Rare case of coexisting hepatic, splenic, and vertebral hemangiomas - A case report

Synchronous existence of hepatic, splenic, and skeletal hemangiomas has not been reported previously in the English literature to our knowledge. In this case report, we present a case of coexistence of hepatic, splenic, and skeletal hemangiomas in a 30-year-old woman with on and off bilateral lumbar region pain and no significant past medical history. Radiological investigations, including ultrasound and computed tomography and magnetic resonance imaging helped identify the synchronous existence of hepatic, splenic, and skeletal hemangiomas. The patient improved with conservative management and was kept on follow-ups. Although there have been reports of coexistence of splenic and hepatic hemangiomas in the literature, to our knowledge, this is the first report of synchronous existence of hepatic, splenic, and skeletal hemangiomas.

Neglected case of recurrent abdominal pain due to a chronically retained and broken double J (DJ) stent following percutaneous nephrolithotomy (PCNL): A case report

Double J (DJ stent) is commonly used in urology practices. Short- and long-term complications of indwelling catheters are increasingly noted resulting in significant morbidity and at times mortality. Retained and broken DJ stent is however rare complication with few cases reported in the literature. We present a case of neglected retained and broken DJ stent in a 55-year-old male who had undergone percutaneous lithotripsy (PCNL) 4 years back presenting with recurrent abdominal pain and was misdiagnosed as peptic ulcer disease at various centers. Radiological investigations including ultrasound, radiographs, and computer tomography helped in identifying the retained and broken DJ stent. Patient improved with conservative management and left against medical advice for definite treatment. Patient education and ensuring proper follow-up can reduce the likelihood of complications associated with DJ stents.

Spontaneous extradural hematoma in a Sickle cell Beta Thalassemia patient-A rare complication

Spontaneous extradural hematoma in Sickle cell disease is rare neurological complication with few cases reported in the English literature. We report a case of a 16-year-old male patient who was previously diagnosed with Sickle Cell Beta Thalassemia and presented with severe headache and vomiting for 3 days. An emergency CT scan of the head demonstrated right-sided acute parietal extradural hematoma with mass effect. Patient underwent emergent craniotomy with evacuation of the hematoma. Patient recovered completely. Although calvarial infarction has been associated with extradural hematoma, an absence of it makes our case distinct. A high index of suspicion should be made in SCD patients for possibility of EDH in progressive headache.

An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report

Introduction

Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve.

Case Report

We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery.

Conclusion

This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.

Prescription Pattern Monitoring and Off-label Use of Medicines in the Pediatric Department at Tertiary Care Teaching Hospital

Background Off-label use means the use, concerning dosage, indication, route of administration, or age, of pharmaceutical products which are beyond the terms of the product license. For regulatory bodies and physicians, the global challenge is to achieve optimum pediatric drug therapy. Objective This prospective observational work was carried out in the paediatric department to evaluate the prescribing pattern of medicines and to identify the use of off-label drugs. Method A cross-sectional study was carried in 200 paediatric patients of ages between 0 and 12 years at the paediatric outpatient department of Universal College of Medical Sciences, Bhairahawa. Data were collected by reviewing the prescription paper and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed by using the World Health Organization (WHO) Prescription Indicators and off-label use was assessed using the WHO Children Formulary 2010. Result Among 413 total prescriptions, only 5.56% of drugs were found to be prescribed by generic name, 16.7% of prescriptions were found to be antibiotic and 57.62% of prescribed drugs were from essential drug list. Out of 413 prescribed drugs, 16.46% of drugs were found to be off-label. The maximum extent of off-label prescribing was 51.47% in the child, followed by infants (42.6%) and neonates (5.8%). Fexofenadine; antihistaminic (23.56%), Amoxicillin+clavulanic acid; antibiotic (22.06%) had higher off-label use. Off-label dose (71.8%) was the most common cause of off-label prescribing. Conclusion Off-label prescribing among pediatric patients is common.More eminence data on the safety and efficacy of off-label medicines must be generated to rationalize paediatric pharmacotherapy.

Gallbladder schistosomiasis - a rare presentation as gallbladder polyp: a case report

Background: Schistosomiasis is a neglected tropical disease second to malaria in prevalence with significant morbidity and mortality. Although, Schistosomiasis can affect multiple organs, gallbladder involvement is very rarely reported. We present a case of isolated gallbladder schistosomiasis in a 20-year-old female presenting as gallbladder polyp radiologically and also correlated the histopathological findings which to our knowledge has never been reported in the English literature. A high index of suspicion should be made for considering Schistosomiasis when an individual hailing from endemic region presents with gallbladder pathologies.

Genital filariasis presenting as a vaginal wall cystic lesion

Vaginal cystic lesions are rare incidental findings detected during physical examination and imaging. To our knowledge, filariasis as a cause of vaginal cystic lesions has not been previously reported in the English literature. We present vaginal cystic lesion which posed diagnostic dilemma and was confirmed on cytology to being filarial in etiology. The patient was treated with single-dose of oral diethylcarbamazine and the lesion subsided on follow up scans at three months thus avoiding inadvertent surgeries. Vaginal cystic lesions are rare entities and have multiple etiologies. A high degree of suspicion for filariasis as cause of vaginal cystic lesions should be made in individuals hailing from or have history of travel to endemic regions of filariasis.

A case report of visceral leishmaniasis and malaria co-infection with pancytopenia and splenomegaly - a diagnostic challenge

Background

Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management.

Case presentation

In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment.

Conclusions

A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.

P37 Do all notochordal lesions require proton beam radiotherapy? A case series of ecchordosis physaliphora

Objectives

Ecchordosis physaliphora (EP) is a benign, usually asymptomatic, notochord tumour but may also present with a spontaneous CSF fistula. Differentiating EP from its more aggressive counterpart, chordoma is challenging but important as the clinical course and management differ significantly, with the latter requiring proton beam radiotherapy. This case series aims to further inform this discussion.

Design

Case series.

Subjects

Patients with suspected EP from 2015–2018.

Methods

Retrospective analysis.

