Early Detection of Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease by Echocardiography.

OBJECTIVE: This study is designed to investigate the effects of pulmonary arterial hypertension on RV systolic and diastolic functions in cases of COPD and to correlate RV systolic and diastolic functions with pulmonary arterial pressure. MATERIALS AND METHODS: 100 patients admitted in various medical wards of tertiary care Hospital and a primary care hospital with stable chronic obstructive pulmonary disease persons with age and sex-matched. 35 age and sex matched person without any associated and known disease were taken as control subjects. Selection of cases has been made on basis of detailed history, thorough clinical examination, electrocardiography, chest x-ray, pulmonary function tests. OBSERVATION: RV Systolic function (RVEF and RVWT) are significantly abnormal in patients of stable compensated COPD and they are significantly correlated with PAP(p< 0.002). RV diastolic function i.e., E/A ratio and PFR are altered in 60%(n-60) of patients of COPD studied against control subjects and significantly correlated with PAP(p< 0.002). CONCLUSION: Echocardiography is a non invasive method to detect changes of right ventricular dysfunctions in early stages with very good significant sensitivity and specificity.

Patient's perception towards quality nursing care.

BACKGROUND: Quality nursing care remains an important role for patients because nurses are involved in almost every aspect of client's care in hospital. Nurses interact with patients more often than any other health care personnel in a hospital. Patients express their requirements in terms of what they need, want, prefer, expect and demand with respect to the nursing service they receive. The main objective of this study was to identify the Patient's Perception towards Quality Nursing Care. METHODS: A descriptive quantitative and qualitative research design was adopted; study areas were Bir-hospital and Tribhuvan University Teaching Hospital (TUTH). Non probability purposive sampling technique with semi structured interview questionnaire including Likert Scale was used to collect the data. Descriptive and inferential statistics were used for analysis. RESULTS: Overall perception of respondents about nursing care (nurses' behavior, safety and security and admission procedure) is positive as 182 (91%) perceived positively, whereas 18 (9%) perceived negatively (not positive). There is no significant difference of perception in relation to total nursing care by sex, education and occupation status of the respondents as highest percentage of respondents had positive perception. CONCLUSIONS: It can be concluded that most of the respondents showed positive attitude towards quality nursing care in both hospitals.

Abnormalities in the thyroid function tests as surrogate marker of advancing HIV infection in infected adults.

OBJECTIVE: To study thyroid function tests in patients infected with human immunodeficiency virus (HIV) infection at various stages of the illness and to correlate the results with the disease progression. METHODS: In a prevalence study of 50 HIV infected patients at various stages of illness thyroid function tests consisting of free-thyroxin (FT-4), free tri-iodothyronine (FT-3), and serum thyroid stimulating hormone (s. TSH) were done. Subjects belonged to both sexes and all subjects were newly diagnosed HIV+ patients and were not receiving antiretroviral therapy (ART) when enrolled in the study. Patients were studied in two groups: Group-1 had 25 patients having AIDS and Group-2 had 25 patients who were HIV+ but were not having AIDS as per 1993 revised CDC classification for HIV infection in adolescents and adults. The results were statistically analyzed and correlation of abnormalities in thyroid function tests with the disease progression was studied. RESULTS: Out of 50 cases, thyroid function abnormalities were observed in substantial number of patients. Nine (18%) patients had FT-3 levels below the normal range, ten (20%) patients had decreased FT-4 levels and twelve (24%) patients had s. TSH levels above the normal range. When the results were statistically analyzed for the 50 patients enrolled in our study using Pearson's correlation coefficient, there was a direct correlation between CD4 count and FT3 and FT4 values (r = 0.357 with p < 0.05; r = 0.650 with p < 0.05 respectively). There was an inverse correlation of CD4 counts with serum TSH levels (r = -0.470 with p < 0.050). CONCLUSION: Thyroid dysfunction is frequent in HIV infection and with progression of disease there is a primary hypothyroid like stage that occurs in patients with HIV infection. FT3 /FT4/serum TSH can be used as a surrogate marker of the progression of the disease.

Pulmonary haemorrhage syndrome associated with dengue haemorrhagic fever.

