Association of cardiometabolic comorbidities with mortality among low-income Black and White Americans

METHODS

Investigated the association of multiple cardiometabolic comorbidities with total/major cause-specific mortality and evaluate if this association might be modified by race among predominantly low-income Black and White participants.

METHODS

The Southern Community Cohort Study, prospective cohort study. Participants (40-79 years) recruited predominantly from community health centers across 12 states in southeastern United States. Enrollment began in 2002 and concluded in 2009, follow-up until 2020. Cardiometabolic comorbidities (diabetes, hypertension, myocardial infarction, stroke) ascertained at the baseline survey. Cox proportional hazard models used.

RESULTS

Study included 76,721 participants; 16,197, 41,944, 5,247, and 4,919 participants with prior diagnosis of diabetes, hypertension, myocardial infarction, and stroke, respectively at baseline. Compared to individuals with no comorbidity, individuals with any single comorbidity experienced a significantly 30 to 90% increased rate of death due to any causes. The increase in mortality was elevated with an increasing number of comorbidities, with HR of 3.81 (95% CI: 3.26-4.46) and a cumulative risk of 62.5% at age 75 years for total mortality for those with four comorbidities. The risk was high for death due to cardiovascular diseases (HR: 6.18, 95% CI: 5.12-7.47). These associations were stronger among Blacks than Whites. Individuals with four comorbidities at age 40 years were estimated to have a 16-year loss in life expectancy compared with those without any comorbidity.

CONCLUSION

Cardiometabolic comorbidities were associated with increases in all-cause and major cause-specific mortality, particularly Black Americans. This study calls for effective measures to prevent cardiometabolic comorbidities to reduce premature deaths in underserved Americans.

Evaluating interactions of polygenic risk scores and NAT2 genotypes with tobacco smoking in bladder cancer risk

Tobacco smoking is the most important risk factor for bladder cancer. Previous studies have identified the N-acetyltransferase (NAT2) gene in association with bladder cancer risk. The NAT2 gene encodes an enzyme that metabolizes aromatic amines, carcinogens commonly found in tobacco smoke. In our study, we evaluated potential interactions of tobacco smoking with NAT2 genotypes and polygenic risk score (PRS) for bladder cancer, using data from the UK Biobank, a large prospective cohort study. We used Cox proportional hazards models to measure the strength of the association. The PRS was derived using genetic risk variants identified by genome-wide association studies for bladder cancer. With an average of 10.1 years of follow-up of 390 678 eligible participants of European descent, 769 incident bladder cancer cases were identified. Current smokers with a PRS in the highest tertile had a higher risk of developing bladder cancer (HR: 6.45, 95% CI: 4.51-9.24) than current smokers with a PRS in the lowest tertile (HR: 2.41, 95% CI: 1.52-3.84; P for additive interaction = <.001). A similar interaction was found for genetically predicted metabolizing NAT2 phenotype and tobacco smoking where current smokers with the slow NAT2 phenotype had an increased risk of developing bladder cancer (HR: 5.70, 95% CI: 2.64-12.30) than current smokers with the fast NAT2 phenotype (HR: 3.61, 95% CI: 1.14-11.37; P for additive interaction = .100). Our study provides support for considering both genetic and lifestyle risk factors in developing prevention measures for bladder cancer.

Abstract 1920: Association of type 2 diabetes with overall and site-specific cancer among predominantly low-income Black and White Americans

Background: Black individuals have the highest cancer incidence rate in the United States compared to White and other populations. Additionally, they are also twice as likely to develop type 2 diabetes (T2D) during their lifetime. Specifically considering the association between diabetes and cancer incidence, both diseases share common modifiable and nonmodifiable risk factors such as, aging, obesity, lack of physical activity, unhealthy diet, excessive alcohol consumption, and smoking. This association could vary between cancer types and race is also a factor which could disproportionately affect this relationship. However, studies on these associations are limited and the impact in terms of risk between the Black and White Americans remains unclear.

Objective: We evaluated the association of T2D with risk of total and 26 site-specific cancers in a large cohort study conducted among predominantly low-income Black and White Americans who have a higher risk of T2D than other populations. Given the previous literature on T2D, cancer, and race, we hypothesized that T2D might be associated with varying risk for cancer.

