Association of aldose reductase gene polymorphism (C-106T) in susceptibility of diabetic peripheral neuropathy among north Indian population

AIM/HYPOTHESIS

Polymorphism in aldose reductase (ALR) gene at nucleotide C(-106)T (rs759853) in the promoter region is associated with susceptibility to development of diabetic peripheral neuropathy. The aim of this study was to detect the association of the C (-106)T polymorphism of ALR gene and its frequency among patients with type 2 diabetes mellitus with and without peripheral neuropathy.

METHODS

The study subjects were divided into three groups. Group I included 356 patients with diabetes having peripheral neuropathy. Group II included 294 patients with diabetes without peripheral neuropathy and group III included 181 healthy subjects. Genotyping of ALR C(-106)T SNPs was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and direct sequencing methods. The genetic risk among the groups was compared and tested by calculating odds ratio with 95% class interval.

RESULTS

ALR 106TT genotype was significantly higher in group I compared to group II with an odds ratio of 2.12 (95% CI: 1.22-3.67; p<0.01). Recessive model (CC+CT vs. TT), as well as T allele distribution also showed significant association to develop neuropathy with relative risk of 1.97 (95% CI: 1.16-3.35; p<0.01) and 1.36 (95% CI: 1.07-1.72; p=0.01) respectively.

CONCLUSION/INTERPRETATION

In conclusion, the ALR C-106T polymorphism was associated with higher risk of peripheral neuropathy in patients with type 2 diabetes mellitus.

Neonatal hypothyroidism affects testicular glucose homeostasis through increased oxidative stress in prepubertal mice: effects on GLUT3, GLUT8 and Cx43

Thyroid hormones (THs) play an important role in maintaining the link between metabolism and reproduction and the altered THs status is associated with induction of oxidative stress in various organs like brain, heart, liver and testis. Further, reactive oxygen species play a pivotal role in regulation of glucose homeostasis in several organs, and glucose utilization by Leydig cells is essential for testosterone biosynthesis and thus is largely dependent on glucose transporter 8 (GLUT8). Glucose uptake by Sertoli cells is mediated through glucose transporter 3 (GLUT3) under the influence of THs to meet energy requirement of developing germ cells. THs also modulate level of gap junctional protein such as connexin 43 (Cx43), a potential regulator of cell proliferation and apoptosis in the seminiferous epithelium. Although the role of transient neonatal hypothyroidism in adult testis in terms of testosterone production is well documented, the effect of THs deficiency in early developmental period and its role in testicular glucose homeostasis and oxidative stress with reference to Cx43 in immature mice remain unknown. Therefore, the present study was conducted to evaluate the effect of neonatal hypothyroidism on testicular glucose homeostasis and oxidative stress at postnatal days (PND) 21 and 28 in relation to GLUT3, GLUT8 and Cx43. Hypothyroidism induced by 6-propyl-2-thiouracil (PTU) markedly decreased testicular glucose level with considerable reduction in expression level of GLUT3 and GLUT8. Likewise, lactate dehydrogenase (LDH) activity and intratesticular concentration of lactate were also decreased in hypothyroid mice. There was also a rise in germ cell apoptosis with increased expression of caspase-3 in PTU-treated mice. Further, neonatal hypothyroidism affected germ cell proliferation with decreased expression of proliferating cell nuclear antigen (PCNA) and Cx43. In conclusion, our results suggest that neonatal hypothyroidism alters testicular glucose homeostasis via increased oxidative stress in prepubertal mice, thereby affecting germ cell survival and proliferation.