Dengue fever is a major public health problem in India. Dengue haemorrhagic fever (DHF), a more serious form of disease, occurs when a person previously infected with dengue is reinfected with a different serotype. Besides common manifestations pleural effusion, pneumonitis, haemoptysis and pulmonary haemorrhage have rarely been seen. We report a case of 30 years old male, who developed pulmonary haemorrhage, haemoptysis requiring blood transfusion. Serology was consistent with the diagnosis of dengue haemorrhagic fever.

Choledochoduodenostomy: a study of 28 consecutive cases.

OBJECTIVES: Choledocholithiasis is a common problem in South Asia. Proper drainage of the CBD is essential to reduce the chance of residual stones and recurrent stones. The paper highlights the surgical management of choledocholithiasis by side to side choledochoduodenostomy and the post surgical complications. METHOD: 28 cases of choledocholithiasis treated by choledochoduodenostomy between March 1995 and June 2003 were studied. After pre operative diagnosis and per operative confirmation, side to side choledochoduodenostomy was done. It is a triangulated anastomosis between the bile duct and post bulbar duodenum using single layer interrupted suture. The cases were meticulously followed up for detecting complications RESULTS: 79% of the patients who underwent choledochoduodenostomy were female and majority (43%) belonged to the 51 to 60 age group. All the patients selected for CDD had a dilated common duct of at least 1.5 cm diameter and 71% of them had multiple stones. 79% were asymptomatic during the follow up, two patients developed wound infection. 18% developed alkaline reflux gastritis and only one patient suffered from recurrent cholangitis because of inadequate stoma size. No case of sump syndrome was observed in this series. CONCLUSION: Side to side CDD is an easy, effective and definitive method of decompression, especially when there are multiple stones in a dilated CBD.

Cases of perforated duodenal ulcer treated in College of Medical Sciences, Bharatpur over a period of one year.

BACKGROUND: Eighteen patients were studied in our institution between January and December 2002. Simple closure followed by eradication of Helicobacter Pylori was used to manage the cases of perforated duodenal ulcer. METHOD: After resuscitation, laparoscopy followed by simple closure of perforation reinforced with pedicled omental patch was performed for all the patients. H- Pylori eradication using "triple regime" was done in all. Follow-up between 6 to 12 months was done, for which endoscopy and Visick's grade was used. RESULTS: All the patients were male, maximum incidence (39%) noted in 51 to 60 age group. Mean time interval between start of symptoms and surgery was 60 hours. As a result the patients were moribund with gross purulent peritonitis and poor general condition. Chest infection was the commonest complication (44%) and two patients (11%) with very poor prognosis died during post operative period. Good to excellent results using Visick's grades were obtained in 81% surviving patients. Endoscopy did not show active ulcer in any of the patients. CONCLUSION: Patients with perforated duodenal ulcer were late in presenting to the hospital, precluding the option of definitive surgery for peptic ulcer disease. Simple closure of perforated duodenal ulcer if combined with eradication of H-Pylori is an effective method of treatment of duodenal perforation and is not associated with high recurrence of symptoms of peptic ulcer disease.

Evaluation of communication skills of physicians about asthma.

OBJECTIVE: Communication skills in medical practice are important. To assess the communication skills of physicians about asthma, we undertook this study. METHODS: One thousand four hundred and twenty one physicians attending the annual conference of association of physicians of India volunteered to participate in the study. They were divided into three categories. 'Teachers' group 1, (n = 131), 'Clinicians', group 2, (n = 951) and 'Students' group 3, (n = 339). Questionnaire containing ten most frequently asked questions by asthmatic patients were given to the physicians. A panel of three patients assessed the replies of these question and graded them as 'Convincing', 'Just convincing' and 'Not convincing'. RESULTS: Replies of only 2% of physicians were graded as convincing, 15.6% just convincing and 82.4 as not convincing. Among group 1 none gave a convincing reply while replies of 2.2% of group 2 and 2.4% of group 3 were graded as convincing. The difference in results was not significant statistically on comparing the three groups (p > 0.1). CONCLUSIONS: Communication skills are the integral part of patient care and management. Our study demonstrated lack of effective communication skills among physicians.

Lipid profile in rheumatoid arthritis and its relation to disease activity.