Methods: For this analysis, we used data from the Southern Community Cohort Study, an on-going prospective cohort study. Enrollment began in 2002 and concluded in 2009, with active follow-up until 2020. Study participants were asked whether they were diagnosed with T2D by physicians at the follow-up interviews and T2D was assessed as a time-varying covariate. Ascertainment of incident cancer was carried out via linkage to state cancer registries. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounders.

Results: This study included 81,525 participants (30.2 % (N=24,581) White; 65.9% (N=53,711) Black) of whom 36.2% (N=29,487) were diagnosed with diabetes. Among those with diabetes, 10.3% (N=3,024) were diagnosed with cancer. Individuals with T2D had an elevated risk of several cancers, including pancreatic cancer (HR = 1.52, 95% CI: 1.18-1.96); but a reduced risk of esophageal cancer (HR = 0.55, 95% CI: 0.34-0.89). Some racial differences were found regarding the association of T2D with cancer risk.

Conclusion: We found varying risks between T2D and risk of cancer between White and Black individuals. This highlights the importance of T2D prevention practices to help mitigate the risk of cancer and that further research is necessary to understand this association in minority individuals.

Citation Format: Pranoti Pradhan, Wanqing Wen, Wei Zheng. Association of type 2 diabetes with overall and site-specific cancer among predominantly low-income Black and White Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1920.

Prospective Cohort Study of Ginseng Consumption in Association with Cancer Risk: Shanghai Women's Health Study

BACKGROUND

Ginseng has been commonly used in Asian countries to promote longevity and health for >2000 years. Recent in vitro and in vivo studies, coupled with limited epidemiologic studies, have suggested that regular ginseng consumption may be related to lower cancer risk.

OBJECTIVES

We evaluated the association of ginseng consumption with risk of total and 15 site-specific cancers in a large cohort study conducted among Chinese women. Given the previous literature on ginseng consumption and cancer risk, we hypothesized that ginseng consumption might be associated with varying risks of cancer.

METHODS

This study included 65,732 female participants (mean age: 52.2 years) of the Shanghai Women's Health Study, an ongoing prospective cohort study. Baseline enrollment occurred between 1997 and 2000, and follow-up concluded on 31 December 2016. Ginseng use and covariates were assessed via an in-person interview conducted at the baseline recruitment. The cohort was followed for cancer incidence. Cox proportional hazard models were used to estimate HRs and 95% CIs for ginseng-cancer associations after adjusting for confounders.

RESULTS

During a mean 14.7 years of follow-up, 5067 incident cancer cases were identified. Overall, regular ginseng use was mostly not associated with risk of any site-specific cancer, or all cancers combined. Short-term (<3 years) ginseng use was found to be significantly associated with increased risk of liver cancer (HR = 1.71; 95% CI: 1.04, 2.79; P = 0.035), whereas long-term (≥3 years) ginseng use was found to be associated with increased risk of thyroid cancer (HR = 1.40; 95% CI: 1.02, 1.91; P = 0.036). Long-term ginseng use was found to be significantly associated with decreased risk of lymphatic and hematopoietic tissue malignancy (HR = 0.67; 95% CI: 0.46, 0.98; P = 0.039) and non-Hodgkin's lymphoma (HR = 0.57; 95% CI: 0.34, 0.97; P = 0.039).

CONCLUSIONS

This study provides suggestive evidence that ginseng consumption may be associated with risk of certain cancers.

Abstract 3228: Body mass index and ovarian cancer: Changes after diagnosis and associations with overall survival

Background: While excess adiposity is positively associated with ovarian cancer risk, the relationship with patient prognosis remains to be fully elucidated, especially with regard to changes over time during survivorship.

Methods: We assembled a retrospective cohort of tumor registry confirmed ovarian, fallopian tube, and primary peritoneal cancer cases and evaluated peri- and post-diagnosis (±30 days and up to 5 years after, respectively) body mass index (BMI) from electronic medical records (EMR) from the Vanderbilt University Medical Center. Associations with overall survival (OS) were quantified by Hazards Ratios (HRs) and corresponding 95% confidence intervals (CIs) from Cox proportional hazards regression; multivariable adjustment included age, stage, grade, histologic subtype, treatment, race, and year of diagnosis.