Results

Six patients were identified. Four presented with suspected CSF leak. MRI revealed a T1-hypointense and T2-hyperintense clival lesion without enhancement. CT showed pneumocephalus, a clival defect and no mass lesion. All underwent endoscopic endonasal repair of CSF fistula with biopsy. Histology revealed physaliphorous cells with no mitoses; immunohistochemistry confirmed notochord origin (EMA, S100, CD10 and/or MNF116) and low proliferation index. In 2 patients, EP was found incidentally on imaging and these lesions have remained static on follow-up.

Conclusions

In the absence of a clival mass, notochord remnant lesions with benign histopathology can be treated as EP and patients can avoid radiotherapy. The diagnosis of EP, however, remains challenging as no distinctive histopathological marker exists to differentiate it from chordoma and until a genetic or immunohistochemical marker is identified, the diagnosis rests solely on the presence or absence of a mass on imaging.

Molecular Epidemiology and Antigenic Characterization of Seasonal Influenza Viruses Circulating in Nepal

BACKGROUND

Influenza is one of the public health burdens in Nepal and its epidemiology is not clearly understood. The objective of this study was to explore the molecular epidemiology and the antigenic characteristics of the circulating influenza viruses in Nepal.

METHODS

A total of 1495 throat swab specimens were collected from January to December, 2014. Real time PCR assay was used for identification of influenza virus types and subtypes. Ten percent of the positive specimens were randomly selected and inoculated onto Madin-Darby Canine Kidney Epithelial cells (MDCK) for influenza virus isolation. All viruses were characterized by the hemagglutination inhibition (HI) assay.

RESULTS

Influenza viruses were detected in 421/1495 (28.2%) specimens. Among positive cases, influenza A virus was detected in 301/421 (71.5%); of which 120 (39.9%) were influenza A/H1N1 pdm09 and 181 (60.1%) were influenza A/H3 subtype. Influenza B viruses were detected in 119/421 (28.3%) specimens. Influenza A/H1N1 pdm09, A/H3 and B viruses isolated in Nepal were antigenically similar to the vaccine strain influenza A/California/07/2009(H1N1pdm09), A/Texas/50/2012(H3N2), A/New York/39/2012(H3N2) and B/Massachusetts/2/2012, respectively.

CONCLUSIONS

Influenza viruses were reported year-round in different geographical regions of Nepal which was similar to other tropical countries. The circulating influenza virus type and subtypes of Nepal were similar to vaccine candidate virus which could be prevented by currently used influenza vaccine.

Characterization of Seasonal Influenza Virus Type and Subtypes Isolated from Influenza Like Illness Cases of 2012

Background Seasonal influenza is one of the increasing public health burdens in Nepal. Objective The objective of this study was to isolate and characterize the influenza virus type and subtypes of Nepal. Method A total of 1536 throat swab specimens were collected from January to December 2012. Total ribonucleic acid was extracted using Qiagen viral nucleic acid extraction kit and polymerase chain reaction assay was performed following the US; CDC Real-time PCR protocol. Ten percent of positive specimens were inoculated onto Madin-Darby Canine Kidney cells. Isolates were characterized by using reference ferret antisera. Result Of the total specimens (n=1536), influenza virus type A was detected in 196 (22%) cases; of which 194 (99%) were influenza A (H1N1) pdm09 and 2 (1 %) were influenza A/H3 subtype. Influenza B was detected in 684 (76.9%) cases. Influenza A (H1N1) pdm09, A/H3 and influenza B virus were antigenically similar to the recommended influenza virus vaccine candidate of the year 2012. Although sporadic cases of influenza were observed throughout the year, peak was observed during July to November. Conclusion Similar to other tropical countries, A (H1N1) pdm09, A/H3 and influenza B viruses were co-circulated in Nepal.

Spectrum of Typical and Atypical Clinico-Histopathological and Radiological Presentation of Soft Tissue and Muscular Cysticercosis in Mid-Western and Far-Western Region of Nepal

INTRODUCTION

Soft tissue and muscular involvement in cysticercosis is a relatively rarer presentation.

MATERIALS AND METHODS

Twenty seven histopathologically confirmed cases of soft tissue and muscular cysticercosis were collected and the clinical, radiological data was reviewed.

RESULTS

There was female predominance for the lesions (19 cases among 27 cases). The most common location for the lesion was in the arm (9 cases), thigh (4 cases), forearm (7 cases), abdominal wall (4 cases) followed by nape of the neck (2 cases). Lesion ranged from 8 mm to 5 cm in size. Ultrasound was diagnostic in 24 cases and inconclusive in three cases. Histopathologically, intact cyst wall was noted in 12 cases, scolex in 5 cases. Seven cases showed degenerating cyst wall surrounded by inflammatory cells, granulation tissue and fibrosis.

CONCLUSION

Fine needle aspiration cytology and histopathological assessment is prudent in the diagnosis of soft tissue and muscular cysticercosis in cases posing clinical diagnostic dilemma.

Hereditary Spherocytosis with Splenomegaly and Cholelithiasis in a Young Male of Western Region of Nepal - A Case Report

Hereditary spherocytosis is an autosomal dominant congenital hemolytic anemia due to defect in RBC membrane protein that commonly presents with intermittent jaundice, anemia, abdominal pain, splenomegaly and sometimes cholelithiasis. Due to the membrane defect, there is increased fragility, hemolytic anemia, marked splenomegaly and hyperbilirubinemia. This is a report of an 11 years old male diagnosed case of hereditary spherocytosis who presented with jaundice, splenomegaly and cholelithiasis. He underwent elective open splenectomy and cholecystectomy after prophylactic immunization for capsulated organisms and was advised lifelong oral penicillin prophylaxis post-splenectomy.

Improved sensitivity of 3.0 Tesla susceptibility-weighted imaging in detecting traumatic bleeds and its use in predicting outcomes in patients with mild traumatic brain injury

BACKGROUND

The efficacy of susceptibility-weighted imaging (SWI) for detecting intracranial bleeds (ICBs) in patients with mild traumatic brain injury (MTBI) has not been directly compared to that of T2*-weighted gradient-recalled-echo imaging (T2*WI). Further, its prognostic value for MTBI patients remains unproven.

PURPOSE

To compare the sensitivity of ICB identification between SWI and T2*WI and examine the prognostic value of SWI for MTBI patients.

