Metabolic syndrome in patients with lichen planus: A case-control study

Background

Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome.

Objectives

To study the association of Metabolic Syndrome in patients with LP.

Materials and Methods

A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis.

Results

The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05).

Conclusion

The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.

Assessing Impact of Health Education in Improving Knowledge of Children on Child Sexual Abuse

BACKGROUND

Every year, millions of children around the world face sexual abuse and exploitation. Sexual and reproductive health education is an important form of health promotion action against it. This study aims to assess the impact of health education program in improving knowledge of the children on child sexual abuse.

METHODS

A school based pre-experimental study was done among 120 lower secondary level students of a private school in Bharatpur municipality of Chitwan District, Nepal during March 2021. An interventional health education program imparting knowledge on child sexual abuse and its preventive measures was given to the children. Their knowledge was assessed and compared before and after intervention using paired t-test. Data analysis was done using SPSS version 17 software.

RESULTS

The mean age of children was 13.77±0.65 years with 1:1.18 girls to boys ratio. The level of knowledge of the children on child sexual abuse and its preventive measures increased significantly post-intervention as compared to pre-intervention. The mean scores of post-test (29.80±4.53) was higher than pre-test (17.04±6.96). The intervention was proved effective with statistically significant t-test values (t=20.996, p=<0.001). About 6.7% children disclosed an experience of child abuse post-intervention.

CONCLUSIONS

The school based health education program effectively increased the knowledge of the children on child sexual abuse, thus helping in preventing and protecting them from child sexual abuse and its harmful effects.

Road Traffic Accident among Patients Presenting to the Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Road traffic accidents are a public health problem and have emerged as the leading cause of mortality and morbidity. Head is the most commonly affected site of road traffic accidents. The aim of this study was to find out the prevalence of road traffic accidents among patients presenting to the emergency department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at the Emergency Department from 12 January 2022 to 14 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: COMSTH-IRC/2021-171). Data was collected using a self-structure questionnaire and from emergency tickets. A convenience sampling method was used. Point prevalence and 95% Confidence Interval were calculated. Results: Among 7654 patients, the prevalence of road traffic accidents was found to be 734 (9.58%) (8.49-10.66, 95% Confidence Interval). Most of the accidents took place on Friday 139 (18.94%). The majority of them were soft tissue injuries 279 (38.01%). Conclusions: The prevalence of road traffic accidents was found to be higher compared to similar studies done in similar settings. Accident preventive strategies should be focused on and implemented by all the stakeholders.

Spectrum of Gastrointestinal Perforations in a Tertiary Care Hospital of Central Nepal: An Analytical cross-sectional study

Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.   Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.   Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.   Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.

Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal

Introduction: Poisoning is an acute medical emergency. Organophosphorus (OP) poison, being easily available and relatively cheaper, is mostly used by people for suicide. It is a major health problem worldwide also a major cause of suicide in Nepal. The purpose of this study was to assess the overall profile of patients with Organophosphorus (OP) poisoning. Methods: A Prospective hospital based descriptive cross-sectional study was conducted on patients of organophosphorous poisoning in the emergency department (ER) of College of Medical Sciences and Teaching Hospital during one year period from 1st January 2020 to 31st December 2021. Data analysis was done using SPSS-16 software. Categorical variables were presented in the form of tables with frequency and percentage. Data was analyzed by using descriptive statistical tools. Results: A total of 123 OP poisoning cases attended in the emergency department of College of Medical Sciences over a period of one year. The overall female to male ratio was 1.19:1. Most poisoning occurred in the age group 15-25yrs. Majority of the patients were married and were students. Oral route (87.83%) was the most common route of administration. The main reason was family and personal issues. Majority of the patients stay 3-7 days in the hospital. The mortality of poisoning was 3.25%. Conclusions: Majority of the intentional poisoning occurred in the female, married & students of younger age group. The main reason was family and personal issue.

Influence of Aging on HbA1C: A Cross-Sectional Study on Diabetic Population Attending a Tertiery Care Center of Central Nepal

Background: Diabetes mellitus is increasing day by day throughout the globe. So, early diagnosis of diabetes is crucially important in reduction of the complications. This study was conducted to determine the correlation between glucose monitoring by fasting blood glucose and two hours postprandial blood glucose with glycated hemoglobin (HbA1c) in diabetic patients and evaluate whether glycohemoglobin levels increase with age in both sexes Methods: A hospital-based analytical cross-sectional study was carried out from March 2020 to December 2021 in diabetic patients attending at outpatient department (OPD) of College of Medical College and Teaching Hospital, Bharatpur, Chitwan. The total number patients was 696 people. HbA1c, fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were analyzed. Results: Both postprandial blood glucose and fasting blood glucose significantly correlated with HbA1c. Postprandial blood glucose showed better correlation to HbA1c than fasting blood glucose (r = 0.630, P <0.001 vs. r =0.452, P = 0.05). Conclusions: These results show that postprandial blood glucose correlated better than fasting blood glucose to HbA1c. Thus, postprandial blood glucose predicted overall glycemic control better than fasting blood glucose. Based on our study, we may concluded a significant correlation exist between age and HbA1c in Nepalese population.