Results: We evaluated 13,676 peri- and post-diagnosis BMI observations for 616 predominantly Caucasian (87.0%) cases; the majority had serous histology (62.5%), advanced stage (58.1% Stage III or IV), high grade (52.4% poorly or undifferentiated) disease. Compared to peri-diagnosis (median =29.0), BMI was lowest 6 months post-diagnosis (median=27.4) and then gradually increased over time among survivors. In multivariable adjusted models, each 5-unit increase in mean peri-diagnosis BMI corresponded with a nonsignificant increase (HR: 1.07, 95% CI: 0.97-1.18) while higher mean post-diagnosis BMI corresponded to a significantly decreased risk of death (HR: 0.92, 95% CI: 0.84-1.00). Adjusted models that incorporated all peri- and post-diagnosis BMI observations evaluated indicated that each 5-unit increase in BMI was associated with a 15% reduced risk of death (HR: 0.85, 95% CI: 0.77-0.94).

Conclusions: Whereas lower adiposity may be beneficial in terms of risk, higher adiposity appears to benefit ovarian cancer survival. Factors including cancer cachexia, weight loss among ill patients, and weight gain among survivors may contribute to this seemingly protective association. Additional research to disentangle the influence of BMI on ovarian cancer outcomes and inform adiposity guidance for ovarian cancer survivors is needed.

Citation Format: Alicia Beeghly-Fadiel, Sharon Phillips, George Bukenya, Pranoti Pradhan, Sara Duque, Nneka Anyanwu, Deok-Soo Son, Andrew J. Wilson, Demetra H. Hufnagel, Marta A. Crispens. Body mass index and ovarian cancer: Changes after diagnosis and associations with overall survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3228.

Problems and Prospects of IT in Healthcare in Russia: Modern Realities

The article deals with the problems and prospects of applying information technologies in healthcare in Russia. The general model of information technologies, problems and ways of dealing with the restrictions from Western IT companies are highlighted. In view of the digitalization of the healthcare system in our country, the article discusses the need to ensure the continuity and independence from external influence of information technology systems in its full cycle: from client terminals, communication systems, to data storage and processing servers. The most important factor that allows us to speak with confidence about the development of specialized IT solutions in the healthcare system of the Russian Federation is an effective state policy in ensuring the digitalization of the economy: national projects, government programs, changes in legislation, roadmaps for achieving key indicators.

Association of ginseng consumption with all-cause and cause-specific mortality: Shanghai Women’s Health Study

Background

Methods

Results

Conclusion

Prevalence of methicillin-resistant Staphylococcus aureus in a tertiary hospital in Nepal

SETTING:

Patan Hospital, Lalitpur, Nepal.

OBJECTIVES:

To describe 1) the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its antibiotic sensitivity pattern; 2) the demographic and clinical characteristics associated with MRSA infections; and 3) the treatment outcomes of in-patients with MRSA infection among patients with S. aureus infection between January 2018 and December 2020.

DESIGN:

This was a cross-sectional study using electronic and paper-based hospital records of patients with S. aureus infection.

RESULTS:

Of the 1,804 patients with S. aureus infection, 1,027 patients (57%, 95% CI 55–59) had MRSA. The MRSA were susceptible to vancomycin (100%), linezolid (96%), doxycycline (96%), chloramphenicol (86%) and cotrimoxazole (70%), and resistant to erythromycin (68%), clindamycin (56%), gentamycin (58%), ciprofloxacin (92%) and ofloxacin (91%). The prevalence of MRSA was higher in 2019, among out-patients, and in respiratory samples, and lower in blood samples. Of the 142 in-patients with MRSA, 93% had a successful clinical outcome (cured/improved).

CONCLUSION:

More than 50% of patients with S. aureus infection had MRSA that were resistant to commonly available antibiotics. This calls for strengthening surveil-lance and good infection control practices in this hospital.