Evaluation of Oxidative Stress and Antioxidant Status in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition involving the airways and characterized by airflow limitation. Gaseous and noxious particles play an important role in this process. Antioxidants are the substances that may protect cells from the damage caused by unstable molecules known as free radicals. The increased oxidative stress in patients with COPD is the result of an increased burden of inhaled oxidants, as well as increased amounts of reactive oxygen species (ROS) generated by various inflammatory, immune and epithelial cells of the airways. A total of 150 subjects with COPD and 100 healthy controls subjects were enrolled in this study from the period October 2015 to January 2016. The investigation included measurements of plasma superoxide dismutase activity (SOD), catalase activity (CAT), glutathione content (GSH) reduced form, (GPx) glutathione peroxidase, glutathione reductase (GR) and lipid peroxidation (LPO). Absorbance was measured by UV spectrophotometer. The estimated values of SOD, catalase, GPx, GSH and GR were found to be significantly (P = 0.0001) lower among the cases compared with controls. But, the levels of MDA were higher (P = 0.0001) in cases as compared to control group and there was significant difference in the oxidative stress parameters among the various stages of COPD. The post hoc analysis revealed that SOD was significantly (P < 0.01) lower among the mild, moderate and severe patients compared with very severe patients. The catalase was also observed to be significantly (P = 0.01) lower among mild, moderate and severe patients than very severe patients. The GPx was found to be significantly (P = 0.002) lower among the mild, moderate and severe patients compared with very severe patients. MDA was observed to be significantly higher in mild, moderate and severe patients compared with very severe (P = 0.001). GR was significantly (P = 0.003) lower among mild, moderate and severe patients than very severe patients. However, there was no significant difference in GSH among severity of COPD patients. This study suggests that oxidant and antioxidant imbalance plays an important role in various stages of severity of COPD. These results revealed the presence of an oxidative stress in subjects with COPD, and it is proportionate to the severity of disease.

Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015)

OBJECTIVE

To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth.

STUDY DESIGN

The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?'

METHODS

Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review.

RESULTS

This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth.

CONCLUSION

This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use.

Identification, antifungal resistance profile, in vitro biofilm formation and ultrastructural characteristics of Candida species isolated from diabetic foot patients in Northern India

PURPOSE

Diabetic foot ulcers are a serious cause of diagnostic and therapeutic concern. The following study was undertaken to determine the fungal causes of diabetic foot ulcers, with their phenotypic and genotypic characterisation.

MATERIALS AND METHODS

A total of 155 diabetic foot ulcers were studied for 1 year. Deep tissue specimen was collected from the wounds, and crushed samples were plated on Sabouraud dextrose agar with chloramphenicol (0.05 g). Identification was done by growth on cornmeal agar, germ tube formation and urease test. For molecular identification, conserved portion of the 18S rDNA region, the adjacent internal transcribed spacer 1 (ITS1) and a portion of the 28S rDNA region were amplified, using the ITS1 and ITS2 primers. Antifungal susceptibility against voriconazole, fluconazole and amphotericin B was determined by standard broth microdilution method. Biofilm formation was studied in three steps. First, on the surface of wells of microtiter plates followed by quantification of growth by fungal metabolism measurement. Finally, biofilms were analysed by scanning electron microscopy (SEM).

RESULTS

Fungal aetiology was found in 75 patients (48.38%). All were identified as Candida species (100%). The prevalence of different species was Candida tropicalis (34.6%), Candida albicans (29.3%), Candida krusei (16.0%), Candida parapsilosis (10.6%), Candida glabrata (9.33%). All were susceptible to amphotericin B (100%). On microtiter plate, all the isolates were viable within 48 h showing biofilms. The metabolic activity of cells in the biofilm increased with cellular mass, especially in the first 24 h. On SEM, majority showed budding yeast form.

CONCLUSION

Non-albicans Candida spp. with potential biofilm forming ability are emerging as a predominant cause of diabetic foot ulcers.

A Comprehensive Review on Role of Nanoparticles in Therapeutic Delivery of Medicine

BACKGROUND

The effective targeted drug delivery system is significant for future development of medicinal product and healthcare. There are also different types of nanostructures which include solid lipid nanoparticles, liposomes, dendrimers, nanostructured lipid carriers, lipid drug conjugate, liquid crystalline particles, polymeric nanocrystals, polymeric nanoparticles and superparamagnetic nanoparticles which have been considered as advanced carriers in drug delivery system. Method & Discussion: In this regard, nano carriers are bringing revolution in therapeutic delivery of drug as compared to conventional delivery systems by overcoming the limitations of usual methods.

CONCLUSION

The objective of this review is to cover the drug delivery system of various therapeutic drugs and biomolecules by means of polymeric nanoparticles, dendrimers, liposomal nanoparticles and magnetic nanoparticles by describing the methods of formulation development.

Does First Serum Beta-Human Chorionic Gonadotropin Value Prognosticate the Early Pregnancy Outcome in an In-Vitro Fertilisation Cycle?

Background:

Pregnancies achieved through in-vitro fertilisation (IVF) are associated with adverse first trimester outcomes in comparison to spontaneously achieved pregnancies. In view of this, it is imperative to predict the success as well as prognosticate the pregnancy outcome of an IVF cycle not only for the clinicians but also the couples undergoing IVF. Serum beta-human chorionic gonadotropin (β-hCG) value has, thus, been used as a biomarker for pregnancy outcome after IVF and also an aid in counselling and management of the patient.