Prescribing Pattern of Antibiotics in ENT Outpatients of Tertiary Care Hospital in Bharatpur, Nepal

Introduction: Upper respiratory tract infection (URTI) like pharyngitis, tonsillitis, sinusitis, laryngitis and otitis media are the most common infections encountered in ENT outpatients. As these infections are caused by the microorganism they should be treated with the antimicrobial agents. The aim of this study was to determine the prescribing pattern of antibiotics in ENT outpatients of tertiary Care Hospital in Bharatpur, Nepal. Methods: It was prospective observational study which was carried out in the ENT Department of College of Medical Science, Bharatpur, Chitwan, Nepal. Total 267 prescriptions were studied. Patient of all age groups and sex were included in the study. Prescriptions were evaluated based on the World Health Organization (WHO) core drug prescribing indicators. Results on categorical measurements are presented in numbers and percentage which was used to generate tables and graphs. Data analysis was done by SPSS software version 20.0. Results: A total of 267 prescriptions were collected and analyzed during the study. Average number of drugs per prescription was 3.12 in which average number of antibiotic per prescription was 1.041. Commonly prescribed antibiotics belongs to the penicillin group (52%) followed by macrolide (27%). Most of the drugs were prescribed by their brand names (92%). Besides antibiotics the common adjuvant drugs that are being prescribed were nasal decongestant (44%) followed by anti-histaminics (27.7%). Conclusions: The present study highlights the wide use of Amoxicillin and clavulanic acid combination for ENT infections. Measures to emphasize the use of generic names are necessary to promote rational drug use.

Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal

Introduction: Long-acting reversible contraceptives (LARC, Intrauterine contraceptives devices and Implants) stand on 1st regards to safety and effectiveness. It is an easily accessible variety for spacing birth as well as preventing unintended pregnancy soon after childbirth in Nepal due to free supply by the Government under safe motherhood program of Reproductive health policy. Despite free supply, LARC is not routinely implemented in practice among immediate post-partum lady as single approach contraceptives concern to unintended pregnancy due to unmet need. To find out the choice of LARC by antenatal and immediate postpartum women after delivery. Methods: A descriptive cross-sectional study was conducted among 200 women in antenatal clinic and obstetric ward of College of Medical Science and Teaching Hospital using non probability convince sampling technique. Ethical approval was taken form Institutional Review Committee of College of Medical Sciences and Teaching Hospital and data was analyzed using descriptive statistical tools in SPSS. Results: Twenty eight percent of antenatal and 42% of postnatal women had induced abortion for unintended pregnancy in past. All women had knowledge about modern method of contraception but only 47 percent antenatal and 58 percent postnatal women adopted contraception in past. Implant was chosen by 44% antenatal and 46% postnatal women; whereas IUCD was chosen by 45% antenatal and postnatal women as LARC. Jadelle was the choice of LARC in both group due to its convenient duration (5 years) for birth spacing and its safety profile during breastfeeding. Twenty women refuse for LARC in immediate postpartum period. Conclusions: Single approach immediate postpartum LARC in is chosen by women who had induced abortion for unintended pregnancy in past for its long action, convenience during breast feeding and reliability. Maximum antenatal women prefer IUCD compared to Implants among postnatal women. Keywords: Copper T; Immediate post-partum; Jadelle; long-acting reversible contraceptives; Puerperium; Unintended pregnancy.

Association of Adverse Effects following COVID-19 Immunization with Previously COVID-19 Infected and Non- Infected Health Care Professionals

Introduction: The immunogenicity of COVID-19 disease and variability among adverse effects following COVID-19 vaccine in previously infected and non-infected individuals is not clearly understood. So, this study aims to assess the association of adverse effects of COVID-19 vaccine with previously infected and non-infected individuals. Methods: A case-control study was conducted at College of Medical Sciences, Bharatpur, Chitwan, Nepal from July 2021 to February 2022 among 324 health care professionals who had received two doses of COVID-19 vaccine. Cases included those who developed any adverse effects following COVID-19 immunization and controls included those who did not develop any adverse effects. Exposure was presence and non-exposure was absence of previous COVID-19 infection. The data collected was analyzed in SPSS version 17 software in terms of frequency, percentage, mean, standard deviation, chi-square, exposure rates and odds ratio. Results: Mild adverse effects like fever, myalgia, headache and pain in injection site were observed following both first dose (46.9%) and second dose (6.17%) of vaccine. The exposure rate was more in cases (23.45%) than in controls (11.11%). Odds ratio was 2.452 (95 % CI, 1.332 to 4.512, p<0.05) which is statistically significant. Conclusions: The risk of developing adverse effects following COVID-19 immunization was 2.452 times more in health care professionals who were previously infected with COVID-19 as compared to those who were not infected. Thus, there is a significant association of adverse effects following COVID-19 immunization with previous COVID-19 infection. Keywords: adverse effects; following immunization; association; case-control study; COVID-19 vaccines; health care professionals

Evaluation of POSSUM Score for Outcome Prediction in Patients undergoing Major Gastrointestinal Surgery in Population of Central Nepal

Introduction: The POSSUM score is one of the several risk scores to predict postoperative morbidity and mortality in the surgical domain.This study was designed to assess the validity of POSSUM scoring system in patients undergoing gastrointestinal surgeries in our setup and to analyse the outcome and compare the observed and expected values. Methods: An analytical cross sectional study was conducted among 100 patients in the Department of Surgical Gastroenterology after taking ethical approval from COMS-IRC. Data was analysed using SPSS -20 via descriptive and inferential statistical tools. p-value <0.05 was considered statistical significant. Results: Using POSSUM score the expected morbidity was 54% and mortality was 21.47%.The observed morbidity was 54% and mortality was 13%. The observed to expected (O: E) morbidity was 1.03 and mortality was 0.61 and there was no statistically significant difference between observed and expected value. The area under curve for POSSUM mortality score was 0.896 and the sensitivity and specificity of POSSUM score to predict mortality was 93.2 and 83.9 respectively. Conclusions: POSSUM score is a good mathematical tool in predicting morbidity and mortality in patients undergoing gastrointestinal surgeries. Keywords: gastrointestinal surgeries; central Nepal; expected morbidity and mortality; observed morbidity and mortality; POSSUM score.

