Kathmandu University Medical Journal

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Vitamin C status in cancer patients and healthy subjects from the local population of Pokhara.
(2006-07-08) Adhikari, D; Baxi, J; Nagamma, T; Azhari, S; Singh, P P
OBJECTIVES: To assess vitamin C status by determining plasma ascorbic acid level in 55 cancer patients and 55 matched normal subjects serving as control. METHODS: The proven cancer patients were selected from those attending Manipal Teaching Hospital, Pokhara. Matched controls were from the staff of Manipal Teaching Hospital or attendants of the patients. Plasma ascorbic acid was determined by the method of Natelson. Unpaired student 't' test was used for the statistical evaluation. Statistical analysis was done by SPSS version 9 software. RESULTS: The mean level of vitamin C in normal subjects and patients was 1.03+/-0.26 mg/dl and 0.90+/-0.30 mg/dl respectively. None of the subjects in either group had deficient status (<0.2 mg/dl). Although its status was normal in both the groups but patients had lower level than normal subjects. Smokers and alcohol consumers had significantly lower level than non-smoker and non-alcoholics. CONCLUSION: In the local population, vitamin C deficiency is not an etiologic factor in malignancy. Smoking and alcohol adversely affects the status of this vitamin.
Structural changes in ocular trauma and the visual outcome.
(2004-04-12) Malla, B K
This is the presentation of one year prospective study on the anatomical structural lesions in ocular traumas with their visual outcome among those cases admitted and treated at Nepal Eye Hospital, Kathmandu. The changing life style of the people and environmental changes around with the changing nature of the causative objects on eye injuries have been observed for causing more serious structural lesions or complications including loss of vision.
Two faces of major lower limb amputations.
(2005-07-25) Paudel, B; Shrestha, B K; Banskota, A K
OBJECTIVES: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. MATERIAL AND METHODS: We retrospectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH), Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC. Major amputation was defined as any amputation at or proximal to wrist and ankle. RESULTS: Major lower limb amputations constituted 73.58%(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54%) followed by Congenital limb conditions (22.72%), Spina bifida with trophic ulcers ( 20.45%), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. CONCLUSION: Main causes of major lower limb amputation in both population is largely preventable by instituting safety measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults.
Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS.
(2006-01-08) Mehta, R S; Karki, P; Sharma, S K
OBJECTIVES: The objective of the study was to find out the demographic profile, identify the known risk factors, assess the associated health problems, find out the reasons for admission and explore the knowledge profile of the patients admitted with diabetes in medical units of BPKIHS. METHODS: It was hospital based exploratory study conducted among the admitted DM patients during the period of 1-3-2003 to 29-2-2004 in medical units using simple random sampling, which included 35 samples. The data was analysed using Excel and SPSS programme. RESULTS: About 54% subjects were of age group between 40-60 yr., Hindu 85.7%, married 92.9%, and non-vegetarian 75.9 %. About 50% of subjects were on Insulin. About 60.7 % subject had hypertension, 39.3 % had ocular problem, and 25 % had renal problems. Majority of subject (82.1 %) had knowledge about the disease, they were suffering but limited subject had the knowledge about, causes, curability, treatment modalities, diet, and other aspects. CONCLUSIONS: As the knowledge regarding various aspects of DM is very low, there is need for information booklet in Nepali and health education programme among public will be very beneficial.
Human papilloma virus and cancer of the cervix: a challenge facing Nepal.
(2006-07-08) Gilbert, D C
Pattern of intraocular pressure changes following manual small incision cataract surgery.
