Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Introduction: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial. Objective of the study was to see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis. Methods: Patients admitted in the surgical ward in Patan Hospital and Bir Hospital with the diagnosis of mild acute biliary pancreatitis who underwent cholecystectomy with intra-operative cholangiography from August 2010 to July 2012 were studied. The outcome of cholangiogram was analyzed together with findings of common bile duct exploration. Results: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The common bile duct stone was found in 1.9%.  Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration.Conclusion: The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 11-15

Age-related changes in anterior cingulate cortex glutamate in schizophrenia: A (1)H MRS Study at 7 Tesla

The extent of age-related changes in glutamate and other neurometabolites in the anterior cingulate cortex (ACC) in individuals with schizophrenia remain unclear. Magnetic resonance spectroscopy (MRS) at 7 T, which yields precise measurements of various metabolites and can distinguish glutamate from glutamine, was used to determine levels of ACC glutamate and other metabolites in 24 individuals with schizophrenia and 24 matched controls. Multiple regression analysis revealed that ACC glutamate decreased with age in patients but not controls. No changes were detected in levels of glutamine, N-acetylaspartate, N-acetylaspartylglutamic acid, myo-inositol, GABA, glutathione, total creatine, and total choline. These results suggest that age may be an important modifier of ACC glutamate in schizophrenia.

Prevalence of Respiratory Diseases According to Spirometry Findings Among Patients Attending the Spirometry Department of Dhulikhel Hospital

Background Spirometry is a standard test for screening and evaluation of patients with symptoms of cough and shortness of breath. Despite its easy availability, low cost and ease of performance it has not been widely used in clinical practice in Nepal. Objective To assess the prevalence of respiratory diseases in a regional referral centre in patients referred for spirometry. Method This is a descriptive cross-sectional study including patients referred for spirometry to the spirometry unit of Dhulikhel Hospital, Kathmandu University Hospital from 2014 July to 2015 October. The spirometry findings of the patients fulfilling the criteria of American Thoracic Society/European Respitatory Society (ATS/ERS) guidelines were analyzed and categorized as normal, having obstructive lung diseases including chronic obstructive pulmonary disease (COPD) and bronchial asthma or restrictive lung disease. Data were analyzed using SPSS 20.0 software. Result Out of 821 patients, 755 patients (92%) fulfilled ATS/ERS criteria for satisfactory spirometry. The prevalence of COPD was 31.4%, bronchial asthma 24.2% and restrictive lung disease 8.1%. The mean age of patients diagnosed with COPD was 57.8±10.8 years; bronchial asthma 44.3±16.2 years; and restrictive lung disease 44.6±21.5 years. Both COPD and bronchial asthma were common in females. About twenty two percent of the COPD patients were non-smokers and 86.3% of these were females. The most common symptoms for referral was cough and shortness of breath: these symptoms were more likely to be associated with abnormal spirometry findings. Conclusion Spirometry is a crucial preliminary test for evaluation of patients with respiratory symptoms. It should be used more frequently to help stratify patients for appropriate treatment.

Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria

Objective:

Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria.

Patients and Methods:

We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria.

Results:

The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity.

Conclusions:

There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.

Comparison of single voxel brain MRS AT 3T and 7T using 32-channel head coils

PURPOSE

The purpose of this study was to compare magnetic resonance spectroscopy (MRS) of three different regions of the human brain between 3 and 7 Tesla, using the same subjects and closely matched methodology at both field strengths.

METHODS

A semi-LASER (sLASER) pulse sequence with TE 32ms was used to acquire metabolite spectrum along with the water reference at 3T and 7T using similar experimental parameters and hardware at both field strengths (n=4 per region and field). Spectra were analyzed in LCModel using a simulated basis set.

RESULTS

Signal-to-noise ratio (SNR) at 7T was higher compared to 3T, and linewidths (in ppm) at both field strengths were comparable in ppm scale. Of the 13 metabolites reported in the paper, most metabolites were measured with higher precision at 7T in all three regions.

CONCLUSION

The study confirms gains in SNR and measurement precision at 7T in all three representative brain regions using the sLASER pulse sequence coupled with a 32-channel phased-array head coil.