Aim:

The main objective of this study was to compare the predictive value of the first serum β-hCG value and the pregnancy outcome after an IVF cycle (whether fresh or frozen embryo transfer) in the two subgroups of patients.

Settings and Design:

The study was conducted at Assisted Reproductive Technology Centre of a tertiary care hospital, and it was a retrospective cohort study.

Methods and Materials:

A retrospective study was performed for post-IVF pregnancies at a single IVF centre from March 2014 to February 2015 with serum β-hCG values less than or equal to 1000 mIU/ml. The initial serum values of β-hCG on the day 16 of embryo transfer were correlated with first trimester pregnancy outcome and ongoing pregnancy rate (>12 weeks gestation).

Results:

Of the 208 post-IVF pregnancies included in the study, the group with β-hCG more than 500 mIU/ml had statistically significant higher ongoing pregnancy rates and a lesser poor pregnancy outcome.

Conclusion:

The study concluded that an early serum β-hCG value can be used as a predictor of a successful or an adverse first trimester pregnancy outcome helping in better counselling and monitoring of the high-risk precious IVF pregnancies.

How Harmful Can Herbal Remedies Be? A Case of Severe Acute Tubulointerstitial Nephritis

Acute interstitial nephritis (AIN) is a condition in which acute kidney injury (AKI) is characterized by the histological finding of interstitial inflammation. Hyponidd is an ayurvedic drug containing Momordica charantia, Gymnema sylvestre, Swertia chirata, etc., used for the treatment of Type 2 diabetes mellitus (DM) and polycystic ovarian disease as an insulin sensitizer. There are no case reports of AIN caused by this drug yet. We report a biopsy-proven case of AKI due to severe AIN associated with the use of hyponidd tablet in a 60-year-old male with DM and hypertension. As these types of various indigenous compounds are used as home remedies in our country, awareness about the possible adverse effects of these agents among physicians is very important in the early diagnosis and management.

Gaseous microflow modeling using the Fokker-Planck equation

We present a comparative study of gaseous microflow systems using the recently introduced Fokker-Planck approach and other methods such as: direct simulation Monte Carlo, lattice Boltzmann, and variational solution of Boltzmann-BGK. We show that this Fokker-Plank approach performs efficiently at intermediate values of Knudsen number, a region where direct simulation Monte Carlo becomes expensive and lattice Boltzmann becomes inaccurate. We also investigate the effectiveness of a recently proposed Fokker-Planck model in simulations of heat transfer, as a function of relevant parameters such as the Prandtl, Knudsen numbers. Furthermore, we present simulation of shock wave as a function of Mach number in transonic regime. Our results suggest that the performance of the Fokker-Planck approach is superior to that of the other methods in transition regime for rarefied gas flow and transonic regime for shock wave.

Collagen cross-linking in recalcitrant corneal ulcers: A case series

Introduction: Corneal ulcer is a leading cause of blindness worldwide. Many of these patients don’t respond to conventional treatment with topical agents. Collagen cross-linking (CXL) has been suggested to avoid complications requiring emergency keratoplasty. Subjects and methods: Six eyes with presumed bacterial keratitis not responding to conventional treatment underwent CXL with ultraviolet A rays and transepithelial riboflavin. Patients with Descematocele and perforated ulcers were excluded. Preoperatively and postoperatively slit lamp examination of cornea and visual acuity recording was done. Postoperative outcome included subjective symptoms like relief in pain, photophobia, lacrimation and objective signs like improvement in epithelisation, corneal scarring with vascularisation. Results: Four of the six eyes healed completely with scarring at 2 months follow-up. One of the patients developed Descematocele on 12 days which perforated later. Other patient developed Descematocele on 20 days post CXL. Of the subjective symptoms, pain and epiphora improved in all the patients except one. Photophobia improved only a week after CXL in four out of six patients. Epithelial defect completely healed over time in four out of six cases. All the cases who responded to treatment developed superficial and deep vascularisation of the cornea. Decrease in corneal edema and scarring was noted in four out of the six cases. Conclusion: The collagen cross-linking has a beneficial role as an adjuvant to medical therapy in recalcitrant bacterial keratitis. It helps in relief of pain and healing of ulcer. Larger randomized control trails with longer follow-up are required to come to a definite conclusion. Nepal J Ophthalmol 2016; 8(15): 47-53

Molecular diagnosis and intraspecific genetic variability of root pathogens of arid legumes in Western Rajasthan, India

