Factors Associated with Intrauterine Fetal Death at Paropakar Maternity Women's Hospital.

Background Intrauterine fetal death (IUFD) is a demise occurring at 20 or more weeks of gestation and weight 500 gram or more. Intrauterine fetal death at any point during gestation is a traumatic event not only to the patient but also to the care giver. The purpose of this study is to know the risk factors associated with intrauterine fetal death. Objective To determine the factors associated with intrauterine fetal death. Method Prospective observational study was conducted at Paropkar maternity women's hospital, Thapathali, Kathmandu. All the cases with intrauterine fetal death were admitted and delivered in the hospital with period of gestation 20 weeks to term pregnancy. All the relevant data were recorded in pre-designed proforma. The collected data were entered in SPSS 25 version for analysis. Result There was a total 5153 deliveries in three months, with prevalence of 1.2% and intrauterine rate of 12.03 per 1000 births. Out of 50 enrolled cases, 78% (n=50) of patient had not attended antenatal checkup. Majority (n=50; 74%), belonged to age group 21-35 years, 48% of intrauterine fetal death were term pregnancies of 37 to 42 weeks of gestation. Maximum 20% of IUFD, weighed between (1-1.5 kg) (1.5-2 kg) and (2.5-3 kg). Thirty-nine babies were macerated and eleven non-macerated. Pregnancy induced hypertension was most common (26%), followed by ante-partum hemorrhage (8%), hypothyroidism and anemia (6%), meconium stained liquor and cord prolapse (6%), gestational diabetes mellitus, congenital anomalies, chronic hypertension (4%), intrauterine growth restriction and urinary tract infection (2%). Twelve cases underwent cesarean section. Postpartum complications were found in 10 cases; 4 cases had postpartum hemorrhage, 4 had prolonged hospital stay and 2 cases developed hemolysis, elevated liver enzyme, low platelet count (HELLP) syndrome. Conclusion This study concluded that maximum no. of intrauterine fetal death were seen antenatally, as 78% of cases were found macerated. The commonest identified risk factor was pregnancy induced hypertension, followed by ante-partum hemorrhage, anemia, hypothyroidism, which seem to be preventable risk factors of intrauterine fetal death, but still unidentified risk factors are of great challenges for the obstetricians.

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal.

SETTING: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). OBJECTIVE: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance. DESIGN: A cohort study using hospital data, January 2018-January 2020. RESULTS: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery. CONCLUSION: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

LIEU: Hôpital ophtalmologique de Biratnagar, Népal, qui propose des interventions chirurgicales de l'oreille aux patients atteints d'otite moyenne chronique suppurée (CSOM). OBJECTIF: Déterminer 1) les caractéristiques sociodémographiques, 2) les isolats bactériens et leurs profils de résistance aux antibiotiques et 3) les caractéristiques des patients se voyant refuser la chirurgie (dont résistance aux antibiotiques) chez les patients atteints de CSOM en attente de chirurgie. MÉTHODE: Étude de cohorte réalisée à l'aide de données hospitalières, janvier 2018-janvier 2020. RÉSULTATS: Sur les 117 patients atteints de CSOM en attente de chirurgie, 64% appartenaient à la tranche d'âge des 18­35 ans et 79% étaient des patients transfrontaliers en provenance d'Inde. Sur 118 isolats bactériens, 80% étaient des isolats de Pseudomonas aeruginosa et 16% de Staphylococcus aureus. Tous les isolats ont montré une résistance à neuf des 12 antibiotiques testés. Les plus faibles résistances chez P. aeruginosa étaient celles à la vancomycine (29%) et à la moxifloxacine (36%). Pour S. aureus, il s'agissait de celles à la vancomycine (9%) et à l'amikacine (17%). Quatorze (12%) patients ont subi une intervention chirurgicale : myringoplastie (n = 7, 50%), mastoïdectomie corticale avec tympanotomie (n = 4, 29%) et mastoïdectomie radicale modifiée (n = 3, 21%). Les patients infectés par P. aeruginosa avec une résistance à plus de six antibiotiques étaient significativement plus susceptibles de se voir refuser la chirurgie. CONCLUSION: Les patients en attente de chirurgie de l'oreille étaient principalement infectés par un isolat multirésistant de P. aeruginosa, et se sont donc vu refuser la chirurgie. Cette étude peut permettre d'orienter les efforts visant à améliorer le taux de chirurgies réalisées et à mettre en place une surveillance transfrontalière des résistances antimicrobiennes.

Pregnancy Complicated by Acute Pancreatitis with Ascariasis.

Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis.

Lumbar Puncture Test in Normal Pressure Hydrocephalus: Does the Volume of CSF Removed Affect the Response to Tap?

