Knowledge of Stroke among Hypertensive Patients in Dhulikhel.

Background More than 50% of patients with stroke have hypertension, a common modifiable risk factor for stroke. Studies reported that 90% of diagnosed hypertensive patients do not seek for treatment in Nepal and the reason for this remains unexplored. There is a possibility that lack of knowledge of stroke and its potential causes may be the reason. Objective To assess the knowledge of stroke in a group of patients with hypertension in suburban Nepal. Method Hypertensive patients visiting a tertiary care hospital in Nepal were approached and were included if they were 18 years or older. We used the Nepali version of 'Awareness of Stroke, Risk Factors, and Treatment' questionnaire to assess the knowledge of stroke. Descriptive statistics were used to analyze the results. Result A total of 273 patients were included with the mean age of 56 years. Almost half (48%) of the patients were uneducated. We found that only 24% of the patients identified brain as an organ affected by stroke, only 32% were aware about more than one warning signs of stroke, 64% reported that they were unaware of the treatment options for stroke and only 5% reported control of blood pressure as a part of stroke management. The commonest reported identifiable risk factor for hypertension was high blood pressure (44%). Conclusion There are significant knowledge gaps regarding stroke in hypertensive patients. Although most patients recognized hypertension as a risk factor for stroke, they were unaware of treatment options. Increasing awareness of hypertension as a risk factor for stroke may help to prevent the stroke burden in Nepal.

Implementation research to assess a health workers performance-based management system in Nepal.

AIM: To test and refine a performance-based management system to improve health worker performance in Nepal. METHODS: A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. RESULTS: Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. CONCLUSION: The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.

Need of The Ministry of Health in Federal Democratic Republic of Nepal.

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level. The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs. It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right.

Primary Total Hip Replacement in The Military Hospital in Kathmandu.

INTRODUCTION: Total hip replacement is one of the most widely performed and amongst the most successful orthopedic procedures performed worldwide. Even though it is a common orthopedic procedure in developed nations, it is performed only in selected centers in Nepal. This study will review the functional outcome of total hip replacements carried out in Shree Birendra Hospital. METHODS: We reviewed the records of total hip replacements, which were carried out in Shree Birendra Hospital, Kathmandu. Twenty-one hips were cemented and nineteen were uncemented. Cases were followed up in six weeks, twelve weeks, six months and every year from then on. Outcome in terms of Harris hip score of 40 osteoarthritic hips were measured pre-operatively as well as post-operatively. RESULTS: The mean age of the patients was 50.63 years (range 22-79 years). The commonest reason for the replacement was primary osteoarthritis of the hip. Thirty-nine patients underwent unilateral total hip replacement while in one patient both hips were replaced. The mean Harris hip score for the forty hips that were available at the latest follow-up examination at an average of five years (range two to six and a half years) after the operation was 85.2 ± 7.65 points as compared to the pre-operative mean Harris hip score of 32.38 ± 3.4. CONCLUSIONS: Based on improved Harris hip scores, we believe that THR is a good option in patients with end stage arthritis of the hip.

Return to preinjury status after routine knee arthroscopy in military population.

BACKGROUND: Knee arthroscopy is frequently advised procedure for knee-related problems in serving soldiers. The scanty published literatures have documented wide range of recovery duration ranging from nine days to four weeks even for routine uncomplicated arthroscopy. However, neither of these studies evaluated military population, where arthroscopic procedures are frequent and physical demands are different. The aim of this study was to ascertain the time required to return to unrestricted physical activities in serving military population. METHODS: This was a prospective descriptive study enrolling 51 patients who underwent two portal arthroscopic procedures like diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these. A uniform home based physiotherapy protocol was used for everyone. All of them were followed up at 2nd, 4th, 6th, 8th and 12th postoperative weeks. At each follow up, 2000 International Knee Documentation Committee subjective knee evaluation form was filled and submitted for analysis. RESULTS: Although all of our patients were able to walk around without any support at two weeks follow up, 88% had restriction to activities of daily living because of knee related problems. The mean International Knee Documentation Committee score was 41 at 1st follow up, which gradually improved to 64, 86, 94, 94 at 4th, 6th, 8th and 12th week follow up respectively. At 6 weeks 91% resumed their preinjury status which reached 94% in eight weeks. CONCLUSIONS: Most of the soldiers return to unrestricted activities within six to eight weeks after diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these procedures.

Cephalometric evaluation of mandibular advancement at different horizontal jaw positions in obstructive sleep apnoea patients: a pilot study.