Albuminuria in Patients with Type 2 Diabetes Mellitus: a Single Center Cross-Sectional Study

Introduction: Diabetes mellitus is one of the commonest non-communicable diseases in Nepal and is associated with long term microvascular and macro vascular complications. Detection of albumin in urine is the earliest recognizable feature in the development of proteinuric diabetic nephropathy. This study aims to study the prevalence as well the determinants of albuminuria in patient with Type 2 diabetes mellitus visiting the medical OPD of College of Medical Sciences-Teaching hospital. Methods: This was a cross-sectional study done from January to June 2022 among Type 2 diabetes patients presenting to medical OPD for the comprehensive diabetes management. Relevant epidemiological, clinical and laboratory data were obtained. Urine dipstick test was done to screen for albuminuria. The prevalence and determinants of albuminuria were studied. Results: Study among 360 patients with mean age of 58.5 + 10.9 years and the mean duration since the diagnosis of diabetes of 6.8 + 5.5 years, showed that the prevalence of albuminuria was 33.3%. Albuminuria in these patients was found to have significant association with age (P<0.001), duration since diagnosis of diabetes (<0.001) and HbA1c (P<0.001). No significant association of albuminuria was found with gender (P=0.087), hypertension (P=0.063) and previous use of Angiotensin-converting enzyme inhibitors/ Angiotensin II receptor blockers. (P=0.217) Conclusions: Albuminuria is highly prevalent among our cohort of diabetic patients. Increasing age, longer duration since diagnosis of diabetes and higher HbA1c are the factors significantly associated with it.

Mortality and Morbidity Patterns of COVID-19 Patients at a Tertiary Health Care Centre of Nepal

IntroductionCOVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) associated with substantial morbidity and mortality putting the entire health system under strain. This study aims to assess the sociodemographic and morbidity factors of COVID-19 patients and their association with COVID-19 mortality. MethodsIt was an analytical cross-sectional hospital based study in a single tertiary level health care centre in Central part of Nepal. Total 425 COVID-19 patients who were treated at the tertiary health care centre from August 1st 2020 to December 31st 2020 were included in the research. ResultsOut of 425 patients, 230 (54.1%) were male and 195 (45.9%) were female. The mean age group of patients was 50.01±20.03 years, ranging from 7 days to 91 years of age. Total 262 (61.6%) patients had some type of comorbidity. The deaths were more in advancing age, in males and in patients residing in urban areas. Out of total deaths, 41(85.4%) patients had presence of some type of comorbidity. Age, place of residence, co-morbidities, length of hospital stay and place of treatment of patients showed a significant association with COVID-19 mortality with p-value <0.05. ConclusionsCOVID-19 mortality risk increases with advancing age and comorbidity. The global morbidity and mortality of the disease can only decline with the combined effect of preventive measures and health promotion of high risk groups especially those with morbidities like diabetes, hypertension and respiratory diseases.

Mean Subpubic Angle of Patients Visiting Department of Radiodiagnosis of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

The subpubic angle in the pelvis is most often used to estimate the sex with a higher degree of accuracy. Despite the anthropological and obstetric importance of the subpubic angle, only a few studies exist in the Nepalese population. The objective of this study was to determine the mean subpubic angle of the patient visiting the department of radiodiagnosis of tertiary care hospital.

Methods:

This was a descriptive cross-sectional study comprising 332 pelvic digital radiographs of the patients visiting the department of radiodiagnosis of a tertiary care center from March to August, 2021. Ethical approval was taken from the Institutional Review Committee at College of Medical Sciences (Reference number: COMSTH-IRC/2021-62). Convenience sampling method was done. Demographic data like age and sex were noted. In the radiograph, the subpubic angle was measured using the program Digimizer Image Analysis Software. The collected data were analysed using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data.

Results:

Among 332 pelvic radiographs studied, the mean subpubic angle was found to be 120.42±22.27° (118.02-122.81 at 95% Confidence Interval). The subpubic angle in females was 137.96±12.47° and that in males was 101.10±12.56°.

Conclusions:

Our findings are similar to those of other studies, with a minor variation. The subpubic angle was comparatively higher in females than males in the present study. The findings of this study may be of interest to forensic scientists and obstetricians.

Prevalence of Newly Diagnosed End-Stage Renal Disease Patients in a Tertiary Hospital of Central Nepal, Chitwan: A Descriptive Cross-sectional Study

INTRODUCTION

End-stage renal disease patients are in rising trend globally, and they have been found to occur predominantly in developing countries. Many studies have been published before, within and across the countries, to know the clinicodemographic profile of end-stage renal disease patients. However, no such studies were done in Chitwan, Nepal. This study's main objective was to find the prevalence of newly diagnosed end-stage renal disease patients.

METHODS

A hospital-based descriptive cross-sectional study was carried out in the Department of Nephrology from May 2016 to April 2019. Convenient sampling was done, and all the consecutive new end-stage renal disease patients were included in the study. The ethical approval was taken from the Institutional Review Committee (reference number. 2016/COMSTH/IRC/042). The prevalence and demographic profile of new end-stage renal disease patients were studied. The data were analyzed with appropriate statistical tools.

RESULTS

A total of 250 new end-stage renal disease patients were found among 2200 admitted patients. The prevalence of new end-stage renal disease was found to be 250 (11.36%). Out of 250 patients, males were 156 (62.4%), and females were 94 (37.6%). The mean age was 49.6±15.5 years. The commonest cause of the incident end-stage renal disease was Type 2 Diabetes mellitus 89 (35.6%).

CONCLUSIONS

The prevalence of new end-stage renal disease was found to be quite high. The commonest cause of the incident end-stage renal disease was Type 2 Diabetes Mellitus.

Effectiveness of Fentanyl in Facilitating Cannulation of Ampulla of Vater during Endoscopic Retrograde Cholangiopancreatography

BACKGROUND

Endoscopic retrograde cholangiopancreatography is carried out under moderate sedation mostly by use of propofol, opioids and benzodizepines. The aim of study is to assess difficulty in cannulation of ampulla of vater with the use of fentanyl.