BACKGROUND AND PURPOSE: There is limited evidence to support the use of high-volume lumbar taps over lower-volume taps in the diagnosis of normal pressure hydrocephalus. The purpose of this study is to detect whether the volume of CSF removed from patients undergoing high-volume diagnostic lumbar tap test for normal pressure hydrocephalus is significantly associated with post-lumbar tap gait performance. MATERIALS AND METHODS: This retrospective study included 249 consecutive patients who underwent evaluation for normal pressure hydrocephalus. The patients were analyzed both in their entirety and as subgroups that showed robust response to the lumbar tap test. The volume of CSF removed was treated as both a continuous variable and a discrete variable. Statistical tests were repeated with log-normalized volumes. RESULTS: This study found no evidence of a relationship between the volume of CSF removed during the lumbar tap test and subsequent gait test performance in the patient population (Pearson coefficient r = 0.049-0.129). Log normalization of the volume of CSF removed and controlling for age and sex failed to yield a significant relationship. Subgroup analyses focusing on patients who showed greater than 20% improvement in any of the gait end points or who were deemed sufficiently responsive clinically to warrant surgery also yielded no significant relationships between the volume of CSF removed and gait outcomes, but there were preliminary findings that patients who underwent tap with larger-gauge needles had better postprocedure ambulation among patients who showed greater than 20% improvement in immediate time score (P = .04, n = 62). CONCLUSIONS: We found no evidence to support that a higher volume of CSF removal impacts gait testing, suggesting that a high volume of CSF removal may not be necessary in a diagnostic lumbar tap test.

An optimal PID controller via LQR for standard second order plus time delay systems.

An improved tuning methodology of PID controller for standard second order plus time delay systems (SOPTD) is developed using the approach of Linear Quadratic Regulator (LQR) and pole placement technique to obtain the desired performance measures. The pole placement method together with LQR is ingeniously used for SOPTD systems where the time delay part is handled in the controller output equation instead of characteristic equation. The effectiveness of the proposed methodology has been demonstrated via simulation of stable open loop oscillatory, over damped, critical damped and unstable open loop systems. Results show improved closed loop time response over the existing LQR based PI/PID tuning methods with less control effort. The effect of non-dominant pole on the stability and robustness of the controller has also been discussed.

Effects of third trimester counseling on pregnancy weight gain, birthweight, and breastfeeding among urban poor women in Bangladesh.

BACKGROUND: Maternal malnutrition and poor gestational weight gain are the most important causes of low birth weight and high rates of newborn mortality. OBJECTIVE: To assess the effects of nutrition counseling in the third trimester of pregnancy on maternal weight gain, birth weight of newborn, and breastfeeding practices. METHODS: This was a longitudinal experimental study with nutrition intervention for a period of 3 months. One hundred fifteen women (57 in the intervention group and 58 in the comparison group) who were visiting the Maternal and Child Health Training Institute at 6 months of pregnancy were randomly selected. The intervention group was given nutrition education twice in the first month and once a month for the next 2 months before delivery; the comparison group received routine hospital advice on food intake, immunization, personal hygiene, and breastfeeding. The women were weighed monthly up to delivery, the newborn infants' birth weights were measured within 24 hours after delivery, and breastfeeding practices were observed 1 month after delivery. RESULTS: Women in the intervention group gained 1.73 kg more weight during the third trimester than women in the comparison group (5.61 vs. 3.88 kg, p < 0.001). The mean birthweight of babies of women in the intervention group was 0.44 kg greater than that of babies of women in the comparison group (2.86 vs. 2.42 kg, p < 0.001). In the intervention group, 10.5% of babies were born with low birthweight, compared with 48.3% of the babies of women in the comparison group (p < 0.001). In the intervention group, 75.4% of mothers initiated breastfeeding within 1 hour after birth, compared with 34.5% of mothers in the comparison group (p < 0.001). CONCLUSIONS: Nutrition education only during the third trimester improved weight gain during pregnancy, reduced 78% of low birth weight, and improved breastfeeding practices.

Effect of mitomycin C-aided trabeculectomy on conjunctival goblet cell density.

INTRODUCTION: Mitomycin C is gaining widespread popularity as an adjunctive with trabeculectomy, as it significantly increases the success rate of the procedure. But it is associated with serious sight-threatening complications. MATERIALS AND METHODS: Twenty eyes planned for trabeculectomy from the glaucoma clinic were enrolled for the study after obtaining an informed consent. The baseline impression cytology was taken. Ten eyes underwent trabeculectomy with mitomycin C (Group A) and the rest underwent trabeculectomy without any antimetabolites (Group B). Impression cytology samples were taken on months 1, 3, 6, 9 and 12. RESULTS: In Group A, the difference between goblet cell density preoperatively and 12 month postoperatively was statistically significant (p less than 0.0001). In Group B, the difference was not statistically significant. (p = 0.27). CONCLUSION: Mitomycin C, though used to augment the success rate of trabeculectomy, has deleterious effect on the conjunctival goblet cell population as is evident from the conjunctival impression cytology.

Effect of nutrition education on exclusive breastfeeding for nutritional outcome of low birth weight babies.

