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A total of 22 patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each patient was assessed light microscopically, and, in select biopsies, spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within 1 day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of eczematous dermatitis, interface dermatitis, granulomatous inflammation, and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris, and guttate psoriasis were seen in select cases. In 2 cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsy specimens of normal skin post vaccine and of skin affected by the post-vaccine eruption showed rare deep microvessels positive for spike glycoprotein with no complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from patients experiencing severe coronavirus disease 2019 (COVID-19). It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly owing to a substance found in the vaccine vehicle (eg, polyethylene glycol). An immune response that is directed against human-manufactured spike has to be considered because some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine-associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis, and subclinical hypersensitivity.

Atopic dermatitis is a chronic inflammatory dermatoses, pruritic and relapsing, with variable density in which attacks mostly patients in pediatric age group. Therefore, the disease can cause a series of psychological and social damage because of its consequences at the family’s routine. Thus, the disease gets involved at the daily activities and interpersonal relationship. In summary, this study objective is to review articles about atopic dermatitis’ impact on the life quality of pediatric patients and their caregivers, using integrative review and literature's descriptive as a method, with a quality approach, at SciELO and Google Scholar data base in the month of June of 2021 with the words: “atopic eczema”, “children”, “relatives” and “welfare”. It was found 200 articles written in English, Portuguese and Spanish, published between 2012 and 2021 that had public access. From this number, 11 studies were selected to compose this review’s data base. In conclusion, the atopic dermatitis negatively affects the daily life of pediatric patients and their caregivers. The discomfort caused by the pruritic eczema adds to sleep deprivation and affects the children’s development at school, family and psychosocial life. The worst of this disease is related to bad quality of life index. A better understanding of atopic dermatitis’ impact can positively affect the patient’s frequent treatment and therapeutic strategies.

AIM AND OBJECTIVE: This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. MATERIALS AND METHODS: The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January-March 2020) and after lockdown (June-August 2020), were included retrospectively and compared. RESULTS: The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. CONCLUSION: The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. CLINICAL SIGNIFICANCE: This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis. How to cite this article: Panta P, Reddy P, Misra SR, et al. Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions. J Contemp Dent Pract 2021;22(5):501-505.

OBJECTIVES There are limited longitudinal data regarding gingival inflammation in adults. This study aimed to assess changes in gingivitis over 4 years and to determine protective factors. METHODS A representative sample of 1023 adults living in Porto Alegre, Brazil, was obtained in the Caries-Perio Collaboration Study. At follow-up, 402 individuals were re-examined. Gingivitis was assessed by the gingival bleeding index (GB) at both time points. Individuals were dichotomized into those showing reductions ≥ 15% and those showing reductions

Low socioeconomic level may contribute to the severity of asthma, frequency of exacerbation, and hospitalization and affects the quality of life. The aim of the study was to evaluate the impact of socioeconomic status (SES) on general score of quality of life (GSQL). Methods: The study group included children aged between 8-16 years with persistent asthma, and we followed them up 12 months. We analyzed the location and the size of the household, educational level, and employment status of parents and family income. The GSQL was obtained based on the questionnaire of quality of life in children with asthma. According to the SES, we divided the study group into high income and low-income groups. Results: Half of the patients belonged to families with low income. There were no significant differences in GSQL regarding the living area, educational level, and parents' employment status. The general score of quality of life was higher in patients from the high-income group than those with lower income at the beginning of the study (5.04±1.09 versus 4.43±0.97; p=0.0101). Alter 12 months GSQL increased significantly in both groups (6.57±0.57 versus 6.49±0.56; p=0.3167). The quality of life was not affected by atopic status. Conclusions: The low income has a negative impact on children GSQL. The educational level and employment status of parents, rural area, and the association of other allergic diseases do not affect the quality of life.

Background Previous studies have suggested that the association between APOE ɛ 4 and dementia is moderated by physical activity (PA), but the results remain inconclusive and longitudinal data on cognitive decline are missing. In this study, we examine whether there is a gene–environment interaction between APOE and PA on cognitive decline in older adults using 9-year follow-up data of three cohort studies. Methods We followed 7,176 participants from three longitudinal cohort studies: Longitudinal Aging Study Amsterdam (LASA), InCHIANTI, and Rotterdam Study for 9 years. PA was assessed with self-reported questionnaires and was categorized in low, moderate, and high PA. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) and cognitive decline was defined as a decrease of three points or more on the MMSE during 3 years follow-up. We fitted logistic regression models using generalized estimating equations adjusting for age, sex, education, depressive symptoms, and number of chronic disease. Interaction between APOE and PA was tested on multiplicative and additive scale. Results Cohorts were similar in most aspects but InCHIANTI participants were on average older and had lower education. APOE ɛ 4 carriers had higher odds of cognitive decline (odds ratio [OR] = 1.46, 95% confidence interval [CI]: 1.29–1.64) while PA was not significantly associated with cognitive decline overall (moderate PA: OR = 0.87, 0.67–1.13; high PA: OR = 0.71, 0.36–1.40). There was no evidence for an interaction effect between PA and APOE ɛ 4 in cognitive decline in older adults (APOE × moderate PA: p = .83; APOE × high PA: p = .90). Conclusions Previous claims of a gene–environment interaction between APOE ɛ 4 and PA in cognitive decline are not supported by our results.

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

Background: The health care cost is increasing not only in developed countries but also in developing countries. Although the modality of treatment has made significant progresses over the years, delivery of treatment is sometimes beyond the expectation of patient as well as inaccessible financially. Citizen from developing countries like Nepal have to pay out of their own pocket for even minor health issues. We initiated a new concept to bridge this gap between treatments and necessity of funds through crowd funding scheme. Methods: This was a cross sectional prospective and observational study conducted at Annapurna Neurological Institute and Allied Sciences from July 2017 to April 2020. This study was conducted on “Get Well Soon “card which was a friendly gesture with monetary value provided by visitors to patients. This card was made available in hospital pharmacy without any hidden cost. A convenient sample survey on 100 participant including admitted patients as well as visitors in the hospital was conducted on their perception about Get well soon card before initiating this program. Results: This innovative self-help scheme has been proven to be quiet successful in a short period of time with many supporters advocating in its favor. Total number of 1012 patients have been benefited from the card which was provided to them by their visitors and relatives during their hospitalization with purchase of card worth NRs. 1144500 (~$11445) during the study period. Conclusion: Get Well Soon Card can be beneficial to those populations who are financially constrained and lack insurance for the treatment. This Cultural Revolution of crowd funding can be duplicated not only in Nepal, but also in different developing countries where out of pocket system is still prevailing.