METHODS

A prospective randomized double blind comparative study was conducted at Bharatpur Hospital from August 2019 to August 2020 among patients undergoing Endoscopic retrograde cholangiopancreatography. Total 100 patients were enrolled in study and were divided in two groups - Group P (propofol and midazolam) and Group FP (propofol, midazolam and fentanyl). Ease of cannulation was determined using Freeman scale. Independent sample t-test was used to compare mean between two groups and Chi Square test was used to compare categorical variables.

RESULTS

Mean age (51.36±17.750 years versus 56.74±16.995 years), weight (58.88±8.151 kg versus 57.32±8.431 kg) and gender distribution (14 versus 12 male patients and 36 versus 38 female patients) were comparable in both groups-Group P and Group FP. There were 34 patients in Group P and 37 patients in Group FP with easy cannulation and 16 patients in Group P and 13 patients in Group FP with difficult cannulation, which was comparable (p value=0.509) Conclusions: Cannulation of ampulla of vater is not affected by the use of fentanyl in combination with propofol when compared to propofol alone and can be routinely used during endoscopic retrograde cholangiopancreatography.

Comparison of Proton Pump Inhibitor and Triple Therapy Regimen for Laryngospharyngeal Reflux Disease

BACKGROUND

Laryngopharyngeal reflux is retrograde flow of contents of the stomach to the larynx and the pharynx. The study aims to compare two regimens (proton pump inhibitor monotherapy versus triple therapy) on the outcome of Helicobactor pylori positive laryngopharyngeal reflux disease.

METHODS

The presence of laryngopharyngeal reflux was determined by reflux symptom index and reflux finding score. The presence of Helicobactor pylori in the tissue was confirmed by rapid urease test. All urease test negative laryngopharyngeal reflux patients were given a course of proton pump inhibitors and results were evaluated. All urease test positive patients were divided into two groups. One group was given a course of proton pump inhibitors and another group was given a course of triple therapy and the results were compared.

RESULTS

A total number of 704 laryngopharyngeal reflux patients were screened for urease test. Among them 138 patients (19.6 %) were urease test negative and were given proton pump inhibitor therapy. Improvement in both reflux finding score (average score 11.75) and reflux symptom index (average score 5.25) score was observed after 3 months with p-value<0.05. In urease test positive patients, improvement in scores was observed in both proton pump inhibitors and triple therapy group, however marked improvement in the clinical features was observed in triple therapy group with p-value<0.05.

CONCLUSIONS

The study reveals association between laryngopharyngeal reflux and Helicobactor pylori. Proton pump inhibitor therapy is sufficient if no Helicobactor pylori is detected, however incase of presence of Helicobactor pylori, triple therapy gives better results.

Clinicodemographic Profile of Kidney Diseases in a Tertiary Hospital of Central Nepal, Chitwan: A Descriptive Cross-sectional Study

Introduction:

Spectrum of kidney diseases differs significantly in developing and developed countries. However, there is no central registry regarding the nature of such diseases in Nepal and our center either. The study aims to know the clinicodemographic spectrum of kidney disease patients admitted to our hospital.

Methods:

This study was a descriptive cross sectional study done in the department of Nephrology, College of Medical Sciences Teaching Hospital from May 2018 to April 219. Convenient sampling was done and all the consecutive kidney disease patients irrespective of their age, sex, and renal diagnosis were included in the study. Ethical approval was taken from the Institutional Review Committee of the college (reference number. 2016/COMSTH/IRC/049). Clinicodemographic profile of kidney diseases were studied using statistical package for the social sciences version 20 and were represented as mean, standard deviation, number, percentage and ratio.

Results:

Out of a total of 829 patients, the commonest clinical syndrome and the histological patterns were end-stage renal disease 248 (29.9%) and IgA nephropathy 18 (20.7%) respectively. The mean age was 51.4±18.6 years. The commonest reason for hospitalization was sepsis 372 (44.8%). Males were 486 (58.6%) and females were 343 (41.4%).

Conclusions:

The commonest clinical presentation and the reason for admissions were end-stage renal disease and sepsis syndrome respectively.

Clinico-pathological Profile of Kidney Biopsy Patients in a Tertiary Hospital of Central Nepal

Background Kidney biopsy is an important diagnostic tool in Nephrology. As of now, we don't have a central kidney biopsy registry in our country and there are many studies showing heterogeneous patterns of pathologies observed in the country. We thought of looking on the clinico-pathological profile of kidney biopsy patients prevailing in our centre. Objective This study was carried out with an objective to know the clinico-pathological profile of kidney biopsy patients prevailing in our centre. Method This was a hospital based, prospective, observational study carried out in a tertiary teaching hospital of Chitwan over a period of 3 years from May 2016 to April 2019. All the consecutive kidney biopsy patients were included in the study. The indication of kidney biopsies were the standard indication based on clinical presentation and investigations. The patient`s demographic profile, indication of kidney biopsy and histological patterns were studied and analysed using appropriate statistical tools. Result A total of 210 kidney biopsies were analysed over a period of three years, that makes around 5-6 biopsies per month. The mean age of the patient was 35.7 ± 14.9 years. Male were 106 (50.5) and females were 104 (49.5) with male to female ratio of 1.01. The average number of glomeruli was 23.4 ± 11.0. The commonest indication of kidney biopsy and histological pattern were nephrotic syndrome 56 (26.7) and IgA nephropathy 51 (24.2) respectively. Among nephrotic syndrome group, the commonest histological pattern was minimal change disease 21 (37.5). Non-diabetic kidney diseases in diabetes were seen in eight (53.4) diabetic patients making it a significant problem in diabetes and the commonest histological pattern in them were minimal change disease and idiopathic cresentic glomerulonephritis two (13.3) each. Conclusion The commonest indication and histological pattern of the kidney biopsy were nephrotic syndrome 56 (26.7), and IgA Nephropathy 51 (24.2) respectively. Nondiabetic kidney diseases in diabetes were seen in eight (53.4) of the diabetic patient making it a significant problem in diabetes and the commonest histological pattern in them were minimal change disease and idiopathic cresentic glomerulonephritis two (13.3) each.