BACKGROUND/OBJECTIVES: Low birth weight (LBW), defined as the body weight at birth of less than 2500 g, is a major public health problem in Bangladesh, where 37% of the babies are born with LBW. The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group. SUBJECTS/METHODS: A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were randomly allocated to either intervention or control group. Enrollment of the study population started in May 2008 and was completed in October 2008. Nutrition education was given to mothers twice weekly for 2 months, on initiation of breastfeeding within 1 h, exclusive breastfeeding and increasing their dietary intake. Nutritional status of LBW babies was assessed for length and weight every 2 weeks. Data were analyzed using SPSS/Window's version 12. Comparison of mean of data was done using standard Student's t-test. RESULTS: Mean initial body weight and length of LBW babies were similar in both groups (2261±198 g vs 2241±244 g, P=0.535 and 43.0±1.3 cm vs 43.0±1.7 cm, P=0.77). Body weight and length of the LBW babies after 2 months increased significantly (3620±229 g vs 3315±301 g, P<0.001 and 50.2±1.3 cm vs 48.7±1.6 cm, P<0.001). It was found that the intervention group suffered less from respiratory illness compared with the control group (39% vs 66%, P<0.001). The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention (59.8% vs 37.2%, P<0.001). Exclusive breastfeeding rate was significantly higher in intervention group (59.8% vs 37%, P=0.003). CONCLUSIONS: The present study showed that weight and length gain of LBW babies significantly increased by breastfeeding and nutrition education. Therefore, nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies.

Prevalence of glaucoma in Sunsari district of eastern Nepal.

AIMS: To determine prevalence of glaucoma and glaucoma suspect in subjects 40 years and above in Sunsari district of eastern Nepal. METHODS: A community based cross sectional study examining 1600 selected subjects was carried out. In all subjects best corrected visual acuity was determined. Oblique torch light test was used for anterior chamber depth evaluation. Intraocular pressure (IOP) measurements with Perkins tonometer and fundus examination were carried out in the community. Subjects diagnosed as glaucoma suspect were further evaluated in the hospital using slit lamp examination, gonioscopy and Goldmann perimetry. Glaucoma was defined by characteristic disc and visual field changes irrespective of the level of IOP. RESULTS: Of 1600 subjects examined, the prevalence of glaucoma was found to be 0.938%. The prevalences of primary open angle glaucoma, primary angle closure glaucoma, secondary glaucoma and ocular hypertension were 0.562%, 0.125%, 0.250% and 0.500% respectively. Lens induced glaucoma accounted for all the cases of secondary glaucoma. CONCLUSION: The prevalence of glaucoma in the Sunsari District of Nepal is 0.938%, which is lower than that reported in the neighboring regions. Lens induced glaucoma is highly prevalent as a cause of secondary glaucoma.

Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal.

PURPOSE: To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal. PATIENTS AND METHODS: This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied. STATISTICS: Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test. RESULTS: Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 +/- 13.7 years (SE = 0.53, 95% CI = 26.34-28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 +/- 11.4 years, 95% CI = 32.85-37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 +/- 13.3 years, 95% CI = 25.8-28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR. CONCLUSION: Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.

CT in the diagnosis of isolated cysticercal infestation of extraocular muscle.

AIM: To evaluate the use of computed tomography (CT) and ultrasound (US) to diagnose orbital cysticercosis, and present the diagnostic features. METHOD: US and CT were used to evaluate patients with proptosis. Four patients were diagnosed as having orbital myocysticercosis and treated with oral albendazole and corticosteroid. Follow-up was undertaken with US and CT. RESULT: US features were confirmatory of myocysticercosis in two eyes where as CT was effective in diagnosing the condition in all four eyes. In two patients the medial rectus was involved, in one the superior rectus and, in the other, the inferior rectus muscles. Serial US and CT revealed complete resolution of the lesions in 3 months. CONCLUSION: CT is useful method in diagnosing isolated orbital myocysticercosis. Our report demonstrated that ophthalmic signs and symptoms in the presence of proptosis, especially in an endemic region, should alert the clinician to the possibility of myocysticercosis. Though CT is superior, US can be used as a economical follow-up investigation.

Outcome of extracapsular cataract surgery plus posterior chamber intraocular lens insertion for age-related cataract in eastern Nepal.

As age-related cataract is the leading cause of blindness in Nepal, much more attention should be given to improving surgical outcomes. The aim of our study was to determine the effectiveness and risks of extracapsular cataract surgery (ECCE) for age-related cataract in a tertiary hospital of eastern Nepal. ECCE with posterior chamber intraocular lens (PC IOL) insertion on 797 eyes (754 patients) revealed improved visual acuity in 97.9%. In 595 (74.6%) the best corrected visual acuity was 6/18 or better, and 167 (20.9%) had 6/24 to 6/60 with negligible operative/postoperative complications. Thus it is concluded that ECCE with PC IOL could be performed safely and effectively even in developing countries where people are unaware that surgery is available and of the good surgical outcome.

Pleomorphic adenoma of lacrimal gland: diagnosis based on fine needle aspiration cytology.

A 48 years old male patient presented with a mass in the supratemporal quadrant of orbit. Fine needle aspiration (FNAC) revealed a cellular tumour with a chondrimyxoid background and epithelial cells intermingled with mesenchymal cells in a fibrillary matrix. A diagnosis of pleomorphic adenoma of the lacrimal gland was made which was confirmed on histopathology. FNA is a rapid and accurate method in diagnosis of lacrimal gland tumours.