Background: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. Clinical diagnosis plays a vital role in appendicitis. The treatment of acute appendicitis remains a health problem and significant morbidity and mortality are still associated with it. Morbidities such as perforation, abscess formation, appendicular lump and surgical site of infection are well reported. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this region of Nepal. Methods: This cross sectional retrospective study was carried out in the Karnali academy of health sciences, Jumla. The data includes the 5 years period from June 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication. Results: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix. Two had abscess in 29 cases of appendicular mass. 2 had a surgical site infection. Conclusion: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication was the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment were equally feasible for acute appendicitis according to the cases presented in the hospital.

Introduction: Osteoporosis is a bone disorder characterized by a reduction in bone density accompanied by increasing porosity and brittleness. It is one of the major public health problem globally and its prevalence is rapidly increasing particularly in women. Osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Therefore the objectives of the study was to assess the existing awareness and health belief of osteoporosis among middle aged women. Methods: Descriptive cross-sectional research design was used on a sample of 328 middle aged women residing in Nagarjun Municipality, Kathmandu. Non probability purposive sampling technique was used to collect the data. Data was collected after informed consent through face to face interview schedule using Osteoporosis Knowledge Assessment Tool (OKAT) and Osteoporosis Health Beliefs Scale (OHBS). Descriptive statistics and inferential statistics (Chi-Square test) were used for data analysis at 5% level of significance. Results: The overall osteoporosis awareness and health beliefs mean scores were9.39 ± 2.93 and 146.18 ±11.58 respectively. Majority(60.0%) of the respondents were unaware of osteoporosis. Existing awareness of respondents was significantly associated with age (p

Introduction: Cervical degenerative disc diseases leading to cervical spondylotic myelopathy (CSM) is one the most common cause of disability in elderly population that progresses with age with continuation of degree of degeneration. Objective: To assess the functional outcome following ACDF in single-level cervical degenerative disc disease in terms of improvement in the mJOA scoring system and postoperative complications. Materials and methods: Eighteen patients with single level cervical degenerative disc diseases who presented at the college of medical sciences from May 2018 to October 2019 fulfilling the inclusion criteria (single-level cervical degenerative disc disease with age between 40 to 70 years with progressive neurological deficits, features of cervical spondylotic myelopathy and patients with mild grade who failed four weeks of conservative treatment and progressed to moderate or severe grades) were included in the study. All patients underwent Anterior Cervical Discectomy and Fusion (ACDF); with tricortical iliac crest graft with cervical plate and screws in 13 patients and polyether ether ketone (PEEK) cage placement in five patients. Patients were assessed using mJOA scoring system and graded into mild, moderate and severe myelopathy. Post-operatively patients were assessed for improvement in terms of mJOA scores at four weeks and three months follow-up. They were also assessed for development of any post-operative complications and documented accordingly. Statistical analysis was done using the Statistical Package for the Social Sciences version 20 software. Results: Out of 18 patients, at the time of presentation 12 were in moderate grade and six were in severe grade. During subsequent follow up at four weeks and three months, patients showed progressive improvement. 15 patients improved to mild grade while two remained in moderate grade and one in severe grade during three months postoperative assessment. One patient each developed dysphagia, hoarseness and superficial wound infection that were managed conservatively. Conclusion: Anterior cervical discectomy and fusion is one of the effective and safe treatments for single-level degenerative cervical disc disease associated with cervical spondylotic myelopathy with minimal complications.

Introduction: Mobile medical and surgical camps are one of the means of providing medical and surgical facilities to people living in rural areas of developing country like Nepal. Methods: An observational cross-sectional descriptive retrospective study was done collecting data from surgical camps done by Nepali Army in six years from February 2013 to February 2019 AD. Total number of surgical cases requiring anaesthesia along with type of anaesthesia, American Society of Anaesthesiologist physical status classification and anaesthesia related complications were collected. Results: In a six year period, total 12 mobile surgical camps were conducted by Nepali Army. Out of which, two were done in collaboration with Ministry of Health, Government of Nepal. Total 703 surgical cases were conducted. Out of which, 583 were general surgical cases and 120 were gynaecological cases. 262 cases were done in local anaesthesia, 242 cases were done in spinal anaesthesia, 108 cases were done in total intravenous anaesthesia and 91 cases were done in general anaesthesia. Hypotension, nausea, vomiting, shivering, failed spinal and difficult airway were the complications noticed during intra-operative and postoperative period. Conclusions: Surgical outreach camps are beneficial in providing surgical care to unaffordable people living in rural and remote areas where health care facilities are limited and inaccessible. Safety of patient is the key concern in such camps. Proper organised plan is required selecting target group of populations with target surgeries per day for successful conduction of safe surgeries in such camps. Key words: anaesthesia; camps; mobile; surgical

Dentigerous cysts are seen in the maxillary canine and third molars. We report a case of dentigerous cysts invading the maxillary sinus, which was managed surgically by endoscopic‐assisted transantral and transnasal approach., Combined endoscopic‐endonasal approach may be a good method for dentigerous cysts at unusual locations.

Introduction: Primary congenital glaucoma is a rare vision-threatening condition of children. Primary congenital glaucoma though a rare disease it is the most common cause of childhood glaucoma with potency to cause blindness. This study was undertaken to find the prevalence of the children with primary congenital glaucoma under 3 years of age in a tertiary care hospital. Methods: This was a descriptive cross-sectional study conducted at a tertiary eye center in Nepal in children (≤ 3 years) presented in the outpatient department of a tertiary eye hospital between June 2017 and June 2020. The study was approved by the hospital review committee and adhered to the declaration of Helsinki. A convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated with frequency distribution. Data analysis was conducted using Statistical Package for the Social Sciences. Results: Out of total children under 3 years who presented to the outpatient department, 46 (0.31%) at 95% Confidence Interval (0.30-0.32) had primary congenital glaucoma. Among them, 30 children (65.2%) had bilateral involvement. Mean intraocular pressure was 42.40±8.15mm Hg. The mean age of initial presentation, horizontal corneal diameter, and axial length were 12.07±8.9 months, 12.95±1mm, and 23.89±1.7mm respectively. Consanguinity was observed in 12 (26%) children. Conclusions: From the study, we conclude that there was a low prevalence of primary congenital glaucoma among children under 3 years of age who presented to the outpatient department in a tertiary care hospital.

