Assessment of Antioxidant Enzyme Superoxide Dismutase (SOD) in Oral Cancer: Systematic Review and Meta-Analysis

Objective

The present article aims to comprehensively review the existing literature on superoxide dismutase (SOD) levels, an antioxidant enzyme, in oral cancer.

Method

An extensive literature search was conducted across various databases, including PubMed, Wiley Online Library, Science Direct, and Cross Reference, spanning 1998-2023. At the outset, 1,177 articles were initially identified, and 907 studies were excluded due to irrelevance or duplication of the research question. Subsequently, 270 articles underwent screening evaluation, resulting in the selection of 85 articles meeting the inclusion criteria. Following this, 68 articles underwent a full-text comprehensive assessment, and ultimately, 39 were chosen for data extraction. The risk of bias in the designated articles was assessed using the Newcastle-Ottawa Scale. Finally, 13 studies were meticulously selected, offering consistent data for the ensuing meta-analysis. Meta-analysis was executed using comprehensive meta-analysis (CMA) version 3 software (Bio Stat Inc., Englewood, NJ, USA). The meta-analysis findings revealed a statistically significant decrease in SOD levels in both erythrocyte samples (P < 0.001) and tissue samples (P < 0.05) among individuals with oral cancer (OSCC) compared to the normal control group. Conversely, the analysis of three studies on salivary samples demonstrated a significant increase (P < 0.05) in SOD levels in the oral cancer group compared to the healthy controls.

Conclusion

This systematic review underscores a statistically significant decline in SOD levels observed across diverse bio-samples in individuals with oral cancer, indicating an excess of oxidative stress (OS). Additional research is needed to delve into the relationship between SOD levels and clinic-pathological prognostic markers within the oral cancer cohort. Such investigations have the potential to significantly contribute to the development of prognostic tools grounded in OS, thereby guiding strategies for treatment planning.

Proliferative verrucous leukoplakia, an enigma to the pathologists: Report of two cases

The oral cavity presents with an array of white lesions ranging from physiological alteration to extensive malignant entities. Among them, proliferative verrucous leukoplakia is a rare highly aggressive multifocal form of leukoplakia that poses a high risk for malignant transformation. Etiopathogenesis and its diagnostic criteria have remained speculative since its inception. The diagnosis of this form of leukoplakia is challenging and it requires updated knowledge and expertise to identify this condition. All the cases of proliferative verrucous leukoplakia are resistant to treatment and have high chances of recurrence. In the present case report, we aim to report and document two cases of proliferative verrucous leukoplakia, which were diagnosed in a dental college. The present case report can serve as a guide to young dental surgeons to spot cases of proliferative verrucous leukoplakia and to refer them to tertiary care hospitals for treatment.

Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation

Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.

Non-familial White Sponge Nevus, an Innocuous yet Clinically Significant Entity: Report of a Case with Review of the Literature

White sponge nevus (WSN) is a hereditary mucosal defect that primarily affects the oral mucosa, presenting with asymptomatic velvety, corrugated hyperkeratotic white plaques that do not disappear on stretching the mucosa. In this case report, we present a non-familial case of a WSN occurring in the tongue in a middle-aged female, which was misdiagnosed as verrucous leukoplakia.

Meta-Analysis of Assessment of Total Oxidative Stress and Total Antioxidant Capacity in Patients with Periodontitis

Background

Periodontitis is intricately linked to oxidative stress-antioxidant (redox) imbalance. The antioxidant system scavenges the oxygen free radicals in biological fluids in patients with periodontitis. However, little is still known about the free radicals mediated oxidative stress and reductive ability of the antioxidant system. Thus, the present meta-analysis aims to quantitatively review the literature that assessed the oxidative stress marker total oxidative stress (TOS) and total antioxidant capacity (TAC) in various biological fluids of patients with periodontitis. Methodology. Electronic databases were searched for studies that assessed TOS and TAC levels in various biological samples of patients with periodontitis.

Results

From the 1,812 articles identified, 1,754 were excluded based on title and abstract screening due to irrelevance to the topic of interest. A full-text assessment of the remaining 58 articles led to the selection of 42 articles that satisfied the inclusion criteria. Of these, only 24 studies had consistent data for quantitative analysis. The periodontitis group displayed significantly elevated TOS levels (p < 0.05) in serum, gingival crevicular fluid (GCF), and saliva samples in the studies evaluated. In contrast, the periodontitis group exhibited significantly attenuated TAC levels (p < 0.01) compared to healthy controls in plasma, serum, and GCF samples of the studies evaluated, which was insignificant in salivary samples (p=0.433). At the same time, the periodontitis group displayed insignificantly elevated TAC levels after periodontal therapy (p=0.130).

Conclusions

The present meta-analysis showed significantly higher TOS and lower TAC in periodontitis, reflecting the elevated oxidative stress level than the control group. Clinical Relevance. Scientific rationale for the study: The imbalance between oxidants and antioxidants (oxidative stress (OS)) plays a critical role in the onset and progression of periodontitis; the assessment of the relationship between OS-related biomarkers in regional samples and systemic samples of patients with periodontitis helps us to evaluate the periodontal disease progression. The OS biomarker levels can be used to assess periodontal disease and therapeutic efficacy.

Elusive long-standing intraoral foreign body: A rare encounter

Foreign body ingestion/aspiration can occur during orthodontic procedures that may be of minimal risk or lead to acute medical and life-threatening emergencies. The present report describes a rare case of retained orthodontic wire fragment in the masticator space for nearly two decades identified as an incidental radiographic finding, highlighting the importance of optimum care in the dental clinic at all times be it surgical or nonsurgical intervention.

Assessment of glutathione peroxidase enzyme response and total antioxidant status in oral cancer - Systematic review and meta-analysis

BACKGROUND

Oxidative stress induced by free radical accumulation contributes to many pathologies, including cancer. Antioxidant defense system fails to scavenge free radicals when it is excessively accumulated. Assessing individual antioxidant enzymes and total antioxidant capacity could direct the customized therapeutic strategies.

OBJECTIVE

Evaluation of total antioxidant status and enzyme glutathione peroxidase activity in the oral cancer group compared to the healthy control group.

