m.) route in our clinical setting the Antirabies Vaccination (ARV) OPD, Sir J.J. Hospital, Mumbai. A total of 1460 patients were administered the Antirabies vaccine by the Intradermal route over the 1 year period as compared to 1075 patients who were administered the Antirabies vaccine by the Intramuscular route in the previous year. 1230 (84.2) of the patients who were administered the vaccine by the i.d. route completed the schedule and 230 (15.8%) partially completed the schedule. Four hundred thirty two (40%) of the patients who were administered the vaccine by the Intramuscular route completed the schedule and 643 (59.8%) partially completed the schedule. The vaccine cost for i.d. was Rs. 2,80,600. The vaccine cost for the intramuscular (i.m.) assuming 84% compliance was estimated as Rs. 15, 64, 000. Assuming 40% compliance the cost was estimated as Rs. 7, 82, 230. Thus a saving of Rs. 5, 01, 630 to Rs. 12, 83, 400 was effected. In our setting, the Intradermal regime was cost effective and increased patient adherence and enrolment. It has now been routinely adopted at the clinic.

Outcome of treatment of nonunion tibial shaft fracture by intramedullary interlocking nail augmentated with autogenous cancellous bone graft.

Abstract: To assess results of operative treatment of non union fracture shaft of Tibia by intramedullary interlocking nail augmented with autogenous cancellous bone graft in our setup. A total of 25 nonunion tibial shaft fractures were evaluated among which 20 cases were male and 5 female with the mean age 31.84 years. Hypertrophic non-union were 14 and atrophic non union were 11. Upper one third of tibial diaphysis was involved in 4 cases, middle one third in 14 cases and lower one third in 7 cases. In all cases open reduction, interlocking nailing and autogenous cancellous bone graft was applied. The mean follow up was one year. Mean time for healing was 8.08 months. Mean operation time was 110 minutes (range 70 to 160 minutes). Satisfactory results (excellent and good) were achieved in 88% cases and unsatisfactory (fair and poor) results in 12% cases. This operative treatment option appears to have a high success rate and should be considered in nonunion of tibial diaphysis.

Spectrum of bacterial pathogens and their antibiogram from cases of urinary tract infection among renal disorder patients.

Abstract: Urinary tract infection (UTI) is the commonest bacterial infection occurring in renal disorder patients and is associated with significant morbidity. Resistance to antibiotics is highly prevalent in bacterial isolates and is an emerging problem in UTI. A hospital based cross sectional study was conducted from April 2011 to September 2011 to determine the frequency and bacterial profile of urinary tract infections in the patients with renal disorders visiting KIST Hospital along with their antimicrobial susceptibility pattern. Urine samples were collected from 300 clinically-suspected cases of UTI among renal disorder patients and investigated by conventional semi-quantitative culture technique, microscopy and antibiotic susceptibility test. Significant bacteriuria were detected in 34% of the total subjects, mostly from patients with Chronic Kidney Disease. Incidence of bacteriuria was found higher in females (40.40%) than in males (27.52%) and mostly occurred in elderly patients. Escherichia coli (62.75%) was the predominant isolate followed by Klebsiella pneumoniae (10.78%), Staphylococcus aureus (9.80%), Coagulase negative Staphylococcus aureus (CoNS) (5.88%), Enterococcus spp (3.92%), Klebsiella oxytoca (2.00%), Pseudomonas aeruginosa (2.00%), Proteus mirabilis (2.00%) and Proteus vulgaris (1.00%). Multidrug resistance was observed in 68.82% of the total bacterial isolates.

Food practices among postnatal mothers in a hilly township in Northeastern Nepal.

Abstract: A descriptive study on food practice among postnatal mothers in a hilly township in northeastern Nepal was carried out with 50 mothers (aged 20-39 years) of different ethnic groups (Adibasi-Janajati: 46.0%, Bahun/ Chhetri: 34.0% and Dalit 20.0%). Findings show that this township was representative of a rural area in northeastern Nepal in terms of demographic characteristics like mixed ethnic composition, high illiteracy rate (especially among women), joint family structure in majority of the households (80% of the total participants) and agriculture as the more common occupation (44% of the total participants). It was seen that various factors are responsible for affecting food practices of mothers during the postnatal period in this region. Socio-cultural beliefs are contributory to the food practices followed, like the frequency of meals/day eaten by the mothers. Other factors that affected were: Lower economic status of the family (33% of Dalit women and 50% of women who work as laborers were only eating meals two times a day); Support from the family (75% of women living in joint families were eating meals four times a day while 80% of the women living in nuclear families were eating meals three times a day); It also showed more attention and care was given to younger, first-time mothers (younger mothers who were mostly first-time mothers were eating meals four times a day while experienced and older mothers were eating meals three times a day). The study also showed that there are food taboos surrounding specific food items, which were not consumed from 11 days to six months after delivery based on various socio-cultural beliefs and practices.