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease. Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc. Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 &plusmn, 23.8 SD) and skin score (mRSS) (r = 0.79, p &lt, 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement. Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands.

AIM This report aims to provide the clinical and radiographic features of two symptomatic Indian patients with florid cemento-osseous dysplasia (FCOD), along with a discussion of the differential diagnosis, potential challenges, and therapeutic implications. BACKGROUND FCOD is a rare, multifocal, periapical, and bilateral condition involving the premolar and molar region of the posterior mandible and sometimes the maxilla. CASE DESCRIPTION The first patient is a 30-year-old female with a recent history of dental pain. The patient was otherwise healthy and the medical history was unremarkable. The second patient is a 50-year-old female with a history of orthodontic therapy. Radiographic evaluation using cone-beam computed tomography (CBCT) revealed bilateral involvement of the posterior mandible, sparing the entire maxilla in both patients Clinical significance: For a pathognomonic condition like FCOD, a radiology survey alone is often sufficient to arrive at the final diagnosis, and therefore surgical interventions should ideally be avoided.

Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa’s fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification.Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence.

Medical devices are sterilized before being used for invasive clinical procedures such as surgery, to prevent pathogen transfer. Failure to sterilize medical devices properly presents a risk of healthcare-associated infections. Studies and reports have indicated that inadequately sterilized medical devices are one of the causes of a higher rate of healthcare-associated infections in developing countries. Steam sterilization (autoclaving) is the most widely used method for sterilization and is considered the most robust and cost-effective method for sterilization of medical devices. The effectiveness of steam sterilization can be measured using biological indicators. A literature search was undertaken to understand the effectiveness of autoclaving in sterilizing reusable medical devices in healthcare facilities across the globe. Studies using biological indicators for measuring the effectiveness of autoclaving were obtained. Failures of steam sterilization practices were identified and discussed as a means of identifying factors that might be associated with the ineffectiveness of steam sterilization practices between different countries. The number of studies measuring the effectiveness of steam sterilization is small, and few evaluate the effectiveness of steam sterilization specifically in developing countries. There are fewer studies on higher level healthcare facilities than dental facilities. More evidence about the effectiveness of autoclaving in healthcare facilities is needed to draw firm conclusions, but the data suggest that there are inadequacies in autoclave procedures and operator education.

Introduction: Infertility is being a common global problem affecting one couple in six. Approximately 167 million ever-married women aged 15-49 years in developing countries were infertile. The problem of infertility has not given attention considering the fact that it is not life-threatening, but, it has substantial community health problems such as depression, anxiety domestic violence and social isolation. The purpose of the study was to explore the causes of infertility among couples who visited the infertility centre. Methodology: Hospital-based descriptive cross-sectional study had been carried out in infertility centre Kathmandu Nepal. One hundred and sixty-five married couple with infertility problem availing the infertility treatment was selected on first come first serve basic sampling method from the infertility treatment centre. Result: The infertility problem varied with the age. The problem was highest among the females of age group 26-30 years (51%), similarly, in males, it was predominant at the age of 31-35 years (45%). The most common causes of female infertility were ovarian cyst (37%) and heavy bleeding (18.7%), uterine fibroids (9%), Pelvic inflammation (9%), Thyroid disease (21.8%), whereas in males the infertility was mostly due to Oligospermia (17.5%), Azoospermia (5.5%), Hydrocele (7.8), Mumps orchids (6%). Conclusion: Infertility was due to various causes in the male or/and the female partner, however, infertility among couples were mostly due to the problem in females. Infertility is a complex problem that should be considered carefully by the individual, community peoples, government and stakeholders in each country. Keywords: Male Fertility, Female Fertility, Causes, Couple, Infertility, Ovarian Cyst DOI: http://doi.org/10.3126/jkahs.v2i2.25180

Background: The subclavian artery is the source of blood supply to the upper limbs. It is the branch of the arch of the aorta on the left side and brachiocephalic trunk on the right side of the neck. It is used as cannulation site for cardiopulmonary bypass and for the insertion of intra-aortic balloon pumps. So its variations in the branching pattern are very important for surgeons and physician as well. Method: The study was conducted on 80 embalmed cadavers over the period of 4 years from August 2013 to August 2017 during the routine dissection for the MBBS and BDS students in dissection hall of anatomy department in Jawaharlal Nehru Medical College, Belgaum, Karnataka, India. The digital vernier calliper was used to measure the morphometric parameter. The data were analysed by using SPSS version 20. Result: Out of 80 cadavers used for dissection, 52 (65%) were male and 28 (35%) were female. The external diameter of the subclavian artery in male was 7.15mm ± 1.7mm and female was 6.85mm ± 1.5mm with significant sexual dimorphism (p=0.002). The classical course of both subclavian arteries was found in 76 (95%) of the artery and the remaining 5% of the artery was found to have an anomalous course. Conclusion: The subclavian artery in male had a larger diameter than in the female. The variation in the subclavian artery was common. The knowledge of its average size and its anomalous origin, course and branching pattern might be helpful for the surgeon as well as the physician, for the disease diagnosis, interventional therapy, and surgical procedures. Keywords: Subclavian Artery, Morphometry, Variation, Branching Pattern, Anomalous course, Costocervical trunk DOI: http://dx.doi.org/10.3126/jkahs.v2i1.24414

Stroke risk and poor stroke outcomes in postmenopausal women have usually beeen attributed to decreased levels of estrogen. However, two lines of evidence suggest that this hormone may not be solely responsible for elevated stroke risk in this population. First, the increased risk for CVD and stroke occurs much earlier than menopause at a time when estrogen levels are not yet reduced. Second, estrogen therapy has not successfully reduced stroke risk in all studies. Other sex hormones may therefore also contribute to stroke risk. Prior to menopause, levels of the gonadotrophin Follicle Stimulating Hormone (FSH) are elevated while levels of the gonadal peptide inhibin are lowered, indicating an overall decrease in ovarian reserve. Similarly, reduced estrogen levels at menopause significantly increase the ratio of androgens to estrogens. In view of the evidence that androgens may be unfavorable for CVD and stroke, this elevated ratio of testosterone to estrogen may also contribute to the postmenopause-associated stroke risk. This review synthesizes evidence from different clinical populations including natural menopause, surgical menopause, women on chemotherapy, and preclinical stroke models to dissect the role of ovarian hormones and stroke risk and outcomes.