AIM OF THE STUDY: To ascertain whether--1. Serum lipids are altered in rheumatoid arthritis (RA) patients and 2. Disease activity has any role in altering lipid profile. METHODOLOGY: Lipid profiles of 25 RA cases were compared with age and sex matched controls. RESULTS: Serum triglycerides (STG) and total cholesterol (TC) were found to be significantly lower in RA patients. In patients with very active disease, activity index (AI) > 80, STG, TC and low-density lipoprotein (LDL-C) were significantly lower as compared to controls. For TG 'r' value of -0.483 indicated negative correlation between disease activity and TG values, though the correlation is not significant (p > 0.05). For TC 'r' value (-0.0551) indicates negative correlation between disease activity and serum TC.

Mitochondrial diseases: an overview of genetics, pathogenesis, clinical features and an approach to diagnosis and treatment.

Defects in structures or functions of mitochondria, mainly involving the oxidative phosphorylation, mitochondrial biogenesis and other metabolic pathways have been shown to be associated with a wide spectrum of clinical phenotypes. The ubiquitous nature of mitochondria and their unique genetic features contribute to the clinical, biochemical and genetic heterogenecity of mitochondrial diseases. This article focuses on the recent advances in the field of mitochondrial disorders with respect to the consequences for an advanced clinical and genetic diagnostics. In addition, an overview on recently identified genetic defects and their pathogenic molecular mechanisms are given.

Biomechanics of human common carotid artery and design of novel hybrid textile compliant vascular grafts.

The mechanical properties and structure of a human common carotid artery were studied in order to develop criteria for designing and manufacturing compliant textile vascular grafts. The arterial wall comprised a composite of elastin and collagen fibers with the collagen fibers crimped. This structure led to a unique pressure-circumferential stretch ratio curve, the slope of which increased with an increase in strain. The increase in slope was particularly rapid at a stretch ratio above 1.4 or pressure above 120 mmHg. Based on the knowledge gained, a criteria for the design of biomechanically compliant arterial grafts was developed. An elastomeric prestretched polyurethane monofilament yarn with a low modulus of elasticity and a bulked polyester multifilament yarn with a high modulus of elasticity were combined and used as threads in the manufacture of grafts. Tubular structures of diameters in the range 4-6 mm were made by weaving. Transverse compliance and morphological and permeability properties of these grafts were determined and compared with those of a currently available woven commercial grafts and human carotid arteries. Results indicated that the compliance values of the hybrid grafts were comparable with those of the human carotid artery. Preliminary in vivo studies in dogs showed promising results: a thin, stable neointima developed within 6 months of implantation on the flow surface.

Effects of caffeine on perceptual judgment.

The present study examined the effects of caffeine on the estimation of felt width of blocks employing haptic presentation. Following a between-subject design, 160 male postgraduate students classified as high or low impulsives received either placebo or one of four doses of caffeine citrate (1, 2, 3 and 4 mg/kg body weight). A double-blind procedure was adopted for drug administration. Caffeine produced differential effects on the performance of high and low impulsives, facilitated performance (decreased error in perceptual judgment) in high impulsives but had no influence on the performance of low impulsives. The dose-response trends also followed different patterns in the two groups of subjects.

Serum, CSF, RBC & urinary levels of magnesium & calcium in idiopathic generalised tonic clonic seizures.

Serum, cerebrospinal fluid (CSF) and urinary levels of magnesium and calcium and RBC magnesium levels were studied in 100 patients of idiopathic generalised tonic clonic seizures and 95 healthy controls matched for age and sex. There was a significant reduction in serum, CSF and RBC magnesium levels and a rise in serum and CSF calcium levels in epileptic patients. The 24 h urinary excretion of calcium and magnesium in the epileptics did not differ from controls. Post ictal (within 24 h of seizure) serum and CSF magnesium levels were significantly lower and calcium levels significantly higher as compared to inter ictal levels (4 wk after seizure). There was no correlation between serum magnesium, serum calcium and CSF calcium levels and the frequency, control or duration of fits. Low CSF magnesium levels correlated with increased frequency, poor control and longer duration of fits. Patients with status epilepticus and those in the EEG abnormalities had low CSF magnesium levels.