Understanding socio economic contexts of female sex workers in eastern Nepal.

Abstract: The present focus is mostly laid on high risk behavior of commercial sex workers without any consideration of their location, educational status and other socio-cultural norms. Thus, we designed a study to understand socio demographic characteristics, lifestyle of female sex workers and search for driving factors for prostitution in eastern Nepal. A descriptive study was conducted in three districts of Eastern Nepal in 2012 over the period of six months. The data regarding their socio demographic characteristics, income, reason for joining sex trade and future choice regarding the profession were recorded from 210 female sex workers through face-to-face interviews. Majority (53.3%) of respondents belonged to the productive age group of 20-29 years, more than one thirds (43.3%) had not received any form of formal education and were unmarried. More than half (53.80%) were presently living alone and about one thirds of the women (31.90%) were minors when they joined this profession. Major portion of the sample (94.80%) worked more than three days a week with median income of 15 thousand per month and 41 percent had sex with more than or equal to ten clients per week. Poor economic condition was the most frequent (47.6%) factor leading to joining of sex trade however, more than two thirds, (72.80%) wanted to quit the profession. Given low level of education, relatively low income, and young age among this population, empowerment and alternative employment/education opportunities should be created to develop this part of Nepalese society.

USG assisted and USG guided percutaneous renal biopsy at Nepal Medical College Teaching Hospital: a three and half years study.

Abstract: A prospective study was carried out from 2009 to 2013 in the Department of Radiology and Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 75 patients underwent percutaneous renal biopsy with a 16 or 18 gauge needles. This was done blindly by marking a site on the skin, or, whenever there was difficulty with the blind procedure, by direct real time USG guidance. In all cases, the marking in the skin was done by the radiologist and the biopsy was performed by the Nephrologist, with the aid of the radiologist in cases of real-time USG guided renal biopsy. This study was carried out to assess the safety and efficacy of the USG aided, and USG guided renal biopsy, to see for the types and severity of complications arising from renal biopsies to determine the optimal period of observation required after the procedure. All renal biopsies were performed after the patients were admitted to the hospital at least 1 day prior to the procedure. Coagulation profile was done in all patients prior to the procedure. All patients were kept under strict complete bed rest for 24 hours post procedure. The ages of the patients ranged between 14 years to 71 years, with 42 female and 33 male patients. A mean of 21.8 glomeruli was obtained in each specimen, with absent glomerular yield seen in only 3 patients. Minimal change disease was seen in 19 patients, being the most common histopathological diagnosis followed by a spectrum of others. The overall complication rate was 4% and all of these were self-limiting needing no other intervention, or management except for observation and bed rest. Late complications were not seen. Percutaneous renal biopsy with the help of USG is a safe and efficacious procedure with less chance of minor complications.

Re-evaluation of the formalin-ether sedimentation method for the improvement of parasite egg recovery efficiency.

Abstract: The formalin-ether sedimentation (FES) method is considered as reliable method of fecal examination for the detection of parasites. In this study, we re-evaluated several aspects of FES such as (i) pretreatment of feces; (ii) filtration of fecal suspensions; (iii) test-tube material and (iv) substitution of ether by other organic solvents as to see an improvement in parasite egg recovery. The egg count was represented by the number of ova detected per 100 μg of sediment. Pre-treatment of feces with formalin (pH 7) increased egg detection rate remarkably compared with original FES method. Use of three layers of gauze dramatically reduced the sediment in the final product, and led to an increase in the number of ova detected. Use of polypropylene test tubes instead of glass test tubes also increased the number of egg detection. None of the organic solvents used to replace the ether produced better results. Based on these findings, we proposed a modified FES procedure. Further, we also compared the parasite positive rate and the number of ova recovered by using original FES and the modified FES procedures by examining 112 fecal samples collected from school children of parasite endemic area in Nepal. Feces collected from Nepal had many parasite ova, and these fecal samples barely displayed false-negative results even by method with low sensitivity. When the mean number of Hemenolepis nana, hookworm, T. trichiura, and A. lumbricoides ova recovered by original FES and the modified FES methods was compared, the values obtained by modified FES were superior (higher). This result suggested that the modified FES is effective and better for the recovery of parasite ova in areas of low-intensity parasitic infection.

