C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour

INTRODUCTION

Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour.

METHODS

Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program.

RESULTS

Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (P=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (P=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (P=0.344) or periodontitis (P=0.541).

CONCLUSIONS

We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.

Clinico-bacterial correlation of bacterial index in Hansen’s disease

Background: Leprosy has a broad spectrum of clinical manifestations. Clinical information along with Bacterial evidence is necessary to achieve accurate diagnosis. The present study was carried out to nd out clinical and bacterial correlation in various presentations according to Ridley Jopling classi cation of Hansen’s Disease. Materials and Methods: It was a hospital based cross-sectional comparative study of 72 leprosy patients over a period of 1 year and it’s clinico-Bacterial correlation was done with the help of Slit Skin Smear and clinical classi cation. Results: This study included 72 leprosy patients at various stages according to Ridley Jopling classi cation. Maximum cases belonged to Borderline Tuberculoid leprosy 28(38.88%) followed by Tuberculoid leprosy 15(20.83%). Slit Skin Smear showed 12(42.85%) of Borderline Tuberculoid and 3(20%) of Tuberculoid cases had disparity and didn’t match corresponding clinical subtype. Conclusion: Clinical features along with Bacterial index is useful in making accurate diagnosis so that appropriate treatment could be started and hence deformity and disability could be prevented. 

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu

INTRODUCTION

Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions.

METHODS

The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification.

RESULTS

Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01).

CONCLUSION

Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Problems Faced by Antiretroviral (ARV) Drug Users in Kathmandu

BACKGROUND

Antiretroviral Therapy (ART) offers an opportunity to improve the prognosis and quality of life of People Living with HIV/AIDS (PLHIV). However, inability to achieve adherence even after drug introduction in Nepal is a matter of concern. Some efforts are to be applied in order to lend a hand to identify and minimize these problems. This study aims to assess the problems faced by antiretroviral drug users attending ART centers of Kathmandu.

METHODS

A descriptive study was carried out in Sukraraj Tropical and Infectious Disease Control Hospital, Teku and Bir Hospital in 2071. Non-probability convenience sampling technique was used to recruit 82 respondents. Semi-structured questionnaire was used for conducting the interview.

RESULTS

The overall problems faced by antiretroviral drug users include side-effects of drugs (65.9%), long waiting time (24.4%), unsatisfactory service (4.9%), geographical (68.3%) and financial barrier (25.6%), etc. Few were turned off from social/religious (70.7%) and recreational activities (51.2%). Absence of disclosure (14.6%), lack of spousal support (10.9%), humiliation (34.1%), etc. were also present. Stigmatization materializes as having to lose job (8.5%), feeling of ashamed (30.5%), feeling of isolation (34.1%), etc. Adherence towards medicine was found to be 86.5%.

CONCLUSIONS

ART is a long term process and to achieve it rationally, a user has to cope with lots of problems, associated not only with physical health but also with outcomes of psychosocial issue. Further worsening of the situation is due to financial constraints. Policy making, planning and service delivery seek improvement in various steps. Awareness is another demand to end psychosocial discrimination.

Rational for Conducting PTSD Research and Challenges of Recruiting and Training Volunteers to Screen and Treat PTSD among the Nepal 2015 Earthquake Survivors

Post-traumatic Stress Disorder (PTSD) is common psychiatric morbidity among earthquake survivors, and if untreated people suffer from it for years. Government of Nepal and NGOs provided various short-term mental health services to the victims of the 2015 earthquake in Nepal, but there was no plan or provision for long-term mental health problems. The prevalence of PTSD following natural disasters depends on various local factors requiring understanding and further investigation before identifying affordable evidence based interventions. This paper discusses the need for PTSD research among the survivors of the 2015 earthquake in Nepal, and describes the challenges and difficulties of recruiting and training PTSD volunteers.

Isolation and molecular characterization of Salmonella spp. from chevon and chicken meat collected from different districts of Chhattisgarh, India

AIM

The aim was to assess the prevalence of Salmonella in raw chevon and chicken meat sold in the retail meat shops situated in and around Durg, Rajnandgaon, Dhamtari, Raipur, and Bilaspur districts of Chhattisgarh. Studies were also conducted to find out the antibiotic resistance in Salmonella isolates.

MATERIALS AND METHODS

A total of 400 samples comprising of 200 chevon meat and 200 chicken meat samples were processed for isolation of Salmonella and all isolates were further confirmed on the basis of cultural and biochemical characters and by targeting invA gene of Salmonella. All Salmonella isolates were also examined for their antimicrobial drug susceptibility/resistance pattern against commonly used antibiotics.