Women are more likely to develop Post Stroke Depression (PSD) than men and generally do not respond well to anti-depressants with age. This study investigated the effect of microRNA mir363-3p treatment on PSD using a physiologically-relevant animal model. Our previous work showed that mir363-3p treatment, delivered post-stroke, effectively reduces infarct volume in the acute phase of stroke in middle-aged females but not males. Middle-aged female Sprague Dawley rats were tested for baseline sensory motor function and depressive-like behaviors, and then subjected to ischemic stroke via middle cerebral artery occlusion (MCAo) or sham surgery. Animals received either control oligos (MCAo+scrambled, Sham+scrambled) or mir363-3p (MCAo+mir363-3p, Sham+mir363-3p) treatment 4 h later. Sensory motor function and depressive-like behaviors were reassessed up to 100 d after stroke, and circulating levels of IL-6, TNF-alpha and Brain-Derived Neurotrophic Factor (BDNF) were quantified at regular intervals. Prior to termination, Fluorogold was injected into the striatum to assess meso-striatal projections. MCAo+scrambled animals had impaired sensorimotor performance in the acute phase (5 days) of stroke and developed anhedonia, decreased sociability and increased helplessness in the chronic phase. MCAo+mir363-3p animals showed significantly less sensory motor impairment and fewer depressive-like behaviors. IL-6 and TNF-alpha were elevated transiently at 4 weeks after MCAo in both groups. BDNF levels decreased progressively after stroke in the MCAo+scrambled group, and this was attenuated in the mir363-3p group. The number of retrogradely-labeled SNc and VTA cells was reduced in the ischemic hemisphere of the MCAo+scrambled group. In contrast, there was no interhemispheric difference in the number of retrogradely-labeled SNc and VTA cells of MCAo+mir363-3p treated animals. Our results support a therapeutic role for mir363-3p for long-term stroke disability.

DOI: https://doi.org/10.3126/njh.v16i1.23894 Background: Hypertension is one of the major risk factors for the rising burden of cardiovascular diseases (CVDs) in developing region. It has also been recognized as one of the major public health problems in the developing countries since the early seventies and the rate is increasing not only in urban areas but in rural areas with low socio-economic condition. Methods: A cross sectional study was conducted in Jogidaha Village Development Comittee(VDC) and Triyuga Municipality of Udaypur district of South-Eastern Nepal. A total of 430 participants of age 18-59 years were selected. Semi-structured questionnaire (WHO NCD STEPS instrument) was used to collect information on demographic variables and associated risk factors with use of show cards. Clinical and anthropometric measurement were done. Primary outcome was prevalence of hypertension. Bivariate and multivariate analysis were performed to show strength of association among various risk factors with hypertension. Results: The prevalence of hypertension was found to be 25.1%. Prevalence of overweight and obesity was found to be 49.8%. Hypertension was significantly associated with age (AOR=1.09, CI=1.05-1.10) and gender (male >female; AOR= 2.12,CI =1.22-3.68). Similarly, increased waist-hip ratio(7.12; CI 2.87-17.67),alcohol consumption(OR=2.82,CI=1.77-4.52), and use of tobacco products (OR =1.8,CI=1.02-3.20) showed significant association with hypertension. Conclusion: There is high prevalence of hypertension in rural districts of South-Eastern Nepal. A community-based preventive approach with early detection and treatment and life-style modification is needed to reduce the burden of disease and make sustainable changes. Keywords: Hypertension, Risk factors, Rural Nepal

Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.

Background: Mefloquine is one of the prophylactic medications recommended by the government of Nepal. In areas of intense malaria transmission, prophylaxis with drugs is an important strategy to prevent malaria. During prophylactic use, several neuro-psychiatric and other systemic adverse effects can occur with mefloquine. Notable psychiatric manifestations include anxiety, depression, restlessness, and confusion. Objective: To study the psychiatric effects of mefloquine in Nepalese serving soldiers posted in the United Nations peace mission nations of the African continent taking mefloquine prophylaxis. Methodology: This prospective descriptive study was conducted among Nepalese soldiers posted for United Nations peace mission in South Sudan over a period of one year. Soldiers of age group 25-55 years posted for peace mission having no past and family history of psychiatric illnesses were enrolled in the study. General Health Questionnaire-12, translated into Nepali by Nepalese Journal of Psychiatry, with a questionnaire about the side effects was used to collect detailed information. Results: A total of 524 soldiers posted on peace mission were enrolled in the present study, among which 520 were male and four were female. There were four positive cases with General Health Questionnaire score 3/12 or more. Among the adverse events noted, neuropsychiatric adverse events were more common than non-neuropsychiatric adverse events but none were of life-threatening severity. Conclusion: In a malaria endemic region with a high prevalence of malaria, mefloquine can be safely used in an apparently healthy population, judging the risk-benefit.