(2005-10-02) Das, H; Das, B P; Panda, A
OBJECTIVES: To find out the pattern of changes in intraocular pressure after manual small incision cataract surgery. METHODS: Consecutive patients (291 eyes of 291 patients) undergoing manual small incision cataract surgery were prospectively evaluated for change in IOP. Patients were further divided into two groups based on whether or not sutures were used to close the scleral tunnel. IOP was serially measured at day 1, 1st, 2nd, 4th, 6th, 8th and 12th week. RESULTS: The mean post operative IOP in eyes where sutures were not applied (12.59+/- 3.02 mmHg, 12.59+/-2.34mmHg, 12.54+/-2.19mmHg and 12.40+/-2.99 mm Hg at day1, 2week and 4weeks respectively) was lower than that where sutures were used to close the wound (15.57+/- 3.86mmHg, 14.05+/-2.52mmHg, 14.43+/-3.39mmHg at day1, 2weeks and 4 weeks respectively). There was a drop of IOP from the preoperative IOP in both suture (1.15+/-3.29mm Hg) and non suture (3.29+/-3.07mm Hg) group at 3 months of follow up. CONCLUSION: There is a small drop of IOP following sutureless MSICS during long term follow up. Eyes where sutures are applied are more likely to have higher IOP than those without sutures at the initial post operative period.
Predicting cubitus varus in supracondylar fractures of the humerus by Baumann's angles in post reduction X-rays.
(2006-04-08) Dahal, M; Kumar, P; Singh, G K; Arora, S S; Singh, M P
OBJECTIVES: The present study presents the technique to predict cubitus varus by post reduction Affected Side and Normal Side Baumann's angle difference (ASBA and NSBA) respectively. It intends to correlate the Baumann's angle to the final carrying angle of the injured elbow and presents the relevant mathematical clinical rule along with its prediction test characteristics. MATERIAL AND METHODS: Total 57 patients of 6.5+/-1.67 yrs, 22 were males and 8 females with 19/30 having left side injury. Isolated closed supracondylar fractures of humerus up to 5 days duration included and previous trauma, pathological fracture, other injury, elbow disease were excluded .30/57 completed >1 year follow-up. RESULTS: The Mean NSBA was 74.4+/-4.14 masculine. The mean normal side carrying angles (NSCA) were 9.56 +/- 2.2 masculine. The NSCA IQR (Inter Quartile Range) was 8.8-10 masculine. The ASBA was 79.9+/-9.1 masculine and affected side carrying angles (ASCA) was 0.20+/-8.7 masculine. The ASCA was best predicted by the difference between ASBA-NSBA (ASCA=3.87-0.65(ASBA- NSBA; F=15.91). At a cut off of 8.8 masculine (the lower limit of IQR for NSCA), a value >0 masculine for ASBA- NSBA was 80% predictive of cubitus varus. With pre test probability of varus at 70%, sensitivity was 0.94 and specificity 0.42. DISCUSSION: A prediction rule to predict the final carrying angle from ASBA NSBA difference is presented with a positive predictive value 0.80, specificity of 0.42, and sensitivity of 0.94 at a pre test probability of 0.70.When the diagnosis of cubitus varus is ASCA<8.8 masculine (Lower limit of the IQR for NSCA). CONCLUSION: If affected side Baumann's Angle - Normal Side Baumann's Angle is equal to or greater than 0 then there was 80% probability of having cubitus varus.
Abdominal tuberculosis--a study of 25 cases.
