Human NLRC4 promotes cancer survival and is associated to type-I interferon signaling and immune infiltration

The immune system can control cancer progression. However, even though some innate immune sensors of cellular stress are expressed intrinsically in epithelial cells, their potential role in cancer aggressiveness and subsequent overall survival in humans is mainly unknown. Here, we show that NLR family CARD Domain Containing 4 (NLRC4) is downregulated in epithelial tumor cells of colorectal cancer (CRC) patients by using spatial tissue imaging. Strikingly, only the loss of tumor NLRC4 but not stromal is associated with poor immune infiltration (mainly dendritic and CD4+/CD8+ T cells) and accurately predicts progression to metastatic Stage IV and decrease of overall survival. By combining multi-omics approaches, we show that restoring NLRC4 expression in human colorectal cancer cells triggers a broad inflammasome-independent immune reprogramming consisting of Type-I IFN signaling genes and the release of chemokines and myeloid growth factors involved in the tumor infiltration and activation of dendritic cells (DCs) and T cells. Consistently, such reprogramming in cancer cells is sufficient to directly mature human DCs towards a Th1 antitumor immune response through IL-12 production in vitro. In multiple human carcinomas (colorectal, lung, and skin), we confirmed that NLRC4 expression in patient tumors is strongly associated with Type-I IFN genes, immune infiltrates and high microsatellite instability. Thus, we shed light on the epithelial innate immune sensor NLRC4 as a novel therapeutic target to promote an efficient antitumor immune response against the aggressiveness of various carcinomas.

Pyrexia in Pregnancy and its Maternal and Fetal Outcome

Background Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (> 38°C), could potentially affect the fetus. Fetus being an integral part of the feto-maternal unit and pregnancy involving numerous physiological changes and adaptations, pyrexia during the pregnancy affects both the mother and her fetus adversely. Objective To find the etiology and prevalence of fever in pregnancy and to know the effect of fever on maternal and fetal outcome. Method Pregnant ladies with fever > 38°C, presenting to Obstetrics and Gynecology, Department of Dhulikhel Hospital were enrolled in the study. A detailed clinical history, thorough general and physical examinations were done. All risk factors were asked and recorded including all baseline investigations and cases were followed up till delivery. Maternal and fetal outcomes were recorded. Data were recorded in Excel and calculated using SPSS 26. Result Eighty patients presented with complaints of fever were included in this study. The mean age of the patient was 25.49± 4.50 years. Out of 80 patients, 46 (57.50%) presented with fever in the third trimester. The most common etiology of fever being urinary tract infection in 21 (26%) cases followed by respiratory tract infection in 20 (25.1%) cases. Twenty two newborns had low birth weight among which 12 (15%) neonates had IUGR. About 14 (17.5%) neonates were admitted in NICU due to various complications and perinatal mortality was in 9 (11.25%) cases. The most common antepartum complication was preterm labor in 16 (20%) cases. Conclusion Fever in pregnancy is still a challenge to obstetrician and the society at large due its problems related to its prevention, diagnosis, management and its feto-maternal outcome. Hence, an evaluation of the effect and outcomes of fever in pregnancy, provides definite knowledge of clinical epidemiology, and facilitates optimum prioritization of efforts and resources.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Burden of Stroke in Nepal: Findings from Global Burden of Disease Dataset 2017

Background Stroke is the second leading cause of death and disability worldwide including Asian countries, surpassing ischemic heart disease. Stroke accounts for 10% of global death, of which more than three fourth occur in low- and middle-income countries. An exact estimate of the burden of stroke in Nepal is not available. Objective To assess the burden of stroke including disability and death over time in Nepal and compare it with other South Asian countries. Method We retrieved data from the Institute of Health Metrics and Evaluation's Global Burden of Diseases database of 2017 on stroke deaths, disability-adjusted life years, incidence, and prevalence rates, for both genders from Nepal, Bangladesh, Pakistan, Bhutan, and India by year. We assessed the trend of deaths and Disability-Adjusted Life Years (DALYs) due to stroke from 1990 to 2017; and the contribution of major risk factors to stroke burden in 2017. Result Stroke contributed 7.6% of total deaths and 3.5% of total DALYs in Nepal, with a higher burden among the male and old age population. Intracerebral hemorrhage was the dominant type of stroke in Nepal with the highest proportion of deaths and DALYs. Among the South Asian countries, incidence, prevalence, and burden of stroke were highest in Bangladesh. Intracerebral hemorrhage contributed the highest DALYs in South Asian countries. High systolic blood pressure was contributing the maximum DALYs due to stroke in Nepal. Conclusion Hemorrhagic stroke causes high mortality and DALYs in Nepal. Most of the burden of stroke is attributed to high blood pressure in Nepal.

Isolation and Intensive Care (ICU) Service, Surge Capacity and Pandemic Training in Government Designated COVID-19 Clinics and Hospitals of Nepal

Background The coronavirus pandemic preparedness and response activities began in Nepal after the detection of the first case on 24 January 2020. Highest daily case record in June 2020 was 671, but it reached above 5,000 in October 2020. Objective This study assessed preparedness and response status of government designated COVID-19 clinics and various level hospitals. Method A web-based survey was conducted among government designated COVID-19 clinics and Level hospitals in June 2020. The Medical Operations Division of the COVID-19 Crisis Management Center (CCMC) retained contact list of focal person in each facility for regular updates. Forty-nine out of 125 clinics and all level hospitals (five Level-1, 12 Level-2, three Level-3) provided responses. Result There were 25 or less isolation beds in the majority of COVID-19 clinics (83.7%) and Level-1 hospitals (60%), whereas the majority of Level-2 (92%) and Level-3 hospitals (67%) had arranged >25 beds. Only five clinics, one Level-1 hospital, six Level-2 and two Level-3 hospitals had a surge capacity of additional 20 or more isolation beds. Only one-fourth of the designated health facilities had arranged separate isolation facility for vulnerable population. Majority of the designated clinics and Level-1 hospitals had five or less functional ICU beds and functional ventilators. Very few Level-2 hospitals had > 10 ICU beds and > 10 ventilators. Healthcare workers in the majority of facilities were trained on donning/doffing, hand washing, swab collection, and healthcare waste management, but, a very few received formal training on patient transport, dead body management, epidemic drill, and critical care. Conclusion This study revealed insufficient preparation in COVID-19 facilities during the initial phase of pandemic. The findings were utilized by the government stakeholders at central, provincial and local levels for scaling up surge capacity and improving health services at the time of case surge. As the pandemic itself is a dynamic process, periodic assessments are needed to gauze preparedness and response during different phases of disease outbreak.