Perception of Students on Online Assessment: A Descriptive Study among Medical Undergraduates at Basic Sciences

Background Assessment drives learning. Student assessment cannot be neglected in the long ongoing online learning during COVID-19 pandemic to motivate and assess students' learning. Hence Patan Academy of Health Sciences (PAHS) conducted online assessment to medical undergraduates amidst limitations. Objective To measure the perception of online assessment of students which will provide applicable insights for the further improvement. Method This is a single center, cross-sectional and descriptive study. A Google form containing a semi-structured questionnaire was sent to MBBS students of Basic Science at PAHS who attended online classes and online examination. The responses from close ended questions expressed in percentage and Chi-square test was used to find the association. Open ended questions were analyzed using Braun and Clarke's thematic analysis. Result Of 118 students that responded, 75% passed the online examination. A majority of students (73%) stated that online exam motivated them in learning process and it could be a good alternative during pandemic time. However the most of students (56%) were unsatisfied with the modality of online assessment and reasons that they mentioned were technical problems (89%), inadequate online proctoring (77%), insufficient examination time (58%), lack of orientation to exam, lack of computer skills. Technical problem was worse in rural areas. Conclusion Even though online assessment motivated students' learning during online classes, a large number of students were unsatisfied with assessment modality.

TRAF6-IRF5 kinetics, TRIF, and biophysical factors drive synergistic innate responses to particle-mediated MPLA-CpG co-presentation

Innate immune responses to pathogens are driven by co-presentation of multiple pathogen-associated molecular patterns (PAMPs). Combinations of PAMPs can trigger synergistic immune responses, but the underlying molecular mechanisms of synergy are poorly understood. Here, we used synthetic particulate carriers co-loaded with monophosphoryl lipid A (MPLA) and CpG as pathogen-like particles (PLPs) to dissect the signaling pathways responsible for dual adjuvant immune responses. PLP-based co-delivery of MPLA and CpG to GM-CSF-driven mouse bone marrow-derived antigen-presenting cells (BM-APCs) elicited synergistic interferon-β (IFN-β) and interleukin-12p70 (IL-12p70) responses, which were strongly influenced by the biophysical properties of PLPs. Mechanistically, we found that MyD88 and interferon regulatory factor 5 (IRF5) were necessary for IFN-β and IL-12p70 production, while TRIF signaling was required for the synergistic response. Both the kinetics and magnitude of downstream TRAF6 and IRF5 signaling drove the synergy. These results identify the key mechanisms of synergistic Toll-like receptor 4 (TLR4)-TLR9 co-signaling in mouse BM-APCs and underscore the critical role of signaling kinetics and biophysical properties on the integrated response to combination adjuvants.

Comparison of gustatory function between mucosal and squamous disease: a randomised controlled study

OBJECTIVE

The aim of this study was to evaluate and compare the gustatory function between patients with chronic mucosal and squamous diseases before and after the surgery.

METHOD

A total of 33 patients with mucosal diseases and 34 patients with squamous diseases were evaluated for gustatory function both in the pre-operative and post-operative periods. The taste scores were compared between the two groups.

RESULTS

The gustatory scores in the mucosal disease group were significantly better than the scores in the squamous disease group (p < 0.05). There was no significant correlation detected between the age of the patients or duration of the disease with the taste scores in any of the study groups.

CONCLUSION

The improvement in gustatory score was better in the chronic mucosal disease group than the squamous disease group. There was no significant correlation found between the age of the patients or duration of disease and the taste score in any of the study groups.

Basal cell carcinoma arising over lesion of discoid lupus erythematosus: a rare occurrence

Although the association of discoid lupus erythematosus (DLE) with squamous cell carcinoma has been described in the literature, coexistence with a basal cell carcinoma is very rare. The indolent and non-pruritic nature of the lesion cause it often to be diagnosed at the late stage of the disease. Long-standing photosensitivity and chronic inflammation later lead to scarring and hypopigmentation, which are considered as the risk factors for the malignant changes over DLE. Incisional biopsy is often performed from the erythematosus lesion which does not respond to medical treatment. Here we have reported a rare case of basal cell carcinoma of the skin developing in the background of long-standing DLE, which was successfully managed with cold knife local excision.

Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration

Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.

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.  