RESULTS

Out of 400 samples, the prevalence of Salmonella in chevon and chicken meat was found 9% and 7% respectively, with an overall prevalence of 8%. Polymerase chain reaction targeting invA gene of Salmonella showed positive result with 31 isolates. All 32 Salmonella isolates were found to be highly sensitive to ciprofloxacin while 96.87%, 96.87% and 93.75% were sensitive to gentamicin, imipenem, and ceftazidime, respectively. 93.75% and 59.37% isolates were resistant to erythromycin and oxytetracycline, respectively. Out of 32, 14 isolates had multiple antibiotic resistance index equal to or more than 0.2.

CONCLUSION

Salmonella in chevon and chicken meat samples is prevailing in the areas of sampling due to poor hygienic conditions and also demonstrated the varied spectrum of antimicrobial resistance, including several multiple drug resistance phenotypes. Therefore, the present study emphasizes the need for continued surveillance of zoonotic foodborne pathogens including antimicrobial-resistant variants throughout the food production chain.

A unique presentation: rectus sternalis

Rectus Sternalis is a rare flat slip of muscle present parasternally in the thoracic wall. During the regular dissection of pectoral region, three slips of Sternalis muscle were observed bilaterally in an adult male cadaver. On the right side there was a single slip (RS 1) while on the left side two slips (RS2 and RS3) were present. All three slips were present anterior to the Pectoralis Major muscle of respective side and each muscle had fleshy origin and tendinous insertions. RS1 had two heads arising from the aponeurosis of External Oblique and Rectus Abdominis. RS2 had a single origin from aponeurosis of Rectus Abdominis and RS3 took its origin from the aponeurosis of Pectoralis Major muscle. Indistinct tendinous intersections were noted in both RS1 and RS3 slips proximal to fusion of both Sternalis muscle (RS1 and RS3) with each other. Out of three slips, right Rectus Sternalis was largest with breadth 3.8cm near its origin while the second slip of Rectus Sternalis on the left was longest with length of 12.5cm. RS2 was smallest and shortest among the three slips. The RS1 even presented a flattened tendon running upwards which fused with the membranous origin of right Sternocleidomastoid muscle. The Rectus Sternalis when present arises from hypomeres as longitudinal group of muscles which usually disappears in the thoracic region. The knowledge about Sternalis muscle and its variations is important for anatomists and clinicians (radiologists and surgeons) to avoid any confusion and misdiagnosis as well as anthropologists.

Clinico-Pathological Study of Lung Carcinoma

Background: Lung cancer is currently the most frequently diagnosed cancer in the world and the number one cause of cancer mortality worldwide.Materials and Methods: A descriptive study was conducted in 55 diagnosed lung carcinoma cases being treated in a Kathmandu based hospital over a period of 18 months from 22nd Oct. 2012 to 21st April 2014.Results: Out of total 55 lung carcinoma cases, 33 patients were male and 22 were female with Male: Female ratio of 1.5:1. The most frequent age group was 71-80 years. Lung cancer was more common among smokers (52.73 % of cases). Out of 47.27% non smokers, 76.92% were female. Squamous cell carcinoma was found to be the most common cancer type, comprising 63.64% of cases followed by adenocarcinoma (29.09% of cases) and small cell carcinoma (7.27% of cases). Among various diagnostic methods, CT guided Fine needle aspiration cytology (FNAC) and Pleural fluid cytology was found to be the best methods.Conclusion: Smoking showed a positive correlation among carcinoma of lung patients. Squamous cell carcinoma and adenocarcinoma were the most common tumors encountered among the smokers and non-smokers respectively. CT guided Fine needle aspiration cytology (FNAC) and Pleural fluid cytology yields the most diagnostic materials.DOI:  http://dx.doi.org/3126/jpn.v4i8.11496   Journal of Pathology of Nepal; Vol4, No.8 (2014) 623-625Background: Lung cancer is currently the most frequently diagnosed cancer in the world and the number one cause of cancer mortality worldwide.Materials and Methods: A descriptive study was conducted in 55 diagnosed lung carcinoma cases being treated in a Kathmandu based hospital over a period of 18 months from 22nd Oct. 2012 to 21st April 2014.Results: Out of total 55 lung carcinoma cases, 33 patients were male and 22 were female with Male: Female ratio of 1.5:1. The most frequent age group was 71-80 years. Lung cancer was more common among smokers (52.73 % of cases). Out of 47.27% non smokers, 76.92% were female. Squamous cell carcinoma was found to be the most common cancer type, comprising 63.64% of cases followed by adenocarcinoma (29.09% of cases) and small cell carcinoma (7.27% of cases). Among various diagnostic methods, CT guided Fine needle aspiration cytology (FNAC) and Pleural fluid cytology was found to be the best methods.Conclusion: Smoking showed a positive correlation among carcinoma of lung patients. Squamous cell carcinoma and adenocarcinoma were the most common tumors encountered among the smokers and non-smokers respectively. CT guided Fine needle aspiration cytology (FNAC) and Pleural fluid cytology yields the most diagnostic materials.DOI: 3126/jpn.v4i8.11496   Journal of Pathology of Nepal; Vol4, No8(2014)