Impact of Albendazole Therapy on Clinical and Radiological Outcomes at One Month in Patients with Active Solitary Neurocysticercosis Patients

Background Cerebral neurocysticerosis is a common parasitic disease of human nervous system but evidence on duration of albendazole therapy and their outcomes in this condition is inadequate Objective To evaluate the impact of varying duration of albendazole therapy on the clinical and radiological outcomes at one month in patients with active solitary neurocysticercosis. Method This is an interventional study conducted at Upendra Devkota Memorial National Institute of Neurological and Allied sciences, Bansbari over 1 year (2017 March - 2018 February). One hundred eighteen patients with new onset seizure secondary to active solitary cysticercal granuloma either received albendazole therapy for 1, 3, 9 or 21 days with the usual care or only received the usual care. Clinical and radiological outcomes were observed at one month follow-up. The difference in the proportion of the outcome measures between intervention and control groups were assessed using chi-square test. Result Our study included 118 patients with male predominance of 61.9%. Albendazole therapy for 3, 9 and 21 days reduced headache by 57.2%, 70.0% and 63.1% respectively which was higher than those with 1-day therapy or without the therapy. This difference in the proportion was statistically significant at p=0.001. Though seizure recurrence also declined but the difference was not significant (p=0.406) between groups. However, at one-month follow-up, majority of patients who received albendazole for 9 days (14, 70%) and 21 days (14, 73.7%) had normal lesion, while most calcified lesion (21, 67.7%) was observed in those who did not receive albendazole therapy. The difference between lesion among the groups was significant (p < 0.001). Conclusion Albendazole therapy in patients with active solitary neurocysticercosis for 9 days is as effective as 21 days and better than 3 days in headache control and lesion dissolution but seizure control could be achieved irrespective of the treatment.

Sex-based eRNA expression and function in ischemic stroke

Enhancer-derived RNAs (eRNAs) are a new class of long noncoding RNA that have roles in modulating enhancer-mediated gene transcription, which ultimately influences phenotypic outcomes. We recently published the first study mapping genome-wide eRNA expression in the male mouse cortex during ischemic stroke and identified 77 eRNAs that were significantly altered following a 1 h middle cerebral artery occlusion (MCAO) and 6 h of reperfusion, as compared to sham controls. Knockdown of one such stroke-induced eRNA - eRNA_06347 - resulted in significantly larger infarcts, demonstrating a role for eRNA_06347 in modulating the post-stroke pathophysiology in males. In the current study, we applied quantitative real-time PCR to evaluate whether the 77 eRNAs identified in the male cortex also show altered expression in the post-stroke female cortex. Using age-matched and time-matched female mice, we found that only a subset of the 77 eRNAs were detected in the post-stroke female cortex. Of these, only a small fraction showed similar temporal expression characteristics as males, including eRNA_06347 which was highly induced in both sexes. Knockdown of eRNA_06347 in the female cortex resulted in significantly increased infarct volumes that were closely matched to those in males, indicating that eRNA_06347 modulates the post-stroke pathophysiology similarly in males and females. This suggests a common underlying role for eRNA_06347 in the two sexes. Overall, this is the first study to evaluate eRNA expression and perturbation in the female cortex during stroke, and present a comparative analysis between males and females. Our findings show that eRNAs have sex-dependent and sex-independent expression patterns that may be of significance to the pathophysiological responses to stroke in the two sexes.

Modulation of Brain Pathology by Enhancer RNAs in Cerebral Ischemia

Recent studies have reported widespread stimulus-dependent transcription of mammalian enhancers into noncoding enhancer RNAs (eRNAs), some of which have central roles in the enhancer-mediated induction of target genes and modulation of phenotypic outcomes during development and disease. In cerebral ischemia, the expression and functions of eRNAs are virtually unknown. Here, we applied genome-wide H3K27ac ChIP-seq and genome-wide RNA-seq to identify enhancer elements and stroke-induced eRNAs, respectively, in the mouse cerebral cortex during transient focal ischemia. Following a 1-h middle cerebral artery occlusion (MCAO) and 6 h of reperfusion, we identified 77 eRNAs that were significantly upregulated in stroke as compared to sham, of which 55 were exclusively expressed in stroke. The knockdown of two stroke-induced eRNAs in the mouse brain resulted in significantly larger infarct volumes as compared to controls, suggesting that these eRNAs are involved in the post-stroke neuroprotective response. A preliminary comparison of eRNA expression in the male versus female cortices revealed sex-dependent patterns that may underlie the physiological differences in response to stroke between the two sexes. Together, this study is the first to illuminate the eRNA landscape in the post-stroke cortex and demonstrate the significance of an eRNA in modulating post-stroke cortical brain damage.

Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal

Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARSCoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 - B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal.

Knowledge, Attitude and Practice of Hepatitis B Vaccination among Health Care Workers at Manipal Teaching Hospital

Background Hepatitis B vaccine is the single most effective and safest strategy for the prevention of the disease among health care workers. Despite the knowledge, higher occupational risk among themselves and increasing prevalence of hepatitis B virus worldwide, there is scanty information on knowledge, attitude and practice (KAP) concerning HBV vaccination among health care workers in our country. Objective To understand the knowledge, attitude and practice of hepatitis B vaccination among health care workers at Manipal Teaching Hospital at Pokhara, Gandaki Province in Nepal. Method Four hundred and eight health care workers were enrolled for an observational, cross-sectional study at Manipal Teaching Hospital, Gandaki Province, Nepal after obtaining ethical clearance from Institutional Review Committee. Pre-tested questionnaire including knowledge, attitude and practice regarding hepatitis B vaccination were studied. Result All participants demonstrated good knowledge and positive attitude towards Hepatitis B infection and vaccination. However many had risky practice towards it. Only about half (51.7%) of these participants were completely vaccinated. The most common reason for non vaccination was negligence. Conclusion Despite good knowledge and positive attitude towards hepatitis B infection and vaccination, low rates of vaccination and risky practice was observed among HCW. Various occupational, behavioural, economical and psychological factors associated with it must be explored. Easy availability of vaccine, regular hepatitis B campaigns must be conducted and policy guidelines need to be formulated by the government to manage all aspects of knowledge, attitude and practice of HCWs regarding hepatitis B vaccination.

