Urinary Bladder Carcinoma: Impact of Smoking, Age and its Clinico-Pathological Spectrum

Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal.Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations.Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics.Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC.Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade.Kathmandu Univ Med J 2013; 11(4): 292-295

Medical and Surgical Abortion in the Second Trimester of Pregnancy

Aims: This study was done to know the demographic profile of women undergoing second trimester abortion at Kathmandu Model Hospital. The aim was to see the success rate of combination of mifeprostone and misoprostol for the medical induction and misoprostol alone for the cervical dilation in case of surgical evacuation.Methods: A retrospective study was done by looking at the profiles of 540 clients on whom second trimester abortion was performed during the period of October 2010 to October 2014. Twenty-nine women underwent dilatation and evacuation (D&E) with misoprostol cervical priming, and 510 underwent medical induction with mifeprostone and misoprostol whereas one client absconded. Furthermore, the reasons for seeking second trimester abortion were also investigated.Results: It can be seen that the age of women undergoing second trimester abortion at Kathmandu Model Hospital was greatest (33.33%) for the age group of 26-30 years. Most women were illiterate (31.67%) and a majority of the women were housewives (89.81%). A greater proportion of the women had never undergone abortion. Mental cause appeared to be the major reason for abortion constituting 82.04%. Success was 90.58%, expulsion with total five doses of misoprostol. The median induction to abortion time was 4-7 hours. The expulsion hours increased as the gestational age increased. The median number of dose of misoprostol required was two for medical induction and three for surgical abortion.Conclusions: Mifeprostone and misoprostol, as combination was a good method for the medical induction of second trimester pregnancy and misoprostol alone for the cervical preparation in surgical evacuation was promising.

Puerperal Sepsis and its Cause in Patan Hospital

Aims: This study was done to find out morbidity related with puerperal pyrexia/sepsis and its risk factors. Methods: This was retrospective study conducted from January 2011 to December 2012 at Department of Obstetrics and Gynaecology, Patan Hospital, Kathmandu, Nepal. All women who delivered in this hospital within 42 days of delivery with puerperal pyrexia/sepsis diagnosed on clinical examination and relevant investigations were included in the study. Women with malaria, typhoid fever and ??other fever were excluded. The data was recorded in predesigned proforma and analyzed. Results: During this period, there were 122 cases of puerperal pyrexia. Puerperal pyrexia accounted for 6.28% of 1945 admissions. Most of the women were aged between 20-29 years, primiparous and booked cases with absent membranes. The causes of puerperal pyrexia in our study were urinary tract infection (47.5%), wound infection (20.5%), endometritis (19.7%) retained product of conception (8.2%), pyoperitoneum (2.5%) and septicemia (1.6%). Conclusions: Puerperal pyrexia/sepsis is one of the causes of preventable maternal morbidity and mortality though in our study it was not proved to be very high in number. Optimal aseptic measures during labour can prevent most of the cases. 

Outcome of unstable fractures of the distal end of the radius treated with external fixator

BACK GROUND AND OBJECTIVES Fracture of the distal radius is the most common fracture treated by the orthopedic surgeons. Although there are several treatment options available today, the aim always remains to restore the anatomy and bring back the function to near normal condition. In this prospective study we intend to evaluate the functional and radiological outcome of the unstable fracture of the distal radius when treated with external fixator. MATERIALS AND METHODS In this hospital based, Prospective study conducted in department of Orthopedics, College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan, during the period from January 2011 to September 2012, 54 patients, (33 male and 21 female) with unstable fracture of the distal end of radius were included in the study. All the patients were treated with external fixator and followed for a period of 12 weeks. RESULT Among 54 patients, 52 were followed up for 12 weeks and two patients were lost to follow up after six weeks. The final result was assessed in detail on the basis of Modification, by Sarmiento et al., of the Demerit Point system of Gartland and Werley at the end of 12 weeks. The result was excellent in 25 cases, good in 19 cases and fair in eight cases. There were no poor results in this series. CONCLUSION External fixator is not only easy to use, allows re-reduction, has lower rate of complications and can be stiff enough to maintain the alignment but it is also a cost effective, patient compliant method which causes lesser morbidity to the patient as compared to the other options available.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12950Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 27-32

Immune responses in neurodegenerative diseases

Neurodegenerative disease is a progressive loss of neurons from central nervous system and has a huge impact on health care system. Various causes have been proposed of which inflammation has been suggested to be a probable key factor in the most of such conditions. The involvement of immune cells including lymphocytes in such diseased condition of the CNS supports this notion. The effective therapy for these diseases has been sought for more than a half century but still lacking such therapy. On such basis this review article has mainly focussed on evidence of the involvement of immune cells in various neurodegenerative diseases including Alzheimer's disease, Parkinson's diseases and Multiple sclerosis and suggests a possible therapy of such diseased conditions of the CNS by the modulation of immune system.