Spinal Anaesthesia Failure among Women Undergoing Caesarean Section in Kirtipur Hospital

Aims: This study was done to find out the spinal anaesthesia failure rate necessitating the conversion to general anaesthesia and use of intraoperative supplemental analgesia. Methods: This was a retrospective study undertaken in Kirtipur hospital in 660 patients. Spinal anaesthesia (0.5% heavy bupivacaine 2.2 ml) was given to women who had undergone elective or emergency caesarean section from January 2009 to December 2013. Results: In this study spinal anaesthesia failure rate was 1.66% (n=11/660). Among them complete failed spinal anaesthesia rate was 0.75% (n=5/660) requiring conversion to general anaesthesia. Intraoperative supplemental analgesic and sedation like pethidine, ketamine or midazolam was required in 0.90% (n=6/660). Conclusions: The failure rate of spinal anaesthesia given for caesarean section was low (1.66%) and it was within the acceptable range.

Aerobic Bacteria in the Diaphragmatic Portion of Stethoscope of Medical Professionals of Tertiary Care Hospital

INTRODUCTION

Hospital environment is a reservoir of wide varieties of microorganisms which are frequently reported colonizing in medical equipment. Stethoscopes are essential tools and of universal use in the medical profession, which might be a source of spreading nosocomial infections. This research project was conducted with an aim to assess the presence of aerobic bacteria in the stethoscope of the medical doctors working at Patan Hospital and students of Patan Academy of Health Sciences.

METHODS

It is a cross sectional study based on structured questionnaire and sample assessment from the stethoscope of doctors and students of Patan Hospital and Patan Academy of Health Sciences. The stethescopes used by the doctors of five major departments of Patan Hospital and students of clinical years were included in this study.

RESULTS

Total of 99 stethoscope owned by different level of professionals (positions) and different departments were examined for bacterial contamination. Out of them, 36 were found to be considerably contaminated. Single strain of bacteria was grown from a single stethoscope. Among them 34 were Gram positive and remaining were Gram negative. Out of 34 gram postive bacteria, 29 were identified as Staphylococcus aureus, six were identified as Coagulase Negative Staphylococcus and remaining were Gram positive bacilli.

CONCLUSIONS

There is presence of aerobic bacteria in diaphragmatic portion of stethoscope of medical professional of which the gram positives were the commonest.

Profile of Caesarean Section in Kirtipur Hospital

Aims: This study was done to find out the incidence and outcome of caesarean sections done at Kirtipur Hospital. Methods: This was a retrospective study conducted from 1st January 2009 to 31st December 2013. Case files of 660 patients who underwent caesarean section for various indications were analyzed for incidence, indication of caesarean section, booking status, parity, and maternal and fetal outcomes. Results: Out of 1295 deliveries, 50.9% (n=660) had caesarean section. Most of the caesarean section was done for fetal distress (40.2%; n=265) and on account of previous history of caesarean section (13.5%; n=89). Majority of caesarean section (44.4%, n=293) was done in age group of 25-29 years. Among them, 65.9% (n=435) were nulliparous. There were 35.3% (n=563) booked cases. Emergency caesarean sections were performed in 62.4% (n=412) cases. Maternal morbidity was less (7.2%, n=48). Conclusions: The study showed high rate of caesarean section. The most common indication was fetal distress. Post-operative complications and fetal outcome were within acceptable range. DOI: http://dx.doi.org/10.3126/njog.v9i2.11763  

Role of Angiogenic Factors in Preeclampsia

Preeclampsia, the syndrome of hypertension, proteinuria, edema and hyperuricemia occurring during the last trimester of pregnancy remains one of the great mysteries. Recently gene expression profiling of placental tissue from healthy and preeclamptic women used to see which genes were up or down regulated in preeclamptic patients. Alterations in circulating angiogenic proteins correlated with disease severity, earlier onset of preeclampsia and birth of small for gestational age (SGA) fetus. These findings lend support to the hypothesis that circulating angiogenic proteins may have an important biological role in preeclampsia. DOI: http://dx.doi.org/10.3126/njog.v9i1.11194 NJOG 2014 Jan-Jun; 2(1):71-73

Prevalence of intestinal parasitic infections among public school children in a rural village of Kathmandu Valley