METHOD

The literature search included databases PubMed, Science Direct, Wiley Online Library, Cochrane and Cross Reference between 1999 and 2021. The database search was completed in the month of August 2022. The extracted data were analyzed by Comprehensive Meta-Analysis (CMA) version 3 software (Biostat Inc. Englewood, NJ). Based on search strategies, 1435 articles have been retrieved from the database. In the segregated articles, 1365 were excluded due to duplicated articles, animal studies, low-quality studies, articles unrelated to the research question, and with unmatched objectives. Based on inclusion criteria, 70 articles were selected for full-text valuation. However, 33 articles were found highly suitable for inclusion and data extraction. Finally, 11 articles were selected for meta-analysis.

RESULTS

The meta-analysis of four included studies of tissue samples showed a significantly (p < .001) increased GPx activity in the oral cancer group, when compared to the control group, whereas three included studies of erythrocyte samples displayed a significantly (p < .001) decreased GPx activity in the oral cancer group than the control group with the pooled standardized mean difference value of -2.766 moles/min/g Hb at 95% CI (-3.297 to -2.234). The meta-analysis of the included studies depicted an insignificant (p = .947) reduction of salivary TAS levels in the oral cancer group when compared to the control group.

CONCLUSION

Our systematic review and meta-analysis depict antioxidant GPx enzyme activity in the regional tissue samples of the oral cancer group differs from other systemic biological fluid samples compared to the healthy control group.

Assessment of Oxidative Stress by the Estimation of Lipid Peroxidation Marker Malondialdehyde (MDA) in Patients with Chronic Periodontitis: A Systematic Review and Meta-Analysis

Objective

The present systematic review and meta-analysis aimed to assess the oxidative stress-mediated lipid peroxidation end product malondialdehyde (MDA) in periodontitis using the available literature.

Materials and Methods

An electronic literature search was performed for the published articles from 2000 to 2022 in PubMed (MeSH), Science Direct, Wiley Online library, and cross-reference using specific keywords.

Results

The literature search identified 1,166 articles. After analyzing the abstracts of the obtained articles, the articles were excluded for the following reasons: duplicate studies (n = 395) and not relevant to the research question (n = 726). The remaining 45 articles were chosen for full-text evaluation. Finally, the present qualitative synthesis selected 34 articles that met the inclusion criteria for evaluation and removed the articles which did not meet the required criteria (n = 11). Out of these, 16 articles had coherent data for quantitative synthesis. The meta-analysis used the standardized mean differences method at a 95% confidence interval by random-effects model. The periodontitis group displayed significantly higher MDA levels (P < 0.001) in gingival crevicular fluid, saliva, and serum samples of the studies analyzed than the healthy control.

Conclusion

The analyzed studies showed significantly higher MDA levels in various biological samples of patients with periodontitis, supporting the role of elevated oxidative stress and consequent lipid peroxidation in periodontitis.

Accidental finding of COVID-associated mucormycosis (CAM) in a patient presenting as toothache: A case report and review of literature

Mucormycosis is an angio-invasive rapidly progressing fungal infection, usually reported in immunocompromised individuals. We present a case of COVID-associated mucormycosis in a patient with a presenting symptom of toothache in the maxilla with a possible mild case of COVID-19.

Abstract

Coronavirus-associated mucormycosis (CAM) had reached epidemic status, especially during the second wave of COVID-19. It was especially prevalent in India with a large mortality rate. Mucormycosis, particularly the rhinocerebral type is seen to be greatly associated with COVID-19, especially in patients with altered immunity. Uncontrolled diabetes, chronic kidney disease, immunocompromised patients, malignant hematological diseases, etc. are the major risk factors of CAM, precipitated by the injudicious use of corticosteroids for the treatment of COVID-19. CAM may often present in the maxillofacial region which warrants that dental clinicians be aware of the clinical presentation, diagnostic guidelines, and appropriate management measures for the disease. This report is one such case of CAM involving the posterior maxilla in a middle-aged individual with mild COVID-19 symptoms.

Pigmented basal cell carcinoma diagnosed in a dental setup: Report of a case with review of the literature

Pigmented basal cell carcinoma is a rare variant of basal cell carcinoma, with only a limited number of reported cases. Because of its similar clinical presentation, it is often over‐diagnosed as malignant melanoma. Along with case presentation, the clinical, microscopic features, and differential diagnosis are discussed in this case report.

Juvenile psammomatoid ossifying fibroma of the maxilla and mandible: A systematic review of published case reports

OBJECTIVE

The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in terms of published cases of Juvenile psammomatoid ossifying fibroma (JPOF) of the maxilla and mandible by a systematic review. MATERIALS AND METHODS: The databases searched were PubMed, MEDLINE, Scopus, Google scholar, and Cross references. Only those case reports of JPOFs published in the English language from 2000 to 2022 were considered. All cases included confirmed JPOF lesions histopathologically. The SR-included details like clinical and radiographic data, follow-up details such as recurrence, and the presence of any adverse outcome.

RESULTS

The database search produced 595 articles from 2000 to 2022, among which 22 case reports were included in the systematic review. The mean age of JPOF occurrence in patients was 18 ± 16 years. A male predilection was noted among patients younger than 14 years of age, whereas a female predilection was noted in patients older than 14 years of age. Frequent involvement of the mandible (56%) compared to the maxilla (44%) was reported. The posterior mandible was the most commonly affected site involving numerous adjacent structures. The expansile nature of the JPOF displayed 57% buccolingual expansion, 50% downward displacement or erosion of the lower border of the mandible and 81% of  involvement of the maxillary antrum/pterygoid plate/orbital floor. Among the 20 cases reported, the treatment provided included surgical excision in 45% of the patients, jaw resection in 35% of the patients, and enucleation and curettage in 18% of the patients. Follow-up details were provided in 80% of the reports that showed recurrence.

CONCLUSIONS

The diagnosis of JPOF requires correlation of the clinical and radiographic features with key histopathological features. Although long-term follow-up of the case reports has been reported, the data lack information about the long-term outcomes of JPOF.

Can an App-Based Maxillofacial Trauma Score Predict the Operative Time, ICU Need and Length of Stay?

Study Design

Retrospective chart review.

Objective

Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay.

Methods

We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of .05 was considered significant at a 95% confidence interval.