(2004-04-12) Sharma, Y R; Roy, P K; Hasan, M
Abdominal tuberculosis is one of the common extra pulmonary tubercular infections. Its clinical presentation is protean and it has diagnostic dilemma, as most of the investigations are non-specific and less sensitive. Therefore this study was undertaken to define the most suggestive clinical features of abdominal tuberculosis, to find out the efficacy of most commonly available investigations and also to evaluate the response of abdominal tuberculosis to conventional antitubercular therapy. Twenty five cases of either sex were studied in department of gastroenterology in BSMMU (earlier IPGMR), Dhaka from January 2001 to June 2003. All patients were clinically evaluated and were investigated by available tests. Eighteen patients were diagnosed by investigations (One by detecting AFB, 9 with caseating granuloma in biopsy specimen and 8 with suggestive radiological findings). Diagnosis of 7 patients were made from the common clinical features (fever, weight loss, altered bowel habit, abdominal pain and distension, positive non-specific findings and from response by antitubercular therapy. All patients received conventional 9 month anti-tubercular treatment with Rifampicin, Isoniazide and Pyrazinamide and were followed up clinically during and one year after completion of treatment. All patients were improved with minimum side effects of drug. Therefore, it is observed that a representative tissue biopsy (when approachable) and radiological findings are good method of diagnosis of abdominal tuberculosis. Strongly suggestive clinical features with positive non specific investigation findings are also an indication for anti tubercular treatment in all endemic countries like Nepal, Bangladesh and India. Treatment of abdominal tuberculosis is in no way different from that of other conventional anti-TB therapy.
Mechanism of lead induced effects on human spermatozoa after occupational exposure.
(2007-01-08) Naha, N; Manna, B
OBJECTIVES: Occupational lead exposure caused several types of male reproductive impairments in different working populations. In the present study we examined the paint factory workers of active reproductive age and compared the data with the non-occupationally exposed desk job holders taken as control from Bangalore, India. MATERIALS AND METHODS: In the above perspective, sperm cell morphology, morphometery and motile activity were assessed. Routine seminal biochemistry, cell cycle phase analysis of sperm head DNA, estimation of serum reproductive hormones and metal levels in blood and semen were also taken into account. RESULT: Low sperm velocity, ATPase activity, gross and forward progressive motility with high stationary motile spermatozoa revealed lowering of cellular activity after lead exposure (p<0.001), which was supported by high seminal plasma fructose level (p<0.001). Lowering of seminal plasma total protein with concomitant rise in free amino acid level was prevalent as the exposure increased (p<0.001), suggesting disturbance in cellular nutritional support essential for cellular motility. Prolonged liquefaction time, reduced semen volume and viscosity as well as altered seminal plasma protein, fructose and cholesterol level among the workers indicated dysfunction of accessory sex glands viz. prostate and seminal vesicle after occupational lead exposure (p<0.001). Deterioration of sperm count, structural abnormality of spermatozoa and sperm head DNA hyploidy was also associated with high blood and semen lead levels in the paint factory workers (p<0.001) without interfering serum FSH, LH and testosterone level (non-significant at p<0.05). CONCLUSION: Therefore, the present study suggested that at the present exposure level lead might cross blood-testis-barrier and increased its value in semen of the occupationally exposed paint factory workers in Bangalore, India, thereby producing detrimental effects on semen quality and sperm characteristics.
An integrated treatment approach: a case report for dentinogenesis imperfecta type II.
(2007-04-08) Shetty, N; Joseph, M; Basnet, P; Dixit, S
Dentinogenesis imperfecta type II or hereditary opalscent dentin is one of the most common autosomal dominant anomaly of dentin that occurs in both sex affecting approximately 1:8000 persons. Clinically this disorder is characterized by variable blue gray to yellow brown teeth, with fracture of enamel and excessive wear. The treatment strategy is focused towards protecting teeth from further wear and tear and total oral rehabilitation of patient with paramount importance to aesthetics, obtaining an appropriate vertical dimension and providing soft tissue support which will help to return the facial profile to a more normal appearance. A multidisciplinary treatment planning is required for treatment of these individuals.
Milk may protect against bowel cancer.
(2004-04-12) Joshi, S
Visual outcome of vitrectomy in seasonal hyperacute pan uveitis.