MATERIAL AND METHODS

T2*WI, SWI, and clinical information of 63 MTBI patients were collected. Sensitivity was compared between T2*WI and SWI for ICB identification, and statistical analysis was conducted to understand the correlations between SWI and clinical characteristics.

RESULTS

ICBs were detected in more patients (47 vs. 35, P < 0.001) and more ICBs were detected (276 vs. 147, P < 0.001) on SWI than T2*WI. On SWI, patients with conscious disturbance showed higher ICBs prevalence (84.6% vs. 58.3%, P = 0.020), and more patients from the post-concussive syndrome (PCS)(+) group than the PCS(-)group were ICBs positive (86.1% vs. 59.3%, P = 0.015). The numbers of ICBs were significantly higher in the PCS(+) group than the PCS(-) group (P < 0.001). Significant correlation was found between PCS and ICBs number (r = 0.510, P < 0.001). Multiple logistic regression analysis showed that ICB number was an independent variable predicting occurrence of PCS.

CONCLUSION

SWI is more sensitive than T2*WI in detecting hemorrhagic foci in MTBI patients and may offer valuable prognostic information regarding these patients, for example, information on PCS. Further, cerebral parenchymal hemorrhage may affect long-term outcomes in MTBI patients.

Effect of Dexamethasone and Pheniramine Maleate in Patients Undergoing Elective Laparoscopic Cholecystectomy

INTRODUCTION

Laparoscopic cholecystectomy (LC) is elective surgical procedure for uncomplicated gallstone disease and gallbladder polyp. The objective of this study was to assess the efficacy of Dexamethasone and Pheniramine hydrogen maleate on reducing stress response and pain after surgery in patients undergoing laparoscopic cholecystectomy.

METHODS

After obtaining approval from the institutional ethics committee and written informed consent, 120 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study from Sep 2103 to Aug 2014 at Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Patients were randomized to receive either 8mg/2ml of Dexamethasone + 45.5/2ml Pheniramine hydrogen maleate (treatment group, n= 60) or 5 ml of normal saline (control group, n=60) 90 minutes before skin incision.

RESULTS

There was a reduction of total bilirubin, C-reactive protein (CRP) value and Visual Analogue Score (VAS) in treatment group as compared to control group (p <0.05).

CONCLUSIONS

Use of Dexamethasone and Pheniramine hydrogen maleate prior to surgical skin incision helps to reduce both postoperative pain and acute physiological stress.

Monitoring the durability of long-lasting insecticidal nets in field conditions in Nepal

Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field is critical for the success of malaria prevention using mosquito nets, as well as contributing to procurement decisions based on the number of years of protection, rather than the current practice of unit cost. Using the recently published guidelines from the World Health Organization (WHO) some progress has been made in the monitoring and assessment of performance of nets in the field. This paper describes the protocol of an ongoing retrospective study of the attrition rate, physical integrity and bioefficacy of three polyester LLIN products that were distributed during 2010 to 2013 in Nepal. It is hoped that robust and auditable data on net survival (physical integrity and bioefficacy) of these three brands in different environments will assist the Nepal National Malaria Control Programme in planning future LLIN-replacement strategies, including behaviour-change communication about LLIN care and maintenance. The advantages and disadvantages of prospective and retrospective cross-sectional approaches are discussed, including appropriate strategies to validate the timing for mass distribution of nets. Similar studies should be done in other countries to (i) track LLIN durability to support management of resupply, and (ii) inform procurement decisions at the global level. New, more predictive, textile laboratory testing is also urgently needed.

HIV and Hepatitis B seroprevalence among the nepalese blood donors

Background: HIV and Hepatitis B infections are public health problems in Nepal. This study was conducted based at NRCS/CBTS, with the objective of determining the HIV and HBsAg sero-prevalence in non-remunerated volunteer blood donors. Materials and Methods: A total of 66,904 units of blood collected, following donor recruitment criteriaduring March 2009-Sept. 2010 was included for analysis. All donated blood samples were subjected to screening for Transfusion transmitted infections including HIV and Hepatitis B surface antigen using standard ELISA test kits (Dade Behring, Germany). Initial reactive sera were re-tested for reconfi rmation with same test kits plus another test kit (Detect-HIV, Adaltis Inc, and Qualisa). Results: Out of 66,904 units of blood collected, 56,973 units were from male and 9,931 were from female donors. Among the total screened samples, 73 (0.10%) were found to be positive for HIV, {0.11% (64/56973) in male and 0.09% (9/9931) in female}; the difference between male and female donors (?2<3.841) was statistically signifi cant. The seroprevalence of HIV was highest in age group of 30- 39 both in male and female (p<0.001). Similarly, for HBsAg, overall seroprevalence was found to be 0.47% (316/66904 {0.42% (242/56973) in male and 0.74% (74/9931) in female}. The difference was statistically signifi cant (?2<3.841). The highest HBsAg sero-prevalence(0.65%) was also observed in same age group i.e. 30-39 (p<0.001) in male but highest seroprevalence (2.63%) was observed inage group of ?50 in female. Conclusion: Both HIV and HBV sero-prevalence is high in adult voluntary blood donors. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 390-393 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7864

Incidence of incidental carcinoma gall bladder in cases of routine cholecystectomy

BACKGROUND

Carcinoma of gall bladder is the most common malignancy of the billiary tract. Most of the cases are diagnosed as an incidental case among patients undergoing cholecystectomy.

OBJECTIVES

To establish the rate of incidental carcinoma of gall bladder in patients undergoing routine cholecystectomy to study the demographic profile and prognosis of these patients.

METHODS

A retrospective study was carried out in Fishtail Hospital and Research Center, Pokhara during 1998-2009. The surgical notes, hospital records and histopathology reports of 783 patients undergoing routine cholecystectomy were studied.

RESULTS

Out of 783 cases, gall bladder cancer was detected in 10(1.28%) of cases and was more common in females (M:F ratio 1:2.3) and the mean age of occurrence was 63.8 years. Most of the cases diagnosed were at their early stages and none of them were in T3 and T4 stages. Six of these patients have survived till a mean follow up duration of 23.7 months.

CONCLUSION

The rate of incidental carcinoma of gall bladder is 1.28%.