Quality and Acceptability of Meat Nuggets with Fresh Aloe vera Gel

Aloe vera has been used worldwide for pharmaceutical, food, and cosmetic industries due to its wide biological activities. However, quality improvement of low fat meat products and their acceptability with added Aloe vera gel (AVG) is scanty. The aim of this study was to explore the feasibility of using fresh AVG on physicochemical, textural, sensory and nutritive qualities of goat meat nuggets. The products were prepared with 0%, 2.5%, and 5% fresh AVG replacing goat meat and were analyzed for proximate composition, physicochemical and textural properties, fatty acid profile and sensory parameters. Changes in lipid oxidation and microbial growth of nuggets were also evaluated over 9 days of refrigerated storage. The results showed that AVG significantly (p<0.05) decreased the pH value and protein content of meat emulsion and nuggets. Product yield was affected at 5% level of gel. Addition of AVG in the formulation significantly affected the values of texture profile analysis. The AVG reduced the lipid oxidation and microbial growth in nuggets during storage. Sensory panelists preferred nuggets with 2.5% AVG over nuggets with 5% AVG. Therefore, AVG up to 2.5% level could be used for quality improvement in goat meat nuggets without affecting its sensorial, textural and nutritive values.

Relationship between Amniotic Fluid Index and Perinatal Outcome

Aims:  This study was done to evaluate the predictive value of low amniotic fluid index (AFI) of < 5 cm for adverse perinatal outcome in term of caesarean section for fetal distress, birth weight, meconium stained liquor and APGAR scores. Methods: This was a prospective study of 200 antenatal women booked at Nepal Medical College Teaching Hospital during the year 2013-2014 with gestational age between 34 and 41 weeks. Patients history and clinical examination were recorded and AFI was measured and the perinatal outcome was compared between two groups i.e AFI <5 cm and >5 cm. Results: The caesarean section (C/S) rate for fetal distress and low birth weight babies (<2.5 kg) was higher in patients with low AFI (p=0.048, 0.001 respectively). There was no significant difference in meconium staining, APGAR score at 5 minutes between the two groups (p=0.881, 0.884 respectively). Conclusions: Caesarean section for fetal distress and low birth weight babies was significantly associated with low amniotic fluid index. There was no significant difference in meconium staining liquor, APGAR score at 5 minutes between the two groups.  

Metal concentrations and histopathological changes in goats (Capra hircus) reared near an industrial area of West Bengal, India

The present investigation was performed to assess the concentrations of four heavy metals-lead (Pb), cadmium (Cd), copper (Cu), and cobalt (Co)-in goats reared in the vicinity of an industrial area of West Bengal, India, including soil, water, and feedstuffs; tissues of liver, kidney, lung, spleen, and muscle; and milk and faeces. In addition, histopathological changes in liver, lung, kidney, spleen, and muscle samples were examined. Mejia block as an industrial polluted site and Vatar block as a reference site (without any industrial activities and 120 km away from the polluted site) were selected for this study. The results showed that concentrations of these heavy metals in soil, water feedstuffs, all tissues, milk, and faeces were greater (P < 0.05) in the polluted site than the reference site. The largest concentrations of Cd and Pb were found in kidney followed by liver, lung, spleen, and muscle. However, Co and Cu accumulations in the tissues were in following order: liver > kidney > lung > spleen > muscle. Concentrations of heavy metals were greater in older animals than in young ones. Haemoglobin, total protein, packed cell volume, total erythrocyte counts, and total leucocytes counts were significantly (P < 0.01) decreased in blood of goats in the polluted site compared with the reference site. Serum glucose, creatinine, aspartate amino transferase, alanine amino transferase, and alkanline phosphatase were significantly (P < 0.05 to P < 0.01) increased. Histological examination showed several pathological alterations including degeneration, vacuolation, and tubulitis in kidney; congestion, degeneration, periportal necrosis, and focal haemorrhages in liver; and congestion and diffuse haemorrhage in lungs. It was concluded that natural exposure to these environmental heavy metals significantly increases toxic heavy-metal concentrations in several visceral organs resulting in pathological changes in these tissues. Thus, consumption of the meat of goats reared in the polluted site may pose human health hazards.