Prevalence of molar incisor hypomineralisation among school children in Kavre

BACKGROUND

Molar incisor hypomineralisation is defined as the hypomineralisation of systemic origin of one to four permanent first molars, and frequently associated with affected incisors. Till date, there is no data available on molar incisor hypomineralisation in any parts of Nepal.

OBJECTIVE

To determine the prevalence and characteristics of Molar incisor hypomineralisation in 7 to 12 years old school children of Kavre.

METHOD

A total of 749 school children of age 7 to 12 years from four different randomly selected schools with at least one of the first permanent molars fully or partially erupted were evaluated using European Academy of Paediatric Dentistry criteria for molar incisor hypomineralisation. The examinations were conducted at respective schools by a single calibrated examiner.

RESULT

Molar incisor hypomineralisation was present in 13.7% of children. No gender differences were found.The mild type of defect (without structural loss of tooth) was the most prevalent type of molar incisor hypomineralisation with white/creamy demarcated opacities more frequent than yellow/brown demarcated opacities. Post eruptive breakdown was more in boys than in girls and this difference was statistically significant (p<0.05). Also, maxillary molars were affected more than mandibular molars and this difference was also statistically significant (p<0.05).

CONCLUSION

The prevalence of molar incisor hypomineralisation in Kavre was 13.7%. Demarcated opacities were more prevalent than breakdown. The hypomineralised defect was more prevalent in maxillary teeth than in mandibular teeth. The severity of defect increased with age and there was no difference in prevalence between girls and boys.

Lymphocytes Protect Cortical Neurons Against Excitotoxicity Mediated by Kainic Acid, an in vitro Model for Neurodegeneration

Background Neurodegenerative disease is a progressive loss of neurons from the central nervous system (CNS). Various conditions have been implicated for such conditions including ageing, inflammation, stress and genetic predisposition. Recently, studies have linked neurodegeneration with inflammation. Some studies have suggested the harmful effect of immune response while others have argued its neuroprotective role in neurodegeneration of the CNS. However, the precise role of inflammation and immune cells in such condition is still not clear. Objective To investigate the role of lymphocytes in neurodegeneration of the CNS and determine the underlying mechanism. Method We have used 4-7 days old mouse pups (C57Bl6) to prepare organotypic slice cultures which were cultured for 13-15 days prior to experiment. To induced cell death kainic acid was used and considered as an in vitro model for neurodegeneration. Lymphocytes were obtained from peripheral lymph nodes of 5-10 weeks old adult mouse which were used in the current study. Propidium iodide was used as a fluorescent dye to determine cell death in brain slice cultures. Result Lymphocytes do not induce cell death in slice cultures in the absence of any toxic insult whereas, after applying toxic insult to the slice cultures using kainic acid, lymphocytes show neuroprotection against such insult. Similarly, purified non-activated and purified activated T cells along with T cells depleted lymphocyte preparation also exhibit neuroprotection against kainic acid-induced cell death. We further, have demonstrated that the observed neuroprotection is contact-independent and soluble mediators released from lymphocytes are responsible for the observed neuroprotection. Moreover, our study has revealed that soluble mediators exhibiting neuroprotection act via astrocytes. Conclusion Lymphocyte preparations are neuroprotective and the observed neuroprotection is contact-independent. Soluble mediators released from lymphocytes are responsible for the observed neuroprotection. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12488 Kathmandu University Medical Journal Vol.11(2) 2013: 132-138

Epidemiological and Outcome Analysis of Orthopedic Implants Removal in Kathmandu University Hospital