Background & Aims Metaplasia in the stomach is highly associated with development of intestinal-type gastric cancer. Two types of metaplasias, spasmolytic polypeptide-expressing metaplasia (SPEM) and intestinal metaplasia (IM), are considered precancerous lesions. However, it remains unclear how SPEM and IM are related. Here we investigated a new lineage-specific marker for SPEM cells, aquaporin 5 (AQP5), to assist in the identification of these 2 metaplasias. Methods Drug- or Helicobacter felis (H felis) infection-induced mouse models were used to identify the expression pattern of AQP5 in acute or chronic SPEM. Gene-manipulated mice treated with or without drug were used to investigate how AQP5 expression is regulated in metaplastic lesions. Metaplastic samples from transgenic mice and human gastric cancer patients were evaluated for AQP5 expression. Immunostaining with lineage-specific markers was used to differentiate metaplastic gland characteristics. Results Our results revealed that AQP5 is a novel lineage-specific marker for SPEM cells that are localized at the base of metaplastic glands initially and expand to dominate glands after chronic H felis infection. In addition, AQP5 expression was up-regulated early in chief cell reprogramming and was promoted by interleukin 13. In humans, metaplastic corpus showed highly branched structures with AQP5-positive SPEM. Human SPEM cells strongly expressing AQP5 were present at the bases of incomplete IM glands marked by TROP2 but were absent from complete IM glands. Conclusions AQP5-expressing SPEM cells are present in pyloric metaplasia and TROP2-positive incomplete IM and may be an important component of metaplasia that can predict a higher risk for gastric cancer development., Graphical abstract

Introduction: Osteoporosis and resulting fracture is a major public health concern worldwide. With increase in life expectancy, osteoporosis and fragility fracture is expected to be more prevalent. It is associated with high patient morbidity, while hip and vertebral fractures have high mortality. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to find out the prevalence of osteoporosis among postmenopausal women visiting a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among 89 postmenopausal women attending at Orthopedic Outpatient Department of Bharatpur Hospital from 1st January 2019 to 30th December 2019. The ethical clearance was taken from the Institutional Review Committee of Bharatpur Hospital. Convenience sampling technique was used. Bone Mineral Density was estimated with dual energy x-ray absorptiometry scan. Statistical Package for Social Science was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 89 postmenopausal women, 29 (32.58%) (Confidence Interval = 32.48-32.68) women had osteoporosis. The mean age and Bone Mineral Density were 62.16±8.17 years and 0.968±0.14 g/cm2 respectively. The women with history of fragility fracture had low bone mineral density. Conclusions: Prevalence of osteoporosis was high among postmenopausal women. Women with history of fragility fracture are at increased risk of another fragility fracture. It is hence necessary to have awareness programs and early screening to minimize the magnitude of morbidity and mortality associated with osteoporosis.

Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.

A 38-year male presented with severe low back pain radiating towards right lower limb which was progressively increasing with decrease in motor power of the ipsilateral ankle dorsiflexion and toe extension. Magnetic Resonance study with gadolinium suggested dorsal epidural migration of the extruded disc at L4-L5 level compressing the thecal sac, which mimics the differential diagnosis epidural abscess, epidural hematoma, synovial cyst and extradural space-occupying lesion. Open lumbar discectomy was done, and the large, herniated disc was found dorsal to the thecal sac adhering dura mater, which was removed meticulously and the patient was symptomatically better postoperatively. The power of his lower limb gradually increased by physiotherapy in subsequent follow-up.

Summary The coronavirus disease 2019 (Covid‐19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is an international public health crisis with devastating effects. In particular, this pandemic has further exacerbated the burden in tropical and subtropical regions of the world, where dengue fever, caused by dengue virus (DENV), is already endemic to the population. The similar clinical manifestations shared by Covid‐19 and dengue fever have raised concerns, especially in dengue‐endemic countries with limited resources, leading to diagnostic challenges. In addition, cross‐reactivity of the immune responses in these infections is an emerging concern, as pre‐existing DENV‐antibodies might potentially affect Covid‐19 through antibody‐dependent enhancement. In this review article, we aimed to raise the issue of Covid‐19 and dengue fever misdiagnosis, not only in a clinical setting but also with regards to cross‐reactivity between SARS‐CoV‐2 and DENV antibodies. We also have discussed the potential consequences of overlapping immunological cascades between dengue and Covid‐19 on disease severity and vaccine development.

Background: Overweight and obesity are major risk factors for non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, musculoskeletal disorders, including cancer. The risk of NCDs increases, with increases of body mass index (BMI). Food choices and eating habits have been changed according to the pace of development and urbanization. Such a nutritional transition has been claimed for increasing rates of overweight and obesity which are recently observed in our adolescent and youths. Adolescents and youths are vulnerable groups of the development of overweight and obesity. Therefore, the objective of this study was to determine the prevalence of obesity and the associated food pattern among Nepalese medical students. Methods: A cross-sectional study was conducted on 170 medical students of Nepal Medical College of 17 to 26 years in December 2018 using a self-administered questionnaire to assess the pattern of eating habit and prevalence of overweight and obesity by using BMI classification. Data were analyzed using SPSS statistical software, and the Chi-square test was used to establish the relationship of variables. Results: The study showed that 7.1% of the participants were overweight and obese with average BMI of 21.46± 2.74. Three-fourth (72.4%) of the participants reported taking meals regularly. Two third of the participants (65.9%) reported that they consume vegetables and the vast majority (83.5%) had eaten fruits at least a day. Less than half of the students (44.1%) were found to be alcohol users whereas consumption of smoking was not common (1.2%). Demographic variables such as the income of the family and ethnicity were significantly associated with BMI (p

In this report, we describe a case of a 61-year-old male patient who had the bacterium Dolosigranulum pigrum growing in a blood culture. It was susceptible to ampicillin, ceftriaxone, levofloxacin, and vancomycin but was intermediately resistant to erythromycin. The patient did not have a negative outcome as a consequence of this bacterium, which retrospectively could have been predicted based on the epidemiological data within the patient's profile.

Cognitive impairment and memory loss are commonly seen after stroke and a third of patients will develop signs of dementia a year after stroke. Despite a large number of studies on the beneficial effects of neuroprotectants, few studies have examined the effects of these compounds/interventions on long-term cognitive impairment. Our previous work showed that the microRNA mir363-3p reduced infarct volume and sensory-motor impairment in the acute stage of stroke in middle-aged females but not males. Thus, the present study determined the impact of mir363-3p treatment on stroke-induced cognitive impairment in middle-aged females. Sprague–Dawley female rats (12 months of age) were subjected to middle cerebral artery occlusion (MCAo; or sham surgery) and injected (iv) with mir363-3p mimic (MCAo + mir363-3p) or scrambled oligos (MCAo + scrambled) 4 h later. Sensory-motor performance was assessed in the acute phase (2–5 days after stroke), while all other behaviors were tested 6 months after MCAo (18 months of age). Cognitive function was assessed by the novel object recognition test (declarative memory) and the Barnes maze (spatial memory). The MCAo + scrambled group showed reduced preference for a novel object after the stroke and poor learning in the spatial memory task. In contrast, mir363-3p treated animals were similar to either their baseline performance or to the sham group. Histological analysis showed significant deterioration of specific white matter tracts due to stroke, which was attenuated in mir363-3p treated animals. The present data builds on our previous finding to show that a neuroprotectant can abrogate the long-term effects of stroke.