(1)H magnetic resonance spectroscopy and diffusion weighted imaging findings of medulloblastoma in 3.0T MRI: A retrospective analysis of 17 cases

¹H magnetic resonance spectroscopy and diffusion weighted imaging features of the cerebellar vermis in 17 medulloblastoma patients were retrospectively analyzed, and 17 healthy volunteers were selected as controls. ¹H magnetic resonance spectroscopy showed that in all 17 medulloblastoma patients, N-acetyl aspartate and creatine peaks were significantly decreased, the choline peak was significantly increased, and there was evidence of a myo-inositol peak. Further, 11 patients showed a low taurine peak at 3.4 ppm, five patients showed a lipid peak at 0.9–1.3 ppm, and three patients showed a negative lactic acid peak at 1.33 ppm. Compared with the control group, the ratios of N-acetyl aspartate/choline and N-acetyl aspartate/creatine were significantly decreased, and the ratio of choline/creatine was increased, in medulloblastoma patients. Diffusion weighted imaging displayed hyperintensity and decreased apparent diffusion coefficient in medulloblastoma patients. These findings indicate that ¹H magnetic resonance spectroscopy and diffusion weighted imaging are useful for qualitative diagnosis of medulloblastoma.

Primary pulmonary cryptococcosis: evaluation of CT characteristics in 26 immunocompetent Chinese patients

BACKGROUND

Discrepancies still exist in the diagnosis of primary pulmonary cryptococcosis in immunocompetent patients.

PURPOSE

To describe and evaluate radiological manifestations of pulmonary cryptococcosis in immunocompetent patients.

MATERIAL AND METHODS

Twenty-six histopathologically confirmed cases of pulmonary cryptococcosis were analyzed for clinical, pathological, and CT characteristics. Necessary statistical tests for differences in CT presentations and correlation analysis between clinical and CT characteristics were performed.

RESULTS

The patients' ages ranged from 24 to 79 years, with 20 men and six women. Eighteen patients were symptomatic, with cough as the most common symptom (n = 14, 53.8%). Nodules (n = 21, 80.8%) were the most common CT findings. Eight cases presented with solitary and nine with multiple nodules, while 13 cases presented with irregular and 19 with ill-defined nodules. The halo sign was demonstrated, encompassing nodules in 14 of the 21 patients. Lesions were mainly localized in the lower lobes of the lungs (n = 15, 57.7%) with peripheral distribution (n = 18, 69.2%). Ground-glass opacities (GGOs) were more easily detected in older patients (66.7%, P <0.01). No significant differences in CT abnormalities were found between male and female patients.

CONCLUSION

Primary pulmonary cryptococcosis in immunocompetent patients exhibits certain CT characteristics. The typical presentation includes multiple nodules with the halo sign scattered in the peripheral field in the lower lobes of the bilateral lungs. This could contribute to diagnosis of the disease entity. However, vigilance should be exercised when facing GGOs, with or without nodules, in older patients.

Significance of adenosine deaminase in diagnosing tuberculous pleural effusion

Tuberculosis (TB) is a major public health problem in developing countries including Nepal. One of the common presentations of TB is pleural effusion. The diagnosis of tubercular pleural effusion can be difficult because of the low rate of detecting tubercule bacilli by direct stain and culture of pleural fluid for acid-fast bacilli (AFB). Pleural biopsy can be useful but is invasive and requires experts. In this context, pleural fluid Adenosine Deaminase (ADA) level has been proposed as easy, cheap and highly sensitive test for diagnosis of TB pleural effusion. The present study was undertaken to define the role ofpleural fluid ADA value in accurate diagnosis of TB pleural effusion. A Prospective analysis of 100 patients admitted in Nepal Medical College and teaching Hospital with pleural effusion was done. Pleural fluid ADA level was evaluated in all patients, and significance of pleural fluid ADA level in TB pleural effusion was studied. It was found that mean ADA level in pleural fluid was 105.8 +/- 67.23 U/L in cases of TB, as compared to 16.83 +/- 8.91 U/L in malignancy, 44.53 +/- 32.84 U/L in parapneumonic effusion and 15.94 +/- 4.88 U/L in patients with miscellaneous diagnosis. For a cut-off value of 42.19 U/L for diagnosis of TB pleural effusion, sensitivity was found to be 90.8% and specificity 82.8%. Almost all patients diagnosed to have TB pleural effusion responded completely to anti-tubercular treatment. So, we concluded that pleural fluid ADA analysis could be easy, cheap and highly sensitive and specific test for diagnosis of TB pleural effusion.

Magnetic resonance imaging characteristics of primary intraspinal peripheral primitive neuroectodermal tumour

PURPOSE

The purpose of our study was to describe the salient magnetic resonance imaging (MRI) findings in primary intraspinal peripheral primitive neuroectodermal tumour (PNET).

METHODS

A retrospective review of the clinical and MRI images of 7 pathologically proven cases of intraspinal peripheral PNETs was performed. The various parameters, such as vertebral level of involvement; tumour location, size, focality, and margin; signal intensity of the lesion; the presence of hemorrhage or calcification; any signal voids; assessment of the adjacent cord for cord compression; cord dilatation; the presence of paraspinal tissue mass; or vertebral or other bony changes, were analysed.

RESULTS

All 7 patients had lesions in the thoracolumbar region. Three patients had extradural lesions, 4 had intradural extramedullary lesions, and none had intramedullary lesions. Six lesions were well circumscribed. Only 1 patient had multifocal involvement. All lesions were of hypointense or isointense signal on T1-weighted imaging, whereas all but one were hyperintense on T2-weighted imaging. Lesions enhanced heterogeneously except 1 intradural extramedullary lesion, which enhanced homogeneously. A paraspinal mass was noticed in 2 patients. Vertebral collapse was present in 1 patients.

CONCLUSION

Intraspinal peripheral PNETs are rare spinal tumours. Although imaging characteristics are not specific, a focal circumscribed lesion in a young individual at the intramedullary, extramedullary intradural, or extradural spinal location that shows hypointense and hyperintense signal on T1- and T2-weighted images, respectively, requires PNET to be considered in the differentials.