Results

There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time (r = 0.67, P < .001) was observed. ZS score predicted operative time (b 1 = 7.67, P < .001) in our study sample. Increasing ZS trauma score was also significantly associated with ICU requirement (X 2 (3) = 13.682, P = .003), but the length of stay could not be predicted based on ZS score.Conclusions: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems.

A long‐standing case of desmoplastic fibroblastoma of the face

The present case report depicts an unusually large desmoplastic fibroblastoma. The diagnosis of the lesion appears to be deceptive clinically. The purpose of this case image is to highlight its size and presenting symptoms, which could easily be mistaken for an odontogenic, salivary gland, or a soft tissue neoplasm.

Multirooted supernumerary tooth in the anterior maxilla: A rare presentation

Multirooted supernumerary tooth is a rare finding, which predisposes to various malocclusion. The present case report depicts the presence of a multirooted supernumerary tooth in the anterior maxilla just adjacent to the midline in a 24‐year‐old patient.

Shaping of comminuted midface fractures with stock Titanium mesh: a technical note

Multiply fragmented fractures of the maxillofacial region are difficult to fix with traditional miniplate osteosynthesis because of the extremely small size of fragments, complex three-dimensional anatomy, thin bone unable to hold screws and multidirectional pull of muscles. We intend to present a technical note on a case series of extremely comminuted midfacial fractures reconstructed with stock Titanium mesh, cut to shape and used to mold the small fragmented segments into the shape of the facial bones. Severe fragmentation of midface leads to facial hollowing, tissue prolapse and asymmetry even after major facial buttresses are fixed and reconstructed. Simple stock Titanium mesh can be used to reconstruct these severe fragmentations of thin bones of the midface as shown in the series and avoid late and unsightly complications.

Do the Benefits of Systemic Corticosteroids Outweigh Adverse Effects During Maxillofacial Trauma Surgery? A Systematic Review and Meta-Analysis

PURPOSE

Perioperative systemic corticosteroids are widely used in maxillofacial trauma surgery to prevent postoperative complications, but potentially perceived benefits are speculative rather than evidence-based. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing maxillofacial trauma surgery.

METHODS

We searched Medline, Embase, CENTRAL, Clinical trial registry, and grey literature as well as references of included trials. Our primary outcomes were facial edema and pain after the surgery. Our secondary outcomes were postoperative nausea and vomiting, neurosensory disturbance, functional recovery, wound infections, and other adverse events.

RESULTS

Of the 94 trials retrieved, 13 were included (n = 652). Perioperative steroid use was associated with reduced pain and facial edema. We observed a decrease in postoperative nausea and vomiting with the use of systemic corticosteroids (n = 184, OR = 0.53, [0.28, 1.02], I² = 0%). Four trials reported infections and impaired wound healing associated with steroids (n = 160. OR = 3.37, [1.43. 7.94], I² = 2%). The 13 trials had an unclear risk of bias.

CONCLUSIONS

Systemic corticosteroids reduced facial edema and postoperative pain, but impaired wound healing was also reported. The use of systemic steroids in maxillofacial trauma surgery is thus supported only by weak evidence and further research is advocated.

Prevalence of Operated Facial Injury in the Department of Oral and Maxillofacial Surgery of a Tertiary Hospital

Introduction: Maxillofacial injury is one of the commonest causes of surgery performed by anoral and maxillofacial surgeon. Socioeconomic conditions, cultural variation, age, and genderaffect the etiology of the injury. The study is aimed to find the prevalence of facial injury that isoperated by the oral and maxillofacial surgeons in the College of Medical Sciences and TeachingHospital, Bharatpur, Chitwan, a tertiary hospital. Methods: A descriptive cross-sectional study was performed using the chart from the hospitalregistry for the patient being operated under general anesthesia from April 1, 2017, to March2019. Simple random sampling was done using computer-generated random numbers. Ethicalapproval was received from the Institutional Review Committee of the hospital. The Data forthe reason for surgery, age, age groups etiology, and tissue involvement were analyzed usingStatistical Package for the Social Sciences version 20. Results: Facial injury occupies 378 (71.59%) of the total operation performed by Oral andMaxillofacial surgeon in a tertiary hospital. Soft tissue 196 (52.85%) and facial bone fracture182 (48.15%) is distributed among the facial injuries. Young adults are commonly affected, andthe road traffic accident is the major cause of facial trauma. Conclusions: Facial injury-related surgeries are more prevalent in the tertiary hospital ofBharatpur.

Pattern of Impacted Mandibular Third Molar in Patients Presenting to Tertiary Care Hospital in Chitwan, Nepal

Introduction: Impacted third molars are a major cause of visit to the oral surgeon and are associated with various complications like pain, inflammation of associated soft tissue and trismus leading to a need for their surgical removal. They are widely classified on the basis of angulation, depth and position as evident from orthopantomogram however they present in a diverse panorama of patterns each presenting different level of difficulty and different techniques for their removal. Our study describes different pattern of impacted lower third molars and perform brief literature review of dental and skeletal implications of impacted third molars. Materials & Method: A retrospective study was designed in which 401 orthopantomogram were examined and the sex of patient, side of impaction and winters angulation based classification, depth and position classification as given by Pell and Gregory were recorded. Descriptive data analysis was performed with SPSS version 24 software. Result: Out of total number of impactions 191(47.6%) were in females and 210(52.4%) were in males. Right sided impaction was seen in 199(49.6%) cases and 202(50.4%) were seen on left side. Mesioangular impaction was most common 203(50.6%) followed by distoangular 97(24.2%), horizontal 51(12.7%) and vertical 17(4.2%). Most common depth level of impaction was level I with 203(50.6%) followed by level II 178(44.4%) and level III 20(5%). Most common position was position B 355(88.5%) followed by position A 43(10.7%) and position C 3(0.7%). The most common pattern was IB (n=170) and IIB (n=166). Conclusion: The most common impaction is mesioangular followed by distoangular and horizontal. Most of the impacted third molars are in moderately difficult position.