Intestinal parasitic infections (IPI) are one of the most prevalent infections in humans residing in developing countries and its burden is high among school aged children. This cross-sectional study was conducted to determine the prevalence of intestinal parasitic infection and types of intestinal parasites in rural public school children of Nepal. It included students from Nursery to Class X of a rural public school located in the northeast part of the Kathmandu Valley, Nepal. Among the 194 participating children, prevalence of intestinal parasitic infection was found as 23.7%; (28.2% for boys; 20.2% for girls). Amongst the infected children, single and mixed parasitic infection was detected in 43 (93.5%) and 3 (6.5%) children respectively. Among protozoan parasites, Giardia lamblia was the most common (58.6%) whereas Hymenolepis nana was the most common (21.7%) among the helminths. Statistically different prevalence of intestinal parasitic infection was observed among children aged above 10 years and children aged below 6 years as well as 6 to 10 years. Gender-wise, there was no statistical difference in prevalence of intestinal parasitic infection. This study suggests the need of health education program in schools along with regular screening of intestinal parasites and treatment for effective management of the intestinal parasites among school children in Nepal.

Serum uric acid level in normal pregnant and preeclamptic ladies: a comparative study

Preeclampsia is a serious pregnancy complication characterized by hypertension, proteinuria with or without pathological edema. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not in preeclamptic patients. Pre-eclamptic patients admitted in Nepal Medical College Teaching Hospital from June 2012 to June 2013 were included in this study. Age matched normal healthy pregnant ladies served as control. The record of their blood pressure and serum uric acid level was evaluated. Results showed significantly high blood pressure [SBP 149.42±12.35 vs 109.00±7.93 mm Hg; DBP 96.85±8.32 vs 72.5±7.10 mm Hg], and serum uric acid level [6.27±1.37 vs 4.27±0.61 mg/dl] in pre-eclamptic patients compared to their healthy counterparts. Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia increasing its synthesis by damage and death of trophoblastic cells and proliferation. Uricemia in preeclampsia likely results from reduced uric acid clearance from diminished glomerular filtration, increased tubular reabsorption and decreased secretion. Results of the present study indicated association of elevated serum uric acid level with preeclampsia which could be used as a biochemical indicator of preeclampsia in pregnant women.

Dermoid Cyst and its bizarre presentation

Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor usually occurring in the reproductive age group. They are commonly unilateral and 10-12 % can be bilateral. They are commonly multicystic and contain sebaceous fluid as well as tissue of three germ cell layers e.g. ectoderm (skin, hair, brain) mesoderm (muscle, fat ,teeth ,bone, and cartilage) and endoderm (mucious and ciliated epithelium).These teratomas usually arise from the gonads but has been found anywhere in the body. Their site, size and clinical presentations are extremely variable causing confusion with medical and surgical diseases, acute emergency due to rupture and torsion , bowel and bladder injuries, and pregnancy etc. The malignant teratoma occurs at 3-4% only among ovarian carcinoma. The malignant transformation in benign cysts is a rare occurrence with 1-2% cases and squamous cell carcinoma being the commonest. This review is undertaken to study the different presentations produced by these tumors.

Massive ascites in severe pre-eclampsia: a rare complication

We report a rare case of massive maternal ascites complicating severe pre- eclampsia toxaemia (PET) seen in April 2013. This complication developed in association with the rise of blood pressure of 160/110 mmHg or more, worsening of proteinuria and hyperuricaemia. The onset of massive ascites caused respiratory compromise to the patient, thus necessitating immediate termination of pregnancy.

Transthoracic echocardiography may be useful for preoperative cardiac evaluation of gynaecological patients undergoing routine surgery

Echocardiography has been an integral noninvasive tool for [preoperative] cardiac evaluation that provides with echocardiographic details which may also be useful to perioperative clinicians to tailor their anesthetic deliberation while dealing with preoperative patients. The objective of this study is preoperative evaluation of routine gynecological patients echocardiographically after being referred from respective internists or anesthesiologists. This was a prospective, nonrandomized study of elective 68 cases who underwent echocardiographic evaluation preoperatively from 15th July 2009 to 14th July 2012. The mean age of the patients was 52.1 +/- 10.3 years with the age range of 30-79 years. Valvular heart disease was the most common echocardiographic finding (129.4%) followed by left ventricular diastolic dysfunction, LVDD (48.5%) and left ventricular hypertrophy (22.1%). Systolic dysfunction was detected in 2.9% of patients and pulmonary arterial hypertension in 2.9% patients. Amongst patients referred after preoperative anaesthetic evaluation, patients had different cardiac lesions echocardiographically. Preoperative echocardiographic evaluation may provide important cardiac informations and values which might be employed by perioperative physicians to tailor their treatment.