Computed tomogram guided fine-needle aspiration cytology of lung and mediastinal masses with cytological correlation: a study of 257 cases in Western region of Nepal.

Abstract: Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. To evaluate the lung and mediastinal masses and to analyze and compare the results with cytological findings, 257 patients were retrospectively studied who underwent CT guided FNAC over a period of 2007 to 2013. The study was done in patients who presented with respiratory symptoms with a localized lung lesion which was confirmed radiologically. 252 cases of lung masses and 5 cases of mediastinal cases were included. Patients' age ranged from 24 to 84 year and the male to female ration was 1.2:1. Radiologically, out of 257 cases, 225 cases were given as malignant, 8 cases as benign and 24 cases as inflammatory lesions. Cytologically, 212 cases were malignant, 12 cases were benign and 21 cases were inflammatory. Most common lung malignancy was adenocarcinoma (87 cases) followed by squamous cell carcinoma (56 cases). 8 cases of lung metastasis were seen. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

D test: a simple test with big implication for Staphylococcus aureus macrolide-lincosamide-streptograminB resistance pattern.

Abstract: D test is a simple disc diffusion test giving high throughput results. It is used to study the macrolide lincosamide streptogramin resistance (MLSB), both constitutive and inducible as well as macrolide streptogramin resistance (MSB) in Staphylococcus aureus. In this test, erythromycin (macrolide) and clindamycin (lincosamide derivative) discs are placed adjacent to each other over the Mueller Hinton agar medium inoculated with the test organism. The growth of the organism up to the edges of the disc, flattening of the clindamycin zone (D test positive) near the erythromycin disc (resistant) and susceptible to both antibiotics implicate that the organism is having constitutive MLSB (CMLSB), inducible MLSB (IMLSB) and no resistance respectively. Further, the organism susceptible to clindamycin without any flattening of the zone (D test negative) near clindamycin disc (resistant) implicates that the organism is having macrolide streptogramin resistance (MSB). The test is performed in the same MHA plate in which the antibiotic sensitivity test is being done, taking into consideration that the discs are placed adjacent to each other maintaining the distance. Since clindamycin and streptogramin are among the few drugs of choice in the treatment of methicillin resistant S. aureus (MRSA) infections, knowing the resistance to these antibiotics is imperative.

Laparoscopic cholecystectomy under spinal anaesthesia: a prospective study.

Abstract: Laparoscopic cholecystectomy under general anaesthesia is the present gold standard in treatment of symptomatic gall bladder disease. This study was conducted to determine the efficacy and safety of laparoscopic cholecystectomy under spinal anaesthesia which could be more cost effective. A prospective study was conducted was over a fourteen month period at a teaching hospital to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia(SA). Patients meeting inclusion criteria were taken up for laparoscopic cholecystectomy under spinal anaesthesia by standardized techniques. They underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were the secondary outcomes measured. All patients underwent laparoscopic cholecystectomy without any major complications. None had to be converted to general anaesthesia in this series. The operation had to be converted to open incision in 3 patients. Commonest complaint was pain in right shoulder and anxiety at the beginning of operation/pneumoperitoneum. All patients were highly or well satisfied during follow up. Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. In this study spinal anaesthesia for laparoscopic cholecystectomy was found to be safe even in patients with respiratory problems, cost-effective, with minimal postoperative pain and smooth recovery; the disadvantage being occasional right shoulder pain following pneumo-peritoneum (40%). Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups where cost is a major factor; provided proper backup is present.

Occurrence of dental caries in primary and permanent dentition, oral health status and treatment needs among 12-15 year old school children of Jorpati VDC, Kathmandu.

Abstract: Dental caries occurrence, distribution, oral health status and corresponding treatment needs in 12 - 15 year old children are useful tools for evaluation of oral health. Dental caries status along with its treatment needs was recorded according to World Health Organization (WHO) index (1997) in 366 children from five schools within Jorpati Village Development Committee (VDC), Kathmandu. Dental caries was diagnosed in 156 (42.6%) children, out of which 122 (78.21%) had caries in permanent teeth, 26 (16.67%) had caries in primary teeth, and 8 (5.13%) had caries in both dentition. The age wise distribution of dental caries showed the highest prevalence among 12 year old students (23.8%) and the lowest among 15 year olds (3.8%). Among the female students (177), 43.5% showed presence of dental caries, while the prevalence among male students (179) was 41.8%.Out of the total number of teeth affected by dental caries (336), 273 (81.25%) were permanent teeth and 63 (18.75%) were primary teeth. The intra arch distribution of dental caries in permanent as well as primary dentition was statistically significant (P < 0.05). Restorative treatment (89.38%) was the main need in permanent dentition, and endodontic treatment (60.32%) in primary dentition. Chronologic enamel hypoplasia was found in 14 (3.83%) of the total population, and 62 (16.94%) required oral prophylaxis. These findings are significant as they can initiate further research in this area, which may help establish reliable baseline data for implementation of preventive oral health programs.