Background Orthopedic Implant removal is one of the commonly performed elective orthopedic surgeries. Implants are generally removed after the purpose of keeping implant is solved by healing of the fracture, but there is no consensus whether routine implant removal should be a policy for all fractures that were fixed. Objective This study aims to analyze the epidemiology and outcome of implant removal surgery carried out in the past three years in Kathmandu University Hospital. Methods Patients who underwent implant removal between 2010 January to 2012 December constituted the study cohort. Demographic data, indications, types of hardware and location of fractures were recorded. Similarly, duration of surgery, type of anesthesia and duration of hospital stay were recorded. All the patients who had undergone implant removal in this three years period were called for follow up examination but those who were not able to come were interviewed on telephone. Results There were 275 implant removals constituting 7.8% of total orthopedic operations and 26.3% of fracture fixations. Male to Female ratio was 189: 86. Pediatric age group (34.5%) had the highest incidence of implant removal. Moderate sized implants were the commonest hardwares removed (63.2%). Femur (27.3%) followed by radius (26.9%) were the commonest bone for implant removal. Average operative time was 47.3 minutes with average hospital inpatient stay of 2.6 days. Commonest indication for the implant removal procedure was pain (45%). Conclusion Implant removal procedures are one of the most commonly performed elective orthopedic surgeries. Though, after orthopedic implants removal, pain relief can be expected but it is not so predictive and hence patient should be well counseled before and the indications for implant removal has to be evaluated for better patient satisfaction and safety. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12489 Kathmandu University Medical Journal Vol.11(2) 2013: 139-143

Post-traumatic Stress Disorder among Medical Personnel after Nepal earthquake, 2015

BACKGROUND

Health professionals involved in a disaster are not immune to the stressors. However, little attention is given on the psychological consequences among these professionals. This study has explored the frequency of posttraumatic stress disorder (PTSD) among them after the Nepal earthquake 2015.

METHODS

A descriptive cross sectional study was carried out amongst the medical professionals at Manmohan Memorial Teaching Hospital, Kathmandu to assess the PTSD among them after the Nepal earthquake 2015. Two months after the post disaster the standard PTSD Checklist for DSM-5 (PCL 5) was administered to medical personnel of a hospital(n=64) along with demographic features, disaster related experience and working hours. PTSD was defined by two ways: 1.using DSM V diagnostic criteria (the presence of at least one intrusion, one avoidance, two negative alterations in cognitions/mood and two alterations in arousal and reactivity symptoms); and 2. a cutoff score of 30.

RESULTS

The overall prevalence of PTSD was 21.9% and 17.1% using cutoff score and diagnostic criteria respectively. Females scored significantly higher than males. No significant difference was observed according to age, marital status, profession, previous disaster experience, tragic events with relatives. Those who were present in the hospital during the initial influx of victims, witnessed patients suffering, worked extra time were at significantly high risk for development of PTSD.

CONCLUSIONS

This study suggest that PTSD is highly prevalent among healthcare professionals after disaster management and therefore it highlights the need for targeted interventions to specific staff who respond to large disasters to reduce the psychological burden.

Unusual Giant Syringomyelia with Neurocutaneous Melanosis

A two year old male presented with feeding intolerance and lethargy. Mother had normal delivery with term baby. The patient denied previous trauma or recent weight loss. Physical examination revealed neurocutaneous melanosis (NCM) over lower back side of body and no signs of peripheral motor deficit or abnormal reflexes. Hematological investigations showed no abnormality. Magnetic resonance (MR) imaging found a large, cystic cavity that was eccentric in the cervicothoracic spine extending from C3 to L1. Suboccipital decompressive craniectomy, bilateral C1 laminectomy, and occipital duraplasty were done. J Nepal Paediatr Soc 2014;34(3):250-251 DOI: http://dx.doi.org/10.3126/jnps.v34i3.11165

Role of Eosinophils in Acute Appendicitis

INTRODUCTION

High negative appendectomy rate still prevails on conventional histologic examination. Increased mural eosinophilic infiltrate had been observed in acute appendicitis. Present study aimed to evaluate the role of mural eosinophils in clinically suspected acute appendicitis but histological normal appendix, as an indicator of acute inflammation, alone or in association with edema and to estimate the cut off value for high eosinophil count for the diagnosis of acute appendicitis.

METHODS

A prospective cross sectional study was conducted on appendectomy specimens which were categorized into three groups of classical acute appendicitis, negative appendectomy and control. HandE and Giemsa stained section were studied for the presence of mural eosinophilic infiltrate, mast cells and edema.

RESULTS

Of total 170 cases, group 1 comprised of 68 cases, group 2 consisted of 78 cases and group 3 consisted of 24 cases. Mean eosinophil and mast cell counts in the muscularis propria were significantly higher in CAA and NA categories when compared to control group. Positive association was found between high eosinophil count and edema in CAA and NA categories. Cut off value of ≥6/ mm2 for mural eosinophil count was not significantly different in between NA and control categories.

CONCLUSIONS

Increased mural eosinophils were significantly present in acute appendicitis and clinically suspected acute appendicitis but histological normal appendix when compared with control group. Sole presence of increased mural eosinophils might represent acute inflammation. However, cut off value for high eosinophil count could not be established to suggest acute appendicitis.