Study of rifampicin and isoniazid resistance mutation genes of M. tuberculosis isolates in Nepal

We studied the rifampicin (RIF) and isoniazid (INH) resistant genes in Mycobacterium tuberculosis isolated from sputum samples of re-treated TB cases using phenotypic drug susceptibility test (DST) and rapid molecular method (Genotype; MTBDR plus, Hains Life Science, Nehren, Germany). Of the total 207 isolates included in this study, 90 (42.0%) were RIF resistant, 107 (50.7%) were INH resistant whereas 86 (41.5%) were multidrug resistant (MDR) by DST. According to genotypic analysis, 37.0% (77/207) were RIF resistant, 50.2% (105/207) INH resistant and 70 (33.8%) were MDR. Among the total 90 RIF resistant isolates, 85.5% (77/90) showed mutation in 81 bp of rpoB gene and the mutation locus were distributed as follows; MUT1 Asp516Val (16.7%; 15/90), MUT2A His526Tyr (6.6%; 6/90), MUT2B His526Asp (5.5%; 5/90) and MUT3 Ser531Lue (56.7%; 51/90). Among the total 107 INH resistant isolates, the mutation located in katG gene was 98.1% (105/107) and in inhA MUT1 gene was (16.8%; 18/107). The mutation locus were distributed as follows; MUT1 Ser315Thr (77.6%; 83/107), MUT2 Ser315Ile (3.7%; 4/107) in katG and in inhA MUT1Cys15Thr (16.8%; 18/107). The highest frequency of mutations in rpoB gene was found at the region of codon Ser531Leu (56.7%) while the frequency of mutation in katG and inhA gene were found at the region of codon Ser315Thr (77.6%) and Cyst15Thr (17.1%), respectively. The rapid molecular test kit used in this study was found to be sensitive as well as specific for detection of RIF and INH resistant gene and also helpful in early detection of MDR-TB.

Primary retroperitoneal malignant melanoma: A case report

Primary malignant melanoma occurring at an extra cutaneous site is rare. A case of primary malignant melanoma located in the retroperitoneum of an 18-year-old female is presented in this study. Histopathological examination of the tissue biopsies at laparotomy with immunohistochemical stains confirmed a diagnosis of malignant melanoma. Further extensive clinical and radiological investigations proved the retroperitoneum to be the primary site.

Seroprevalence of HBV and HCV in blood donors: A study from regional blood transfusion services of Nepal

BACKGROUND AND OBJECTIVE

Hepatitis B and hepatitis C are significant health problems that might involve the late sequel of liver cirrhosis and hepatocellular carcinoma. A high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors poses an increased risk of window period transmission through blood transfusion. The present study aimed to know the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors in regional blood transfusion services of Nepal.

MATERIALS AND METHODS

This was a retrospective study conducted among blood donors in Banke (5,211), Morang (5,351), and Kaski (5,995) blood transfusion services. Serum samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using rapid enzyme immunoassays. The donors information was collected via the donor record register through their respective blood transfusion services. The software "Winpepi ver 3.8" was used for statistical analysis.

RESULTS

The seroprevalence rate of HBV was highest in the Banke (1.2%) followed by Biratnagar (0.87%) and Kaski (0.35%) (P < 0.0001). The seroprevalence of HCV was highest in the Morang (0.26%) followed by Kaski (0.16%) and Banke (0.11%) (P > 0.05). The seroprevalence of HBV was significantly higher than HCV in all three blood transfusion services. The burden of HBV as well as HCV seems to be higher in male donors (P > 0.05).

CONCLUSION

The study revealed that the seroprevalence of HBV was alarmingly higher in two of the three blood transfusion services. Implementation of community-based preventive measures and improved strategies for safe blood supply might prove useful to decrease the seroprevalence.

Pulmonary cryptococcosis and tuberculoma mimicking primary and metastatic lung cancer in 18F-FDG PET/CT

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely incorporated in cancer management. Although, it has increased sensitivity, 18F-FDG is not tissue specific thus posing diagnostic dilemma in certain situations. False positivity in pulmonary nodules have been seen in various inflammatory, infective as well as post operative conditions while false negativity is common with adenomas, low grade lymphomas, bronchoalveolar carcinomas and carcinoid tumors. We present two cases of granulomatous diseases as pulmonary cryptococcosis and tuberculosis showing false positivity in a resected colorectal cancer patient and highlight the importance of recognition of this entity in an endemic region for granulomatous infections.

Rare synchronous primary large B-cell gastric lymphoma and huge retroperitoneal liposarcoma with inguinal hernia in chronic hepatitis B patient

Multiple primary neoplasms with synchronous or metachronous presentation are rare, although the incidence has recently increased because of several factors. We present the case of a 53-year-old patient with chronic hepatitis B who presented with abdominal mass, mild abdominal pain, and inguinal hernia. Computed tomography imaging demonstrated diffuse thickening of the gastric antral wall, together with a huge heterogeneous abdominal mass with predominant fat attenuation with septa that showed mild enhancement on contrast-enhanced scans. Distal gastrectomy and wide resection of the retroperitoneal mass was performed. Pathology exam led to a diagnosis of diffuse large B-cell gastric lymphoma with retroperitoneal liposarcoma. This is a rare case of a primary gastric lymphoma with another primary (sarcomatous) malignancy occurring synchronously in same patient.

Primary gastrointestinal lymphoma

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.

Spigelian hernia

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. So far, about 1000 cases have been reported worldwide. These hernias are difficult to diagnose as they do not present with a subcutaneous swelling and have high risk of going for strangulation. We discuss the case of a 36 year old female who presented with history of pain and lumpiness in left lower abdomen, both of which decreased on lying down. She presented to emergency with an episode severe pain at same site which subsided spontaneously. Diagnosis was confirmed on CT scan, plication and onlay prolene mesh repair performed. Spigelian hernias are rare, interparietal type of hernias which have high risk undergoing strangulation. Knowledge of symptoms and signs is vital to diagnosis and treatment of these rare type of hernias.

Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review

Primary lymphoma that involves the esophagus is very rare, with fewer than 30 cases reported in the English-language literature. Non-Hodgkin lymphoma accounts for most of the cases. Esophageal lymphomas have varied radiological appearances, which poses diagnostic difficulty. We report two cases of histopathologically confirmed primary diffuse large B-cell esophageal lymphoma and describe their radiological features, and briefly review the literature.