Mucosal irritation caused by cusps of upper and lower teeth represents a source of persistent, low grade mechanical trauma. This type of trauma can initiate and/or perpetuate oral lichen planus in a few susceptible patients. Here, we report a rare case of bilateral white linear striations in the buccal mucosa of a young patient, associated with sharp cusps. Oral lesions demonstrated a unique cuspal signature highlighting the causal role of subtle mucosal trauma in the genesis of reticular-oral lichen planus. Lesions appeared to be exacerbated by significant psychological distress experienced by the patient. Although the Koebner phenomenon is well reported in the cutaneous lichen planus literature, such presentations are relatively rare in the oral cavity. This report emphasizes the potential role of low-grade cuspal trauma/irritation in conjunction with psychological distress in the genesis of oral lichen planus.

Background Reusable medical devices in healthcare facilities are decontaminated and reprocessed following standard practices before each clinical procedure. Reprocessing of critical medical devices (those used for invasive clinical procedures) comprises several processes including sterilization, which provides the highest level of decontamination. Steam sterilization is the most used sterilization procedure across the globe. Noncompliance with standards addressing reprocessing of medical devices may lead to inadequate sterilization and thus increase the risk of person-to-person or environmental transmission of pathogens in healthcare facilities. We conducted nationwide multicenter clustered audits to understand the compliance of primary- and secondary-care public hospitals in Nepal with the standard practices for medical device reprocessing, including steam sterilization. Methods We developed an audit tool to assess compliance of hospitals with the standard practices for medical device reprocessing including steam sterilization. Altogether, 189 medical device reprocessing cycles which included steam sterilization were assessed in 13 primary and secondary care public hospitals in Nepal using the audit tool. Percentage compliance was calculated for each standard practice. Mean percentage compliances were obtained for overall primary and secondary care hospitals and for each hospital type, specific hospital and process involved. Results For all primary and secondary care hospitals in Nepal, the mean percentage compliance with the standard practices for medical device reprocessing including steam sterilization was 25.9% (95% CI 21.0–30.8%). The lower the level of care provided by the hospitals, the lower was the mean percentage compliance, and the difference in the means across the hospital types was statistically significant (p Conclusion The primary and secondary care hospitals in Nepal had poor compliance with the standard practices for steam sterilization and reprocessing of medical devices. Interventions to improve compliance of the hospitals are immediately required to minimize the risks of person-to-person or environmental transmission of pathogens through inadequately reprocessed medical devices.

Background: Acute appendicitis is the most common general surgical disease, worldwide. The exact etiology is still in conjecture. However, the inadequate fiber in diet, smoking, mechanical obstruction in appendiceal lumen, has been attributed as factors for appendicitis. Appendicitis presents throughout months of the year, however, incidence increases in particular months. The objective of this study is to observe the appendicitis incidence variation with months of the year in high altitude region of Nepal. Methods: The cross-sectional retrospective study was conducted in the Karnali Academy of Health Sciences, Jumla situated at the altitude above 2500 m from sea level. The clinical data were retrieved from the hospital record book in the Operation Theater that included age, gender, ethnicity, month of the appendectomy executed, pre-operative clinical presentation, and operative findings. The period of study was from July 2014 to March 2020. The data were entered in Microsoft Excel software and descriptive analysis was done to get mean, median percentage, standard deviation by SPSS 16. Results: A total of 119 appendectomies performed during 5 years period, from 2014 to 2020, in the surgery department of Karnali Academy of Health Sciences were recorded. The mean age of appendectomy was 27 years. There were 53% female (n=64) and 46% male (n=55) patients. The months in which the highest appendectomy executed were July/August/September and February with 16% (n=19), 13.4% (n=16), (n=15) 12.6% and 13.4% (n=16) respectively. The lowest incidence was 1.7% in the month of April. Conclusion: The incidence of appendicitis is high in the months from July to September with the lowest incidence is in the months of April and May. This information could be useful to decrease the disease-associated morbidity and mortality as well as it can be useful for hospital administration for enrolling the needed health-workers in those particular time periods.

Background Anemia though is a major risk factor for unfavorable pregnancy outcomes; no previous studies have yet described the hemoglobin (Hb) concentrations and anemia prevalence among pregnant women of remote mid western highlands of Nepal where the aggravating factors that increase the risk of anemia are very common. In addition, the physiological adaptive Hb rise to altitude was considered in the study while evaluating anemia. Thus, our primary objectives were to study the hemoglobin levels and prevalence of anemia among pregnant women of Jumla and its adjoining districts, and to assess the potential associations of hemoglobin and anemia with women’s characteristics. Methods The study was conducted in 319 singleton term non-smoker pregnant women who visited to the teaching hospital for delivery. Their blood samples were tested for Hb and related sociodemographic information was collected. One-way analysis of variance (ANOVA) and independent t-test were used to compare the mean Hb levels. Multiple linear regression model and multiple logistic regression model were used to assess the association of Hb level and anemia with pregnant women’s characteristics. The prevalence of anemia was calculated based on the altitude and pregnancy-adjusted Hb cut off value for anemia [{11+ adjustment factor (1.3)} gm./dl]. Results The overall mean hemoglobin concentration was (13.497 ± 1.64) gm/dl, ranging from 8 to 19.20 g/dl. The pregnant women Hb level showed significant association with their age (Coeff = 0.059; 95% CI: 0.011, 0.106; p = 0.015) and parity (Coeff = − 0.21; 95% CI: − 0.382, − 0.038; p = 0.017). The overall prevalence of anemia in the study population was 17.9% (57/319), which varied with age, parity and ethnicity. The disadvantaged Janajatis were more likely (OR = 4.615, 95% CI: 1.48, 14.35, p = 0.008) to have anemia compared to upper cast group. Conclusion The mean Hb concentration was high and prevalence rate of anemia was low among pregnant women in karnali zone compared to average Nepali pregnant women. Women’s age and parity were significant predictors of Hb level. Ethnicity, however, was associated with the occurrence of anemia.

