Microvessel density in Prostatic Lesions : Relevance to prognosis

Background:  Angiogenesis is required for growth and metastasis of tumor tissue. Quantization of angiogenesis by calculating the microvessel density can be done in histopathology specimens with the help of immunochemistry. In this study we used anti CD 34 antibody to highlight the endothelial cells and thus calculate microvessel density. Most studies have shown a positive correlation of microvessel density with increasing pathological grade and have also shown microvessel density as an independent predictor of cancer progression and survival. The present study was to find out the microvessel density in benign and malignant lesions of prostate and also to correlate the vascularity with increasing grade of cancer.Materials and methods:  Sixty five prostatic biopsies were evaluated for microvessel density using CD34 monoclonal antibody. Comparison was done between BPH and Carcinoma Prostate. MVD was correlated with Gleason’s score, weight of specimen and increasing age of patient. Effect of prostatitis on Microvessel density was studied.Results: Microvessel density was significantly higher in carcinoma prostate than in Benign Prostatic Hyperplasia. There was positive correlation of Microvessel density with increasing Gleason’s score. Microvessel was significantly increased in patients having symptoms for more than a year and also with biopsies revealing prostatitis. However, there was no significant correlation between Microvessel density and weight of specimen or increasing age.Conclusion: Since Microvessel density was found to be significantly higher in Prostatic Carcinoma and it showed positive correlation with Gleason’s score it can be added as one of the indicators for predicting the disease outcome. 

Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center

INTRODUCTION

Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal.

METHODS

This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection.

RESULTS

A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed.

CONCLUSION

There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect.

Survey on Street Dog Population in Pokhara Valley of Nepal

A survey was carried out to determine the population of street dogs and people’s opinion about their persistence in Pokhara Valley, Nepal. Information of street dog population was necessary to construct a future animal birth control (ABC) plans. For this, mark-resight survey method was used. Further, local residents were interviewed to know their opinion about the persistence of street dog population in that area. Among total 1767 dogs, 1072 (60.66%) were male, 641 (36.28%) were female and 54 (3.06%) were puppies. About 367 (57.25%) of the female street dogs were already spayed. A total of 371 local residents were interviewed to know their opinion about the causes of persistent street dogs in Pokhara Valley. Numerous reasons were put forward including unmanaged slaughter house (24.5%), abandoned due to disease (15.4%) and abandoned due to unmanageable estrus behavior (10.2%). Future ABC programs may need to consider these factors responsible for maintaining persistent street dog population, to enable control over street dog population in an efficient and sustainable manner.DOI: http://dx.doi.org/10.3329/bjvm.v13i1.23722Bangl. J. Vet. Med. (2015). 13 (1): 65-70

Perception of Palliative Care among Medical Students in a Teaching Hospital

INTRODUCTION

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. Palliative care must be a part of every medical personnel's practice. But still medical education curriculums have not included palliative care in its syllabus, sufficiently due to which most of the health professional are not aware about this specialty. The purpose of this study is to find out the perception of the medical students in palliative care in a teaching hospital.

METHODS

A descriptive study was done among 270 undergraduate medical students studying in Institute of Medicine using a self structured pretested questionnaire. Data was entered in Microsoft Excel and analyzed by using SPSS 21.

RESULTS

Of the total 270 undergraduate medical students only 152 has heard the word "palliative care". Only 84 students know, palliative care can be provided early in the life threatening illness. Total 80 students know it doesn't intend to postpone and hasten death. Though only 49 students didn't know PC is not included in our curriculum, 227 are interested to learn about it if given any opportunity.

CONCLUSIONS

The perception of palliative care medicine is low in first couple of year of medical study. It is increased in clinically exposed students but is surprisingly more in fourth year than final year undergraduate medical students. However, it should be included in undergraduate medical study.