Complications of Kidney Biopsy in a Tertiary Hospital of Central Nepal, Chitwan

Background: Kidney biopsy is an important diagnostic tool in Nephrology and is said to berelatively a safe procedure.There are limited studies in the complications of kidney biopsy from this region. We therefore thought of looking into the complications of kidney biopsy and its risk factors. Methods: A hospital based analytical cross sectional study was carried out over a period of 3 years. Kidney biopsies were done under ultrasonography guidance. The complications and its risk factors were recorded and were analyzed using mean, standard deviation, ratio, percentage and chi square.   Results: A total of 210 patients were analysed. The mean± standard deviation of 210 patients was 35.7±14.9 years. The commonest minor complication was biopsy site pain not requiring analgesics 136 (64.8%)and the commonest major complication was biopsy site pain requiring analgesics 18(8.6%) followed by perinephric hematoma 10 (4.8%).There was a significant association between low platelet count and the development of complications like pain requiring analgesic (p value 0.04), perinephric   hematoma (p value 0.022) and gross hematuria (p value 0.011). Conclusions: Kidney biopsy is a safe procedure and low platelet count is a significant risk factor for complications (p value <0.05).  Keywords: complications; kidney biopsy; perinephric hematoma; platelet count.  

Comparison of heart rate recovery between normotensive young adults with and without a parental history of hypertension

Introduction: Studies have reported that off springs of hypertensive parents are more likely to develop hypertension. Affection of target organ starts even before the diagnosis of hypertension. Autonomic dysfunction may be the initial cardiac effects in the pathogenesis of hypertension. Till now very few studies have been done to find the early outcomes in the cardiac autonomic functions in the normotensive siblings of hypertensive patients. Heart rate recovery after exercise is a useful marker for cardiac autonomic function. Since the etio-pathogenesis of hypertension is expected to affect the autonomic cardiovascular parameters even before the prehypertensive stage, the following study was carried out to analyze the heart rate recovery, in the descendent non- hypertensive young adults with and without parental history of hypertension. Aim and objective: This research study was aimed to study the quantify and compare the difference (if any) of heart rate recovery in response to 3minute step test between non hypertensive children of non- hypertensive and hypertensive parents within an age group of 18-22 years. Material &Methods: A total of 63 normotensive students were divided into one hypertensive parents(HP) group containing students with parental history of hypertension) and one non hypertensive parents group (NHP) having students without parental history of hypertension). Each student was subjected to 3 minute Master step test. Recordings of heart rate were made before and after exercise. Heart rate recovery index (HRRI) of 1minute (HRRI1), as well as in 2, 3 and 4 minute (HRRI2, HRRI3, HRRI4) were calculated and analyzed. Results: The resting (basal) heart rate as well as 1st minute heart rate recovery index (HRRI1) was not significantly different in the two groups. Likewise, the 2nd minute (HRRI2), 3rd minute (HRRI3), and 4th minute HRRI (HRR4) respectively were also not significantly different between the two groups. Conclusion: This study concluded that there is no significant difference in heart rate recovery among non-hypertensive young adults, with and without parental history of hypertension.

Association of Autonomic imbalance with Parental history of Type 2 Diabetes Mellitus

Background: Off springs with a parental history of type 2 diabetes mellitus are genetically susceptible to develop diabetes. In some recent reports it has been shown that these vulnerable population exhibit altered autonomic activity even before the manifestations of disease. Autonomic dysfunction might be the initial cardiac pathology in subclinical type2 diabetes. Till now very few studies have been done to find out the early outcomes of this genetic transmission. Keeping in view of the above facts, the current study was carried out to find out the association between autonomic dysfunction and parental history of diabetes. Aim and Objectives: This study was aimed to quantify and compare the difference (if any) of heart rate recovery in response to 3minute step test between the young non diabetic children of non-diabetic and diabetic parents. Materials and Methods: Fifty-one non diabetic students were divided into two groups. One group comprised of students with parental history of type2 diabetes mellitus and another group with students without parental history of diabetes. Each student was subjected to 3minute Master step test. Recordings of heart rate were made before and after exercise. Heart arte recovery (HRR) in 1 minute (HRR1) as well as in 2, 3 and 4 minute (HRR2,HRR3, HRR4) were recorded and analyzed. Results: The resting (basal) as well as 1stminute heart rate recovery (HRR1) was not significantly different between the two groups. Likewise, the 2nd minute HRR (HRR2), 3rd minute HRR (HRR3) and 4th minute HRR (HRR4) respectively were also not significantly different between the two groups. Conclusion: This study concludes that there is no difference in the heart rate recovery in response to the exercise stress test between the young non diabetic children of non-diabetic and diabetic parents. Therefore, parental history of diabetes does not have any impact on the cardiovascular autonomic activity before the disease manifestation.

Prevalence and Associated Factors of Depression among People Attempting Suicide

Background: Suicide is the act of taking one's own life. Suicidal attempts, (both fatal and nonfatal) are a challenging public health issue. Suicide causes heavy morbidity and mortality in the most productive group of a community. This study was aimed to calculate the prevalence rate of major depressive disorder among persons who attempted suicide and also to measure the severity of suicidal ideation. Methods: The study involved 50 persons above 18years of age of both sexes who has attempted suicide in the recent past. An informed consent was obtained from all of them. The prevalence of depression among those suicide attempters was studied based on major ICD- 10 depression inventory. Also, suicide intent rating based on Beck’s suicide intent scale was done to assess the severity of suicide attempt. Questionnaire was given and the details were collected. Results: The prevalence of depression is estimated to be 38% (with 95% CI 25.86% to 51.85%) among the suicide attempters and 10% showed high intent for suicide.statistically significant factors are age (p-value <0.001), gender (p-value=0.002) and suicide intent (p-value <0.001). Conclusions: Prevalence of depression is common among people who attempt suicide. Early diagnosis and intervention will reduce suicide attempts.