The productivity of arid legumes, such as Clusterbean (Cyamopsis tetragonoloba), Cowpea (Vigna unguiculata), Moth bean (Vigna aconitifolia) and Horse gram (Macrotyloma uniflorum), may remain stagnant over decades because of their high susceptibility to root diseases. Besides, there is a limitation on the information about molecular diagnosis and intraspecific genetic variability of root pathogens in arid legumes. To contribute in this field, we assessed a total of 52 isolates from 88 root samples that were found infected with fungal pathogens in Jodhpur, Jaipur and Bikaner Districts of Rajasthan. Diseased roots samples were analyzed following standard microbiological methods for fungus extraction and purification, and for genetic studies. Irrespective of the geographical location from where the diseased samples were collected, all pathogen isolates were clustered in RAPD dendrograms as per their respective genera. Phylogram, based on multiple sequence alignment, revealed that different genera (i.e. Fusarium, Neocosmospora and Syncephalastrum), separated from each other, and species within the same genera, clustered together with their reference sequences with apreciable bootstrap values. Out of 20 representative isolates representing each cluster and all outgroups sequenced, eight were molecularly identified as Neocosmospora vasinfecta, five as Fusarium solani, two as Neocosmospora striata, two as Fusarium acutatum, one as Syncephalastrum monosporum, one as Fusarium oxysporum and one as Fusarium species. The root pathogens of the arid legumes were found neither restricted to a geographical location nor were host specific in nature. Fusarium solani wilt in cowpea and seedling rot in moth bean, F. oxysporum wilt in moth bean, F. acutatum damping off in cowpea and Clusterbean, Fusarium sp. seedling rot in Clusterbean, Neocosmospora striata root rot in cowpea and wilt in Clusterbean and Syncephalastrum monosporum root rot in Clusterbean were molecularly identified as new fungal records as pathogens causing root diseases in arid legumes.

CD133+ brain tumor-initiating cells are dependent on STAT3 signaling to drive medulloblastoma recurrence

Medulloblastoma (MB), the most common malignant paediatric brain tumor, is currently treated using a combination of surgery, craniospinal radiotherapy and chemotherapy. Owing to MB stem cells (MBSCs), a subset of MB patients remains untreatable despite standard therapy. CD133 is used to identify MBSCs although its functional role in tumorigenesis has yet to be determined. In this work, we showed enrichment of CD133 in Group 3 MB is associated with increased rate of metastasis and poor clinical outcome. The signal transducers and activators of transcription-3 (STAT3) pathway are selectively activated in CD133⁺ MBSCs and promote tumorigenesis through regulation of c-MYC, a key genetic driver of Group 3 MB. We screened compound libraries for STAT3 inhibitors and treatment with the selected STAT3 inhibitors resulted in tumor size reduction in vivo. We propose that inhibition of STAT3 signaling in MBSCs may represent a potential therapeutic strategy to treat patients with recurrent MB.

Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.

Amniotic membrane transplantation with and without limbal stem cell transplantation in chemical eye injury

INTRODUCTION

Chemical burns of the eyes are one of the important causes of visual disability. Chemical burns particularly alkali burn may lead to gross limbal stem cell deficiency. Amniotic membrane transplantation with limbal graft is a good method for ocular surface reconstruction.

CASE

A 39 years male presented to Biratnagar Eye Hospital after 5 months of chemical injury with redness, pain, photophobia and gradual loss of vision. His visual acuity was counting fingers close to face in both eyes. Amniotic membrane transplantation alone was done in right eye while in left eye limbal stem cell allograft was combined with amniotic membrane transplantation. There was not much visual improvement in right eye while left eye improved significantly to 6/60.

CONCLUSION

Limbal stem cell graft with amniotic membrane transplantation can be an effective method of restoring vision and reducing symptoms rather than amniotic membrane transplantation alone in cases with total limbal stem cell deficiency following chemical burn.

Epidemiology and etiological diagnosis of infective keratitis in eastern region of Nepal

OBJECTIVE

This study aimed to determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in patients presenting to Biratnagar Eye Hospital (Nepal).

METHODS

All patients presenting to Biratnagar Eye Hospital between January 1 and December 31, 2011 with corneal ulceration were retrospectively reviewed. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined and corneal scrapping and cultures were carried out.