Epidemiology of malaria in two Eastern districts of Nepal

BACKGROUNDS

Malaria is one of the major public health problems in Southeast Asia including Nepal having relatively high burden of malaria. Jhapa and Morang districts are malaria endemic plain area of South-eastern part of Nepal.

OBJECTIVES

The evaluate the recent epidemiology of malaria situation in Jhapa and Morang districts, which are the districts in eastern Nepal with high transmission of malaria and to assess the knowledge, attitudes and practices of the people in prevention and treatment for malaria infection.

MATERIALS AND METHODS

This descriptive cross-sectional study was carried out with volunteer participation of suspected malaria patients seeking care at the government of Nepal managed primary health care centres located in 2 malaria endemic districts in eastern Nepal. Conventional Giemsa stained thick and thin blood smears prepared from finger prick blood were examined following standard protocols. Suspected patients'/attendants' knowledge on malaria, disease symptoms, prevention and control measures were assessed using a structured questionnaire. Chi square and Fisher exact test were used for statistical analysis of the data.

RESULTS

Among the total 199 malaria suspected cases studied, 32 (16.1%) cases were confirmed by microscopic findings; where, P. vivax was 12.6% (25/199) and P. falciparum in only 3.1% (6/199). The highest numbers of cases were in age group 20-29 years. Among the total positive cases 75% were male and 37.5% were labourers in occupation. Among the total cases, 32 had provided the history of recent travel to malaria endemic area in India, among them 43.8% (P<0.001) were found to be infected with the malarial parasites (P<0.001). Among the total cases, 69.7% showed some knowledge of malaria, among which fever was the most common symptom mentioned by 68.3%. Occupation (P<0.001) and education (P<0.001) were found significantly associated with the knowledge on mode of transmission.

CONCLUSION

Jhapa district showed higher SPR than Morang, which indicated that Jhapa may be more malaria affected than Morang. Knowledge on malaria transmission and preventive measures are still lacking in deep villages, in spite of different efforts of the government. To improve the malaria morbidity in the districts, health education of the most marginalized people through audio visual methods may be beneficial.

Antibiotic susceptibility of group A Streptococcus isolated from throat swab culture of school children in Pokhara, Nepal

Group A Streptococcus (GAS) or Streptococcus pyogenes is estimated to be present in 5.0-15.0% of norma individual in the respiratory tract, vagina, skin and anus without any sign of disease. This study was carried out to find out the rate of asymptomatic throat carriage of S. pyogenes and antibiotic susceptibility of the isolates in school children of Pokhara, Western Nepal. A total of 487 randomly selected children younger than 16 years were included in the study. Throat swabs collected were subjected to 5.0% Sheep blood agar supplemented with crystal violet (CVBA).GAS was identified by a-haemolytic colonies, bacitracin sensitivity, cotrimoxazole resistivity, catalase negativity and PYR positivity. Antibiotic susceptibility test was performed on Muller Hinton agar (MHA) containing 5% sheep blood by modified Kirby-Bauer disc diffusion method. Out of total 487 throat swabs, GAS was isolated in 9.2% (n = 45). Among the isolates, 46.6% (n = 21) were from male children where as 53.4% (n = 24) from female children. There was no significant sex difference in colonization of GAS (p > 0.05). Out of 45 isolates, 100.0% isolates were sensitive to antibiotic penicillin-G and amoxycillin where as 15.6%, 6.6%, and 2.2% isolates were resistant to antibiotic erythromycin, tetracycline and azithromycin respectively.

Perfusion computed tomography in colorectal cancer: Protocols, clinical applications and emerging trends

Perfusion computed tomography (CT) has emerged as a novel functional imaging technique with gradually increasing importance in the management of colorectal cancer (CRC). By providing the functional tumor microvasculature, it also helps the assessment of therapeutic response of anti-angiogenic drugs as it may reflect tumor angiogenesis. Perfusion CT has been applied in clinical practice to delineate inflammatory or neoplastic lymph nodes irrespective of their size, identify micro-metastases and to predict metastases in advance of their development. It is of increasing significance for preoperative adjuvant therapies and avoidance of unnecessary interventions. Despite controversies regarding the techniques employed, its validity and reproducibility, it can be advantageous in the management of CRCs in which the prognosis is dependent on preoperative staging. With recent advances in the perfusion CT techniques, and incorporation to other modalities like positron emission tomography, perfusion CT will be a novel tool in the overall management of CRCs. This article aims at reviewing the existing clinical applications and recent advances of perfusion CT with a reference to future development in the management of CRCs.

Seroprevalence of anti HCV antibodies among blood donors in Kathmandu valley, Nepal

AIMS AND OBJECTIVES

To study the seroprevalence of anti HCV antibodies among Nepalese blood donors in relation to their age, sex, type of donation and times of donation.

MATERIALS AND METHODS

Descriptive cross-sectional study conducted in Nepal Red Cross Society (NRCS), Central Blood Transfusion Service (CBTS), Kathmandu, from December 1, 2006 to September 1, 2007. A total of 33,255 blood donors were screened for anti HCV antibodies by ELISA. Donor's information was collected from blood donor's record form and statistical analysis was done using the software 'SPSS 11.5' and 'Winpepi ver. 3.8'.

RESULT

The seroprevalence of anti HCV antibodies in blood donors was 0.66% (95% CI= 0.58-0.76). Higher seroprevalence was observed in male donors (0.7%, 95% CI= 0.6-0.8) than in female donors (0.4%, 95% CI= 0.2-0.6) (P < 0.05). The seroprevalence was highest (0.82%) in the age group of 21-30 years and there was significantly decreasing trends in seroprevalence with increasing age (P < 0.05). The highest seroprevalence among the male donors (0.88%) was also observed in the age group of 21-30 years (P < 0.001). Among female donors the seroprevalence (0.47 %) was highest in age group 41-50 years (P > 0.05). The seroprevalence of anti HCV was significantly higher in volunteer donors (0.7%) than in replacement donors (0.4%) (P < 0.05). Similar seroprevalence of anti HCV was observed in first time (0.65%) and repeat blood donors (0.67%) (P > 0.05).