Clinicodemographic Profile and Outcome of Maintenance Hemodialysis Patients in a Tertiary Hospital of Central Nepal, Chitwan

Background Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients; however their mortality seemed to be rising in our centre. There were no previous studies regarding the clinicodemographic profile and outcome of maintenance hemodialysis patients from this region. Objective This study was carried out with an objective to know the clinicodemographic profile and outcome of maintenance hemodialysis patients in our centre. Method This study was a hospital based prospective observational study carried out over a period of three year, from May 2016 to April 2019, in the hemodialysis unit of the department of nephrology. All the consecutive end stage renal disease patients on maintenance hemodialysis were included in the study. The patient's demographic profile and outcome were studied and analysed using appropriate statistical tools. Result A total of 156 patients were enrolled in the study. Males were 96(61.5%) and females were 60(38.5%). The mean age of the patient was 52.2±15.6 years. The commonest causes of end stage renal disease and reasons for admission were Type 2 diabetes mellitus 68(43.6%) and volume overload with heart failure 101(64.7%) respectively. At the end of three years, 39(25%) were expired, 14(8.9%) were transferred to other centre and four (2.6%) underwent kidney transplantation. The average duration of hemodialysis was 20.3± 17.5 months. Majority of the patients 154(98.7%) had repeat admission ranging from 1 time 21(13.5%) to 10 times two (1.3%). There was a significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively). Conclusion The commonest cause of end stage renal disease and the reason of admission were Type 2 diabetes mellitus 68 (43.6%) and volume overload with heart failure 101 (64.7%) respectively. The overall mortality was 39 (25%) and the commonest cause of mortality was sepsis/health care associated pneumonia 30 (76.9%). There was significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively).

Knowledge on National Free Health Services among Preclinical Medical Students

Background: National free health services are those facilities which are given by the government in free of cost for all the citizens in specific countries. Free health service program provides essential health care services free of charge to all users at Primary Health Care Centers, Health Posts. Methods: A cross-sectional analytical study was conducted among 395 preclinical medical students Bharatpur, Chitwan, Nepal by using non probability sampling technique. In the Bivariate analysis, Chi-square test was done. Before the binary logistic regression Multicollinearity of independent variables was check by using Variance inflation factor (VIF). Binary logistic regression was performed to examine the net effect of each independent variable on the Dependent variable. Results: Result showed that 24.8% students had good knowledge on national free health services (with 95% CI 20.81% to 29.3%). The overall level of knowledge of BPH students had good followed by nursing students. Students who were in the age group 20-25 years had 3.54 times (with 95% CI for OR = 1.869 to 6.689) as compared 15-20 years and students of age 25-30 years had 14.04 times (with 95% CI for OR = 5.292 to 37.262) good knowledge as compare to those who were in the age group 15-20 years. Female students had 2 times (with 95% CI for OR = 1.002 to 3.977) good knowledge as compare to male students. Students who were from BDS had 0.83 times (with 95% CI for OR = 0.159 to 4.319), students who were from Nursing had 1.70 times (with 95% CI for OR = 0.658 to 4.402), students who were from BPH had 4.34 times (with 95% CI for OR = 1.698 to 11.087) and students who were from B Pharmacy had 1.10 times (with 95% CI for OR = 0.415 to 2.941) times higher odds of knowledge as compare to those students who were from MBBS. Conclusions: The overall level of knowledge among the preclinical medical students is poor; only one fourth students had good level of knowledge. Majority of the students don’t know name of the basic free health services provided by government of Nepal. Students of younger adult had good knowledge. BHP and Nursing students had good knowledge as compared to other level. Statistically significant variable with level of knowledge are age (p-value <0.001), gender (p-value 0.049), level of education (p-value<0.001).  

Prevalence of Leptoprosopic type of Face among Dental Students

Introduction:

Facial index is useful for anatomists, forensic scientists and plastic surgeons during treatment of congenital and traumatic deformities, identification of individuals in medico-legal cases and identifying craniofacial deformities and they help us in distinguishing one person from another. Very few researchers from Nepal have worked on these facial features with respect to population and environment. The study aims to find the prevalence of leptoprosopic type of face among dental students of Kantipur Dental College, Kathmandu, Nepal.

Methods:

The descriptive cross-sectional study was conducted among 173 dental students of age group 17-25 years in the Department of Anatomy, Kantipur Dental College Teaching Hospital and Research Center, Basundhara, Kathmandu from September to December 2018. Ethical clearance was obtained from Institutional Review Committee of the institution and convenience sampling was done. The facial parameters include facial height, facial width which was measured using Digital Vernier Caliper and Sliding Caliper respectively. The face was classified into three different types based on the value of facial index, according to Bannister Classification. Data was analyzed using SPSS 20.

Results:

Prevalence of leptoprosopic type of face was 70 (40.46%) [40.39-40.53 at 95%CI]. Among these, 37 (21.39%) were males and 33 (19.07%) were females. Leptoprosopic was most common which was followed by hyperleptoprosopic in 64 (36.99%), mesoprosopic in 26 (15.03%), euryprosopic in 12 (6.94%) and hypereuryprosopic facial types in 1 (0.58%). All three facial parameters including facial height, facial width and facial index were greater in male than in female.

Conclusions:

This study concludes that the leptoprosopic face was most common followed by hyperleptoprosopic, mesoprosopic, europrosopic and hypereuroprosopic type of face.