RESULTS

Over one year period 1644 patients with corneal ulcer were evaluated, out of which 76.6% of patients were in the age range of 30 to 69 years and 65% of patients had presenting visual acuity less than 3/60. Ocular trauma was the most common cause of keratitis accounting for 60.3% of corneal ulcer and majority of the patients (40%) presented after 2 weeks of symptoms. Among corneal scraping positive cases 1150 (70%) showed fungus, 73 (4.4%) showed bacteria and 20 (1.2%) showed both bacterial and fungus.

CONCLUSION

Corneal ulcer continues to be one of the leading causes of preventable blindness in this region. Lack of awareness about gravity of this disease, financial constraints and geographic barriers remain the major reasons for delay in seeking proper medical help.

Occurrence and characterization of hitherto unknown Streptomyces species in semi-arid soils

Streptomyces the predominant genus of Actinobacteria and plays an important role in the recycling of soil organic matter and production of important secondary metabolites. The occurrence and diversity assessment of Streptomyces species revealed alkaline and poor nutrient status of soils of semi-arid region of Jodhpur, Rajasthan. The morphological and biochemical characterization of 21 Streptomyces isolates facilitated Genus level identification but were insufficient to designate species. Species designation based on 16S rRNA gene delineated 21 isolates into 14 Streptomyces species. Upon BLAST search, the test isolates exhibited 98 to 100% identities with that of the best aligned sequences of the NCBI database. The GC content of 16S rRNA gene sequences of all the Streptomyces isolates tested ranged from 59.03% to 60.94%. The multiple sequence alignment of all the 21 Streptomyces isolates generated a phylogram with high bootstrap values indicating reliable grouping of isolates based on nucleotide sequence variations by way of insertion, deletion and substitutions and 16S rRNA length polymorphism. Some of the Streptomyces species molecularly identified under present study are reported for the first time from semi-arid region of Jodhpur.

Intranasal Eutectic Powder of Zolmitriptan with Enhanced Bioavailability in the Rat Brain

Intranasal administration can potentially deliver drugs to the brain because of the proximity of the delivery site to the olfactory lobe. We prepared triturates of micronized or crystalline zolmitriptan with a GRAS substance, nicotinamide, to form a eutectic. We characterized the formulation using differential scanning calorimetry, powder X-ray diffraction, and FTIR spectroscopy to confirm its eutectic nature and generated a phase diagram. The eutectic formulation was aerosolized using an in-house insufflator into the nares of rats. Groups of rats received zolmitriptan intravenously or intranasally, or intranasal eutectic formulation. Zolmitriptan was estimated in the olfactory lobe, cerebral cortex, cerebellum, and blood plasma at different time-points by LC-MS. Pharmacokinetics in these tissues indicated the superiority of the intranasal eutectic formulation for brain targeting when compared with results of IV solution and intranasal pure zolmitriptan powder. Enhancement of nose-to-brain transport is likely to have resulted from more rapid dissolution of the eutectic as compared to pure drug.

Seasonal immunohistochemical reactivity of S-100 and α-smooth muscle actin proteins in the epididymis of dromedary camel, Camelus dromedarius

The S-100 and alpha smooth muscle actin (α-SMA) proteins have been localised in epididymal tissue of several mammalian species, but there have been no data for a seasonal work in camel. The aim of this study was to investigate the immunoreactivities of S-100 and α-SMA proteins in the epididymis of dromedary camel during breeding and nonbreeding seasons. The immunopositive signals for both proteins were observed in different regions of camel epididymis. S-100-immunopositive signals were noted in both the epididymal epithelium and the intertubular connective tissue, while α-SMA signals were confined to the intertubular connective tissue, especially in the peritubular smooth muscle coat and the blood vessels. This study showed an increase in the intensity of S-100 and α-SMA immunoreactions during the breeding season in different regions of camel epididymis than that seen in the nonbreeding season. In conclusion, epididymis might be considered as a source of S-100 and α-SMA proteins in the camel and the secretion of these proteins showed distinct seasonal variations. Further, S-100 and α-SMA may affect the structural and physiological states of the epididymal duct.

Laser-induced excited-state crossover and spectral variation of Cr3+ in the high-crystal-field environment of CaGa2O4

We have studied a wide-bandgap oxide semiconductor, CaGa_1.99Cr_0.01O₄, which possesses high crystal field strength and develops deep traps. These traps efficiently store electric charges after excitation with ultraviolet light. Stimulation of trap charges using infrared radiation (both coherent and incoherent) gives wideband emission of Cr³⁺ in the red-infrared region, which is similar to the photon upconversion process in lanthanides. Under laser excitation, high photon density and local heating pronounce the coupling of E2 and T₂4 states and causes an excited state crossover of the population from the E2 to T₂4 state. This expands the emission band-width of Cr³⁺ up to 900 nm.