BACKGROUND: The aim of this study was to comparatively evaluate the efficacy of the mandibular advancement device (MAD) at 50% (P2) and 75% (P3) of maximum mandibular advancement, relative to maximum intercuspation (P1) subjectively and objectively. METHODS: Eighteen subjects previously diagnosed with obstructive sleep apnoea (OSA) were selected for the study. ESS score, VAS score, soft palate angle, MP-H distance, S-H distance, a C4 -H distance, a Pu -p Pu distance and total pharyngeal area were calculated at P1, P2 and P3 positions with the help of an adjustable MAD. The results were statistically analysed. RESULTS: ESS score, VAS score, soft palate angle, MP-H distance, S-H distance and radius of curvature of airway at P2 and P3 were significantly lower compared to P1, but there was no significant difference between P2 and P3. CONCLUSIONS: The MAD produced significant improvement in objective signs and subjective symptoms at both 50% and 75% of the maximum mandibular protrusion positions at comparable comfort levels. Therefore, MAD may be given at 50% of maximum advancement in order to reduce dental or temporomandibular joint disturbances.

Hairy root cultures of butterfly pea (Clitoria ternatea L.): Agrobacterium × plant factors influencing transformation.

Transformed rhizoclones were developed from Agrobacterium-treated explants of the medicinally important twinning legume Clitoria ternatea L. Several key factors influencing transformation events were optimized. A4T was the most infectious among the strains employed. Internode segments were more responsive than leaves, outdoor-grown explants preferred to those from in vitro cultures. High frequency transformation, resulting in up to 85.8% rhizogenesis, was attained using pre-pricked internodal explants for immersion (10 min) in Agrobacterium rhizogenes suspension grown overnight with acetosyringone (100 µM) to an OD(660) â‰… 0.6, diluted to a density of 10(9) cells ml(-1), followed by 5-day co-cultivation. Roots were individually cultured in MS0 supplemented with the bacteriostatic antibiotic cefotaxime (500 µg ml(-1)). Rhizoclones were renewed through successive subcultures in MS0 under diffused illumination. The T ( L )-DNA rolB and rolC ORF were detected in rhizoclones through PCR amplification. The T ( R )-DNA gene encoding mannopine synthase (man2) was revealed by positive amplification and opine gene expression substantiated by agropine and mannopine biosynthesis in all selected transformed rhizoclones. The implication of such findings is discussed on the context of utilization of such genetically transformed root cultures towards sustainable production of medicinally useful phytocompounds, besides providing a means for plant conservation.

Calcaneal myxoid chondrosarcoma: a rare case.

Skeletal myxoid chondrosarcoma is an extraordinarily rare neoplasm with a distinct histological morphology. Although it grows slowly, the clinical course was found to be worse than usual chondrosarcoma. We report a case of a skeletal myxoid chondrosarcoma in the calcaneus of a 21-year-old female who presented to us with a feature of gradually increasing benign swelling left foot for last two years. Initial investigations were indicating towards a benign lesion for which excision of the lesion was performed. But intra operative findings were suggestive of an aggressive lesion, and to our utter surprise histopathologically it turned out to be myxoid chondrosarcoma. Because of its high malignant nature below knee amputation was performed as second definitive surgery. Since her clinical course and radiological pictures were suggestive of benign lesion we got carried away with a diagnosis of chondromyxoid fibroma and excision of the lesion was attempted without attempting histopathological diagnosis by less invasive methods.

Comparative study on the effect of chemicals on Alternaria blight in Indian mustard--a multi-location study in India.

High severity of Altemaria blight disease is a major constraint in production of rapeseed-mustard in India. The aim of this study was to investigate the suppressive potential of chemicals viz., zinc sulphate, borax, sulphur, potash and calcium sulphate, aqueous extracts viz., Eucalyptus globosus (50 g l-1) leaf extract and garlic (Allium sativum) bulb (20 g l-1) extract, cow urine and bio-agents Trichoderma harzianum, Pseudomonas fluorescence in comparison with the recommended chemical fungicide (mancozeb), against foliar disease Alternaria blight of Indian mustard [Brassica juncea (L.) Czern. and Coss] under five different geographical locations of India. Mancozeb recorded the lowest mean severity (leaf: 33.1%; pod: 26.3%) of Alternaria blight with efficacy of garlic bulb extract alone (leaf = 34.4%; pod = 27.3%) or in combination with cow urine (leaf = 34.2%; pod = 28.6%) being statistically at par with the recommended chemical fungicide. Chemicals also proved effective in reducing Alternaria blight severity on leaves and pods of Indian mustard (leaf = 36.3-37.9%; pod = 27.5-30.1%). The effective treatments besides providing significant reduction in disease severity also enabled increase in dry seed yield of the crop (mancozeb = 2052 kg ha-1; garlic = 2006 kg ha-1; control = 1561 kg ha-1).

ED-XRF spectrometry-based comparative inorganic profile of leaf-derived in vitro calli and in vivo leaf samples of Phyllanthus amarus Schum. & Thonn.--a hepatoprotective herb.