Indications and Complications Associated with Coronal Approach to Upper Midface Fracture

Background: Coronal approach has been widely used by maxillofacial surgeons around the world for wide exposure and fixation of upper midface fractures. Coronal approach hides the scar in hair and completely avoids any incisions on face thus providing better aesthetic outcome. Our aim was to describe the data on indications and complications associated with coronal approach in our patient population. Methods: Prospective longitudinal study was planned and data was collected from a study population of all patients treated with coronal approach for facial fractures from January 2016 to June 2019. Demographic variables, Type of fracture, hemicoronal or bicoronal approach used and early complications of hematoma, infection and dehiscence were recorded. Delayed complications of neurosensory disturbances, facial nerve weakness, temporal hollowing and alopecia scar in hair bearing area was recorded. Results: Isolated zygomatic arch fracture was most common indication with 14 cases followed by ZMC fractures with 12 cases, NOE fracture with 7 cases, Lefort III with 6 cases and Frontal bone fracture with 2 cases. Hematoma was not observed in any of our cases. Infection was observed in 2 cases (4.8%), Dehiscence was observed in 5 cases (11.9%), Neurosensory disturbance was observed in 12 cases (28.6%). Permanent neurosensory changes beyond 6 months of follow up was not observed. Alopecia scar was seen in 7 cases (16.7%) and Facial nerve weakness was observed in 4 cases (9.5%). Conclusions: Coronal approach is best approach in terms of exposure provided to upper midface fractures and can be safely performed with minimal complications. Keywords: complications; coronal approach; upper midface fractures.

Door-to-balloon time and the determining factors in a tertiary cardiac center in Nepal

Background

Door-to-balloon (DTB) time of 90 min during primary angioplasty is considered as the benchmark duration. Shorter DTB time is preferable, and longer duration can have poor clinical outcomes.

Methods

A cross-sectional observational study of three months in Shahid Gangalal National Heart Center was conducted in which all patients undergoing primary angioplasty were included. The DTB time was calculated, and the different determining factors were studied.

Results

Seventy-nine patients undergoing primary percutaneous intervention were studied. The median DTB time was 79 minutes (Interquartile range [IQR] 59–115 min). Forty-six (58.2%) patients had a DTB time of less than 90 min. DTB time varied significantly with direct visit vs transfer (p = 0.029) and office time visit (9 am–5 pm) vs off time (5 pm–9 am) (p = 0.012). DTB time did not differ between any infarct-related vessels (p = 0.471), number of vessels involved (p = 0.638), and the added procedures (defibrillation, thrombosuction, and temporary pacemaker insertion) (p = 0.682) during angioplasty. No significant differences were recorded according to age (p = 0.330), gender (p = 0.254), hypertension (p = 0.073), diabetes (p = 0.487), heart failure (p = 0.316), and baseline left ventricular ejection fraction (LVEF) (p = 0.819).

Conclusion

The median DTB time in primary angioplasty was less than 90 minutes. The significant determining factors were timing of hospital visit (office vs off time) and type of visit (direct vs transfer). There can be improvement in factors determining DTB time to lower it further.

Densely calcified tuberculous constrictive pericarditis with concurrent active pulmonary tuberculosis infection

Though pulmonary tuberculosis is a common chronic infection in the developing countries like Nepal, the incidence of tubercular constrictive pericarditis is very low. Here we report a patient of active pulmonary tuberculosis with sputum positive for acid fast bacilli along with densely calcified constrictive pericarditis which has been reported as a very rare presentation in the literature.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12955 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 41-43

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

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

Evaluation of control of blood pressure in chronic kidney disease patients with hypertension attending echo-lab of Nepal Medical College Teaching Hospital

Hypertension and Chronic kidney disease (CKD) are common in Nepal. Control of blood pressure (BP) in general hypertensive patients is poor. Evaluation of adequacy of BP control in CKD patients with hypertension is rare. All consecutive indoor patients (52) with CKD and hypertension, attending echo-lab of Nepal Medical College Teaching Hospital during prospective study of 3 years period from 16th April 2008 to 15th April 2011, were evaluted. Mean age was 45.3 +/- 16.7 years. Male female ratio was 8:5. Brahman and Chhetri (22, 42.3%) were the usual sufferers. There were two peaks in the age group wise distribution; one in age group 20-29 years and the next in 50-59 years. One hypertensive patient's BP was normalized after starting hemodialysis without antihypertensive therapy and was excluded from this study. Others' BP (n = 51) were followed up during admission for the evaluation of the adequacy of their BP control and their antihypertensive medications were reviewed. The control of hypertension in CKD patients was difficult. More than two third of the patients (68.6%) had BP > 140/90 mm Hg. Intensive BP control was present in less than one tenth (7.9%) of the patients. In comparison to intensive group, uncontrolled group received more antihypertensive agents (3.0 +/- 1.3 vs. 2.0 +/- 0.8, p < 0.05). Amlodipine (39, 76.5%) and frusemide (39, 76.5%) were very popular antihypertensives used followed by Prazocin (20, 39.2%) and Metoprolol (11, 21.6%). Despite good efforts, BP control of Nepalese CKD patients with hypertension, were poor.

Correlation of the hand length and stature in adult Musahar females of Nepal; an anthropometric study

Stature of a person is one of the most important and useful anthropometric parameter for establishing identification of unknown living or a dead person. A descriptive cross sectional study was done on 165 Nepalese adult Musahar females of Aurahi Village of Mahottari district, Nepal to predict the stature from their hand length. Measurement of stature and the length of both right and left hands taken with a standard standing height measuring instrument and a slide caliper respectively showed significant (p<0.001) positive correlation between the stature and hand lengths. The multiplication factor which was obtained by dividing the height of the subject by the respective hand lengths was found appropriate parameter to calculate the stature of a questioned person. The importance of the hand length alone will be of a great value for anthropologists and forensic experts. As an alternative method, the coefficient of regression and intercept which were obtained from the measured height and hand length were also proved to be equally valuable to estimate the height of a questioned person.

Both olfactory epithelial and vomeronasal inputs are essential for activation of the medial amygdala and preoptic neurons of male rats

Chemosensory inputs signaling volatile and nonvolatile molecules play a pivotal role in sexual and social behavior in rodents. We have demonstrated that olfactory preference in male rats, that is, attraction to receptive female odors, is regulated by the medial amygdala (MeA), the cortical amygdala (CoA), and the preoptic area (POA). In this paper, we investigated the involvement of two chemosensory organs, the olfactory epithelium (OE) and the vomeronasal organ (VNO), in olfactory preference and copulatory behavior in male rats. We found that olfactory preferences were impaired by zinc sulfate lesion of the OE but not surgical removal of the VNO. Copulatory behaviors, especially intromission frequency and ejaculation, were also suppressed by zinc sulfate treatment. Neuronal activation in the accessory olfactory bulb (AOB), the MeA, the CoA, and the POA was analyzed after stimulation by airborne odors or soiled bedding of estrous females using cFos immunohistochemistry. Although the OE and VNO belong to different neural systems, the main and accessory olfactory systems, respectively, both OE lesion and VNO removal almost equally suppressed the number of cFos-immunoreactive cells in those areas that regulate olfactory preference. These results suggest that signals received by the OE and VNO interact and converge in the early stage of olfactory processing, in the AOB and its targets, although they have distinct roles in the regulation of social behaviors.