(2003-04-03) Byanju, R N; Pradhan, E; Rai, S C; Sapkota, Y D
INTRODUCTION: Seasonal Hyper Acute Panuveitis (SHAPU) is a sight threatening condition often affecting children. Its management as yet is a challenge in ophthalmic practice. Most of the eyes even after treatment end up in pthisis bulbi. MATERIALS AND METHODS: A retrospective hospital based analysis of 18 patients with SHAPU managed with vitrectomy at Himalaya Eye Hospital (HEH) Pokhara over a period of two years was carried out. RESULTS: Out of 18 patients 10 were males. Majority of them were below the age of 15 years. Best corrected visual acuity (BCVA) at presentation was less then 3/60 in 72% of them. BCVA was better then 6/60 in 7 (50%) out of 14 patients, who underwent vitrectomy. CONCLUSION: Vitrectomy is a useful procedure in management of SHAPU.
A study of therapeutic effect of the growth of children with hypothyroidism.
(2006-07-08) Bajracharya, B L; Baral, M R; Thapa Chhetri, P
OBJECTIVES: This study was done to see the therapeutic effect of the growth of children who was diagnosed as hypothyroidism. METHODS: Thirty-four children with primary hypothyroidism were included in this study. Height, weight and head circumference were measured at initial diagnosis and at every follow up visit. Thyroid function was done. The value was interpreted as abnormal if the range was above or below the normal (T3=70-200 u/L, T4=4-13 u/L, TSH=0.3-6 u/L). X-ray to see the bone age for the chronological age was performed. The value was interpreted as abnormal if the ossification center for the chronological age in inappropriate. Treatment was started with Eltroxine from the day of diagnosis. Dose was adjusted according to the response to the medicine. T3, T4 and TSH level was taken as the guideline to adjust the dose of the drug. X-ray was considered in the follow up where it was indicated. RESULT: Marked improvement in the anthropometry was seen in comparison to the initial assessment which was well correlated with the normalization of the TSH level and the x-ray of the bone. CONCLUSION: Serial follow up of these patients was necessary in order to assess the growth in height, weight and head circumference along with the repeated thyroid function to correlate the response of the drug.
Intensive care unit drug utilization in a teaching hospital in Nepal.
(2005-04-18) Shankar, P R; Partha, P; Dubey, A K; Mishra, P; Deshpande, V Y
OBJECTIVES: The intensive care unit (ICU) is a setting where a large number of drugs are administered to patients and the costs of hospitalization and drug treatment are high. Information on drug utilization in intensive care units (ICUs) are lacking in western Nepal. The present study was carried out to obtain information on the basic demographic pattern of the respondents, drug utilization during the study period, the antibiotic sensitivity patterns of isolated microorganisms and measure drug consumption in defined daily dose (DDD)/ 100 bed-days. METHODS: A retrospective analysis of patients admitted to the ICU of the Manipal Teaching hospital, Pokhara, Nepal during the time period from 01/02/2002 to 31/05/2002 was carried out. The ICU mortality rate, length of stay greater than 7 days and median length of stay were calculated. RESULTS: A total of 259 individuals were admitted. The ICU mortality rate was 15.4%; median length of stay was 4 days. E.coli, H.influenzae, K.pneumoniae, S.aureus and P.aeruginosa were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics. Mean +/- SD number of drugs and cost of drugs were 5.1 +/- 2.7 and 1958.5 +/- 1267.8 Nepalese rupees (25.1 +/- 16.2 US dollars). Total drug consumption was 356.4 DDD/100 bed-days. Consumption of intravenous fluids was 25.8 litres/100 bed-days. CONCLUSIONS: An antibiotic use policy should be framed. Formation of a multidisciplinary team to oversee drug use and periodically review microbial sensitivity patterns will be helpful. Longitudinal surveillance of ICU drug use should be carried out.
Effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health.