The Energy Dispersive X-ray Fluorescence (ED-XRF) set-up incorporating a molybdenum secondary exciter was used for quantitative determination of major and minor elements in leaves of in vivo grown medicinal herb Phyllanthus amarus vis-á-vis its leaf-derived in vitro callus culture. The elements such as K, Ca, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Se, Rb, Sr and Pb were identified, quantified and compared between both the sources. Experimental results revealed that, compared to the naturally grown herb, in vitro leaf-derived callus cultures were more efficient in accumulating inorganic elements, especially trace elements, which are essential for growth and development and more importantly for prevention and cure of diseases. This investigation on a medicinal plant species is the first of its kind to have used the ED-XRF technique to demonstrate a comparative account of the elemental profile of in vitro callus cultures with their in vivo donor in order to explore the possibility of exploiting the former as a viable alternative and a renewable source of phytochemicals.

ED-XRF spectrometric analysis of comparative elemental composition of in vivo and in vitro roots of Andrographis paniculata (Burm.f.) Wall. ex Nees--a multi-medicinal herb.

The multi-elemental composition of in vitro--proliferated root tissues of Andrographis paniculata (Burm.f.) Wall. ex Nees was compared with that of the naturally grown in vivo plants. Trace elements namely Cr, Mn, Fe, Co, Ni, Cu, Zn, Se, Rb, Sr and Pb in addition to two macro-elements K and Ca were identified and quantified in root tissues of both sources using the energy dispersive X-ray fluorescence (ED-XRF) technique. ED-XRF analysis was performed using Mo K X-rays generated from a secondary molybdenum target. The elemental content of in vitro roots was found to be at par with that of naturally grown plants of the same species. This opens up a possibility of exploiting in vitro root cultures as a viable, alternative and renewable source of phytochemicals of relevance, besides providing a means for conservation of the valuable natural resources.

Cyto-architecture and neuronal types of the dorsomedial cerebral cortex of the common Indian wall lizard, Hemidactylus flaviviridis.

The cyto-architecture and morphology of the neuronal types of the dorsomedial cortex of the lizard, Hemidactylus flaviviridis has been studied with the help of Cresyl violet staining and Golgi impregnation method. The dorsomedial cerebral cortex displayed three neuronal layers. Layer-I contains only few neuronal somas and also the dendrites ascending from the subjacent layers. Layer-II is characterized by two to three cell thick densely packed neuronal somas. Layer-III contains loosely packed neuronal somas and the dendrites and axon descending from layer-I and II. Below the layer-III an ependymal layer is observed just above the ventricle. Six classes of neurons were distinguished in the cellular layer of dorsomedial cortex of Hemidactylus flaviviridis: bitufted neurons, pyramidal neurons, inverted pyramidal neurons, bipyramidal neurons, multipolar neurons, and candelabra-like monotufted neurons. The pyramidal cells were large showing more or less single type present in the cellular layer. The multipolar neurons have mostly intracortical dendritic branching and connections. Bipyramidal neurons showed pyramidal appearance of their soma and send dendritic branches towards the superficial plexiform layer and deep plexiform layer. The candelabra-like monotufted neurons have very high dendritic branching. The comparison of the neuronal types of dorsomedial cortex of reptiles with the parahippocampal area of birds and CA3 region of mammalian hippocampus suggests possibility of their homology.

Gluon-spin contribution to the proton spin from the double-helicity asymmetry in inclusive pi0 production in polarized p+p collisions at [sqrt]s=200 GeV.

The double helicity asymmetry in neutral pion production for pT=1 to 12 GeV/c was measured with the PHENIX experiment to access the gluon-spin contribution, DeltaG, to the proton spin. Measured asymmetries are consistent with zero, and at a theory scale of micro2=4 GeV2 a next to leading order QCD analysis gives DeltaG[0.02,0.3]=0.2, with a constraint of -0.7

Neuronal classes in the corticoid complex of the telencephalon of the strawberry finch, Estrilda amandava.

The present study, based on neurohistological techniques (Nissl-staining, Golgi-impregnation), focuses on the cytoarchitecture of the corticoid complex in the strawberry finch, Estrilda amandava. This complex in birds occupies the dorsolateral surface of the telencephalic pallium and remains subdivided into an intermediate corticoid area (CI) and a dorsolateral corticoid area (CDL). The CDL in the strawberry finch is a thin superficial part of the caudal pallium adjoining the medially situated hippocampal formation, whereas the CI is demarcated between the CDL and the parahippocampal area of telencephalon. Neurons of the corticoid complex are classified into three main cell groups: predominant projection neurons, local circuit neurons and stellate neurons. The spinous projection neurons send out distant projecting axons that typically extend several varicose collaterals. Most of these collaterals lie parallel to the ventricle. These neurons are subclassified into pyramidal neurons (localized only in the CI) and multipolar neurons (present in both the CI and CDL). The CDL also possesses small and medium-sized horizontal cells, which are bitufted or multipolar with smooth, moderately branching dendrites. The aspinous local circuit neurons extend short axons that ramify locally. Stellate neurons have sparse spinous dendrites and locally arborizing axons. The corticoid complex of birds corresponds to the lateral cerebral cortex of lizards and to the entorhinal cortex of mammals on the basis of neuronal morphology and bidirectional connections between adjacent areas.