Optical studies of Sm³⁺ ions doped zinc alumino bismuth borate glasses

Zinc Alumino Bismuth Borate (ZnAlBiB) glasses doped with different concentrations of samarium (Sm(3+)) ions were prepared by using melt quenching technique and characterized for their lasing potentialities in visible region by using the techniques such as optical absorption, emission and emission decay measurements. Radiative properties for various fluorescent levels of Sm(3+) ions were estimated from absorption spectral information using Judd-Ofelt (JO) analysis. The emission spectra and con-focal photoluminescence images obtained by 410 nm laser excitation demonstrates very distinct and intense orange-red emission for all the doped glasses. The suitable concentration of Sm(3+) ions in these glasses to act as an efficient lasing material has been discussed by measuring the emission cross-section and branching ratios for the emission transitions. The quantum efficiencies were also been estimated from emission decay measurements recorded for the (4)G5/2 level of Sm(3+) ions. From the measured emission cross-sections, branching ratios, strong photoluminescence features and CIE chromaticity coordinates, it was found that 1 mol% of Sm(3+) ions doped ZnAlBiB glasses are most suitable for the development of visible orange-red lasers.

Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal

Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation.

Chronic bilateral dislocation of temporomandibular joint

Dislocation of the condyle of the mandible is a common condition that may occur in an acute or chronic form. It is characterised by inability to close the mouth with or without pain. Dislocation has to be differentiated from subluxation which is a self reducible condition. Dislocation can occur in any direction with anterior dislocation being the commonest one. Various predisposing factors have been associated with dislocation like muscle fatigue and spasm, the defect in the bony surface like shallow articular eminence, and laxity of the capsular ligament. People with defect in collagen synthesis like Ehler Danlos syndrome, Marfan syndrome are said to be genetically predisposed to this condition. Various treatment modalities have been used ranging from conservative techniques to surgical methods. Acute dislocations can be reduced manually or with conservative approach and recurrent and chronic cases can be reduced by surgical intervention. Though the dislocation in our case was 4 months a simple manual reduction proved to be successful. We believe that manual reduction can be attempted as first line of treatment prior to surgical intervention.

Color Vision Defects in School Going Children

Introduction: Color Vision defect can be observed in various diseases of optic nerve and retina and also a significant number of people suffer from the inherited condition of red and green color defect.  Methods: A cross-sectional descritptive study was designed with purposive sampling of students from various schools of Kathmandu Valley. All children were subjected to color vision evaluation using Ishihara Isochromatic color plates along with other examination to rule out any other causes of color deficiency.  Results: A total of 2001 students were examined, 1050 male students and 951 females with mean age of 10.35 (±2.75) and 10.54 (±2.72) respectively. Among the total students examined, 2.1% had some form of color vision defects. Of the male population , 3.9% had color vision defects while none of the female was found with the deficiency.  Conclusions: The prelevance of color vision defect in Nepal is significant and comparable with the prelevance quoted in the studies from different countries. Keywords:color vision; congenital red green color effect; Nepal; prevalence.

Color vision defects in school going children

INTRODUCTION

Color vision defect can be observed in various diseases of optic nerve and retina and also a significant number of people suffer from the inherited condition of red and green color defect.

METHODS

A cross-sectional descriptive study was designed with purposive sampling of students from various schools of Kathmandu Valley. All children were subjected to color vision evaluation using Ishihara Isochromatic color plates along with other examination to rule out any other causes for color deficiency.

RESULTS

A total of 2001 students were examined, 1050 male students and 951 females with mean age of 10.35 (+/- 2.75) and 10.54 (+/- 2.72) respectively. Among the total students examined, 2.1% had some form of color vision defects. Of the male population, 3.9% had color vision defects while none of the female was found with the deficiency.

CONCLUSIONS

The prevalence of color vision defect in Nepal is significant and comparable with the prevalence quoted in studies from different countries.