Abstract 174: Regulation of Post-Stroke Gene Expression and Pathophysiology by an Enhancer RNA

Enhancer elements orchestrate genomic regulatory interactions to facilitate gene expression and phenotypic changes in development and disease. Recent studies have shown that mammalian enhancers are transcribed into noncoding enhancer RNAs (eRNAs) in a stimulus-dependent manner and some of these eRNAs have central roles in enhancer-mediated gene induction. Due to the very recent discovery of eRNAs, their expression and functions in cerebral ischemia are virtually unknown. Recently, we applied a combination of genome-wide H3K27ac ChIP-seq and genome-wide RNA-seq in ipsilateral cortices from adult male C57BL6/N mice following a 1 h middle cerebral artery occlusion (or sham surgery) and 6 h of reperfusion (n=6/group) to identify enhancer elements and stroke-induced eRNAs. We identified 77 eRNAs that were significantly upregulated (absolute fold-change ≥2.0; q<0.05) in stroke as compared to sham, of which 55 were exclusively expressed in stroke. All 77 eRNAs were novel, unspliced transcripts. Using luciferase reporter assays, we confirmed the enhancer capabilities of multiple eRNA-encoding genomic loci, and using cell fractionation experiments we determined that the eRNAs are preferentially localized to the chromatin, consistent with their eRNA status. Knockdown of one such eRNA in the mouse brain using antisense oligos, followed by a 1 h MCAO and 6 h of reperfusion, resulted in 49 downregulated genes and 106 upregulated genes (absolute fold-change ≥2.0; q<0.05) versus negative controls. The downregulated subset was enriched in several important genes with roles in mitochondrial activity, receptor signaling, ion channels and calcium homeostasis, and the upregulated subset was enriched in genes involved in inflammation and apoptosis. These changes were associated with worsened neurological scores and an 11.9% increase in infarct volume in the eRNA knockdown group versus negative control (p=0.004). This suggests an innate neuroprotective role for the eRNA during the stroke injury. Together, our study presents the first genome-wide identification of stroke-induced eRNAs in the adult cerebral cortex and illuminates the functional importance of one such eRNA in modulating post-stroke cortical gene expression and pathophysiology.

Physiology and Distribution of Archaeal Methanotrophs That Couple Anaerobic Oxidation of Methane with Sulfate Reduction

In marine anaerobic environments, methane is oxidized where sulfate-rich seawater meets biogenic or thermogenic methane. In those niches, a few phylogenetically distinct microbial types, i.e., anaerobic methanotrophs (ANME), are able to grow through anaerobic oxidation of methane (AOM). Due to the relevance of methane in the global carbon cycle, ANME have drawn the attention of a broad scientific community for 4 decades. This review presents and discusses the microbiology and physiology of ANME up to the recent discoveries, revealing novel physiological types of anaerobic methane oxidizers which challenge the view of obligate syntrophy for AOM. An overview of the drivers shaping the distribution of ANME in different marine habitats, from cold seep sediments to hydrothermal vents, is given. Multivariate analyses of the abundance of ANME in various habitats identify a distribution of distinct ANME types driven by the mode of methane transport. Intriguingly, ANME have not yet been cultivated in pure culture, despite intense attempts. Further advances in understanding this microbial process are hampered by insufficient amounts of enriched cultures. This review discusses the advantages, limitations, and potential improvements for ANME laboratory-based cultivation systems.

Deep Sequencing Reveals Uncharted Isoform Heterogeneity of the Protein-Coding Transcriptome in Cerebral Ischemia

Gene expression in cerebral ischemia has been a subject of intense investigations for several years. Studies utilizing probe-based high-throughput methodologies such as microarrays have contributed significantly to our existing knowledge but lacked the capacity to dissect the transcriptome in detail. Genome-wide RNA-sequencing (RNA-seq) enables comprehensive examinations of transcriptomes for attributes such as strandedness, alternative splicing, alternative transcription start/stop sites, and sequence composition, thus providing a very detailed account of gene expression. Leveraging this capability, we conducted an in-depth, genome-wide evaluation of the protein-coding transcriptome of the adult mouse cortex after transient focal ischemia at 6, 12, or 24 h of reperfusion using RNA-seq. We identified a total of 1007 transcripts at 6 h, 1878 transcripts at 12 h, and 1618 transcripts at 24 h of reperfusion that were significantly altered as compared to sham controls. With isoform-level resolution, we identified 23 splice variants arising from 23 genes that were novel mRNA isoforms. For a subset of genes, we detected reperfusion time-point-dependent splice isoform switching, indicating an expression and/or functional switch for these genes. Finally, for 286 genes across all three reperfusion time-points, we discovered multiple, distinct, simultaneously expressed and differentially altered isoforms per gene that were generated via alternative transcription start/stop sites. Of these, 165 isoforms derived from 109 genes were novel mRNAs. Together, our data unravel the protein-coding transcriptome of the cerebral cortex at an unprecedented depth to provide several new insights into the flexibility and complexity of stroke-related gene transcription and transcript organization.

Cheiro-Oral Syndrome

Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers. MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as CheiroOral Syndrome as a result of ischemic stroke and managed.