Poisonings at Nepal Medical College Teaching Hospital

Poisoning is an increasingly common social problem in Nepal. Studies on poisoning in semi urban areas of Nepal are minimal. Here we, present a prospective study of poisoning in semi urban area of capital, Kathmandu lasting for six years duration. Altogether there were 354 cases of various poisoning, admitted in Nepal Medical College Teaching Hospital from Baisakh 2062 (April 16, 2005) to Chaitra 2067 (April 15, 2011). Male: Female ratio was 135:219 (1:1.6) and Age +/- SD was age 29.3 +/- 13.8 years. Age group (20-29 years) comprised of 138 patients (38.9% followed by < 20 years age group (92, 25.9%). Brahman/ chhetri (150, 42.4%) and Mongolian (146, 41.2%) ethnic groups were the main sufferers of poisoning, followed by newars (41, 11.6%) patients. Deliberate self harm was the cause for poisoning in maximum number of patients (156, 44.1%), followed by depression (64, 18.1%) and accidental poisoning (42, 11.9%). Organophosphorus (152, 42.9%), medicines (71, 20.1%), and rodenticide poisoning (38, 10.7%) were common poisons. Metacid (Methyl parathion) (46, 15.5%) was the most popular brand of poisoning agent used in Nepal for suicidal purpose. The over all mortality rate of poisoning in general was 7.1% with organophosphorus poisoning topping the list (19, 12.5%). We also present mad honey poisonings in a small group of 9 (3.2%) patients with M:F 8:1, age 26.5 +/- 8.8 years. Due precaution should be undertaken during their management as some of them may go into cardiopulmonary arrest and should not be considered benign when more than 5 tablespoonful wild honey is consumed.

A morphometric study of human pancreas in Nepalese people

Considering the seriousness of pancreatic diseases and the utmost importance of its correct diagnosis and treatment, a morphometric study of pancreas among Nepalese population has emerged as a demand of present time. This study was carried out to establish a normal dimension of pancreas which could be a guideline for the correct diagnosis, treatment and research on various diseases related to it. Thus, a descriptive type of study was done within a period of eight years of time (2004-2011) on 40 pancreases of both sexes and different age groups, collected from embalmed cadavers from four medical colleges of Kathmandu, Nepal. The obtained specimens of pancreas were classified according to the age and sex. Simultaneously, the weight and length were measured. The data was statistically analyzed and compared, which revealed that the mean size of pancreas was significantly larger in below forty years of age group. Although, there was no significant difference in the size of pancreas between male and female, the pancreas of male subjects was found larger. Thus, the result of the present study not only provides standard dimension of pancreas in Nepalese peoples but also reveals that it is larger in younger people and males.

Variation in inferior vena cava with persistence of left posterior cardinal vein. A case report

Left sided single inferior vena cava is a rare developmental anomaly affecting clinical diagnosis, treatment and raising academic quest. Incidentally, a similar case was found in the museum of the Department of Anatomy of Nepal Medical College. Along with the anomaly, there were other associated vascular anomalies. The article discusses the possible causative situations.

Spirometric evaluation of pulmonary function tests in clinically diagnosed patients of bronchial asthma

The present study was undertaken to assess the difference between the normal predicted value and observed value of pulmonary function test (PFT) amongst the asthmatic patients and also to compare the aforesaid observed values between male and female asthmatic patients. Clinically diagnosed cases (male 62, female 75) of bronchial asthma attending medical out patient department of Nepal Medical College Teaching Hospital were assessed. All the pulmonary parameters showed significantly less observed values than the normal predicted values except PEFR in female and FVC in male asthmatic patients. Hence, PEFR in female and FVC in male asthmatic patients might not be considered as a valid parameter to indicate bronchial asthma. Present study also revealed that all the pulmonary variables were significantly higher in males than in females.

Effect of maternal alcohol consumption on cerebellum of rat pups: a histological study

Consumption of alcohol during pregnancy results in fetal alcohol syndrome (FAS) in newborn affecting the central nervous system which is more sensitive to deleterious effect of alcohol. This study was conducted to observe the histological alterations in cerebellum of rat pups born to alcohol consuming mother rats. Virgin female albino rats were given 20.0% (v/v) alcohol through oral route two weeks prior to mating and continued till the weaning of their offspring. On postnatal day 27 (PND27), rat pups were sacrificed. Their brains were collected and weighed. The cerebellums were isolated and processed for histological study. The diameter of Purkinje cell and width of molecular and granular layers of the cerebellar hemisphere were measured. Results showed significantly decreased brain weight in rat pups of experimental group when compared to control. The diameter of Purkinje cells, width of molecular and granular layers were also found to be decreased in the experimental group. These results suggest that the maternal consumption of alcohol affects the brain growth and induces significant alterations in the histological architecture of cerebellum of growing rats.

Cranio facial anthropometric measurements among Rai and Limbu community of Sunsari District, Nepal

Anthropometry is applied to obtain measurements of living subjects for identifying age, stature, and various dimensions related to particular race or an individual. Population based cross sectional study was carried out in Dharan and its neighbouring areas with the help of departments of Anatomy and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan. This study included 444 healthy people aged 25-50 years belonging to pure race of Rai and Limbu communities. Head length, nasal ergonomics and total stature were measured for each selected individual. Student't' test was applied to identify significance of the variables. Except nasal breadth of Limbu, the results showed a significant variation (p < 0.001) in all parameters between male and female of both the communities. It was also revealed that Limnbu males and females were taller with larger head length, longer nasal length and nasal height. Similarly nasal breadths of Limbu females were broader where as in males, Rai had broader nose than that of the Limnbu. Therefore it was concluded that anthropometric measurements can play significant role in determining the sex and ethnicity of characteristic pure races of national importance.