Visual rehabilitation and intraocular pressure control after combined manual small incision cataract surgery and mitomycin-C augmented trabeculectomy.

Abstract: Both cataract and glaucoma are significant public health problems. Combined cataract operation and trabeculectomy is required for visual rehabilitation and control of intraocular pressure (IOP) thereby preventing progressive optic nerve damage, in patients with coexisting cataract and glaucoma. The aim of this study was to find out the visual rehabilitation and IOP control following combined manual small incision cataract surgery (SICS) and mitomycin-C (MMC) augmented trabeculectomy. In this study 45 consecutive eyes of 45 patients who had undergone combined procedures (manual SICS+ trabeculectomy with MMC) were reviewed between September 2011 and August 2012. Postoperative visual acuity and IOP were recorded at postoperative day 1, 2nd week and 6th week to see the short term outcome of surgery and any postoperative complications were recorded. Best corrected visual acuity (BCVA) at 6th week follow-up was noted. Out of 45 patients males were 31 (68.8%) and females were 14 (31.1%). Twenty nine (64.4%) patients were Primary open angle glaucoma (POAG), 11 (24.4%) Primary angle closure glaucoma (PACG), 5 (11.1%) Normal tension glaucoma (NTG) with visually significant cataract. The mean preoperative and postoperative IOP was 23.93 mmHg ± 0.75 mmHg and 11.2 mmHg ± 1.5 mmHg respectively. The mean reduction in IOP was 12.73 mmHg on the 6th week of follow up. There was statistically significant reduction in IOP on the 6th week follow up (p < 0.000 1). Twenty three patients (65.7%) achieved best corrected visual acuity between 6/6 to 6/18 and 6 patients (17.1%) had 6/24 to 6/60 on the 6th week follow up. Combined SICS with MMC augmented trabeculectomy is effective in terms of IOP control and visual rehabilitation in treating glaucoma patients with cataract.

Clinico-epidemiological study of low birth weight newborns in the Eastern part of Nepal

Abstract: Low birth weight (LBW) remains an important cause of newborn morbidity and mortality. A hospital based prospective and descriptive study was conducted at Paediatric wards, Nursery, Neonatal intensive unit (NICU) and Post natal ward during period of June to October 2010 to note the clinico-epidemiological profile of Low Birth Weight (LBW) newborns. Incidence of the LBW babies in our hospital was 14.45%; more than four fifth (82.2%) baby's mothers were primigravida. Eighty two percent mothers had unbooked pregnancies. Twenty and half percent LBW babies were twins. The mean duration of hospital stay of the subject was 7.4 (± 5.5) days. The mean birth weight of LBW babies was 1648 (± 344) grams. Clinical sepsis, non physiological jaundice and hypoglycaemia were the three most common complications of LBW babies. Antibiotics, oxygen and phototherapy were the three commonest modes of therapy. Majority of children (82.0%) improved and were discharged. Birth weight and gestational age were significantly different between survivors and babies who expired. Primigravida and lesser antenatal visits were important risk factors for Low birth weight babies. Birth weight, gestational age, apnoea and mechanical ventilation were the predictors of outcome.

Value of conventional cervical cytology as a screening test for cervical cancer.

Abstract: This is a prospective study conducted in the department of Obstetrics and Gynecology of Nepal Medical College Teaching Hospital, Kathmandu, Nepal. The main Objective of the study is to see the value of opportunistic screening program for cervical pre-cancerous lesion for prevention of cervical cancer. It also aims to see how many cases can be picked up by such screening test and is it worth doing this tset? We analysed 1751 cases of pap smear taken during almost 2 years period and found infl ammatory smear being the predominant fi nding and it was found in reproductive age group. We had 1.14% cases of abnormal smear and 0.74% cases were proved by biopsy.

A qualitative assessment of methadone maintenance therapy program in Nepal: evidence to scaling up at national level.