Abstract TP104: Exploring the Noncoding Transcriptome for Novel Therapeutic Targets Against Cerebral Ischemia

The mammalian genome pervasively transcribes a variety of functional noncoding transcripts, including the recently discovered long noncoding RNAs (lncRNAs). LncRNAs play major roles in regulating gene expression in mammals, but their expression and functions in the post-stroke brain remain largely unknown. Using a mouse model of transient focal ischemia, we applied RNA-sequencing to evaluate for the first time the unbiased, genome-wide expression of lncRNAs as a function of reperfusion time in the cerebral cortex. A 1h middle cerebral artery occlusion was conducted in adult male mice and ipsilateral cortices were harvested at 6h, 12h or 24h of reperfusion. RNA was isolated and used for Illumina sequencing. The reads were assembled and mapped to mouse reference genome GRCm38/mm10 and differential expression between the groups was evaluated using TopHat-Cufflinks. We observed that the baseline expression of lncRNAs in the healthy cortex was low, but hundreds of lncRNAs were highly altered after stroke. We identified 1311 isoforms at 6h (1146 upregulated; 165 downregulated), 1287 isoforms at 12h (954 upregulated; 333 downregulated), and 1090 isoforms at 24h (907 upregulated; 183 downregulated) of reperfusion that were significantly altered (absolute fold-change ≥ 2; q-value <0.05) versus sham controls. Of these, 1261 (98%), 1221 (95%) and 1039 (95%) isoforms at 6, 12 and 24h of reperfusion, respectively, were novel lncRNAs. Importantly, hundreds of transcripts that were not detectable in the healthy cortex were robustly expressed in response to stroke, thus representing ischemia-specific lncRNAs. A total of 975 isoforms (74%) at 6h, 815 isoforms (63%) at 12h, and 800 isoforms (73%) at 24h were detected exclusively in the post-stroke cortex. Barring 3 isoforms at 6h, 1 isoform at 12h and 2 isoforms at 24h, all were novel transcripts. Overall, this study reveals a plethora of previously undiscovered, disease-related lncRNAs in the adult post-stroke cortex and identifies distinct reperfusion time-point-dependent expression characteristics. Further investigation of these lncRNAs will elucidate their functional roles in the progression of the post-stroke pathophysiology and may identify new opportunities for therapeutic intervention.

Clinico-Epidemiological Profile, Health Care Utilization and Practices Regarding Snake Bite at Ilam District of Eastern Nepal

IntroductionSnake bite is neglected problem of the rural agrarian society of the world. Nepal is one of the vulnerable countries of snakebite. The utilization of health care services and practices regarding snake bite is not known.ObjectiveThis objective of the study was to explore clinicoepidemiological profile, health care utilization and practices regarding snake bite at Ilam District of eastern Nepal.MethodologyThis was a cross-sectional study and conducted from th th 25 March to 25 May 2013 using a systematic random sampling of 300 people from communities of Ilam district. The data was collected after receiving informed consent. The collected data was entered into Microsoft excel and analysed by using SPSS.ResultsThe majority (76.7%) of the respondents had seen snakes in their locality. The major snake noticed was mountain pit viper (Ovophis monticola)- Grube (94.8%). Among respondents, 5.3% had a history of snake bite which was predominant among productive age of 15-39 years. The most common bitten part of the body was leg (56.3%). There was no any serious injuries and death. Treatment was done by different modalities such as by using local antidote (31.3%) at the bite site and by soap-clean water (25%). Sixty-nine percent of the snake bite victims utilized modern health care system. Charali snake bite management center, Jhapa was the major treatment center. Seven out of 10 had knowledge of using a tourniquet. After full recovery from a snake bite, 1 out of 5 had avoided milk due to their false belief.ConclusionActive age group was more victimized. The commonest bitten part was a leg. The knowledge of first aid of snake bite was not adequate and many were unaware of post snake bite practices. Reassurance, early first aid and timely transportation to health center save many victims of snake bite.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 179-183

Discovery of novel stroke-responsive lncRNAs in the mouse cortex using genome-wide RNA-seq

Long noncoding RNAs (lncRNAs) play major roles in regulating gene expression in mammals, but are poorly understood in ischemic stroke. Using a mouse model of transient focal ischemia, we applied RNA-seq to evaluate for the first time the unbiased, genome-wide expression of lncRNAs as a function of reperfusion time in the cerebral cortex. Focal ischemia was induced in adult male C57BL/6 mice followed by reperfusion for 6, 12 or 24h. Total RNA from ipsilateral cortices was used for Illumina sequencing and reads were mapped to the mouse reference genome (GRCm38). Annotated and novel transcript isoforms were identified and differential expression between the groups was estimated. We observed that the baseline expression of lncRNAs in the healthy cortex was low, but many were highly altered after stroke. Very few of these altered lncRNAs were previously annotated. A total of 259 lncRNA isoforms at 6h, 378 isoforms at 12h, and 217 isoforms at 24h of reperfusion were differentially expressed versus sham controls. Of these, 213, 322 and 171 isoforms at 6, 12 and 24h of reperfusion, respectively, were novel lncRNAs. Reperfusion time-point-specific analyses revealed that the lncRNAs reached peak expression levels at 6h of reperfusion. Positional analysis of ischemia-responsive lncRNAs with respect to ischemia-responsive protein-coding genes identified potential gene-regulatory relationships. Overall, this work shows that transient focal ischemia induces widespread changes in the expression of lncRNAs in the mouse cortex with distinct reperfusion time-point-dependent expression characteristics that may underlie progression of the ischemic pathophysiology. The detection of hundreds of novel ischemia-responsive lncRNAs marks the discovery of new disease-related genomic regions in the adult cortex and may help identify novel opportunities for therapeutic targeting.

Krüpple-like factors 7 and 6a mRNA expression in adult zebrafish central nervous system

Krüpple-like factors (KLFs) are transcription factors with zinc finger DNA binding domains known to play important roles in brain development and central nervous system (CNS) regeneration. There is little information on KLFs expression in adult vertebrate CNS. In this study, we used in situ hybridization to examine Klf7 mRNA (klf7) and Klf6a mRNA (klf6a) expression in adult zebrafish CNS. Both klfs exhibit wide and similar expression in the zebrafish CNS. Brain areas containing strongly labeled cells include the ventricular regions of the dorsomedial telencephalon, the ventromedial telencephalon, periventricular regions of the thalamus and hypothalamus, torus longitudinalis, stratum periventriculare of the optic tectum, granular regions of the cerebellar body and valvula, and superficial layers of the facial and vagal lobes. In the spinal cord, klf7- and klf6a-expressing cells are found in both the dorsal and ventral horns. Numerous sensory structures (e.g. auditory, lateral line, olfactory and visual) and several motor nuclei (e.g. oculomotor, trigeminal, and vagal motor nuclei) contain klf7- and/or klf6a-expressing cells. Our results may provide useful information for determining these Klfs in maintenance and/or function in adult CNS.

Malnutrition Status Among Under-5 Children in a Hill Community of Nepal

BACKGROUND

Malnutrition, especially under nutrition puts children at increased risk of morbidity and mortality and remains a serious barrier in child growth, development and survival. This is a major public health problem among under- 5 children in Nepal particularly in rural areas.