Occurrence of dental caries in primary and permanent dentition, oral health status and treatment needs among 12-15 year old school children of Jorpati VDC, Kathmandu

Dental caries occurrence, distribution, oral health status and corresponding treatment needs in 12 - 15 year old children are useful tools for evaluation of oral health. Dental caries status along with its treatment needs was recorded according to World Health Organization (WHO) index (1997) in 366 children from five schools within Jorpati Village Development Committee (VDC), Kathmandu. Dental caries was diagnosed in 156 (42.6%) children, out of which 122 (78.21%) had caries in permanent teeth, 26 (16.67%) had caries in primary teeth, and 8 (5.13%) had caries in both dentition. The age wise distribution of dental caries showed the highest prevalence among 12 year old students (23.8%) and the lowest among 15 year olds (3.8%). Among the female students (177), 43.5% showed presence of dental caries, while the prevalence among male students (179) was 41.8%.Out of the total number of teeth affected by dental caries (336), 273 (81.25%) were permanent teeth and 63 (18.75%) were primary teeth. The intra arch distribution of dental caries in permanent as well as primary dentition was statistically significant (P < 0.05). Restorative treatment (89.38%) was the main need in permanent dentition, and endodontic treatment (60.32%) in primary dentition. Chronologic enamel hypoplasia was found in 14 (3.83%) of the total population, and 62 (16.94%) required oral prophylaxis. These findings are significant as they can initiate further research in this area, which may help establish reliable baseline data for implementation of preventive oral health programs.

Clinico-epidemiological characteristics of central retinal vein occlusion in a tertiary level eye care center of Nepal

BACKGROUND

Central retinal vein occlusion (CRVO) is one of the common retinal disorders causing severe visual impairment.

OBJECTIVE

To study the clinical profile, risk factors and visual outcome in central retinal vein occlusion.

MATERIALS AND METHODS

Seventy-four eyes of 74 patients with central retinal vein occlusion were retrospectively enrolled during the period of one year. All the patients in the study were classified with regard to their ischemic status into two groups, ischemic CRVO and non-ischemic CRVO. The demographic pattern of the patients was recorded. The other parameters studied were visual acuity, history of glaucoma, hypertension, diabetes mellitus and hyperlipidemia. The patients were followed up at 1 month, 3 months and 6 months after treatment.

RESULTS

The majority of the patients (n = 49, 66.2 %) had the ischemic type of CRVO, whereas, 25 (33.8 %) of them had the non-ischemic type. The CRVO was more commonly observed in males in both the groups. Hypertension was the most common risk factor associated with CRVO. The visual improvement was significantly better in non-ischemic CRVO (RR = 0.04, 95% CI = 0.01 - 0.31, p = 0.000).

CONCLUSION

The CRVO was more common in males than in females. It was associated with systemic hypertension. The ischemic type of the CRVO was more prevalent than the non-ischemic one in this study. Visual outcome was better in the non-ischemic CRVO.

Experience of Managing Urogenital Fistula

 Aim: The study was done to review the demography of urogenital fistulae including obstetric fistula (OF) and its surgical outcome in the early phase of fistula surgery and to create awareness about OF. Methods: This was a retrospective study of 47 patients who underwent fistula surgery during the period of January 2012 to May 2014 in Kathmandu Model Hospital, Helping Hand Community Hospital, Camp in Mid-wetern Regional Hospital Surkhet and Hamlin Hospital, Ethiopia. The primary outcome was in terms of urinary continence after 14 days of repair. Results: In the study 70% (n=33) of fistula were due to obstructed labour and 30% (n=14) were due to hysterectomy for gynecological indications. Ninety six percent (n=45) had successful closure of fistula. Seventy seven percent (n=36) were continent after surgery, and 17% (n=8) had some stress incontinence. Conclusions: The study showed obstructed labour was the major cause of OF, however iatrogenic fistula was also becoming common. The success of repair depended on the type, site, size of fistula and urethral length. Majority of our cases had successful closure of fistula with some degree of stress in some patients. DOI: http://dx.doi.org/10.3126/njog.v9i1.11181 NJOG 2014 Jan-Jun; 2(1):17-20