Neuroblastoma is the most common cancer in young children accounting for over 15% of deaths in children due to cancer. Identification of the class of neuroblastoma is dependent on histopathological classification performed by pathologists which are considered the gold standard. However, due to the heterogeneous nature of neuroblast tumours, the human eye can miss critical visual features in histopathology. Hence, the use of computer-based models can assist pathologists in classification through mathematical analysis. There is no publicly available dataset containing neuroblastoma histopathological images. So, this study uses dataset gathered from The Tumour Bank at Kids Research at The Children’s Hospital at Westmead, which has been used in previous research. Previous work on this dataset has shown maximum accuracy of 84%. One main issue that previous research fails to address is the class imbalance problem that exists in the dataset as one class represents over 50% of the samples. This study explores a range of feature extraction and data undersampling and over-sampling techniques to improve classification accuracy. Using these methods, this study was able to achieve accuracy of over 90% in the dataset. Moreover, significant improvements observed in this study were in the minority classes where previous work failed to achieve high level of classification accuracy. In doing so, this study shows importance of effective management of available data for any application of machine learning.

Aims: To study the maternal and perinatal outcome of pregnancies complicated with obstetric cholestasis with active management.Methods: This is a cross- sectional, descriptive study done at the department of obstetrics and gynecological of KMCTH for 24 months. All the cases of obstetric cholestasis that were managed by active management were enrolled as cases. Their demographic details, maternal and perinatal outcome were noted. Data was analyzed and presented as mean, percentage and frequency and presented as tables and figures. Results: Total 84 cases of obstetric cholestasis were managed by active management during the study period. The mean age of the women were 26.59 years (21-34 years), the mean gestational age at diagnosis was 32.53 weeks (18 - 38 weeks). Diabetes mellitus was present in 17.85% and15.47% % had hypertensive disorder of pregnancy.All the cases had complaint of pruritus and 89.25% of the case had itching over abdomen, 73.78% of the women had itching over palms and soles. The itching was severe enough to cause sleep disturbance in over 65% of the cases. Meconium staining of liquor was present in 17.85% of the cases; cesarean section rate was 60.69%. There were 3 cases (3.57%) of postpartum hemorrhage but none required blood transfusion. There were no cases of still birth or neonatal death. Over 10% of the neonate had Apgar score less than 7 at 5 minute and approximately one fourth of the newborn required NICU care.Conclusions: Adverse pregnancy outcome associated with obstetric cholestasis can be minimized with active management of the cases.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is parenchymal lung disease with systemic effects and hemodynamic alteration more so in pulmonary circulation. In COPD, right ventricular (RV) after load increases due to structural and mechanical changes in the pulmonary vascular bed leading to increase in pulmonary arterial pressure which also leads to alteration in structure and function of RV. In COPD, congestive cardiac failure and ventricular dysfunction may coexist and demands proper assessment and management of dual condition.Objectives: This study was aimed to study the effect of COPD in cardiac anatomical and functional parameters in COPD patients in Shree Birendra Hospital.Methodology: This study was a retrospective review of hospital data on echocardiographic findings in 86 COPD patients visiting the outpatient department (OPD) in six months from June 2016 to December 2016. Available data was entered, edited and analyzed using Statistical package for social sciences (SPSS) version 22.Results: Among 86 cases studied, 43% had dilated RA and 41% with dilated RV, 24% with dilated LA and dilated LV in 22%. Normal pulmonary artery pressure was present in 41 (48%) cases and 45(52 %) individuals were having PAH. Among valvular disorder tricuspid regurgitation was commonest (50%). Left ventricle abnormalities like dilated left ventricles, LVDD, concentric ventricular hypertrophy, LVSD were also presented in significant number of COPD patients counting 22%, 37%, 7%, 30% respectively. Among the various factors analyzed in echocardiogram; there was significant association between the PAH with right atrial dilatation, right ventricular dilatation, left atrial dilatation, LVDD, tricuspid regurgitation (p

Introduction: Doppler study is a good screening test for initial screening of renal artery stenosis however controversies exists regarding its use as screening study. This study aims to evaluate the Doppler study findings in patients with atypical hypertension.Methods: The study was a retrospective hospital record based study conducted in Metro Radiological and Imaging Center, Kathmandu. Reports of Doppler studies performed for atypical hypertension were reviewed for the duration of 6 years (2009 to 2014). Doppler studies were performed by two experienced radiologist with more than 5 and 20 years of experience. Patients with transplant kidney, patient with accessory renal artery and patient with known chronic kidney disease were excluded from the study. Data was entered in predesigned proforma and analysis was done with SPSS 21.0.Results: A total of 1001 Doppler studies done during the study period revealed abnormalities in 227 patients. The most common abnormality was elevation of main renal artery and lobar renal artery resistance index, alone which was seen in 187(82.4%) patients. Renal artery stenosis was noted in 30(13.2%) cases with 10 patients each having renal artery stenosis involving left and right renal arteries respectively and 10 patients had bilateral renal artery stenosis.Conclusion: Non-specific raised resistance index indicating renal impairment is the most common abnormality in atypical hypertensives. The presence of renal artery stenosis in atypical hypertensive is around 3%.

Introduction: Ultrasound (USG) can be a good screening tool to identify high-risk nodule requiring fine-needle aspiration cytology (FNAC). The study aimed to assess the association of USG characteristic of thyroid nodule with malignancy. Methods: A cross-sectional study was performed from August 2011 to July 2012 at Tribhuvan University Teaching Hospital. Patients referred for USG of the neck with thyroid nodule more than 10 mm were offered FNAC and included in the study after taking informed consent. USG characteristics were compared with histopathologic diagnosis of benign or malignant nodule. Results: USG characteristics significantly (P < 0.05) associated with malignancy were as follows: size of thyroid nodule more than 30 mm, ill-defined margin, solid echotexture, hypoechoic lesion, microcalcification, and any form of increased vascularity. High sensitivity was seen in microcalcification, hypoechoic echogenicity, and ill-defined margin and high specificity was seen in ill-defined margin and solid echotexture. Relatively high sensitivity and specificity was found in ill-defined margin. Conclusions: Texture, size, margin, echogenicity, and vascularity are important factors for discriminating benign from malignant nodule. Hypoechogenicity, vascularity of any type, ill-defined margin, and microcalcification were independent predictors of malignancy. None of the characteristics were sensitive and specific to be used independently as screening tool to identify high risk of malignancy.

