Prevalence and Risk Factors of Diabetic Peripheral Neuropathy in T2DM Patient Presenting to Community Hospital in Nepal

Background Diabetic peripheral neuropathy (DPN) is a well-known microvascular complication of type 2 diabetes mellitus (T2DM) attributed to chronic hyperglycemia, and is defined as the presence of peripheral nerve dysfunction in patients with diabetes after exclusion of other causes. Objective To determine the prevalence and risk factors of Diabetic Peripheral Neuropathy among type 2 diabetes mellitus patients. Method A cross sectional study was carried out in a University Teaching Hospital. Type 2 diabetes mellitus patients with diabetes duration of more than 6 months were recruited. Michigan Neuropathy Screening Instrument Scoring was used to diagnose Diabetic Peripheral Neuropathy. Result Among a total of 160 patients who were enrolled, 61 (38.1%) had diabetic peripheral neuropathy and 26 (16%) had diabetic peripheral neuropathy within 1 year of being diagnosed with diabetes. Mean Diabetes duration was 5.56 years and mean age was 57.32 years, with 90 (56%) of the participants being female. The mean HbA1c was 8.33%. Among them 25% of the participants were alcoholics and 30% were smoker. No statistically significant risk factors are evident on multivariate analysis. Conclusion Diabetic peripheral neuropathy was found to be highly prevalent in patients with type 2 diabetes including the patients with relatively shorter diabetes duration. This finding warrants the need of improving the preventive measures and quality of care related to foot complication among patients with type 2 diabetes.

Fine needle aspiration cytology of neck masses in a hospital

BACKGROUND

Fine needle aspiration cytology is a valuable technique in the work-up of masses arising within neck and represents a screening, inexpensive, and rapid technique to sample masses found in neck.

METHODS

This study included 117 cases of neck masses, subjected to fine needle aspiration cytology at the department of Pathology of a hospital in Nepal from January 2013 to December 2013.

RESULTS

The study included 117 patients with neck masses with median age of 37 years. The majority of the patients were in the age group of 20-29 yrs with female predominance. The most frequent cause of neck swelling is lymphadenopathy 65 (55.6%), followed by thyroid swelling 36 (30.7%), soft tissue lesion 12 (10.3%) and salivary gland lesions 4 (3.4%). The most common lesion in these patients was non-neoplastic, followed by malignant neoplasm. Tuberculosis is the most common cause of neck lymphadenopathy and colloid goiter is the commonest cause of thyroid swelling. In soft tissue, abscess is the most frequent one. Pleomorphic adenoma is more common than other salivary gland lesions.

CONCLUSIONS

Lymphadenopathy is commonest cause of neck mass, followed by thyroid gland & soft tissue swellings. Tuberculosis is the most common diagnosis of neck masses, followed by colloid goiter. Fine needle aspiration cytology is pretty accurate technique to diagnose neck masses and it is helpful to avoid unnecessary surgeries and in general clinical management and it is recommended as a first line of investigation in the diagnosis of neck masses.

Concomitance of luteinizing hormone and progesterone oscillations during the transition from preluteolysis to luteolysis in cattle

The temporal relationships of episodes of luteinizing hormone (LH) oscillations, 13,14-dihydro-15-keto-PGF2α (PGFM) pulses, and progesterone (P4) fluctuations during the latter portion of preluteolysis and the early portion of luteolysis were characterized. In Experiment 1, the detection of LH episodes in blood samples collected every 15 min for 8 h was compared with detection in the samples collected every hour in 4 heifers. The number of independently detected episodes/heifer (total = 7) was the same for the 15-min and hourly collection intervals. In Experiment 2, blood samples were collected every hour (n = 7 heifers) and retrospectively assigned to 15 h before and 15 h after the transitional hour between preluteolysis and luteolysis. During preluteolysis, compared with luteolysis, the amplitude of LH oscillations was greater (0.28 ± 0.03 vs 0.18 ± 0.03 ng/mL; P < 0.02) and the interval between peaks of LH oscillations was shorter (3.3 ± 0.3 h vs 4.3 ± 0.6 h; P < 0.04). The LH peaks occurred at the same hour as the peak of a P4 fluctuation in 77% and 29% of LH oscillations (P < 0.0009) during preluteolysis and luteolysis, respectively. In preluteolysis, synchrony between LH and P4 episodes occurred consistently during the P4 rebound after the peak of a PGFM pulse. In luteolysis, the LH peak preceded the peak of the P4 rebound. On a temporal basis, the hypothesis was supported that episodic LH accounts, at least in part, for the reported P4 rebound that occurs after the P4 suppression at the peak of a PGFM pulse.

Luteal blood flow and concentrations of circulating progesterone and other hormones associated with a simulated pulse of 13,14-dihydro-15-keto-prostaglandin F2α in heifers

Progesterone and luteal blood flow effects of an i.u. 2-h infusion of 0.25 mg/h of prostaglandin F2α (PGF) that simulated a natural pulse of 13,14-dihydro-15-keto-PGF (PGFM) were compared to the effects of a single bolus i.u. injection of PGF (4 mg) that induced complete luteolysis in heifers. Blood sampling and an estimate of the percentage of luteal area with colour-Doppler signals of blood flow were performed every 2 min for 20 min and less frequently thereafter for 6 h. After the beginning of PGF infusion or a bolus injection, progesterone increased to a peak at 14 and 10 min respectively, and was accompanied by an increase in blood flow in the bolus group but not in the infusion group. Progesterone then decreased for 1 or 2 h and was accompanied by a continued elevation in blood flow in the PGF bolus group and by a slight increase in the PGF infusion group. Progesterone then rebounded in both groups, but the rebound was greater in the infusion group. Blood flow decreased during the descending arm of the progesterone rebound. Cortisol and prolactin began to increase 6 min after the bolus PGF injection but did not increase during or after PGF infusion. The increases in cortisol, prolactin and blood flow after a PGF bolus treatment but not during a simulated PGFM pulse indicated that the bolus treatment was pharmacologic, and its use may lead to faulty conclusions on the nature of physiologic luteolysis. The comparisons between progesterone and blood flow are novel.