Adamantinoma of tibial shaft.

Adamantinoma is an extremely rare primary bony neoplasm. Because of its malignant nature, accurate and early diagnosis is very important. On the other hand adamantinoma mimics many benign conditions, so it is doubly important to establish correct tissue diagnosis to avoid radical surgery with morbidities. Because of its rarity, diagnosing adamantinoma still remains difficult, even if when it occurs in classical sites. We report a case of adamantinoma of tibial shaft diaphysis in a 23 year male. In this case, because of classic clinic-radiological features, we were suspecting adamantinoma from very beginning but final diagnosis was delayed for nine months.

Femoral neck stress fractures in military personnel.

INTRODUCTION: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. METHODS: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profile, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. RESULTS: The mean age of the patient was 19.94 years. Total 74% of them developed first symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion). CONCLUSIONS: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.

Tolosa-Hunt syndrome: MRI appearances.

A review of MRI findings in seven patients with Tolosa-Hunt syndrome was carried out. Seven patients presented with unilateral painful ophthalmoplegia. Magnetic resonance imaging studies were carried out to evaluate the cavernous sinuses and orbits. Coronal fast spin-echo T2-weighted images and fat-saturated T1-weighted coronal and transverse images with and without contrast enhancement were obtained for the cavernous sinuses and orbits. All patients showed focal-enhancing masses expanding the ipsilateral cavernous sinus. In one patient the mass was extending to the orbital apex and intraorbitally. All patients recovered on corticosteroid therapy and resolution of the masses was documented on follow-up MRI studies in five patients. One patient had a relapse of symptoms after discontinuing therapy. Magnetic resonance imaging studies of the cavernous sinus and orbital apex show high sensitivity for the detection and follow up of inflammatory mass lesions in Tolosa-Hunt syndrome. Magnetic resonance imaging should be the initial screening study in these patients.

Intestinal myiasis caused by Muscina stabulans.

Intestinal maggots were isolated from a patient, who had reported to the Department of General Medicine of Sri Manakula Vinayagar Medical College, Puducherry, in southern India with complaints of abdominal distress, bloating of abdomen and intestinal hurry following a meal. He was diagnosed as a case of intestinal myiasis. Maggots obtained from his stool were identified to be Muscina stabulans based on characteristic patterns of posterior spiracles. He was treated with purgatives and albendazole. This intestinal myiasis case caused by M. stabulans is reported here because of its rare occurrence and the need to establish a correct diagnosis.

Cytoarchitectonic organization and morphology of the cells of hippocampal complex in strawberry finch, Estrilda amandava.

Neurons in the hippocampal complex (dorsomedial forebrain) were described and located following Golgi impregnation. Five fields were recognized in the hippocampal complex: medial and lateral hippocampus, parahippocampal area, central field of the parahippocampal area and crescent field. In the medial hippocampus three layers have been observed: suprapyramidal towards the pial surface, pyramidal at the central and infrapyramidal adjacent to the ventricle. Neurons of the hippocampal complex were classified in to two main cell groups: predominant projection neurons with spinous dendrites and local circuit neurons. Projection neurons were further sub classified into three main types: pyramidal, pyramidal like, and multipolar neurons. In addition to these neurons, monotufted and bitufted neurons were also observed in the medial and lateral hippocampus with low frequency. The pyramidal neurons were dominant neuronal types in the pyramidal layer-II of the medial hippocampus, mixed with pyramidal like and multipolar neurons. Pyramidal and pyramidal-like neurons were found restricted in the pyramidal layer II of the medial hippocampus while the multipolar neurons were uniformly distributed in all subfields of the hippocampal complex. In the lateral hippocampus irregular shaped radial glial cells were present near the ventricular wall and projecting their dendrites towards the pia. Second group of local circuit neurons with local arborization of their projections were present in the medial hippocampus and in parahippocampal area.

Evidence for a long-range component in the pion emission source in Au+Au collisions at sqrt sNN=200 GeV.

Emission source functions are extracted from correlation functions constructed from charged pions produced at midrapidity in Au+Au collisions at sqrt[s(NN)]=200 GeV. The source parameters extracted from these functions at low k(T) give first indications of a long tail for the pion emission source. The source extension cannot be explained solely by simple kinematic considerations. The possible role of a halo of secondary pions from resonance emissions is explored.