Background/aim Several risk scores can stratify patients with acute heart failure (AHF) at the Emergency Department (ED). Registration of vital signs, such as blood pressure (BP), heart rate (HR) and respiratory rate (RR) upon admission is mandatory. Nevertheless, measurement of RR remains neglected worldwide. Patients and methods The predictive value of RR in classifying patients with AHF was investigated by processing several vital signs recorded in the ED. Results HR and RR individually did not discriminate patients according to hospitalization length, Intensive Care Unit (ICU) admittance, mechanical respiratory support or death. The derivative indices, HR:RR and Respiratory Efficacy Index (REFI) (=RR×100/SatO2), differentiated study patients regarding hospitalization length. Receiver operating characteristic curves predicting mortality and ICU admission for REFI and HR:RR revealed high accuracy, sensitivity and specificity for cut-off values of REFI >27 and HR:RR ≥4. Conclusion The RR and its derivative indices are easily accessible vital signs monitored at the ED which merit 'revitalization'.

Oral lichen planus (OLP) is a chronic immune-mediated, inflammatory, and psychosomatic condition that frequently affects the oral mucosa in a typical bilateral pattern, often noticed in middle-aged females.1 It involves the buccal, lingual, and/or gingival mucosa and is also an oral potentially malignant disorder (OPMD). OLP is associated with etiological factors ranging from viruses like hepatitis C, systemic factors like thyroid disorders,2 local factors like dental plaque, calculus and cuspal trauma, to deep rooted, often underestimated, psychological triggers. OLP is routinely encountered in oral medicine clinics and is sometimes accompanied by the simultaneous involvement of skin, nails, genitals, and/or mucous membranes. Although OLP is multifactorial in origin, a large share of these presentations can be attributed chiefly to psychological factors like stress, anxiety, and depression. OLP is even more striking as its genesis, progression, and exacerbation closely mirror the dynamics of emotional disturbance.

Introduction. Neuropathies in type 2 diabetes mellitus (T2DM) patients are well known. However, electrophysiological changes in their peripheral nerves, particularly before overt peripheral neuropathy have received much less attention. Hence, we aimed to study the electrophysiological status of bilateral sural nerves in T2DM patients who do not show symptoms and signs of peripheral neuropathy. Material and methods. We selected 35 T2DM male patients and 35 age- and sex-matched control subjects without any clinical evidence of peripheral neuropathy and infectious, systemic, metabolic, and neuropsychiatric illnesses after informed written consent. Nerve conduction study (NCS) of bilateral sural nerves of both the groups was done at the lab temperature of 26 ± 2oC by antidromic method of stimulation using standard methods. Their latency, conduction velocity, amplitude, and duration of bilateral sural sensory nerve action potentials (SNAPs) were measured and compared. Results. T2DM patients had reduced amplitudes of bilateral sural SNAPs compared to control subjects [left (12.46 ± 3.77) μV vs. (16.42 ± 4.58) μV, p = 0.000; right (11.96 ± 4.45) μV vs . (16.62 ± 6.20) μV, p = 0.001] though they were above the normal cut-off value of ≥ 4 μV. T2DM patients showed prolonged durations of bilateral sural SNAPs compared to the control subjects [left (1.99 ± 0.38) ms vs . (1.67 ± 0.27) ms, p = 0.000; right (1.92 ± 0.47) ms vs . (1.55 ± 0.33) ms, p = 0.000]. Conclusion. Reduced amplitudes and prolonged durations of bilateral sural SNAPs are the electrophysiological alterations, suggestive of peripheral neuropathy, in T2DM patients that appear before they show clinical symptoms and signs of peripheral neuropathy.

Background: Accurate estimation of fetal weight is of paramount importance in the management of labour and delivery.Methods: This was a cross sectional study conducted over a period of 6 months in a tertiary care teaching hospital. All singleton term mothers with cephalic presentation and intact membranes with ultrasound examination done within a week were included in the study. IUFD, multiple gestation, malpresentation, diagnosed oligohydramnios or polyhydramnios, pelvic and or abdominal masses, and current weight more than 80 Kgs were excluded from the study. Expected fetal weight was estimated by clinical method (Johnson’s formula), which was compared with Ultrasound weight estimation (Hadlock method) and actual birth weight.Results: The estimated mean birth weight by clinical method was 3492.75±393.16g, by Ultrasound was 3230.02±407.22g and actual mean birth weight was 3236.32±472.87g. The estimated birth weight by ultrasonographic method showed slightly stronger positive correlation (r=0.54; p

Utsav Joshi, Roshan Subedi, Prakash Poudel, Prajwol Ram Ghimire, Sagar Panta, Mahesh Raj SigdelDepartment of Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj, Kathmandu, NepalBackground: Assessment of quality of life (QOL) of patients with end-stage renal disease has become increasingly important, both in order to evaluate the influence of the disease on patients and the type of renal replacement therapy they require. Therefore, in this study, we aimed to assess QOL in patients undergoing hemodialysis and evaluated the effects of various sociodemographic factors affecting QOL of such patients in Nepal. Methods: A cross-sectional study was conducted among 150 patients with chronic kidney ­disease undergoing hemodialysis at two major centers in Nepal. Demographic data including age,sex, ethnicity, educational status, marital status, employment, income, duration of illness, and duration on hemodialysis were collected. QOL was assessed using the World Health Organization Quality of life (WHOQOL-BREF) questionnaire. Four domains (­physical, psychological, social, and environmental) and two items (overall perception of QOL and health) of the WHOQOL‑BREF were the primary end points of this study. Bivariate relationship between sociodemographic factors and QOL scores were analyzed using independent samples t-test and one-way analysis of variance. Multiple linear regression analysis was performed to determine independent predictors of QOL. Results: Following QOL scores were recorded: environmental domain (53.17±15.59), psychological domain (51.23±18.61), social domain (49.86±21.64), and physical domain (45.93±16.90). Older age was associated with a better QOL score in the social domain (p=0.005), and employed patients scored better in the environmental domain (p=0.019). Unemployed patients and those of the Terai/Madhesi ethnic group had significantly low scores in overall perception of health (p