Screening for hepatitis B, C and non-alcoholic fatty liver disease: a survey of community-based physicians

BACKGROUND

Screening guidelines for hepatitis B (HBV) and hepatitis C viruses (HCV) as well as a position statement for non-alcoholic fatty liver disease (NAFLD) have been put forth by different sources, but awareness of these guidelines and their impact on the physician practices have not been assessed.

AIM

To assess the attitudes of primary care physicians (PCPs), gastroenterologists (GEs) and hepatologists (HEPs) regarding screening for HBV, HCV and NAFLD.

DESIGN

A survey questionnaire was sent to community-based PCPs and GEs to assess issues related to HBV, HCV and NAFLD. The same questionnaire was sent to hepatologists (HEPs). The questionnaire contained 10 items related to demographic and practice patterns of these physicians, 35 items related to HBV, 35 items related to HCV and 29 items related to NAFLD.

RESULTS

A total of 214 physicians (103 PCPs, 59 GEs and 52 HEPs) completed the survey. A majority of PCPs, GEs and HEPs agreed on most screening issues for these causes of liver disease. Nevertheless, within group comparison of physicians (guideline aware versus guideline unaware) showed significant differences in accurate response between those who were aware of guidelines and those who were not aware.

CONCLUSIONS

A large percentage of PCPs and GEs were unaware of official guidelines for viral hepatitis B and hepatitis C. Those aware of guidelines were more likely to screen appropriately and avoid unnecessary testing. More needs to be done to assess awareness and the impact implementation of guidelines in hepatology.

Echocardiography based cardiac evaluation in the patients suffering from chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the most common medical problem in Nepal. Echocardiography based cardiac evaluation in COPD is rare in Nepal. The purpose of this study is to evaluate the echocardiography based cardiac function in consecutively admitted COPD patients (507) in medical wards of Nepal Medical College Teaching Hospital during 13th April 2007 to 12th April 2008. Male female ratio was 0.9:1. Age (mean +/- SD) was 66.1 +/- 10.9 yr. Brahman and Chhetri ethnic group comprised of more than half of total COPD patients followed by similar number of patients in Newar (22.1%) and Mongolian ethnic groups (21.5%). More than half of the COPD patients were in age group 60-75 years, followed by less number of patients (approximately 20.0%) in both 45-59 years and 75-89 years age groups. Of the total patients (507), 141 patients underwent echocardiographic evaluation. Among them significant number of patients had poor LVEF (29, 20.6%) with statistically significant difference in LVEF (36.0 +/- 10.5 vs. 64.3 +/- 8.5%, p value < 0.01). More than half of the total patients showed features of chronic cor pulmonale (56.3%), followed by valvular heart disease (49.3%), diastolic dysfunction (38.7%) and left ventricular hypertrophy (14.1%). Mild pulmonary artery hypertension (PAH) was detected in approximately half of patients (49.1%), followed by moderate PAH in 17.6% patients. Transthoracic echocardiography was found to be very useful to identify various concomitant cardiac abnormalities demanding special treatment consideration in managing clinically COPD like patients.

High fat diet induces obesity in British Angora rabbit: a model for experimental obesity

A reliable and cost-effective animal model for human obesity with its manifested disorders is yet to be established in the context of increased morbidity and mortality due to obesity and its related problems. Therefore, an attempt was made to produce obesity in locally available British Angora Rabbits (BAR) and examine the effect on metabolic and cardiovascular parameters. Adult male BARs weighing nearly 2 kg were randomly divided into two groups, one of the groups was fed with high fat diet (HFD) ad libitum for 10 weeks and the control group received standard normal rabbit chow for same period. Body weight, skinfold thickness, serum cholesterol, serum glucose and resting heart rate were measured before and after the dietary regimens. After 10 weeks, HFD group of rabbits demonstrated significant (P < 0.05) increase in body weight (+24%) and skinfold thickness (+37%). The gain in body weight was positively correlated to skinfold thickness (r = 0.61). Serum cholesterol, serum glucose and resting heart rate were also increased by 46%, 52% and 15%, respectively. Whereas no such increases in any of these parameters were observed in control group of rabbits. Our results suggest that obesity can be produced in BARs by feeding HFD. The obesity manifests with cardiovascular and metabolic changes. It is proposed that this may serve as a valid and reliable model of experimental obesity.

Obesity attenuates formalin-induced tonic pain in British Angora rabbits

Obesity is known to alter various physiological parameters including the pain sensitivity. There are conflicting reports on the pain sensitivity in obesity. In this context, the present study was aimed to investigate the tonic pain response in obese rabbit model. To achieve this aim, two groups of adult male British Angora rabbits were used. One of the groups was fed with standard rabbit chow and served as control. The other group was fed high fat diet (HFD) for 10 weeks to produce obesity. The standard formalin test was performed at the start and after 10 weeks of dietary regimen in both the groups. Timed behavioral responses (limping, elevation of paw, licking, biting, grooming etc.) were categorized and quantified with the help of standard pain rating scale. The total average pain rating score decreased significantly from 2.01 +/- 0.02 to 1.47 +/- 0.08 (P < 0.05) in HFD group after 10 weeks of dietary regimen, whereas there was no change in the control group. A significant negative correlation was observed between body weight and pain rating score in HFD group of rabbits (P < 0.05, r = -0.62). Results suggest that obesity attenuates the tonic pain responses induced by formalin in British Angora rabbits.

Experience of newly constructed echocardiography-database with video clips and color still images at the Echocardiography Lab of Nepal Medical College Teaching Hospital

Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still color snaps are converted into JPEG format. Window media player can be used later on to review the video clips. All together 1059 patients including pediatric, adults and geriatric patients underwent echocardiographic evaluation at the Echo-lab of Nepal Medical College Teaching Hospital during 10th January 2007 to 9th May 2008. Age ranged from 2 months to 98 years. Mean+SD was 52.4 +/- 18.5 years. Male/female ratio was 0.8:1. More than half of the patients (64.3%) came from Kathmandu. Brahman/Chhetri (478, 45.1%), Tamang, Sherpa etc 278 (26.3%) and Newar (226, 21.3%) were the main echo-users. Elderly age group (>60 yr) comprised of more than one third of the patients (42.0%) followed by the age group of 45-59 yr (27.7%). No abnormality was detected in 133 (12.6%) patients. Valvular heart disease was noticed in more than half of patients (60.7%), followed by diastolic dysfunction (393, 14.0%) and left ventricular hypertrophy (210, 7.5%). This database is not very expensive but demand minimal extra time and energy. It will be a valuable tool to increase diagnostic accuracy and a great resource for academic purpose aiding in the improvement of cardiac care in Nepal.