Abstract: Methadone maintenance therapy is widely accepted form of substitution therapy in people with Opioid dependent client. It is a kind of harm reduction strategy which prevents the spread of HIV and hepatitis among injecting drug users. It also improves quality of life and help decrease crime and other social issues. The program has been in Nepal for few years. The clients are increasing more each day and the demand for the program is also increasing. There is an urgent need of scaling-up the program in Nepal to address the increasing number of clients and unreached clients. This is an attempt to assess qualitatively the methadone maintenance therapy program in Nepal to generate evidences as a support to existing programs and to scale up the program in unreached population. The qualitative study revealed that the clients had adequate knowledge on the program and the program is quite satisfactory. However, they have to wait for a long to get enrollment in the program, there is no counseling session and they were more concern about the quality of the drug. Despite many lacunae, the participants found the program very useful in terms of developing good relation with family members, decreasing the necessity of money, being able to attend social functions, health and economic benefits, time saving, easily getting job. On the other hand, they were experiencing adverse effect such as decreasing sexual performance, dental caries, nausea, social stigma due to misuse of the program by some clients which are not properly addressed by the program. The program can be improved by making it priority problem at national level by the government, improving it as one stop shopping such as providing counseling, medicine and skill development program at one place.

Prevalence of high level gentamicin and vancomycin resistance among clinical isolates of enterococci from a tertiary care hospital in central Nepal.

Abstract: High level aminoglycoside resistance is an established phenomenon in enterococci. With the increasing use of broad spectrum cephalosporins and glycopeptides, vancomycin resistant enterococci are being increasingly reported from different parts of the world. The objective of our study was to determine the prevalence of high level gentamicin resistant (HLAR) enterococci among the clinical isolates in our hospital and to find the minimum inhibitory concentration (MIC) of vancomycin against these isolates. The enterococci isolated over a year (n = 41) were subjected to HLAR screening by disc diffusion and MIC of vancomycin by agar dilution method. HLAR prevalence was 63%. MIC of vancomycin showed none in the resistant range. However, 4 (9.7%) isolates were in the intermediate range heralding the eminent emergence of VRE if adequate control measures are not implemented in time.

Clinical and contact allergological observations on hand eczema: a descriptive study.

Abstract: Hand eczema (HE) is a common and distressing condition that is perplexing to the patient and the physician alike. To study the frequency and clinical features of hand eczema and to correlate the frequency of atopy and contact sensitization with different clinical features a total of 61 clinically diagnosed patient of Hand eczema were included within a period of one year. Patch test was done in 47 patients and graded accordingly. The frequency of hand eczema was 0.57%. Morphologically pompholyx was the most common type while aetiologically endogenous hand eczema was the commonest. Contact allergy was observed in 55.3% of the cases of which nickel sulphate (18.5%) was found to be the commonest sensitiser followed by Gentamicin and Fragrance mix though contact allergens with positive patch test in different morphological types of hand eczema have no apparent relevance but it still could contribute to the persistence or exacerbation of hand eczema.

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal.

Abstract: There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

Variations in total facial index among students of Kathmandu University School of Medical Sciences.

Abstract: The total facial index exhibits sexual differences and different shapes of face. Facial anthropometry has its well known implications for forensic scientists, anatomists, human biologists, criminologists and physical anthropologists. Facial index is the ratio of the morphological facial height to facial width and multiplied by 100. The present study aimed to examine the facial length, facial width, facial index and to find out the facial type in students of Kathmandu University School of Medical Sciences. The present study was conducted on 300 medical, dental and human biology students of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Of the total 300 students 150 students were male and 150 students were female and were between the age group 18-25 years. The study had been approved by the Institutional review committee of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The study result showed that the mean facial index of Nepalese students was 87.01. The mean facial index of Nepalese male was found to be 87.20 and female was found to be 86.81. The dominant facial type in students of Kathmandu University School of Medical Sciences was found to be mesoproscopic and least common was hyperleptoproscopic. The dominant facial type in male was euriproscopic and the dominant type in female face was mesoproscopic.

Magnification error of digital x rays on the computer screen.

Abstract: Templating x-rays of total hip and knee replacements pre-operatively are important to plan surgery. This is usually done using acetate templates of the prosthesis on hard copies of the x-ray. With the change in practice, to use digital x-rays on computer screens instead of hard copies, it is important to assess if acetate templates can be used for digital x-rays on the computer screen. This is a retrospective x-ray study of 19 hip replacements and 30 knee replacements to assess their magnification using the Patient Archiving Computerised System (PACS) software. This study was done to assess the accuracy of magnification, using acetate templates over a computer screen. In total hip replacement, the outer cup diameter was also measured using the digital measurement scale. The mean magnification was 0.59 for the acetabular cup and the femoral stem in total hip replacement and 0.48 for the femoral and tibial implant in total knee replacement. The mean difference in cup diameter comparing to the real size was an excess of 10.21 mm. The study showed over-magnified hip and knee x-rays thus suggesting that acetate templates and measurement scales on PACS was not reliable.