In vitro loss of tensile strength and elasticity of five absorbable suture materials in sterile and infected canine urine.

The loss of breaking strength and elasticity of five absorbable suture materials (polydioxanone [PDS-II], polyglycolic acid [PGA], polyglactin 910 [PG-910], polyglyconate [GTMC], and chromic gut) after in vitro incubation in sterile, Escherichia coli- and Proteus mirabilis-inoculated canine urine was studied. Biomechanical testing, in a controlled environment, was performed during the 28-day study period. Polydioxanone and chromic gut retained greater than 90% of their original strengths after 28 days of incubation in sterile urine and 87% of original strengths in E. coli-inoculated urine. Polyglyconate retained 24% and 18% of original strength, respectively, after incubation in sterile and E. coli-inoculated urine for 28 days. Polyglycolic acid and PG-910 retained less than 30% of original strength in sterile urine and only 7% in E. coli-inoculated urine after 21 days of incubation. In P. mirabilis-inoculated urine, loss of tensile strength and elongation was significant for all suture materials. Polyglycolic acid and PG-910 lost all strength after 24 hours of incubation. Polydioxanone lost all strength after 7 days of incubation, whereas GTMC retained 19% at day 7. Chromic gut retained 78% at day 7 and 16% after 21 days of incubation, however, the absence of normal phagocytic destruction of chromic gut in this in vitro study may have artificially elevated these values. In sterile urine with chemically modified pH, loss of strength and elongation was greater in alkaline urine than in neutral or acidic urine for all types of suture materials.

Use of carbon dioxide laser in improving knot security in polyester sutures.

Knot slippage continues to be a serious concern in surgery. This study explored the possibility of improving knot performance by exposing it to radiation from a CO 2 laser. The specimens were mounted in a special device and exposed in a predetermined position for precisely controlled lengths of time. In the first set of experiments, the welding of ends was examined in nylon and polyester sutures. Although the welding was easily achieved, the joint was found brittle and its strength lower than that of a surgical knot. In the next set of experiments, the work was performed at a more fundamental level using oriented, high density, polyester films. The results showed that up to a certain level of exposure the tensile properties did not change, but beyond it a rapid decay took place. Shear tests on polyester sutures twisted together and then exposed to various levels of energy indicated that a bond of maximum strength developed at this exposure. Mersilene sutures of size 3/0 containing a two throw square knot when exposed to energy of this level produced optimal results. The knot strength increased by about 16% (from 13.4 N unexposed to 15.6 N exposed) and the slippage often known to occur in a two-throw knot was completely absent. This work performed under standard atmospheric conditions provided a direction for greatly enhancing the performance of a two-throw knot in terms of both the security and the strength.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of enalapril in essential hypertension and its comparison with atenolol.

The effect of enalapril was evaluated in 67 patients with essential hypertension, and its therapeutic efficacy was compared with atenolol in a placebo run-in, single-blind, cross-over trial. Enalapril significantly reduced blood pressure in all grades of essential hypertension. As monotherapy it 'normalized' blood pressure in 88%, 50% and 25% of patients with mild, moderate and severe hypertension respectively. Optimal dose for most of the patients was 20 to 40 mg/day. Comparison with atenolol revealed almost parallel efficacy of the two drugs, although enalapril produced a significantly greater reduction in systolic blood pressure in patients with mild and moderate hypertension (P less than 0.01 in each group). No serious side effects were encountered with either drug. Enalapril, therefore, has a potent and slightly superior antihypertensive effect to that of atenolol, and may be used as a 'first-step' drug in the treatment of hypertensive patients.

Caffeine differentially affects kinesthetic aftereffect in high and low impulsives.

The effects of caffeine on kinesthetic aftereffect (KAE) were examined. Following a between-subjects design, high and low impulsive male postgraduate students were administered placebo and four doses of caffeine (1, 2, 3 and 4 mg/kg body weight) in a laboratory situation. A double blind procedure was adopted for drug administration. The study supports the following conclusions: (1) caffeine reduces KAE in high impulsive subjects; (2) the larger dose of caffeine (4 mg/kg) enhances KAE in low impulsive subjects; (3) caffeine produces profound effects on the performance of high impulsives; (4) caffeine leads to different dose-response trends in the two groups.