Ambulatory blood pressure monitoring: a useful tool to diagnose hypertension and supervise it's treatment

Automatic ambulatory blood pressure monitoring (ABPM) for the diagnosis and treatment ofhypertension(HTN) is not common in Nepal. The purpose of this study is to evaluate various characteristics of hypertensive patients undergoing ABPM before starting antihypertensive treatment and evaluate the adequacy of the blood pressure (BP) control during antihypertensive treatment. ABPM was performed in 108 consecutive patients attending the hypertension clinic of Nepal Medical College Teaching Hospital from 1st March 2005 to 30th April 2007 with DynaPulse 5000A (version 3.20q ) for approximately 24 hours. Male female ratio was 59:49 and age (mean +/- SD) was 47.8 +/- 16.4 years. The maximum use of ABPM (25.9%) was noted in the age group of 40-49 years. Body mass index was 25.7 +/- 3.8. Diabetes was noted in 13% patients. Maximum use of ABPM was observed in Newar ethnic group (56.5%). ABPM was used for the diagnosis of HTN in 62.0% patients and for follow up in 38.0% patients. Severe HTN was seen in approximately half (47.2%) of the hypertensive patients. Majority of the patients (88.0%) had dipper type of HTN. Beta-blocker (35.6%), ACE inhibitor/Losartan (31.1%) and calcium channel antagonist (26.7%) were the usual antihypertensive agents used. Single antihypertensive agent was used in the majority of patients (64.1%). In a small number of patients (42, 38.9%) undergoing ABPM during antihypertensive therapy, the adequacy of control of HTN was very poor.

Role of PGL-I of M. leprae in TNF-alpha production by in vitro whole blood assay

Phenolic glycolipid-I (PGL-I) is known to be a major antigen of Mycobacterium leprae. We have studied the influence of PGL-I on the production of Tumour Necrosis Factor alpha (TNF-alpha) using the in vitro whole blood assay. Armadillo-derived M. leprae (ADML) are thought to be depleted of PGL-I during the purification process. M. leprae obtained from mouse foot pad material (MFPML) has been subjected to a less rigorous purification process; their PGL-I coating is therefore believed to be more intact than that of ADML. PGL-I or ADML alone induced the secretion of minimal levels of TNF-alpha in whole blood assay; when added in combination, higher levels of this cytokine were observed. The highest TNF-alpha response was seen following stimulation with MFPML. MFP material not infected with ML did not elicit any response. The difference in TNF-alpha response shown by ADML and MFPML was postulated to be largely due to the presence of higher levels of PGL-I in MFPML. This increase in TNF-alpha production suggests that PGL-I may play a significant role in the induction of TNF-alpha during natural infection.

Effect of prenatal exposure of alcohol in the morphology of developing rat embryo

The objective this study was to observe the morphological changes in developing rat embryo exposed to alcohol in utero. Virgin female Wistar rats in experimental group (n=15) were given 20% (v/v) alcohol two weeks before mating and throughout the gestational period through oral route. The controls (n=15) were also maintained and were given the tap water. On gestational day 15 (GD15) and 19 (GD19), five rats from each group were sacrificed by cervical dislocation and the abdomen was incised to expose the uterine horn. The number of implantation sites and resorptions were counted and recorded. The body weight and length of the fetuses were also recorded. The litter size and body weight of the newborn were also recorded at the time of birth from the remaining dam. The incidence of resorption was higher in alcohol treated group than in control which was found to be 25% and 8.7% at days 15 and 19 respectively. The body weight and length of fetuses were found to be decreased and was significant at GD15 (p<0.001 for weight and p<0.05 for length). Similarly, the litter size and body weight of newborn were also found to be decreased significantly (p<0.05 for litter size and p<0.01 for body weight). The present study shows that the maternal consumption of alcohol during pregnancy has adverse effect on fetal viability and development of growing embryo.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role

INTRODUCTION

As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD.

OBJECTIVE

The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development.

MATERIAL AND METHODS

It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital.

RESULTS

The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients.

CONCLUSION

Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.

Effect of methotrexate (MTX) administration on spermatogenesis: an experimental on animal model

An experiment was conducted to observe histomorphometric and cellular toxicity on rat testes after sixty days of methotrexate administration intraperitoneally (ip). Total 30 adult male rats were divided into one control and two experimental groups containing 10 rats in each group. Experimental groups received methotrexate in two different doses i.e 25 ig and 50 ig, whereas control one received normal saline intraperitoneally. At the end of the experiment, animals were sacrificed and testes were processed for paraffin sectioning and stained in haematoxylin and eosin. Further microscopic study of seminiferous tubules, interstitial spaces, primary spermatocytes and spermatids were carriedout. Results revealed decreased diameter of seminiferous tubules, increased interstiial spaces in experimental groups in dose dependent manner and found to be statistically significant (p < 0.05) as well as distortion of morphology of Leydig cells in experimental group. Therefore, it can be concluded that these qualitative and quantitative changes in male gonads may alter the reproductive performance of animals.

Utility of phenotypic dermal indices in the detection of Down syndrome patients

Down syndrome (DS) is the most common cause of mental retardation. The frequency of DS patients is about 1:800 and is mainly because of the presence of extra copy of chromosome number 21. Dermatoglyphic has been well established as a diagnostic aid in number of diseases having hereditary basis. Dermatoglyphic data was obtained by the use of ink and prints on a paper, from 15 cytogenetically confirmed patients of Down syndrome attending to the genetic clinic at BPKIHS. The data were correlated and compared with equal number of controls. Dermatoglyphic prints were used to evaluate the variation in the fingerprint patterns, the presence of simian crease and the difference in 'atd' 'dat' and 'adt' angles between the control and the DS patients. The results showed that both the 'atd' and 'adt' angles differed significantly from the control group. The dactylography study revealed higher incidence of loops and lower incidence of whorls in the DS patients as compared with the controls. This method is non-invasive and cost effective. The observed changes in the 'atd' and 'adt' angles plus the fingerprint patterns in the dermatoglyphic study proved that this simple technique could be a valuable tool for selecting patients of DS for cytogenetics analysis.