CONCLUSION

The seroprevalence of anti HCV antibodies among blood donors in this study was similar to the seroprevalence reported for general population by other studies. Similar seroprevalence in first time and repeat blood donors as well as higher seroprevalence in volunteer donors than in replacement donors are the potential threats to safe blood supply, which urges the need of more effective donor education and counselling of blood donors.

Comparative evaluation of microscopy and polymerase chain reaction (PCR) for the diagnosis in suspected malaria patients of Nepal

Microscopy has been the most common technique for the diagnosis of malaria in Nepal. This study was undertaken at CDM, TU, Kathmandu, and Department of Clinical Tropical Medicine, Mahidol University, Bangkok to compare the efficiency of microscopy and PCR for malaria diagnosis in Nepalese context. During July-August 2007, blood samples were collected in glass slides and on filter papers from suspected malaria cases of Kanchanpur, Jhapa and Morang Districts. Sample transportation and storage was done using standard protocol. Microscopy was done at the heath posts in the district in Nepal while Nested PCR using previously standardized primers was carried out at Mahidol University. Among 824 malaria suspected cases, 19.2% (157) were laboratory confirmed as malaria cases (P. vivax 10.9%, P. falciparium 7.7% and 0.4% were of mixed infection) by microscopy. The parasite count range was detected as 320-25020 parasites/microl. Among total 132 samples (114 microscopic positive, 18 negative) were processed for nested PCR. Among microscopic positive samples with increase of the parasitaemia/microl of the blood, the rate of detection by PCR (75.4%) was increased though the PCR failed to detect 2 cases having the parasitaemia 5000-15000/microl of blood however 4 microscopic negative cases were detected as P. vivax infection. Among the microscopy positive samples for P. falciparum, 3 were found P. vivax and 2 were found as mixed infection of Pv and Pf and 6 P. vivax were found positive for P. falciparum by PCR. Two microscopy positive samples for mixed infection were found be positive for one Pv and one Pf by PCR. PCR could be good tool in confirming the clinically strongly suspected but microscopically negative malaria cases and advanced molecular epidemiological studies, although its use in routine diagnosis may not be feasible.

Tuberculosis co-infection in HIV infected persons of Kathmandu

Tuberculosis is itself a major Public health problem in Nepal and the emergence HIV further complicated the issue. A cross-sectional analytical study was conducted between January 2004 and August 2005, with a general objective to determine the Tuberculosis co-infection status in HIV/AIDS cases of Nepal. Altogether 100 HIV infected persons visiting different Voluntary counseling and testing centers (VCT) and HIV/AIDS care centers located in Kathmandu valley were enrolled in the study. Investigation of tuberculosis was done by standard method prescribed by WHO using sputum specimen. Among 100 HIV infected cases, 66 (66.0%) were males and 34 (34.0%) were females. Majority of the HIV cases were in the age group 21-30 (60.0%) followed by 31-40 (31.0%). Tuberculosis was detected in 23 cases with highest prevalence in the age group 21-30 years (65.2%). No significant relationship could be established between gender and TB (c2 = 0.83, p > 0.01).Significant relationship was established between smoking/alcoholic habit and the subsequent development of tuberculosis (c2 = 7.24, p < 0.05 for smoking habit; c2 = 4.39, p < 0.05 for alcoholic habit at 1 degree of freedom). Among 22 culture positive isolates the predominant was Mycobacterium avium complex (40.9%) followed by M. tuberculosis (27.3%), M. kansasii (18.2%), M. fortuitum (9.1%) and M. chelonae (4.5%). Among the 23 cases of tuberculosis, 22 cases were diagnosed by cultural technique of which 4 cases were smear positive while the remaining one case was diagnosed by direct microscopy although it was culture negative. Smear negative Tuberculosis is found to be alarmingly higher in HIV positive individuals of productive age group. The disease significantly higher in smokers and alcoholics.

Study on CD4 cell responses in HIV infected subjects in Nepal

HIV infection is characterized by gradual deterioration of immune function mainly the CD4 cells. This study was conducted with the objectives to evaluate the kinetics of CD4 cell depletion and duration of HIV infection and the role of ART in improving CD4 cell levels specifically in Nepalese HIV patients. During April 2005 to March 2006, all together 220 blood samples collected from 110 HIV patients visiting National Public Health Laboratory (NPHL), Kathmandu, were analyzed for CD4 cell count using standard protocol. CD4 cell count before and after starting of anti-retro viral therapy showed significant association (P<0.05). The results of this study clearly indicated that antiretroviral therapy has been playing a role in maintenance CD4 cell counts in HIV infected patients.

Characterization of mycobacteria in HIV/AIDS patients of Nepal

Besides Mycobacterium tuberculosis, a number of other Mycobacterium species are also occasional human pathogens. Tuberculosis due to Mycobacterium avium complex (MAC) and Mycobacterium kansasii is particularly prevalent in AIDS patients as compared to the normal population. A cross-sectional study was carried out during January 2004 to August 2005 in 100 HIV-infected persons visiting Tribhuvan University, Teaching Hospital, and about a dozen of HIV/AIDS care centers of Kathmandu with the objectives to characterize the different mycobacterial species in HIV/AIDS patients. Three sputum specimens from each person were used to investigate tuberculosis by Ziehl-Neelsen staining, culture and identification tests. Among the 100 HIV-infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Mycobacteria were detected in 23 (23%) HIV cases of which 15 (65.2%) were in the age group of 21-30 years ; 17(74%) were males and 6 (26 %) were females. Among 23 co-infected cases, 22 were culture positive for mycobacteria. Among these, the predominant one was Mycobacterium avium complex (MAC), 9 (41%), followed by M. tuberculosis, 6 (27%), M .kansasii, 4 (18%), M. fortuitum, 2 (10%) and M. chelonae 1 (4%). Significant relationship was established between smoking/alcoholism and the subsequent development of tuberculosis (chi(2)=7.24, p<0.05 for smoking habit and chi(2)=4.39, p<0.05 for alcoholism). Fourteen (61%) co-infected cases presented with weight loss and cough whereas diarrhea was presented only by those patients with atypical mycobacterial co-infection, which was as high as 5 (56%) in patients with MAC co-infection. This study demonstrated the predominance of atypical mycobacteria, mainly MAC, in HIV/AIDS cases and most of them were from sputum smear-negative cases.