OBJECTIVE

To assess the burden and contributing factors for malnutrition in hill community of Ilam district in eastern Nepal.

METHOD

A cross sectional study was conducted in rural hill communities of Ilam district, Nepal with a sample of 240 under- 5 children. Anthropometric measurements were used as per WHO guidelines to asses three nutritional status: Underweight, Stunting, and Wasting using descriptive statistics and chi square test was applied using SPSS 12.0 to assess social and predisposing factors.

RESULT

Seventeen percent of under- 5 children were moderately and 10.4 % were severely underweight. Similarly, 22.9%, and 17.5% were found to be moderately and severely stunted respectively. Less than 10% were found to be moderately and severely wasted. Older age group of children, education level of mother, not exclusive breast feeding practice had significant (p <0.05) effect on stunting. More than 50% children were affected with stunting, underweight and wasting at the same time.

CONCLUSION

Significant proportion of under - 5 children were malnourished in the communities of the hilly areas. The study unveiled the importance of literacy and exclusive breast feeding for the prevention of malnutrition in under- 5 children.

Giant Left Atrium - A Rare Case of Acute Upper Gastrointestinal Bleeding

Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Various rare causes have been described in the literature but there are very few cases of giant left atrium leading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumatic valvular heart disease with giant left atrium who presented in our department with acute upper GI bleeding.

Childhood Mishaps and Its Cognizance among Nepalese Mothers of Parsa District for Its Prevention, Small Cross-sectional Study

INTRODUCTION

Several studies have shown that there several unintentional causes for the unwanted childhood accidents. In addition, Nepal demographic health survey via West University of England revealed at 2006 A.D, 11% death casualties of under- five aged children are due to unintentional injuries 1. This particular study is extremely useful to health care planner, provider and researcher to have grand design to be produced by government of Nepal, such that; there shall be minimal rate of casualties of deceased children due to accidents.

METHODS

This study is descriptive cross sectional study carried out in Parsa district of Nepal where the respondents were mother to assess their awareness of cause of childhood accidents and its prevention. Computer software SPSS is use to scrupulous analysis of study where the chi-square test is used with 95% level of confidence (p=0.05).

RESULTS

Poisoning 96% cases is the cause of childhood accident unintentionally, followed by 94% foreign body aspiration, 85% flame burn. Unsupervised children are more prone to injury than supervised children. Finally and foremost the crucial correlation of parents level of awareness with childhood are as follows; inadequate level of knowledge have higher percentage of accident (58%), followed by moderately adequate (32%) and adequate (10%).

CONCLUSION

This study though done on small scale on small part of Parsa district can play key role to the policy to have vigilantive and supervision power to see the loopholes that need to be detected and dealing in curative manner.

Carcinoma of the appendix – A diagnostic challenge

INTRODUCTION Primary tumors of the appendix are rare. They are usually diagnosed after pathologic inspection of the appendix removed for suspected appendicitis. The main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. It mimics ovarian pathology in female because of close proximity to its anatomical structures. CASE PRESENTATION We report a case of 52 years female who presented to us in casualty with complains of pain abdomen and other findings suggestive of acute appendicitis. In spite of extensive preoperative investigations, the diagnosis was confirmed only after opening the abdomen as giant mucocele of appendix demanding right hemicolectomy as a treatment modality. CONCLUSION Although primary tumors of appendix is rare identity in the arena of surgery, it should be in the corner of thought as a possible diagnosis which require extensive surgery when compared to simple Appendicectomy.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12953 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 36-40

Doppler ultrasound evaluation of pattern of venous incompetance and relation with skin changes in varicose vein patients

BACKGROUND Varicosity of lower limb is a common problem in agricultural country like Nepal. Doppler ultrasound is a standard investigation modality for confirmation of diagnosis, evaluation of severity and venous mapping to plan treatment. We aim to find out the epidemiology, common pattern of incompetance, severity assessment by doppler and association of the important doppler variables with skin changes.METHODOLOGY Doppler venous study was done in 56 patients from june 2013 to july 2014. Patients with deep vein thrombosis and peripheral arterial disease were excluded. Altogether 56 patients, 96 limbs were studied. Data was entered in preformed proforma. Doppler study was conducted by senior radiologist with linear probes. Data was entered in SPSS software version 16 and statistical significance was calculated using chi square test.RESULTS Bilateral limb involvement was seen in 40 patients and unilateral in 16 patuents only. Skin related changes were seen in 58 limbs. Saphenofemoral junction incompetance was seen in 79(82.2%) limbs and was most common pattern of incompetance. Overall, superficial veins were involved in 88(91.7%) limbs and deep in 30(31.2%) limbs. Prolonged duration of varicosity (>9 year) (p=0.000), bilateral limb involvement(p=0.024), reflux in deep venous system(p=0.002), larger Greater Saphenous Vein (GSV) size(p=0.003), prolonged duration of reflux(p=0.000) and perforator incompetence (p=0.002) were associated with skin changes. GSV diameter more than 7 mm was associated with reflux significantly (P=0.002).CONCLUSION Superficial vein incompetance is common pattern compared to deep venous system. Sapheno Femoral Junction (SFJ) incompetance is the commonest pattern. Larger caliber of vein, prolonged duration of reflux, reflux in deep venous system and perforator insufficiency are significantly associated with skin changes.Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 1-7

Impact of Patch Testing on Quality of Life in Patients with Hand Eczema: A Follow-up Study

Background Patch testing has previously been shown to influence the quality of life, although a very few studies have shown if this is dependent on the result of the patch tests. Objective To assess the impact of patch testing on the quality of life (QOL) in patients with hand eczema (HE). Methods A total of 50 patients diagnosed of hand eczema at the time of patch testing, aged 16 years and above participated in this study. Detailed demographic information and diagnosis of hand eczema were collected on the day of the patch test. After six weeks, the patients were asked about the hand eczema, knowledge of their allergies and change in their life style to avoid the relevant allergens demonstrated on the patch test. Dermatology Life Quality Index (DLQI) was used to measure the QOL on both occasions. Results The patch test positivity was found in 68% of patients to one or more allergens. The sum score of DLQI at baseline was 12.16 ± 5.58 with median 12.0. HE had most impact on symptoms and feelings. Patients with both positive patch test (mean baseline= 11.94± 5.88; mean at six weeks=2.81± 2.01; P<0.001) and negative patch test (mean baseline=12.63± 5.03; mean at 6 weeks=5.4± 3.56; P=0.001) showed significant improvement in DLQI scores, however it was more improved in patients with positive patch test than in patients with negative patch test. Conclusions Hand eczema had an appreciable impact on the QOL. Patch testing had been beneficial to most patients in improving patient quality of life considerably. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12506 Kathmandu Univ Med J 2013; 43(3):216-220