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.

Asymptomatic bacteriurea among pregnant women visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal

Urinary tract infection is the commonest bacterial infection in pregnancy. The overall incidence is 5.0-10.0% of all pregnancy. During pregnancy bacterial growth is favoured by increased urinary content of glucose, aminoacids and other nutrients. Other factors responsible for infection are basically related to hormonal effect and mechanical factors. Prolonged stasis of urine in urinary bladder favours growth of micro organism, relaxation of vesico-ureteric junction leads to reflux of urine from bladder to ureter and later up to renal pelvis and later can affect the renal parenchyma affecting the function of kidneys. In addition, some maternal defense mechanism are less effective during pregnancy. Bacteriuria either asymptomatic (5.0%) or symptomatic is common in pregnancy, if left untreated, asymptomatic bacteriuria will lead to acute pyelonephritis in 20.0-30.0%. This may result in abortion, premature delivery, low birth baby and even still birth. About 12.0% of antenatal admission are sepsis due to pyelonephritis. Keeping in mind that UTI in pregnancy leads to increase in maternal morbidity as well as neonatal morbidity and mortality. In this prospective study all asymptomatic consecutive antenatal women were included 200 from each trimester with total of 600 in number to see the incidence in different trimester, most prevalent organisms and it's sensitivity. They were followed up till delivery to see the incidence of asymptomatic bacteriurea in different trimester and its outcome in terms of type of delivery, baby weight, apgar score given at the time of birth and hospital admission for morbidity.

First case of congenital toxoplasmosis from Nepal

Reportedly, nearly half of the Nepalese are Toxoplasma seropositive. However, neither the prevalence of congenital toxoplasmosis (CT) nor the confirmed case to CT is reported from Nepal yet. In this case report, we report the first case of CT in a 53 days old full term male baby (weight: 2,600 grams) delivered by caesarean section. The baby had hepatosplenomegaly and optic nerve coloboma with large scar in the right eye. The TORCH panel test showed significantly high Toxoplasma IgM antibody level (5.77 OD Ratio) compared with IgM antibody level against other agents. The baby was diagnosed as a case of CT and treatment was started accordingly. The baby, however, did not improve with the treatment and died after six days. The immediate cause of death was cardiorespiratory failure with antecedent cause of liver failure, renal insufficiency with thrombocytopenia.

Still-birth--a tragic journey: a critical analysis

Despite improvement in antenatal and intrapartum care, late intrauterine fetal death at and after 28 weeks of gestation remains a persistent and challenging problem to the obstetricians. We undertook the retrospective review of the medical records of 89 women with singleton pregnancy who gave birth to still-born infants at or more than 28 weeks gestation during the period from April 1998 to April 2007 at Nepal Medical College Teaching Hospital to know the prevalence rate and devise preventive measures for still-born infants which accounts more than 50.0% of perinatal death in Nepal. Major malformations were present in 5 (5.6%) of 89 infants including three infants with neural tube abnormalities. Pre-eclampsia preceded the stillbirth and might have been an indirect cause of stillbirth in 16 (19.0%) of 84 women whose infants had normal formations. The cause of still birth in 68 non-pre-eclamptic women was unclear in 31 (45.6%) home breech delivery with head stuck in 11 (16.0%), abruptio placentae in 5 (7.3%), intrauterine fetal growth restriction in 10 (14.7%), infection in 6 (8.8%) and cord accidents in 5 (7.3%). The causes of still births were many and varied, with large population having no obvious cause, although autopsy was not done in any case in this study. Proper monitoring of women with preeclampsia and early diagnosis and prompt delivery for women with abruption placenta might be helpful in reducing the number of stillbirths. Great advocacy with community education on importance of community focused antenatal care and increasing institutional delivery with availability of emergency obstetric care is necessary to decrease the number of stillbirths and perinatal mortality in developing countries like Nepal.