Impact and Perception of Social Networking Sites on Academic Performance of Medical Students

Background: A social networking site is an online platform that allows users to create a public profile and interact with other users on the website. The emergence of Social Networking Sites has broadened the base of contact, interaction and communication among people living round the globe via internet. Millions of students are logging in to these social networking sites, everyday. That’s why many students have been blaming various social networking sites for their steady decrease in grade point averages and has affected their study time, poor grammar and wrong spellings when socializing on social media as well as diverting their attention from their studies. The objective of this research is to find the impact and perception of social networking sites on academic performance of medical students. Methods: A descriptive cross-sectional study design conducted among 230 Medical students of MBBS, BPH, Pharmacy and BN Nursing’s students. A well-structured questionnaire was prepared and which were distributed among students using probability sampling technique (random number table). Results: The response of 230 students was collected by using well structure questionnaire. The mean±SD of students age was 21.87±2.16 years. Majority of the students were in the age group 20-25 years. Majority of them were female by gender and Hindu by religion. They most commonly used social networking site was face book/messenger (48.7%) followed by YouTube (41.3%). The main aim of using these sites is to update with their family, friends and for entertainment. Nearly 60% students told that there are negative effects of using social networking sites. And only 15.6% students used these sites only for academic purpose. Conclusions: This study revealed that majority of the students used mobile phone as a device and Wi-Fi in their place of residence. The overall perception of students towards social networking sites is positive. Excessive use of these sites decreases their academic performance which conclude that there is Negative relationship between the use of social networking sites and academic performance which in turn negatively affect their academic results.

Mean Nasal Index of Dental Students of A Dental College in Nepal

Introduction

Human nose is one of the important anthropometric parameters for identification of sex and ethnicity of an individual of an unknown identity. The nasal index holds a great value in anthropological studies, because it is one of the anthropometric indices acknowledged in nasal surgery as well as management. The study aims to find the mean nasal index and the nose type of dental students of Kantipur Dental College of Nepal.

Methods

The descriptive cross-sectional study was conducted among 140 dental students in the Department of Anatomy, Kantipur Dental College Teaching Hospital and Research Center, Basundhara, Kathmandu. The study population belongs to dental students of Kantipur Dental College and Research Center. The nasal parameters include nasal height, nasal width which was measured using Digital Vernier Caliper and the nose was classified in three different types based on the value of nasal index.

Results

The mean nasal index of total population was 81.34±14.88 mmwith confidence interval range of 78.85 and 83.83 mm. Mesorrhine type of nose was found to be most common among the total population. Mean nasal index in male is 84.49±12.46 mm and in female is 80.66±15.32 mm.

Conclusions

This study concludes that the mean values of nasal index of the students fall under mesorrhine type of nose.

Preventive Practices of Tuberculosis Patients in a Municipality of Chitwan District, Nepal

Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide and sixth leading cause of death in Nepal. Preventing new infections of Mycobacterium tuberculosis is crucial to reduce TB burden and death. The source of infection is an open (sputum positive) case of pulmonary tuberculosis. Poor management of TB-related waste like disposal of sputum by patients has been reported as a risk factor for increasing susceptibility to active TB infection. The present study was undertaken to assess preventive measures practiced by TB patients. Methods: A cross-sectional study was conducted among 82 tuberculosis patients who visited the five different DOTs centres of Bharatpur Municipality of Chitwan district, Nepal during December 2016 to February 2017. To find the association between variables, chi-square test was used. P-value less than 0.05 were considered as statistically significant.  Results: The Mean ± SD of age of patients was 37.02±18.90 years. 67.10% of the patients received health education on preventive measures. 59.8% of the respondents had good practice on prevention measures of TB. Only 3.70% used burning method for the sputum disposal after diagnosis of TB. None of the respondents used boiling method for the disposal of sputum. Among all only 6% practiced safe method of sputum disposal. The statistically significant variables with health education were preventive measures like self isolation (ᵪ2 = 7.54, p = 0.006), covering face while coughing and sneezing (ᵪ2 = 4.113, p = 0.043) and keeping surrounding clean (ᵪ2= 7.880, p = 0.005).  Conclusions: Patients and family members should be well educated on practicing different preventive measures by further strengthening the preventive measures strategy in the transmission of tuberculosis if we envisioned to end TB by 2035.

Sildenafil is Safe and Effective for the Treatment of Lower Ureteric Stone with no Major Side Effect

INTRODUCTION: Urolithiasis is one of the most common diseases of the urinary tract. Prevalence of urinary stones in a life time is approximately 1% to 15%.Peak age of incidence is 30 years. Male are more commonly affected than female about 2 to 3 times. At the time of presentation 20 % of the calculi are found in the ureter, among which 70% are located in the distal third of the ureter. OBJECTIVE: To study the effect of sildenafil citrate on passage of stone from distal ureter. METHODOLOGY: This is the Quasi experimental study performed in College Of Medical Sciences, Chitwan, Nepal, from February 2017 to February 2018 for a period of one year. First 100 patients of urolithiasis were selected and divided into two groups with the help of lotiery method Group A and Group B. In group A we had patient on placebo and in group B we had patient receiving sildenafil 50 mg once daily and for the period of two weeks. RESULTS: The mean ± standard deviation of stone size was 7.01±1.70mm for treatment group and 6.85±1.56mm for placebo group (p> 0.64) .The stone expulsion rate was 74.5% for treatment group and 41.7% for placebo group (P<0.001). Mean ± standard deviation of expulsion time was 7.6 ±3.49 days for treatment group and 10.25±3.12 days for placebo group (P<0.008). Mean ± standard deviation of VAS was 3.49±1.300for treatment group and 6.77±1.308 for placebo group (P<0.0001). CONCLUSION: Medical Expulsive Therapy (MET) for lower ureterolithiasis with sildenafil during conservative treatment period is safe and effective as demonstrated by the absence of serious side effects and increased stone expulsion rate with early time.

