USG assisted and USG guided percutaneous renal biopsy at Nepal Medical College Teaching Hospital: a three and half years study

A prospective study was carried out from 2009 to 2013 in the Department of Radiology and Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 75 patients underwent percutaneous renal biopsy with a 16 or 18 gauge needles. This was done blindly by marking a site on the skin, or, whenever there was difficulty with the blind procedure, by direct real time USG guidance. In all cases, the marking in the skin was done by the radiologist and the biopsy was performed by the Nephrologist, with the aid of the radiologist in cases of real-time USG guided renal biopsy. This study was carried out to assess the safety and efficacy of the USG aided, and USG guided renal biopsy, to see for the types and severity of complications arising from renal biopsies to determine the optimal period of observation required after the procedure. All renal biopsies were performed after the patients were admitted to the hospital at least 1 day prior to the procedure. Coagulation profile was done in all patients prior to the procedure. All patients were kept under strict complete bed rest for 24 hours post procedure. The ages of the patients ranged between 14 years to 71 years, with 42 female and 33 male patients. A mean of 21.8 glomeruli was obtained in each specimen, with absent glomerular yield seen in only 3 patients. Minimal change disease was seen in 19 patients, being the most common histopathological diagnosis followed by a spectrum of others. The overall complication rate was 4% and all of these were self-limiting needing no other intervention, or management except for observation and bed rest. Late complications were not seen. Percutaneous renal biopsy with the help of USG is a safe and efficacious procedure with less chance of minor complications.

Nanostructuring of the conjugated polyelectrolyte poly[9,9-bis(4-sulfonylbutoxyphenyl)fluorene-2,7-diyl-2,2'-bithiophene] in liquid crystalline C12E4 in bulk water and aligned thin films

We report on the conjugated polyelectrolyte 12 mM poly[9,9-bis(4-sulfonylbutoxyphenyl) fluorene-2,7-diyl-2,2'-bithiophene] (PBS-PF2T) mixed in concentrated aqueous 680 mM tetraethylene glycol monododecyl ether (C12E4) in bulk and thin films. A blue-shift in the fluorescence spectrum demonstrates breakup of PBS-PF2T aggregates in bulk aqueous C12E4. Small-angle X-ray scattering data indicate that this mixture follows a very similar phase behaviour to binary mixtures of a pure surfactant with water, including a micellar phase below about 20 °C, a lamellar phase in between about 20 and 70 °C and a proposed coexistence of water and the liquid surfactant solution above 70 °C. Molecular dynamics simulations reproduce these transitions and suggest that PBS-PF2T is incorporated into the surfactant headgroup region, and is, on average, perpendicular to the alkyl chains. In wet thin films, grazing-incidence small-angle X-ray scattering shows that the phase window for the lamellar phase becomes much narrower, located at about 30-34 °C. Weakly ordered phases exist both below and above these temperatures. These phases are isotropic, but lamellae become aligned in a stacked manner on the surface whether approached from low or high temperatures. Dry films are disordered but can be reversibly ordered and disordered and aligned and misaligned by maintaining the temperature at 30-34 °C and switching relative outside humidity between 32% and 100%.

Role of USG guided FNAC in diagnosis of abdominal and thoracic lesions

A prospective study was carried out during 2010 - 2012 in which a total of 194 patients underwent USG guided FNAC from lesions in deep seated thoracic and abdominal organs. These included liver, lungs, intra-abdominal lymphnodes, gall bladder, ovary and adnexa, pancreas, stomach, omentum, other mass of unknown origin in peritoneal cavity, mediastinum, kidney, colon, small intestine, pleura, appendix and adrenal gland. Of these, FNAC was diagnostic in 168 (86.7%) cases, in 15 (7.7%) cases it was not conclusive. In next 6 (3.1%) it was suspicious of malignancy and the smears were acellular and /or contained blood only in 5 (2.6%) cases. Of all diagnosed cases, 153 (78.9%) cases were malignant, 28 (14.4%) were non-noplastic which included inflammatory, infective and granulomatous lesions and 13 (6.7 %) were benign neoplastic lesions. In liver, metastatic adenocarcinoma was the most common FNAC diagnosis, in lungs non-small cell carcinoma. The aim of this study was to evaluate the overall role of USG guided FNAC in diagnosis of abdominal and thoracic lesions.

Sonographic assessment of placental migration in second trimester low lying placenta

To assess the migration of low lying placenta diagnosed in the second trimester ultrasonogram (USG). All the women attending antenatal OPD clinic had undergone routine obstetric USG in the second trimester (14 weeks onwards). Those cases who had low lying placenta lower edge of placenta within 3.0 cms from the cervical internal os were included in the study. These cases were subjected to be followed up at 4 weekly interval to repeated serial ultrasonogram by Transabdominal and/or Transvaginal USG well through 3rd trimester of pregnancy or delivery which ever was earlier. Of the total 1229 second trimester USG, 312 (25.3%) women had low lying placenta in the second trimester. Follow up of this 312 cases indicated that in 288 (92.4%) cases it had migrated to upper segment by 3rd trimester. The migration of placenta was 92.4% and 68.0 % where the distance between the leading edge of placenta and cervical internal os was more than 2.0 cm or less than 2 cm respectively. Migration was not observed in women where the distance was less than 1.5 cm. Placental migration was 94.5% in anteriorly situated placenta and 90.2% in posteriorly situated placenta. The rate of placental migration was 95.1%, 77.7%, 55.5% in women who had previous normal delivery, previous caesarean delivery and prior history of dilatation and curettage (D & C) or manual removal of placenta (MRP), respectively. The prevalence of low lying placenta in 2nd trimester is 25.3%, which reduces to 7.3% at term. The rate of placental migration was over 90.0%. Factor like initial distance between the lower edge of the placental and cervical internal os. placental position and previous birth by caesarean section influence the placental migration.

Plasma Cell Gingivitis: A Case Report

Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction. This is sometimes considered as a hypersensitive reaction. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds with minimal trauma. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen along with nonsurgical periodontal therapy. We report a 29-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. The patient gave history of herbal dentifrice for a period of one year. Nonsurgical periodontal therapies along with discontinuation of herbal dentifrice lead to remission of the condition within a month. Keywords: Herbal dentifrices, non-surgical periodontal therapy, plasma cell gingivitis

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

Early initiation of community-based programmes in Nepal: a historic reflection

Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.

Plasma cell gingivitis: a case report

Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction. This is sometimes considered as a hypersensitive reaction. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds with minimal trauma. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen along with nonsurgical periodontal therapy. We report a 29-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. The patient gave history of herbal dentifrice for a period of one year. Nonsurgical periodontal therapies along with discontinuation of herbal dentifrice lead to remission of the condition within a month.

Interrelationship between Diabetes and Periodontitis- A Review

Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes. Keywords: Diabetes mellitus; inflammation; insulin resistance; periodontitis.