Tamsulosin versus Alfuzosin as medical therapy for ureteric stones

Objectives: To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones.Patients and Methods: A total of 87 patients with ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group I patients (n-30) received 0.4 mg of tamsulosin daily, group II patients (n-29) received 10 mg of alfuzosin daily and group III patients (n-28) received no alpha blockers. All patients were given analgesia when needed. Follow up was done in weekly basis for 4 weeks.Results: The mean stone size (5.33±1.58, 5.79±1.84, 5.67±1.64) and age (29.1±6.3, 30.31±7.22, 29.4±7.63) were comparable in each groups. The stone expulsion rate was 83.3%, 79.3% and 50% in group I, II and III respectively. The drugs related side effects reported by patients were mild and transient.Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other

Clinicopathological study of gall bladder cancer and its relationship with gall stones

Introduction: Gall bladder cancer is the most common cancer of the biliary tree and one of the highly malignant tumors with poor prognosis. Although its incidence is low in west, it is common in our part of the world. There are very few studies regarding gall bladder cancer in Nepal. The incidence of gallstones in patients with gall bladder cancer is high. The aim of the study was to evaluate the clinicopathological aspect of the disease in patients with gallbladder cancer and to Asses the incidence of gallstones in patients with gall bladder cancer.Material and Methods: This was a retrospective study carried out in GI Surgery unit of National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients diagnosed as gallbladder carcinomas during 12 years period from 2002 to 2014 were included in this study. Their clinical characteristics, laboratory data, tumor histopathology reports were obtained and analyzed using SPSS17.Results: Total of 47 patients who met inclusion criteria were included in the study. Male to Female ratio was 1:1.8. Age ranged from 32 to 72 years with mean age of 54. Most common presenting symptom was Pain abdomen (93.6%) followed by weight loss (51.1%) and Jaundice (46.8%). Most common finding on examination was Icterus (42.6%) followed by palpable gall bladder (34%) and Hepatomegaly (29.8%). Gall Stones were seen in 37 (72.3%) patients. Most common histopathology was Adenocarcinoma (93.6%).Conclusion: Most of the patient with gall bladder cancer remained asymptomatic until late. Pain abdomen was most common presenting symptom and icterus was most common findings. There was strong association between gall bladder cancer and gallstones. There should be high index of suspicion if patient with gallstones has constant pain in right hypochondrium and has jaundice.

Analysis of Post Earthquake Disease Pattern in a Camp at Gyampesal Gorkha

Background A major earthquake occurred in Nepal on 25th April 2015 with magnitude of 7.8 causing mass panic amongst people. Objective To analyze scenario, experience and disease pattern of Post Earthquake camp at Gyampesal, Gorkha. Method A prospective observational study done on 13th and 14th June 2015 in a population who attended the health camp at health post, Gyampesal Gorkha. Analysis was done for age, sex, and disease pattern. Medicines for their health problems was provided by Manipal Teaching Hospital, Pokhara, Nepal Pediatric Society and Children Welfare in Nepal, Kathmandu. Result Total 159 patients [80.5% children and 19.5% adults] had attended the health camp. The mean age of children was 6.18±4.27 SD with maximum between 2-5 years (39%) and mean age of adults was 37.87±14.07 SD. Among the children males were more (50.8%) than females but in adult group females (83.9%) were more. Most common complaints were earthquake related fear (Children- 60.23% / adults -71%), insect bite [children -25.8% /adults -35.5%], pain abdomen (children- 64.1% / adult -38.7%) and decreased appetite (children- 83.6% / adults - 16.1%). Pain abdomen and decreased appetite was significantly high in children with p < 0.009 and 0.001 respectively. The common disease patterns noted in children were recurrent abdominal pain (25%), acute gastroenteritis (19.5%), upper respiratory tract infections (15.6%), Impetigo (15.6%), Dental caries(10%), Pityriasis alba (10%). In adults Acid peptic disease (51.6%), Headache (32.5%), hypertension, Upper respiratory infections, scabies and Urinary tract infection (16%), Acute gastroenteritis (13%) was common. Conclusion Earthquake related fear, insect bite and Communicable diseases both airborne and water borne were the commonest findings observed. Therefore basic needs and services like safe water and sanitation, adequate shelter, primary healthcare services and vector-control campaigns are crucial and essential for these displaced populations.