RIPASA vs Modified Alvarado Scoring System for diagnosis of Appendicitis

INTRODUCTION: Acute appendicitis is the most common surgical condition presented to the emergency department. Clinical scoring systems such as the Alvarado and modified Alvarado scoring system were developed with the goal of reducing the negative appendectomy rate to 5%–10%. In the other hand the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian population. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in the Nepalese population. METHODS: This study included 125 patients who had undergone appendectomies from March of 2017 to January 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 125 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 68.64% and a specificity of 28.57%. The PPV was 95% and the NPV was 5.12%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded 88.13% sensitivity and 28.57% specificity. The PPV was 95.41% and the NPV was 12.5%. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity similar to the modified Alvarado scoring system. KEYWORDS: Acute appendicitis, Modified Alvarado Score, RIPASA score.

Correlation between Body Mass Index and Lipid Profile in a Diabetic population of Central Nepal

Background: Diabetes is an important public health problem as global prevalence of diabetes has nearly doubled reflecting an increase in risk factors like overweight or obesity and dyslipidemia. Both obesity and dyslipidemia share a common pathogenesis associated with “insulin resistance”. Thus the aim of this study is to find out correlation between BMI and lipid profile in type 2 diabetics. Materials and Methods: A cross-sectional study was conducted among 136 type 2 diabetes patients visiting the Diabetes Clinic of College of Medical Sciences, Bharatpur, Nepal during Jan-Dec 2017 and who went through lipid profile testing. The informations were taken from hospital records. To find the significant association between categorical variables chi-square test was used. P-value less than 0.05 were considered as statistically significant. To find the association between continuous variables correlation was used. Results: Out of 136 diabetic patients 77.2% of patients were either overweight or obese. 92.6% of patients had dyslipidemia. Among which 58.1% had high TG levels, 56.6% had high LDL levels, 34.6% had high TC levels and 44.9% had low HDL levels. The overall mean ± SD of age was 54.54±12.03 years and of BMI was 28.54±4.57. Positive correlation was seen between BMI with LDL levels and negative correlation with HDL levels. The correlation with other lipid profile parameters were negative. These correlations were found to be statistically not significant. But statistically significant association was seen between gender with weight, total cholesterol and HDL levels. Conclusions: Obesity and dyslipidemia were highly prevalent. As BMI increases LDL levels increases and HDL levels decreases. Also increased weight and abnormal lipid levels of total cholesterol and HDL were found significantly higher among females than males. Keywords: body mass index; lipid profile; type 2 diabetes; HDL; LDL.

Prevalence of low birth weight babies and its association with socio-cultural and maternal risk factors among the institutional deliveries in Bharatpur, Nepal

Background: The low birth weight (LBW) is considered as sensitive index of nation’s health and development. Almost a third of the newborn in the South East Asia region is low birth weight. Over three- quarters of newborn deaths in Nepal occur in low birth weight babies. The causes of low birth weight are multi-factorial and birth weight is determined by the interaction of both socio-demographic and biological factors. Aims and Objective: To find out the prevalence of low birth weight babies among institutional deliveries and its association with socio-cultural and maternal risk factors. Materials and Methods: A hospital based cross-sectional study was undertaken comprising of 220 postnatal mothers along with singleton live born baby delivered in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal during the study period of April 2011 to March 2012. Binary logistic regression was used to find the association between dependent variable (LBW) and independent variables. Model accuracy test in binary logistic regression was done by using Hosmer and Lemeshow Test . To find the strength of binary logistic regression Pseudo R-square was used. Results: Out of 220 respondents, the prevalence of LBW was 23.6% (with 95% CI 21.88 to 25.32%). The risk factors like rest received in afternoon during pregnancy, dietary intake during pregnancy and period of gestation were found to be statistically significant. The odds of having LBW babies was 9.07 times higher in preterm births, 2.44 times higher among mothers who took afternoon rest of less than two hours and 3.44 times higher among those mothers who took dietary intake less or same as before during pregnancy. The variation in LBW due to these factors was found to be 22.9% to 34.4%.  Conclusion: The prevalence of low birth weight was found to be significantly high among institutional deliveries of this region of the country. Socio-cultural and maternal risk factors like rest received in the afternoon during pregnancy, dietary intake during pregnancy and period of gestation were found to be significantly associated with low birth weight babies. The problem of low birth weight babies can be lessened down as most of these factors can be tackled easily by providing adequate and effective antenatal care services with its maximum utilisation as well as home care by emphasising upon education of mothers and family members, hence decreasing infant and child mortality rates. 

Thyrotrophin augmentation after commencing thyroxine replacement in primary hypothyroidism

Prospective measurements of serum thyrotrophin and thyroxine concentrations were made in six patients with primary hypothyroidism treated consecutively with an incremental regimen of oral thyroxine. A fall in thyrotrophin occurred over several months, accompanied by a concurrent slow rise in serum thyroxine. Those patients with the highest initial values for thyrotrophin showed the typical curvilinear decline in thyrotrophin, whereas the remaining patients disclosed a transient rise in thyrotrophin for the first 3 months. This paradoxical rise was not associated with depression of cardiac output or glomerular filtration rate. The significance of thyrotrophin augmentation is uncertain, but it may be more common than generally appreciated. It did not occur in those patients with the most severe degrees of thyroid deficiency. Thyroxine exerts a dual action, and augmentation of thyrotrophin may reflect a dominant effect of increased protein synthesis, in contrast to negative feedback inhibition which suppresses thyrotrophin. These opposing actions are in competition at different dose levels of thyroxine, and may contribute not only to augmentation or suppression of thyrotrophin, but also to the curvi-linear pattern of fall. Such variations impair the utility of thyrotrophin as an index of euthyroidism.