Differential expression of protocadherin-19, protocadherin-17, and cadherin-6 in adult zebrafish brain

Cell adhesion molecule cadherins play important roles in both development and maintenance of adult structures. Most studies on cadherin expression have been carried out in developing organisms, but information on cadherin distribution in adult vertebrate brains is limited. In this study we used in situ hybridization to examine mRNA expression of three cadherins, protocadherin-19, protocadherin-17, and cadherin-6 in adult zebrafish brain. Each cadherin exhibits a distinct expression pattern in the fish brain, with protocadherin-19 and protocadherin-17 showing much wider and stronger expression than that of cadherin-6. Both protocadherin-19 and protocadherin-17-expressing cells occur throughout the brain, with strong expression in the ventromedial telencephalon, periventricular regions of the thalamus and anterior hypothalamus, stratum periventriculare of the optic tectum, dorsal tegmental nucleus, granular regions of the cerebellar body and valvula, and superficial layers of the facial and vagal lobes. Numerous sensory structures (e.g., auditory, gustatory, lateral line, olfactory, and visual nuclei) and motor nuclei (e.g., oculomotor, trochlear, trigeminal motor, abducens, and vagal motor nuclei) contain protocadherin-19 and/or protocadherin-17-expressing cell. Expression of these two protocadherins is similar in the ventromedial telencephalon, thalamus, hypothalamus, facial, and vagal lobes, but substantially different in the dorsolateral telencephalon, intermediate layers of the optic tectum, and cerebellar valvula. In contrast to the two protocadherins, cadherin-6 expression is much weaker and limited in the adult fish brain.

Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis

Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.

Understanding socio economic contexts of female sex workers in eastern Nepal

The present focus is mostly laid on high risk behavior of commercial sex workers without any consideration of their location, educational status and other socio-cultural norms. Thus, we designed a study to understand socio demographic characteristics, lifestyle of female sex workers and search for driving factors for prostitution in eastern Nepal. A descriptive study was conducted in three districts of Eastern Nepal in 2012 over the period of six months. The data regarding their socio demographic characteristics, income, reason for joining sex trade and future choice regarding the profession were recorded from 210 female sex workers through face-to-face interviews. Majority (53.3%) of respondents belonged to the productive age group of 20-29 years, more than one thirds (43.3%) had not received any form of formal education and were unmarried. More than half (53.80%) were presently living alone and about one thirds of the women (31.90%) were minors when they joined this profession. Major portion of the sample (94.80%) worked more than three days a week with median income of 15 thousand per month and 41 percent had sex with more than or equal to ten clients per week. Poor economic condition was the most frequent (47.6%) factor leading to joining of sex trade however, more than two thirds, (72.80%) wanted to quit the profession. Given low level of education, relatively low income, and young age among this population, empowerment and alternative employment/education opportunities should be created to develop this part of Nepalese society.

A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding

BACKGROUD

Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality.

OBJECTIVE

To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome.

METHOD

This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis.

RESULT

Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6.

CONCLUSION

Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

Factors Contributing to Antenatal Care and Delivery Practices in Village Development Committees of Ilam District, Nepal

Background Proper antenatal care and good delivery practice helps to prevent the complications of childbirth and ensures a wholesome maternal and child health in the future. Almost half of the births in the developing countries take place without a skilled birth attendant. Objectives To assess the antenatal care (ANC) and delivery practices in the Village Development Committees (VDC) of Ilam district, Nepal and to identify the relationship with the socio-demographic factors. Method Cross sectional study of 262 mothers of reproductive age group having at least one child of less than five years of age, selected by simple random sampling, was carried out over different VDCs of Ilam by face to face interview using semi-structured questionnaire. Results Among 262 mothers, 34.7% were married before the age of 18 years. 69.5% of the mothers had attended four antenatal care visits. Nearly 47% of the deliveries were conducted at home out of which only 33.6% were conducted by skilled birth attendant. Number of children and maternal education were found to significantly affect the ANC visit and place of delivery. Age at marriage and age at first pregnancy were significantly associated with the place of delivery. Conclusion Large proportion of mothers still do not have adequate antenatal visits and this is supported by the fact that nearly half of the deliveries were conducted at home. Motivation and incentives are required for pregnant mothers especially in rural areas regarding importance of adequate antenatal visits and delivery in health institutions. Population policies should be aimed at reducing proportion of women marrying and giving birth in their teens. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11029 Kathmandu University Medical Journal Vol.11(1) 2013: 60-65

The Study of Prevalence of Helicobacter Pylori in Patients with Acne Rosacea

Background Acne rosacea is an inflammatory disease affecting the central part of the face characterized by erythema, papules, papulo pustules and telangiectasias of unknown etiology. More recently numerous studies have described an association with Helicobacter pylori (Hp) and the extra gastric symptoms of cutaneous origin. Objectives To establish the prevalence of Helicobacter pylori (Hp) infection in the stomach in patients with rosacea based on standard Hp serological test. Methods All patients with the clinical staging of 2, 3 and 4 rosacea attending the Dermatology Out Patient Department from May 2009 – April 2010 were included in the study. Quantitative serological test using the SERION ELISA classic Helicobacter pylori IgG was done. Result A total of 26 patients were enrolled in the study with the age ranging from 26- 82 years. There were 14 males and 12 females and the male: female ratio was 1.6:1. Three (11.53%) patients presented with Grade IV rosacea, a severe clinical presentation and symptoms suggestive of acid peptic diseases were found in 14/26 (53.8%) patients. A positive serology to H. pylori was found in 17/26 (65.4%) of patients. A statistically significant correlation was found when association of H.pylori positivity in patients of rosacea compared with the seropositivity in controls. However correlation in the seropositivity was not found amongst the patients having gastritis and rosacea. Conclusion There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease . DOI: http://dx.doi.org/10.3126/kumj.v10i4.10995 Kathmandu Univ Med J 2012;10(4):49-52