Prevalence of gastrointestinal zoonotic helminths in dogs of Kathmandu, Nepal

INTRODUCTION: Considering the close association of dog and human beings and increasing trend of pet rearing, it is important to know the status of zoonotic helminths of pet and stray dogs and awareness of owners about this in Kathmandu, Nepal. This study was carried out to determine the prevalence of gastrointestinal zoonotic helminth parasites in dogs and to assess the awareness about canine helminth zoonoses in pet owners. MATERIALS AND METHODS: This cross-sectional study was conducted from September- 2012 to December- 2013. A total of 210 fecal samples (105 each from pet and stray dogs) were collected perrectally and examined by using Formalin-Ether Concentration method. Questionnaire survey was carried out among dog owners. RESULTS: The prevalence of gastrointestinal helminths was 46.7% (98/210). Out of 98 positive samples five different parasite species observed were Ancylostoma spp. 52.0% (51/98), Toxocara canis 41.8% (41/98), Taenia/Echinococcus spp. 15/98 (15.3%), Dipylidium caninum, 9.2% (9/98), and Trichuris vulpis, 5.1% (5/98). Prevalence was higher in stray dogs (56.2% vs. 37.1%) (p<0.05); in females (51.6% vs. 39.8%) (p>0.05); in younger dogs up to 2 years of age (56.3% vs. 35.7%) (p<0.05); in non-dewormed dogs (72.7% vs. 33.0%) (p<0.05) and in dogs sharing rooms with owner (46.1% vs. 13.8%) (p<0.05). Only 11.4% of the owners surveyed were aware about canine helminth zoonoses. CONCLUSIONS: Due to potential risk of zoonotic helminths to human beings and low level of zoonoses awareness in pet owners, there is need of generating awareness to pet owners regarding periodic anthelminthic treatment of pet dogs and other prevention and control measures. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8211 Int J Infect Microbiol 2013;2(3):91-94

Seroprevalence of brucellosis in different animal species of Kailali district, Nepal

Introduction: Brucellosis is a contagious disease of livestock with significant economic impact. It is also a zoonotic disease, highly infectious for humans causing a disease called undulant fever or Malta fever. This study was carried out to determine the sero-status of Brucella spp. infection in cattle (cows), buffalo and goat in Kailali district of Far Western Region of Nepal. Materials and Methods: This cross-sectional study was conducted in Kailali district of Nepal during a period from September, 2012 to January, 2013. A total of 233 animal blood samples (50 Cattle, 67 Buffalo and 116 Goat) were collected and tested for Brucella antibody by plate agglutination test (PAT). Results: The seroprevalence of Brucellosis was 12% (28/233). Thirty two percentage (16/50) of cattle, 13.4% (9/67) of buffaloes, and 2.6% (3/113) goats were sero positive (p<0.05). Seroprevalence was higher in females (14.6% vs. 10.6%) (P>0.05) and was higher in younger cattles and older buffalo and goats (p>0.05). Conclusions: This study showed that brucellosis exists as a potential threat in animals of Kailali district. This could be a potential source of infection to humans. Considering the high economic losses it can impart on livestock sector and the possible human health abnormalities, timely facilitation of awareness generation program and adoption of proper prevention and control strategies are recommended. DOI: http://doi.dx.org/10.3126/ijim.v2i1.8005 Int J Infect Microbiol 2013;2(1):22-25

Transcriptomic analysis identifies candidate genes and functional networks controlling the response of porcine peripheral blood mononuclear cells to mitogenic stimulation

It is difficult to obtain phenotypic data on disease susceptibility directly from swine in an industry setting. The magnitude of the proliferative response of peripheral blood mononuclear cells (PBMC) to the T cell mitogen concanavalin A (Con A) has long been used as an indirect measure of the responsiveness of the immune system to antigenic stimulation. This trait is known to exhibit moderate heritability in swine, but little is known about the identity of the genes that control the response. In this study, we carried out a time-course microarray experiment to measure gene expression at 3 different stages (3, 20, and 68 h) poststimulation of PBMC with Con A. A total of 46, 452, and 418 differentially expressed (DifEx) genes were identified at each time point, respectively. Expression changes for a subset of these genes were subsequently confirmed by real-time PCR. Functional annotation analyses of the microarray results successfully identified sets of genes involved in processes associated with multiple aspects of cell division, such as DNA and protein synthesis, and control of mitosis. However, the discovery of genes that controlled the response of PBMC to mitogen was limited with this approach, because the drastic changes in the transcriptional program necessitated by cells undergoing division masked changes in smaller immune response gene sets. Pathway and network analyses that focused on immune cells proved to be a more effective strategy for the identification of genes that coordinate aspects of the mitogenic response that are specific to PBMC. The cytokine gene IL15 was shown to be central to the highest scoring network at 20 h and affect the expression of 16 other DifEx genes, including some genes known to regulate T cell activation, such as IL7R, JUN, TNFRSF9, and ZAP70. The IL15 gene maps to a previously identified QTL interval for immune responsiveness to Con A on SSC 8, which also contains the related IL2 gene. At 68 h, a distinct downregulation of major histocompatibility complex class II antigen presentation genes was observed. Overall, the gene expression profile of the Con A-stimulated porcine PBMC points to a Th(1) bias in immune activation. Further work is required to determine whether polymorphisms linked to genes identified in this study affect this immune response trait in pig populations and whether the trait itself correlates with decreased susceptibility to intracellular pathogens in swine.