Characteristics of pulses of 13,14-dihydro-15-keto-prostaglandin f2alpha before, during, and after spontaneous luteolysis and temporal intrapulse relationships with progesterone concentrations in cattle

Pulses of the prostaglandin F2alpha (PGF) metabolite 13,14-dihydro-15-keto-PGF (PGFM) were compared among heifers that were in the preluteolytic, luteolytic, and postluteolytic periods (n = 7 or 8 heifers/period). Hourly blood sampling was done in 18-h sessions 15, 16, or 17 days after ovulation. Hourly sampling and statistical identification of a PGFM pulse allowed novel comparisons of PGFM pulses among the three periods. Each period had a similar number of PGFM pulses (2.3 +/- 0.2). The pulses were more prominent during the luteolytic period than during the other periods, as indicated by significantly greater concentration for the peak and amplitude between nadir and peak. Significantly more fluctuations that did not meet the definition of a pulse occurred at the beginning of the preluteolytic period and end of the postluteolytic period than during the luteolytic period. The same nadir ended a pulse and began the next pulse in 85% of adjacent pulses. Seven heifers were selected objectively, based on a progesterone concentration >5 ng/ml at Hour -3 (Hour 0 = peak of PGFM pulse) and a progressive decrease in progesterone from Hours -3 to 0. Progesterone increased (P < 0.03) between Hours 0 and 1, remained at a mean plateau at Hours 1 and 2, and then decreased. Results support the hypothesis of a transient intrapulse rebound in progesterone during an individual PGFM pulse, but only during the first portion of luteolysis. These findings should be considered in future proposals on the mechanisms involved in the effects of PGF on progesterone concentrations.

Detection of tubal abnormalities by HSG in Nepalese subfertile women

Fallopian tube defects are responsible for subfertility in 12.0-33.0% of subfertile couple. Hysterosalpingography (HSG) is a safe and less invasive method of detecting both the tubal and uterine defects. The objective of this study was to find out the incidence of tubal blockage including its site and side diagnosed by HSG in subfertile Nepalese women and to find out the incidence of uterine and other abnormalities detected by this test. This was a prospective study of 1000 cases of subfertility, conducted in Om Hospital, Kathmandu. A short history and HSG report of these cases were obtained from the Radiology department of the hospital. Size and shape of the uterine cavity, evidence of cervical incompetence, tubal visualization, spillage of dye, tubal block with its side and site, evidence of peritoneal adhesion and intravasation of dye in vessels were noted. Quick spillage of the dye in the peritoneal cavity or spillage only after pushing the dye with pressure was also noted. Results were entered in simple tabulations and analyzed. Among 1000 cases, 65.8% had primary and 34.2% had secondary subfertility. 29.0% of the total 1000 cases had abnormal HSG findings. 19.0% of total 1000 cases had tubal blockage. Incidence of tubal blockage in both primary (19.1%) and secondary subfertilty (18.7%) was almost same, in contrary to previous belief. Mullerian defect was present in 3.2% of primary subfertility and 2.0% of secondary subfertility cases. Cervical incompetence was not detected in any case. Evidence of uterine infection was present in 0.7% of primary subfertility and 0.2% of secondary subfertility cases. Abnormal size of uterine cavity was present in 1.2% of primary subfertility and 0.5% of secondary subfertility. Features of phimosis of fimbrial opening, localized spill and intravasation of dye were present respectively in 5.6%, 1.5%, 1.2% in primary subfertility and 4.9%, 1.7% and 1.7% in secondary subfertility.In conclusion; the incidence of tubal blockage detectable by HSG in this study was 19.0%.

Eradication of virulent footrot from sheep and goats in an endemic area of Nepal and an evaluation of specific vaccination

Programmes based on the identification and treatment of cases and the culling of animals refractory to treatment had failed to eradicate virulent footrot from two districts in the western region of Nepal. From 1993 to 1996 vaccination against two endemic virulent strains of Dichelobacter nodosus was tested for its potential to contribute to the eradication of footrot from the region. Only sheep and goats which had been free of signs of footrot at three inspections at monthly intervals before their annual migration to alpine pastures were eligible for inclusion. From November 1992, the treatment of cases identified during inspections included the injection of specific vaccine. Successfully treated cases migrated with their flocks but were excluded from the vaccine trial. Non-responding cases were culled. Forty combined flocks of sheep and goats (approximately 9500 animals) were used initially to compare three vaccination regimens. Eleven flocks (sheep and goats) were treated with two doses of specific vaccine (group A), nine (sheep and goats) were treated with commercial vaccine followed by specific vaccine (group B) and 10 (sheep and goats) were treated with two doses of commercial vaccine (group C) in March to April 1993 before the annual migration; 10 flocks (sheep and goats) remained unvaccinated (group D). Only sheep and goats free of signs of footrot were allowed to migrate. Nevertheless, virulent footrot recurred in many flocks three months later. However, its prevalence was significantly lower in group A than in the other three groups combined. Groups A, B and C then received the specific vaccine before their migrations in 1994 to 1996; group D remained unvaccinated. The annual programme of inspection and identification and treatment of cases continued for seven years, but the vaccinations ceased after four years. There was no recurrence of virulent footrot after November 1993. After the first season the virulent strains of D nodosus used in the specific vaccine could no longer be isolated, although antigenically distinct, benign strains of the organism persisted in cases of benign footrot.