Clinical and contact allergological observations on hand eczema: a descriptive study

Hand eczema (HE) is a common and distressing condition that is perplexing to the patient and the physician alike. To study the frequency and clinical features of hand eczema and to correlate the frequency of atopy and contact sensitization with different clinical features a total of 61 clinically diagnosed patient of Hand eczema were included within a period of one year. Patch test was done in 47 patients and graded accordingly. The frequency of hand eczema was 0.57%. Morphologically pompholyx was the most common type while aetiologically endogenous hand eczema was the commonest. Contact allergy was observed in 55.3% of the cases of which nickel sulphate (18.5%) was found to be the commonest sensitiser followed by Gentamicin and Fragrance mix though contact allergens with positive patch test in different morphological types of hand eczema have no apparent relevance but it still could contribute to the persistence or exacerbation of hand eczema.

Determinants of Intrauterine Contraceptive Device Use Among the Women of Urban Areas of Nepal

Aims: This study aimed to identify the determinants of Intrauterine Contraceptive Device (IUCD) use among the married women of reproductive age group living in urban areas of Nepal. Methods: This study was an analytical cross-sectional study which aimed to compare different factors between 110 IUCD users and 110 non-users. Both groups were selected randomlyand interviewed by using semi-structured questionnaire. Chi-square test was used to detect the difference between two groups and corresponding odds ratios with 95% confidence intervals were also computed. Results: When the IUCD users were compared to non-users, religion, occupational status of women, occupational status of the husbands, total number of children, sources of information about IUCD, having wrong beliefs about IUCD, availability of IUCD services, reproductive intention and spousal communication were significantly associated with the use of IUCD.The main reason for using IUCD was due to the effectiveness for longer duration and for not using IUCD was due to the feeling of no need. Conclusions: Wrong beliefs about the device discouraged women from using IUCD, hence, awareness programs are strongly recommended.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 16-20 DOI: http://dx.doi.org/10.3126/njog.v8i2.9760

A study of prevalence of Taenia infestation and associated risk factors among the school children of Dharan

BACKGROUND

Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue.

OBJECTIVES

To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan.

METHODS

A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation.

RESULTS

Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than nonpork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present.

CONCLUSION

Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors.

Prevalence of intestinal parasitic infection of kindergarten children

INTRODUCTION: Intestinal parasitic infections are the major public health problems of Nepal. Apart from causing mortality and morbidity, infection with intestinal parasites has been associated with stunting of linear growth, physical weakness and low educational achievement in school children. The drinking water is considered as the major cause for parasitic infection. This study aims to determine the prevalence of parasitic infection among the children visiting kindergarten of the Kathmandu, Khusibhu area. MATERIALS AND METHODS: Cross sectional study was done in randomly selected Kindergarten of Khusibhu area. A total of 101 samples were examined. The study was focused in isolating intestinal parasites using normal saline and iodine wet mount method. Both macroscopic and microscopic studies were performed. RESULTS: Among the samples 45.5% (n=46) showed parasitic infection in which the Giardia lambia infection was found the highest 56.5% (n=26) and infection with Ascaris lumbricoides was found lowest 8.7% (n=4). Infection rate was found to be high in children drinking filtered water than among those drinking boiled and filtered water. CONCLUSION: The prevalence of parasitic infection in children is mainly associated with hygiene and food habit of the children. Hence good education about the hygienic practice helps in the prevention of the infection. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8205 Int J Infect Microbiol 2013;2(3):111-113

Leprosy after the Elimination: A BPKIHS experience

DOI: http://dx.doi.org/10.3126/njdvl.v11i1.7933 Nepal Journal of Dermatology, Venereology & Leprology Vol.11(1) 2013 pp.41-44

Urinary tract infection in vaginitis: a condition often overlooked

Despite the differences between the organisms that cause vaginitis and urinary tract infections (UTI), it is possible that women with vaginitis develop UTI. The main objective of the study was to find the association of the common types of infectious vaginitis with UTI. Cross sectional study was conducted for six months in a referral hospital at Lalitpur, Nepal. Three hundred and sixmid-stream urine samples and high vaginal swabs (HVS) collected from non pregnant women were investigated by standard microbiological techniques. Among the women with bacterial vaginosis (BV), 75% also had UTI. Similarly, 46% and 13% of those with vaginal candidiasis and trichomoniasis respectively had concurrent UTI. Considering this strong association of UTI and vaginitis, women with either of these conditions should be tested for the other.

Protocadherin-17 function in Zebrafish retinal development

Cadherin cell adhesion molecules play crucial roles in vertebrate development including the development of the retina. Most studies have focused on examining functions of classic cadherins (e.g. N-cadherin) in retinal development. There is little information on the function of protocadherins in the development of the vertebrate visual system. We previously showed that protocadherin-17 mRNA was expressed in developing zebrafish retina during critical stages of the retinal development. To gain insight into protocadherin-17 function in the formation of the retina, we analyzed eye development and differentiation of retinal cells in zebrafish embryos injected with protocadherin-17 specific antisense morpholino oligonucleotides (MOs). Protocadherin-17 knockdown embryos (pcdh17 morphants) had significantly reduced eyes due mainly to decreased cell proliferation. Differentiation of several retinal cell types (e.g. retinal ganglion cells) was also disrupted in the pcdh17 morphants. Phenotypic rescue was achieved by injection of protocadherin-17 mRNA. Injection of a vivo-protocadherin-17 MO into one eye of embryonic zebrafish resulted in similar eye defects. Our results suggest that protocadherin-17 plays an important role in the normal formation of the zebrafish retina.