An atomic magnetometer with autonomous frequency stabilization and large dynamic range

The operation of a highly sensitive atomic magnetometer using elliptically polarized resonant light is demonstrated. It is based on measurement of zero magnetic field resonance in degenerate two level systems using polarimetric detection. The transmitted light through the polarimeter is used for laser frequency stabilization, whereas reflected light is used for magnetic field measurement. Thus, the experimental geometry allows autonomous frequency stabilization of the laser frequency leading to compact operation of the overall device and has a preliminary sensitivity of <10 pT/Hz(1/2) @ 1 Hz. Additionally, the dynamic range of the device is improved by feedback controlling the bias magnetic field without compromising on its sensitivity.

Oral Health Condition of School Children in Nawalparasi District, Nepal

BACKGROUND

Oral diseases and feeding habits are inextricably linked. Significance of assessing oral health conditions among the school children therefore exists. The current study investigated the oral health condition among 5-6 years and 12-13 years children in Nawalparasi district, Nepal.

METHODS

Recruiting 1,000 school children aged (5-6) and (12-13) years in Nawalparasi district, a cross-sectional study was carried out from November to December, 2014. Data assembled from standard instrument was entered in Epi-Data 3.1, cleaned in SPSS version 16.0, and analyzed in Epi Info 3.5.4.

RESULTS

Of 12-13 years children, three out of ten (32.0%, 95% CI: 27.8-36.4) suffered from occasional dental discomfort and pain, and 8.1% (95% CI: 5.9-11.0) often experienced dental discomfort and pain during the last 12 months. It was 73.6% (95% CI: 69.3-77.4) who brushed teeth at least once a day, while another 20.7% (95% CI: 17.2-24.7) brushed twice a day. Among all children, 86.1% (95% CI: 82.6-89.1) used toothpaste to brush the teeth. A three-fourth (73.8%, 95% CI: 69.5-77.7) drank tea with sugar daily. Dental caries was visible on 42.2% (95% CI: 37.7-46.8) (mean DMFT score 2.3 ± 1.5). Likewise, a quarter (24.1%, 95% CI: 20.3-28.3) had gingival bleeding, 10.9% (95% CI: 8.3-14.1) questionable enamel fluorosis, 4.5% (95% CI: 2.9-6.9) dental trauma, and 1.7% (95% CI: 0.8-3.5) oral mucosal lesion. Referral for preventive/routine treatment was observed in 40.5% (95% CI: 36.145.1). Among 5-6 years old children, a remarkable proportion of dental caries (64.4%, 95% CI: 59.2-69.4 and mean DMFT score 4.4 ± 3.0) was noted. Statistics of enamel fluorosis, dental trauma, and oral mucosal lesions in this age group were: 3.1% (95% CI: 1.6-5.6), 1.7% (95% CI: 0.7-3.8), and 1.1% (95% CI: 0.4-3.0) respectively. About 40.1% (95% CI: 35.0-45.4) were referred for preventive treatment, and the rest for prompt treatment.

CONCLUSIONS

Oral health of the children was poor, chiefly dental carries remained widespread. Dental hygiene awareness should be promoted in schools in active coordination and collaboration with education authorities.

Fetal Transcerebellar Diameter/ Abdominal Circumference Ratio as a Gestational Age Independent Parameter for Fetal Growth

Aims: The purpose of this study was to evaluate accuracy of trans-cerebellar diameter / abdominal circumference (TCD/AC) ratio to assess fetal growth. The ratio of TCD with head circumference (HC) and biparietal diameter (BPD) was also determined. Methods: This was a prospective cross-sectional study involving 442 women with uncomplicated singleton gestation between 15-40 weeks. Protocol included obtaining the BPD, HC, TCD and AC in conventional planes  and obtaining ratio of TCD with other biometric parameters.Results: We were able to visualize the cerebellum in about 93% of scans. The TCD/ AC ratio remained nearly constant throughout gestational age and was 0.138. The mean TCD/HC ratio was 0.124 and mean TCD/BPD ratio was 0.476.Conclusions: TCD/HC and TCD/BPD ratio showed a small increase towards the completion of gestation while TCD/AC ratio remained nearly constant throughout gestational age. TCD/AC ratio is reliable as a gestational age independent parameter of fetal growth.DOI: http://dx.doi.org/10.3126/njog.v9i2.11770