Effect of maternal deprivation on growth of Wistar rats in preweaning period

OBJECTIVE

The objective of this study was to observe the effect of maternal deprivation on somatic growth of wistar rat pups viz. Body weight, nose-rump length, tail length and head length.

MATERIALS AND METHOD

5 days old 50 rat pups were studied dividing equally into control and experimental groups. Experimental group (N=25) of rats were maternally deprived 1-4 hours twice daily till the weaning period. Body weight and measurement of body parts were recorded at 4 days interval till 29th day. Recorded parameters were statistically analysed.

RESULT

The result of this study revealed that maternal deprivation stress produces significant effect in the body weight, nose-rump length and tail length from D9 till the study period whereas head length insignificantly affected.

CONCLUSION

MD stress has profound effects on somatic growth and found irreversible even after withdrawal for a period of 8 days.

Can homemade alcohol (Raksi) be useful for preserving dead bodies? An experiment on wistar albino rats

INTRODUCTION

Embalming is the through disinfection and art of preserving bodies after death using chemical substances. It keeps a body life like in appearance during the time it lies in a state prior to funeral.

OBJECTIVE

This study was undertaken to investigate the effectiveness of Raksi in sacrificed rats in arresting postmortem changes and establishing scientific fact whether Raksi can be an alternative to standard embalming constituent if it is not available.

MATERIAL AND METHODS

50 albino rats were systematically randomized into control and experiment groups. Raksi and distilled water were injected for embalming purpose intraventricularly in experiment and control groups of rats respectively and kept for 48 to 96 hours for observation for postmortem changes.

RESULT

Observations made at 48 and 72 hours of embalming revealed that Raksi can arrest postmortem changes in the rats up to 72 hours (3rd day) successfully in the experimental group whereas moderate to severe postmortem changes were seen in the control group. The experimental group showed mild degree of putrefactive changes, liberation of gases and liquefaction of tissues only at 96 hours (4th day) of embalming.

DISCUSSION

The Raksi used in this experiment contained 34% of alcohol, which was determined by an alcohol hydrometer. Experiment clearly demonstrated from its result that raksi can be utilised temporarily for embalming since it contains alcohol and has preservative, bactericidal and disinfectant properties.

CONCLUSION

It is concluded from the study that this knowledge if applied to dead human subjects, may preserve dead bodies temporarily allowing delayed funeral.

Effect of chronic low dose of methotrexate on cellular proliferation during spermatogenesis in rats

This study was conducted to evaluate cellular proliferation of germinal and non-germinal elements of seminiferous tubules following continuous Day 1 to Day 17 exposure of methotrexate (12.5 microgram) in male rats. There was significant decrease in the diameter of seminiferous tubules (P < 0.10) followed by increase of interstitial space (P < 0.01). The size of various stages of primary, secondary spermatocytes, and spermatids was altered significantly compared to controls. Vacuolization/decondensation of "chromatin-mass" in spermatocytes changed from rounded to oval. The size of the Sertoli and Leydig cells were reduced significantly. Basement membrane at some places seems to be disrupted and thin in experimental testis. Methotrexate induced cytotoxicity on the proliferation of cellular contents of seminiferous tubules elucidating the mechanism of dose-dependent drug induced testicular damage during spermatogenesis.

EFFECT OF COLD INDUCED PAIN AND MENTAL TASK ON BREATH HOLDING TIME

The breath holding time (BHT) is under voluntary control to a considerable extentand is dependent on various factors. Pain interrupts ongoing mental processes andmental task stimulates the respiratory complex as a part of generalised central nervoussystem arousal. We hypothesised that the concurrent cold-induced pain and mentaltask may change BHT. In this study BHT with concurrent mental task (MT) or coldinducedpain (CPT) was assessed in healthy individuals (n=25). The objective was toinvestigate the effect of CPT and MT on BHT. Initially basal BHT was recorded thenthe BHT was recorded during MT and CPT. The data were analysed by Friedmantest. The results showed no significant effect of MT and CPT on BHT. However, BHTshowed an increasing trend with CPT and MT. It is concluded that cold pressor painand mental task do not have vital influence on breath holding time.Key Words: breath holding time, cold pressor test, pain, mental task.

Thyroid function testing in eastern Nepal and the impact of CME on subsequent requests

This study reveals 1 year's experience of the introduction of thyroid function tests (TFT) in B P Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal. These were performed on theadvice of doctors working in this region. The rational TFT advice by the medical practitioners was evaluated according to how closely the advice was in line with the algorithms recommended in the textbooks. Only about 14% of the TFT advice followed some rational strategy. A retrospective analysis showed that rational TFT advice could have reduced the cost of a TFT investigation to 43.11% without altering the patient management and disease outcome. Continuing medical education (CME) lectures arranged for a limited number of doctors were found to improve the quality of the subsequentTFT advising pattern. This emphasizes the importance of CME while introducing a costly laboratory test panel (e.g.TFT, lipid profile) needing a strategic approach.

Prevalence of non-insulin dependent diabetes mellitus in urban areas of eastern Nepal: a hospital based study

Non-insulin dependent diabetes mellitus (NIDDM), which affects millions of people throughout the world, is a widely prevalent chronic debilitating disease that causes short term and long term complications. It is a problem in a developing country like Nepal, where there has been no report of prevalence. Hence this study was undertaken to investigate the prevalence of NIDDM among urban patients attending the outpatient clinic of BP Koirala Institute of Health Sciences (BPKIHS) hospital, and coming from the eastern part of Nepal. A sample of 1,840 subjects was incorporated in the study during a period of one year. WHO diagnostic criteria (1985) were followed to establish the diagnosis of NIDDM. The prevalence of diabetes was 6.3% (1.63% previous and 4.67% new) which is relatively high in comparison to many other countries. The prevalence of NIDDM in females was relatively lower (5.75%) than in males (6.73%). The prevalence showed an increasing trend with increasing age. The high incidence (new cases) of NIDDM in Nepal as found in the study may be due to lack of public awareness regarding the problem and poor medical services in the country.