Pyoderma gangrenosum: A clinico- therapeutic profile of patients attending a tertiary care hospital in Nepal

Pyoderma gangrenosum (PG) is a primarily sterile inflammatory neutrophilic dermatosis characterized by recurrent cutaneous ulcerations with mucopurulent or hemorrhagic exudate. In many cases, PG is associated with inflammatory bowel disease, rheumatic disorder or neoplasia. The peak of incidence occurs between the ages of 20 to 50 years with women being more often affected than men. To study the clinical and therapeutic profile of patients with pyoderma gangrenosum. All patients diagnosed as pyoderma gangrenosum in the department of dermatology from July 14th 2003- July 12th 2008 were included in the study. Demographic profile, clinical features as well as relevant investigations, treatment and follow-up were noted. A total of 8 patients with pyoderma gangrenosum were diagnosed over a 5 year period. There were 3 males and 5 female patients whose ages ranged from 32 to 80 years. Lower limbs were the commonest site to be involved in 6 patients (75%). Recurrent episodes were noted in 4 patients (50%) and among them 3 patients (75%) had multiple ulcers. Histopathological confirmation of the diagnosis was done in 7 patients (87.5%). Association with ulcerative colitis was seen in 2 patients (25%). All patients were treated with dapsone and systemic steroids which showed resolution of the lesions in all patients. Pyoderma gangrenosum was seen more frequently in females and association with ulcerative colitis was seen in 25% of the patients. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 29-35 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6823

A retrospective analysis of Sweet's syndrome in a tertiary care hospital in Nepal: A BPKIHS perspective

Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis without vasculitis. To study the clinico-pathological features, clinical course and treatment of patients with sweets syndrome. A retrospective observational analysis of 12 diagnosed cases of sweet’s syndrome attending and admitted in the Department of Dermatology from June 2003- April 2009 were considered in this study. The study comprised of 9 females and 3 males (3:1) between the age group of 22-73 years. Typical lesions of sweets syndrome were present in all cases and the duration of illness ranged from 3-8 days. Constitutional symptoms of fever, pain and malaise were present in all and the extremities were the most common site of involvement 12 (100%). Leucocytosis was present in 7 (58.3%), raised ESR in 9 (75%) and raised C reactive protein in 7(58.3%) patients. Characteristic histological features were recorded in specimens of all patients. 9 (75%) patients responded promptly to systemic oral corticosteroids while 3 (25%) were treated with intravenous steroids. Complete Response was seen in 7 (58.3%), partial response in 5 (41.6%) and recurrence in 1(8.3%) patient after therapy. Characteristic skin lesion, histopathological diagnosis and relevant abnormal laboratory parameters can act as a useful diagnostic tool in patients with sweet’s syndrome. DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6703 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 17-23

Need for improvement of medical records

INTRODUCTION

A medical record is a systematic documentation of a patient's medical history and care for legal and future use. A poor quality medical record can negatively affect patient care and safety. The study aims to assess the adequacy of medical records in Bir Hospital, a central hospital.

METHODS

A cross-sectional study was conducted by analyzing consecutive discharge summaries of patients admitted during a 6 month period in a single unit of a tertiary care center. The discharge summary format of the hospital was taken as the standard and evaluation for adequacy of data entered was assessed. Descriptive statistics were used to analyze various statistical discrepancies.

RESULTS

Patient's condition at discharge was missing in 86 (66.15%). Patient's address was missing in 21 (16.1%) cases. Almost all the discharge sheets lacked mailing address. Total 96 (73.8%) had use of abbreviations diagnosis. Age and sex were missing in 1 (0.76%). Doctor's signature was illegible in 103 (79.3%) and missing in 2 (1.5%) summaries. Doctor's name and their level/position were missing in 118 (90.76%) and 125 (96.1%) respectively. Total 126 patients (96.9%) were not given any instructions on discharge.

CONCLUSIONS

The discharge summaries analyzed were seen to be inadequate especially in documenting course during the hospital stay, condition at discharge, appropriate instructions and the treating physician's details. These can probably be addressed by introducing electronic medical records if feasible. Otherwise, the discharge summary should be standardized and doctors should be trained to write legible, complete discharge summaries.

Antiviral activity of some plants used in Nepalese traditional medicine

Methanolic extracts of 41 plant species belonging to 27 families used in the traditional medicine in Nepal have been investigated for in vitro antiviral activity against Herpes simplex virus type 1 (HSV-1) and influenza virus A by dye uptake assay in the systems HSV-1/Vero cells and influenza virus A/MDCK cells. The extracts of Astilbe rivularis, Bergenia ciliata, Cassiope fastigiata and Thymus linearis showed potent anti-herpes viral activity. The extracts of Allium oreoprasum, Androsace strigilosa, Asparagus filicinus, Astilbe rivularis, Bergenia ciliata and Verbascum thapsus exhibited strong anti-influenza viral activity. Only the extracts of A. rivularis and B. ciliata demonstrated remarkable activity against both viruses.

The stability of gingerol and shogaol in aqueous solutions

Gingerols, pungent principles of ginger (the rhizome of Zingiber officinale), are biologically active components that may make a significant contribution towards medicinal applications of ginger and some products derived from ginger. Gingerols, however, are thermally labile due to the presence of a beta-hydroxy keto group in the structure, and undergo dehydration readily to form the corresponding shogaols. This study investigated the stability of [6]-gingerol [5-hydroxy-1-(4-hydroxy-3-methoxyphenyl)decan-3-one] at temperatures ranging from 37 to 100 degrees C in aqueous solutions, at pH 1, 4, and 7. Quantitative measurements of [6]-gingerol and its major degradation product [6]-shogaol [1-(4-hydroxy-3-methoxyphenyl)decan-4-ene-3-one] were performed by HPLC. Kinetics of [6]-gingerol degradation was characterized by least square fitting of a rate equation. It was found that gingerol exhibited novel reversible kinetics, in which it undergoes dehydration-hydration transformations with shogaol, the major degradation product. Degradation rates were found to be pH dependent with greatest stability observed at pH 4. The reversible degradation of [6]-gingerol at 100 degrees C and pH 1 was relatively fast and reached equilibrium within 2 h. Activation energies for the forward and reverse reactions for [6]-gingerol were calculated from the Arrhenius equation using reaction rates obtained at temperatures ranging from 37 to 100 degrees C.

Effectiveness of training of basic health workers in Leprosy Control Programme

This study was undertaken in two adjacent districts (Rautahat and Parsa) in Nepal to measure the impact of training of basic health workers on Leprosy Control Programme. Knowledge, attitude and leprosy service delivery by them were studied before and after training. There was an improvement in all the three components after training. However, improvement was also seen in the control group as well. Possible reasons for this are discussed. Improper selection of the area and an inadequate methodology were the identified drawbacks of the study.