A study of ocular morbidity of patients attending a satellite clinic in Bhaktapur, Nepal

A community based retrospective study was conducted in the satellite clinic of Nepal Medical College Teaching Hospital at Jhaukhel VDC of Bhaktapur, from March 2007 to February 2008. A total of 395 patients were examined, where males comprised of 135 patients (32.9%) and females 265 patients (67.1%). The common ocular diseases observed in this study were refractive errors 22.5%, age related cataract 17.5%, extra ocular diseases like conjunctivitis 14.9%, conjunctival degenerations 10.8%.

Safety and efficacy of misoprostol for induction of labour

BACKGROUND

Induction of labour is widely carried over the world in cases where continuation of pregnancy is hazardous to mother or fetus. Varieties of techniques are available for induction of labour. Prostaglandin is one of the most effective means for achieving cervical ripening and induction of labour. This study was carried out to see safety and effectiveness of Misoprostol for induction of labour.

METHODS

This prospective study was carried out at Kathmandu University Hospital, Dhulikhel from Jan 2008 to Aug 2009. A total of 70 patients were included in this study. All patients received 50 μg of Misoprostol in the posterior fornix with maximum dose up to 3 doses at interval of 6 hours. Bishops scoring was reviewed each time before application of Misoprostol. When favourable cervix along with good uterine contraction is noted then augmentation with Oxytocinon was done holding Misoprostol. The measures used for the analysis of effectiveness and safety of Misoprostol were change in bishop score, total dose required, need for augmentation, side effects, duration of first, second and third stages of labour, duration from induction till delivery, mode of delivery and neonatal outcome. The primary outcome measures were induction to delivery interval and caesarean section rate.

RESULTS

Out of 70 patients, 21 (30%) required augmentation. Among 70 patients, 46 (65%) underwent normal delivery, 6 (8.6%) underwent instrumental delivery and 18 (25%) patients underwent cesarean section for various indications (p=0.00). Total 31 (44%) patients delivered within 10 hours of induction, 16 (22%) within 15 hours and 4 (4.7%) took more than 18 hours. Duration of second stage of labour was also found to be shortened with use of Misoprostol for induction of labour. Duration of second stage of labour was less than 30 minutes in 42 (60%) cases and more than 30 minutes in 9 (17%) cases.

CONCLUSIONS

Misoprostol is an effective cervical ripening agent with favorable outcome and comparable with other inducing agents.

Consultation liaison psychiatry at Nepal Medical College and Teaching Hospital

The authors reviewed the all referral cases from different inpatient and outpatient department, in Nepal Medical College and Teaching Hospital. It was a descriptive study. There were 484 referred cases during the study period. Around half the referral were from department of medicine (49.8%), surgery (11.2%), Eye/ENT (10.3%). The referral rate was 1.4%, with an average three cases per day. Among the referral cases depression was diagnosed in 26.9%, anxiety in 15.5% and substance related problem in 14.5%. The consultation liaison psychiatry service is satisfactorily used. Depression, substance use problem, anxiety, deliberate self harm is the main diagnoses in liaison psychiatry.

Delirium at Nepal Medical College Teaching Hospital: reason for referral and subtypes

The important neuropsychiatric disorder delirium is the most single important disorder in onsultation liaison psychiatry. There is a dearth of study in delirium. The purpose of this study was to find out the demographic profile, reason for referral, and subtypes of delirium. Thirty two consecutive cases of delirium diagnosed by psychiatrist in consultation liaison psychiatry were enrolled in the study. This is a descriptive study and diagnoses were made based upon 'The International Classification of Disease (ICD-10)'. The majority of cases were from age 70 and above, male sex being more common and most commononest reason for referral being disturbed behavior. The hyperactive subtype of delirium was the frequent finding. Medicine and ICU followed by surgery and post operative ward were the most referring departments.

Change in refractive status of the patients undergoing phacoemulsification surgery

This study was carried out with the objective of finding refractive status of patients undergoing phacoemulsification surgery for cataract extraction. Success of cataract surgery can be quantified with the improvement in visual acuity with least amount of refractive error. Prospective study of 44 patients was done pre operatively and with subsequent follow up in the first, third and eighth week post operatively. Pre and post operative evaluation was carried out in terms of visual acuity, refractive error and corneal curvature. Among patients undergoing surgery, 91.0% achieved visual acuity of 6/9 or better at eighth week follow up 73.3% of patients had astigmatism of 1.25 dioptric cylinder or less. Keratometry readings showed insignificant variability in the preoperative and postoperative period (p > 0.05). This confirms that phacoemulsification surgery does not change the corneal curvature significantly and thereby induces less amount of astigmatism.