Status of tuberculosis in bovine animals raised by tuberculosis infected patients in Western Chitwan, Nepal

INTRODUCTION: Bovine tuberculosis (bTB) is an important public health concern worldwide. This study was conducted to determine the status of bTB in animals raised by tuberculosis patients in Western Chitwan, Nepal. MATERIALS AND METHODS: This cross-sectional study was conducted from August, 2011 to January, 2012. A total of 100 bovines (cattle and buffalo) raised in 60 farms of tuberculosis patients were tested with single intradermal tuberculin test considering various animal factors. Well designed questionnaire survey was taken with 70 tuberculosis patients of same 60 families focusing knowledge, awareness and various practices related to bovine tuberculosis. RESULTS: Overall 15% bovines were positive for tuberculosis (13.6% cattle and 15.4% buffaloes). Age of animal was significantly associated with tuberculosis (p<0.05) while sex and species were not. 24% tuberculosis patients had raw milk consuming habit while very few of them (9%) were aware of zoonotic aspect of bovine tuberculosis. CONCLUSIONS: There is high chance of tuberculosis transmission form animals to humans or vice versa. Further detailed study is needed in large scale with stronger intersectoral collaboration of medical and veterinary health sector to determine the scale of problem and find out prevention and control strategies against zoonotic tuberculosis. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7407 Int J Infect Microbiol 2012;1(1):49-53

Cubitus varus in adults correction with lateral closing wedge osteotomy and fixation with posterior plating

To share the result of lateral closing wedge osteotomy and fixation with posterior reconstruction plate in correction of cubitus varus in adults. It is a retrospective case analysis of 8 cases of cubitus varus in adult treated with lateral closing wedge osteotomy through posterior triceps retracting approach. Internal fixation was done with two posterior reconstruction plates. All cases were from 15 to 29 years of age (mean 22.3 ) with 3 female and 5 male. All had cubitus varus ranging from 15- 28 deg (mean 20.16 deg) due to childhood malunited supracondylar fracture of humerus. Indication for operation was cosmetic reason only. Follow up duration was 4-22 months (mean 12.5 months). All the osteotomy united clinically in mean duration of 9 weeks ( range 8-12 weeks) with mean carrying angle 8.33 degree in postoperative phase. There was no loss of motion, no loss of fixation, no surgical site infection, nonunion or neurovascular deficit. Lateral closing wedge corrective osteotomy and fixation with posterior reconstruction plate is easy technique with satisfactory result in correction of cubitus varus in adults. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 49-53 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6839

Extended spectrum beta-lactamase producing multidrug resistant urinary isolates from children visiting Kathmandu Model Hospital

A study was conducted to analyze the status of the multidrug resistant (MDR) isolates producing Extended Spectrum of beta-lactamase (ESBL) among the uropathogens infecting children less than 15 years from November 2010 to April 2011 in the Bacteriology laboratory, Kathmandu Model Hospital. Urine samples received in the laboratory were processed for routine culture. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute (CLSI) recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be multidrug resistant was resistance to two or more drugs of different structural classes. Isolates were confirmed for ESBL-production by performing the Inhibitor Potentiated Disk Diffusion (IPDD) Test/ Combined Disk Assay for ESBL confirmation. Out of 252 urine samples received in the laboratory, 59(23.41%) showed significant growth of which 54.23% (32/59) were MDR isolates. Additionally, 25 isolates (21 Escherichia coli and 3 Citrobacter freundii and single Enterobacter aerogenes) among them were ESBL producers. Among the first line drugs used against gram negative isolates, Nitrofurantoin was drug of choice; meanwhile among the second line drugs Cefoperazone/Sulbactum was drug of choice, whereas, Cephotaxime, Ciprofloxacin, Norfloxacin and Gentamicin were the drug of choice for Gram positive isolates. Significant association was found between ESBL production and spectrum of drug resistance (p < 0.05).

The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions

BACKGROUND

Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions.

OBJECTIVES

To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy.

METHODS

Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured.

RESULTS

We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment.

CONCLUSIONS

This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.

Knowledge and practices of pig farmers regarding Japanese encephalitis in Kathmandu, Nepal

Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population.