Comparison between Laparoscopic Hysterectomy and Abdominal Hysterectomy

Aims: Hysterectomy can be performed by abdominal, vaginal and laparoscopic methods. Laparoscopic hysterectomy has been reported as an alternative to traditional abdominal hysterectomy with benefit of early recovery, short hospital stay and less operative complications. This study compared laparoscopic versus abdominal hysterectomy in terms of surgery time, blood loss, post-operative recovery, and duration of hospital stay. Methods: This is a retrospective comparative study among sixty patients who underwent laparoscopic or abdominal hysterectomy for various indications in the Department of Obstetrics and Gynaecology of the Third affiliated hospital of Zhengzhou University from January to March 2007. The data of the patients meeting the set criteria were obtained from the hospital records and hospital based computerized coding system. Enrolled cases were divided in two groups with thirty in each arm. Group TLH (total laparoscopic hysterectomy) was designated for patients who underwent total laparoscopic hysterectomy and group TAH (total abdominal hysterectomy) for those who underwent total abdominal hysterectomy. Results: There was comparatively less blood loss in TLH group (60.2±5.17 ml versus 75.7±7.12 ml) but it was statistically insignificant (p=0.12). The laparoscopic hysterectomy took longer time (107.6±32.4 min versus 74.9±31.1 min) than the abdominal (p<0.001). There was early recovery among TLH group 1.6±0.6 days versus 2.1±0.5 days in TAH group (p=0.001). Mean duration of hospital stay was significantly shorter in TLH group 7.6±1.9 days versus 10.1±2.1 days in TAH group (p<0.001). Conclusions: Laparoscopic hyserectomy is an effective alternative to abdominal hysterectomy with the advantage of less intra-operative blood loss, fast recovery and short hospital stay. DOI: http://dx.doi.org/10.3126/njog.v9i1.11183 NJOG 2014 Jan-Jun; 2(1):26-28

Survival for 38 years with Animal-type malignant melanoma

Animal-type melanoma is a low-grade malignant tumor with a good prognosis. Although it is common in old grey horses, the tumor is exceedingly rare in humans. Only 173 cases have been reported till 2011. We report a case in a 38-year-old woman who had the neoplasm in the left labium majus since birth. The tumor was composed of heavily melanized polygonal tumor cells with mildly atypical nuclei proliferating diffusely and in nests in the dermis and subcutis with invasion of hair follicles and nerve bundles. Mitotic figures were not seen. Regional lymph nodes were not enlarged. Present case describes a patient with animal-type melanoma who has had the lesion since birth and who is still living despite having the tumor for 38 years. It attests to the fact that this tumor has indolent biologic behaviour despite being malignant. Mistaking this case for other highly pigmented melanocytic tumors, benign or malignant, is a potential diagnostic pitfall.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11599 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 685-687

Outcomes of extra corporeal shock wave lithotripsy in renal and ureteral calculi

BACKGROUND

Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones.

OBJECTIVE

The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital.

METHOD

In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0.

RESULT

Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10 mm, 10-15 mm and > 15 mm was 97%, 97% and 90%.

CONCLUSION

ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5 cm.

Stapled haemorrhoidectomy in the operative treatment of grade III and IV haemorrhoids

Stapled haemorrhoidectomy (SH) is a minimally invasive intervention that uses a stapling device which avoids the need for wounds in the sensitive anal area and reduces the pain after surgery. This study was undertaken in Nepal Medical College Teaching Hospital from January 2010 to December 2012 to evaluate the efficacy of this modality of treatment among patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids. The results of SH were evaluated by the relief of symptoms, severity of post operative pain, and complications of SH. Twenty five (78.1%) patients had grade III and 7 (21.9%) presented with grade IV hemorrhoids. The most frequent presentation reported in our study was bleeding per rectum with perianal prolapse. Mean operating time was 40-60 minutes whereas mean hospital stay was 1.9 days. Urinary retention was the most common complication found in 12 (37.5%) patients in the immediate post operative period. SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoperative pain, and shorter hospital stay.

A comparative study on epidemiology, spectrum and outcome analysis of physical trauma cases presenting to emergency department of Dhulikhel Hospital, Kathmandu University Hospital and its outreach centers in rural area

BACKGROUND

Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal.

OBJECTIVE

This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community.

METHODS

Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management.

RESULT

In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations.

CONCLUSION

Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma.

Is central nervous system an immune-privileged site?

The central nervous system (CNS) was once considered to be an immune-privileged area. However, increasing evidence shows that the central nervous system is not an immune-privileged but is an active surveillance site. There is a bi-directional communication between the central nervous system and immune system. Normally, immune cells migrate into the central nervous system microenvironment through choroid plexus and interact with the central nervous system resident cells through either through neuromediators or immunomediators. This finding has led to a significant interest in neuroimmunological interactions and investigation onto the role of the immune system in the pathology of various neurological disorders and examine whether it can be targeted to produce novel therapeutic strategies.