Characterization of Mycobacteria in HIV/AIDS Patients of Nepal

Besides Mycobacterium tuberculosis, a number of other Mycobacterium species are also occasionalhuman pathogens. Tuberculosis due to Mycobacterium avium complex (MAC) and Mycobacteriumkansasii is particularly prevalent in AIDS patients as compared to the normal population. A crosssectionalstudy was carried out during January 2004 to August 2005 in 100 HIV-infected personsvisiting Tribhuvan University, Teaching Hospital, and about a dozen of HIV/AIDS care centersof Kathmandu with the objectives to characterize the different mycobacterial species in HIV/AIDSpatients. Three sputum specimens from each person were used to investigate tuberculosis by Ziehl-Neelsen staining, culture and identifi cation tests. Among the 100 HIV-infected cases, 66 (66%) weremales and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years.Mycobacteria were detected in 23 (23%) HIV cases of which 15 (65.2%) were in the age group of 21-30years ; 17(74%) were males and 6 (26 %) were females. Among 23 co-infected cases, 22 were culturepositive for mycobacteria. Among these, the predominant one was Mycobacterium avium complex(MAC), 9 (41%), followed by M. tuberculosis, 6 (27%), M .kansasii, 4 (18%), M. fortuitum, 2 (10%) andM. chelonae 1 (4%). Signifi cant relationship was established between smoking/alcoholism and thesubsequent development of tuberculosis (χ2=7.24, p<0.05 for smoking habit and χ2=4.39, p<0.05for alcoholisn). Fourteen (61%) co-infected cases presented with weight loss and cough whereasdiarrhea was presented only by those patients with atypical mycobacterial co-infection, which wasas high as 5 (56%) in patients with MAC co-infection. This study demonstrated the predominanceof atypical mycobacteria, mainly MAC, in HIV/AIDS cases and most of them were from sputumsmear-negative cases.Key words: Human Immunodefi ciency Virus, mycobacteria, tuberculosis

Tuberculosis and other clinical presentation of HIV/AIDS in patients with or without undergoing antiretroviral therapy in Kathmandu

OBJECTIVES

To screen tuberculosis (TB) and examine the clinical presentation of AIDS in HIV sero-positive persons.

METHODS

A Cross-sectional study was designed. One hundred HIV infected persons were randomly selected from different parts of the country visiting Tribhuvan University, Teaching Hospital, Kathmandu and different HIV/AIDS care centres. After taking informed consent, questionnaires were filled and three sputum specimens from each person were collected to investigate tuberculosis by Ziehl-Neelsen staining and culture. Data generated were entered into SPSS 11.5 and relevant statistical tools were applied.

RESULTS

Among 100 HIV infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Majority of them were Smokers (41%), alcoholics (34%), illiterates (54%) and unemployed (59%). Heterosexual activity (51%) was found to be the major risk factor for HIV infection. Of the 100 HIV cases, 23 (23%) were co-infected with tuberculosis of which 18(78%) were sputum smear negative tuberculosis, mostly developed in late stage of HIV infection. Weight loss (54%) and diarrhoea (43%) were the major clinical presentations of AIDS. Antiretro-viral therapy non-receiver were more likely to suffer with various clinical disorders/TB as compared to ARV therapy receiver but the values were statistically insignificant, 2 values ranging from 0.003 to 2.24, p>0.05.

CONCLUSION

Prevalence of tuberculosis was still high in HIV/AIDS patients, and specifically, sputum smear negative tuberculosis cases constituted the significant proportion, particularly in late stage of HIV infection. Weight loss and diarrhoea were found to be the major clinical presentation of AIDS. Illiterate and unemployed young adults involved in unsafe sexual practice and drug addiction were high risk of acquiring HIV infection. Key words: Clinical features, HIV/AIDS, Kathmandu; Smear Negative Tuberculosis.

Comparison of Acid Fast Bacilli Smear and Culture for the Diagnosis of Extra-Pulmonary Tuberculosis

The study was conducted with the objectives to compare the Acid Fast Bacilli (AFB) staining and Culture for the diagnosis of extra-pulmonary tuberculosis and to find out the burden of extra-pulmonary tuberculosis from the different site of the body in suspected TB patients. The standard Ziehl-Neelsen Technique was done for AFB staining and culture was done in Ogawa Medium. Of the 292 extra-pulmonary samples examined by AFB smear only 2(0.7%) were positive and of the 1058 extra-pulmonary samples cultured 20 (1.9%) were positive. The isolation rate for extra-pulmonary samples was three fold higher in culture in comparison to AFB Smear. The confirmation rate of extra-pulmonary tuberculosis was approximately 1/ 8th of the pulmonary tuberculosis by conventional bacteriological diagnostic methods. Of the extra-pulmonary tuberculosis renal, endometrial or pelvic and cold abscess were common in this study. M.tuberculosis was also isolated from peritoneal fluid, pericardial fluid, Synovial fluid, lymph node and cerebro spinal fluids only by culture. In conclusion, the standard AFB culture has significant role for diagnosis of extra-pulmonary tuberculosis, even though the conventional bacteriological technique could diagnose very low number of extra-pulmonary tuberculosis. The new methods of diagnosis should be considered to confirm more extra- pulmonary  tuberculosis.Key Words: Extra-pulmonary tuberculosis, AFB Smear, Culture, Diagnosis, Nepal.

Neurenteric Cyst- Case Report

Abstract

Quantitative buffy coat: a special adjunct for diagnosis of malaria

Quantitative buffy coats (QBC) technique was compared with conventional blood film technique for the diagnosis of malaria in a tertiary care hospital. The QBC technique was found to be a rapid technique with a sensitivity of 83% and specificity of 94%. Malaria species identification was also possible. It was essentially very useful to detect parasites below < or = 100 parasites/ul of blood by QBC technique. However, quantification of parasitaemia could not be made using this technique. Many cases of carriers having very few gametocytes in their blood were also identified. It is therefore, concluded that the QBC technique, may be appropriate for screening populations for malaria and for detection of asymptomatic carriers to control further transmission of the disease in the community.