(2005-10-02) Dhital, A D; Badhu, B P; Paudel, R K; Uprety, D K
INTRODUCTION: Development of knowledge and attitude takes place during the adolescent period, which can have lifelong effects on the individual, family and society. Proper education in this age group is important for prevention of untoward social and health related problems. OBJECTIVE: To find out the effectiveness of structured teaching program in improving knowledge and attitude of school going adolescents on reproductive health. MATERIALS AND METHODS: An experimental study with pretest - posttest control group design was carried out in four selected schools with similar settings in Dharan town of Nepal. All the subjects were divided into two groups: experimental and control, each comprising of two subgroups of 50 boys and 50 girls. Structured teaching program consisting of information on human reproductive system was used as a tool of investigation for the experimental group, whereas conventional teaching method was used for the control group. RESULTS: A total of 200 Adolescent school students were included in this study. The mean (+/-SD) pretest score of the experimental group on knowledge of reproductive health was 39.83 (+/- 16.89) and of the control group was 39.47(+/- 0.08). The same of experimental group after administration of the structured teaching program (84.60+/-10.60) and of the control group with conventional teaching method (43.93+/-10.08) was statistically significant (p<0.001). Similarly, the post-test scores of knowledge of the groups on responsible sexual behaviour and their attitude towards reproductive health were better in the experimental group than in the control group (p<0.001). CONCLUSION: The knowledge of adolescent school students on reproductive health is inadequate. The use of structured teaching program is effective in improving knowledge and attitude of the adolescents on reproductive health.
Two cases of severe falciparum malaria in KMCTH.
(2006-01-08) Singh, S B; Chaudhary, D; Neopane, A; Karki, D B
Malaria is the most important parasitic disease of man. It is the protozoan infection of RBCs transmitted by bite of blood feeding female anopheline mosquito. Until the 19th century malaria was found throughout Europe, North America and Russia. Since then, it has been eradicated from these areas but in tropics though initial efforts of eradication had been successful, there has been resurgence of disease accompanied by increasing resistance of the anopheline vector to insecticide and of the parasite to antimalarial drugs. We report two cases of falciparum malaria in which there was co-existent vivax malarial infection. These two cases were both exposed to highly endemic zone for malaria.
Vaginal delivery: a forgotten art!
(2007-01-08) Chawla, C D
Primary meningeal melanocytoma.
(2008-04-05) Khadilkar, U N; Agarwal, N; Deeshma,; Bhat, V
Meningeal melanocytoma is an uncommon benign pigmented primary lesion that has to be distinguished as a pathological entity separate from other benign melanin containing tumours as well as its overtly malignant counterpart, melanoma. In the present study, a 58 year old lady presented with bilateral sensory and motor symptoms in the lower limbs. The MRI scan showed a dumb-bell shaped lesion in the spinal canal at 6th cervical vertebra to 1st thoracic vertebra (C6-T1) level mimicking a schwannoma and histologically proved to be melanocytoma.
Prevalence of adverse drug reactions with commonly prescribed drugs in different hospitals of Kathmandu valley.
(2008-01-20) Alam, K; Palaian, S
Risk factors in early neonatal sepsis.
(2006-04-08) Shah, G S; Budhathoki, S; Das, B K; Mandal, R N
OBJECTIVE: To study the maternal and neonatal risk factors for neonatal sepsis. MATERIALS AND METHODS: This is prospective case control study, conducted on the neonates up to 7 days of life with a diagnosis of neonatal sepsis. There were 100 cases of neonatal sepsis and 100 control cases. The neonates in the case and control groups were evaluated for various maternal and neonatal risk factors. RESULTS: The factors which carried a significant risk for development of neonatal sepsis were premature rupture of membrane (PROM), meconium stained amniotic fluid (MSAF), foul smelling liquor, low birth weight, prematurity and low Apgar score at birth. The blood culture was positive in 22% of cases. The commonest organisms isolated were S. aureus and Klebsiella. The overall mortality was 11%. The incidence of risk factors was almost equal in culture positive and culture negative cases. CONCLUSION: The study identifies PROM, MSAF, foul smelling amniotic fluid, prematurity, low birth weight and low Apgar score at birth as strong risk factors for development of neonatal sepsis. In the presence of above factors, the neonate should be screened and observed for sepsis and considered for early institution of antibiotics.

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