Lung hypoplasia and patellar agenesis in Ehlers-Danlos syndrome

A 22-year-old male patient was admitted with severe cough associated with purulent expectoration, left-sided chest pain and breathlessness. There was a history of recurrent respiratory ailments since childhood. The patient appeared younger than his chronological age. His face and ears were both dysmorphic. Clinically, the patient was diagnosed with Ehlers-Danlos syndrome (EDS). Computed tomography of the thoracic region revealed hypoplasia of the left lung and hyperplasia of the right lung. Both the patellae were absent. However, ultrasonography of his abdomen, echocardiography and other routine blood and urine examination showed no gross abnormalities. Although other respiratory tract abnormalities with EDS are not uncommon, unilateral lung hypoplasia and patellar agenesis in EDS make this case unique.

Low-coherence enhanced backscattering and its applications

The phenomenon of enhanced backscattering (EBS) of light, also known as coherent backscattering, has been the object of intensive investigation in non-biological media over the last two decades. However, there have been only a few attempts to explore EBS for tissue characterization and diagnosis. We have recently made progress in the EBS measurements in tissue by taking advantage of low spatial coherence illumination, which has led us to the development of low-coherence enhanced backscattering (LEBS) as a technique to characterize living tissue. In this paper, we review the current state of research on LEBS. In particular, we show that LEBS spectroscopy enables detection of early microarchitectural changes in tissue associated with carcinogenesis prior to the development of histologically-detectable alterations as well as any other known markers of neoplasia. Thus, LEBS may offer insights into initial events in carcinogenesis.

Prevalence of anti HCV, HBsAg and HIV antibodies in high risk recipients of blood and blood products

Along with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), Hepatitis C virus (HCV) is emerging as a major transfusion hazard. 22 cases of haemophilia (A 19, B 3) and 20 cases of thalassaemia (2 16, E(2) 4) constituted the study group. Patients tested for anti HCV (using third generation ELISA), HBsAg and antibodies to HIV I and II. Prevalence of anti HCV was 54.5% in haemophilics and 5% in thalassaemics. HBsAg was detected in 9.09% haemophilics and 5% thalassaemics. No anti HIV was detected in this cohort. Anti HCV seropositivity in haemophilics has increased compare to previous studies.

Eclampsia An Obstetric Disaster

Eclampsia has been graded as fatal and dreadful disease even before Christ and is the important cause ofmaternal and perinatal mortality in developed and developing countries. Severe morbidity associated witheclampsia include placental abruptio, cerebral haemorrhage, cortical blindness, renal failure, disseminatedintravascular coagulopathy, pulmonary oedema, psychosis and growth retardation and preterm or both.Present management of eclampsia aims to stop the convulsions, its recurrences, control of blood pressureand correct fluid and electrolyte balance and delivery of the baby. There have been great controversiesabout the best anticonvulsants to use. The randomised trials comparing magnesium sulphate with diazepamor phenytoin showed greater efficacy of magnesium sulphate in the control and prevention of recurrence offits. Perinatal mortality is also better with magnesium sulphate. Intramuscular injection is painful andlocal abscess formation at the site of injection is possible. Control of dose is better with intravenous routetherefore preferred. Magnesium sulphate should be continued for 24 hours after the delivery or after thelast fit. Antihypertensive drug therapy is now a routine practice in the management of pre-eclampsia andeclampsia. Methyl dopa, Lobetelol, Nefedipine are well tried in pregnancy and safe in pregnancy. However,hydralazine intravenous is good for quick and smooth control of blood pressure. Termination of pregnancyhas been an important part of the management of eclampsia. Studies have shown that maternal outcomesseems better with caesarean delivery compared to vaginal delivery. The caesarean section rate is high at26.3-80.4% in different studies. Recently maternal mortality and morbidity has been greatly improvedeven in developing countries by better control of fits by magnesium sulphate and caring them in intensivecare unit.Key Words: Eclampsia, Anticonvulsants, Antihypertensives, Delivery.