Neuro-ophthalmic manifestations in traumatic brain injury: a hospital-based study from Nepal.

Objective: Neuro-ophthalmic manifestations occur frequently in patients with a traumatic head injury which are often ignored, leading to late presentation with permanent visual disability and visual field defects. This study aimed to find the various neuro-ophthalmic manifestations of traumatic brain injury and correlate them with the neurological status and neuroimaging abnormality. Methods: A hospital-based cross-sectional study was carried out among patients admitted to our centre with a diagnosis of traumatic brain injury for a period of six months from August 2020 to January 2021. Glasgow Coma Score was used to grade the severity of the head injury. Detailed ophthalmological examinations were documented in predesigned proforma. Descriptive statistics were used to describe the outcomes. Results: A total of 377 head injury patients underwent neuro-ophthalmic examination-271 (71.9%) were males and 106 (28.1%) were females. The mean age in our study population was 38.6 ± 16.8 years, their age ranging from 3 to 85 years. Time from injury to ophthalmologic examination ranged from 30 min to 12 days post-injury, the mean duration being 24.2 ± 34 h. Road traffic accidents were the most common cause of head injury, with 203 cases (53.8%). 38 (10.1%) patients had neuro-ophthalmic manifestations-16 (42.0%) had afferent pathway deficits and 22 (57.9%) had efferent pathway deficits. The most frequently encountered neuro-ophthalmic abnormality was optic neuropathy in 14 (36.8%) followed by trochlear, oculomotor, abducens nerve, and chiasmal injury. The presence of brain contusion was associated with traumatic optic neuropathy while skull fractures were associated with trochlear nerve palsy, these associations being statistically significant (P<0.05). Conclusion: Neuroimaging abnormalities, particularly brain contusions and skull fractures were significantly associated with neuro-ophthalmic deficits.

Dosage individualization proposed for anti-gout medications among the patients with gout.

BACKGROUND: The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to explore the need of individualization and optimization of the dose of anti-gout medications among gout patients. METHODS: Cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and who were taking antigout medications. Patients not taking anti-gout medications and not showing willingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and verified with the BNF 80. Data were analyzed via R 4.0.3 by applying the multinomial logistic regression to analyze statistical significance of risk with various predictors, and considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and medicines were coded according to the WHO Guidelines for ATC classification and DDD assignment 2020. RESULTS: The high risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. Also, high risk increased by 29.83 and 20.2 times for the overweight and the obese respectively. Aceclofenac 100mg was prescribed for maximum patients (30.5%). Need of dose individualization was realized in 30 patients, with maximum (7) in case of etoricoxib 90mg. Various glucocorticoids were prescribed for 36.9% patients, out of whom 3.8%required dose individualization and 15.9% patients with xanthine oxidase inhibitors, out of whom 1.3% required dose individualization. CONCLUSION: Thirty cases required dose individualization, which was although minimal but could have meaningful impact on the clinical success of the individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups.

Aldosterone Antagonists in ST Elevation Myocardial Infarction Patients with Low Left Ventricular Ejection Fraction: a Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal.

BACKGROUND: Aldosterone antagonists (AA) improve survival in ST elevation myocardial infarction (STEMI) patients with left ventricular ejection fraction(LVEF) "T40% ,with either clinical heart failure or diabetes mellitus. Our aim was to assess the adherence of AA use in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. METHODS: Medical records of 171 STEMI patients with LVEF "T40% and discharged from our centre between January 2012 and December 2012 were retrospectively reviewed, regarding the use of AA use. RESULTS: Among the 171 STEMI patients with LVEF "T40%, 5 patients were excluded study due to the presence of contraindication to AA therapy. Among the remaining 166 patients, only 135 (81.2%) patients were eligible for the AA therapy (58 patients with diabetes mellitus and clinical heart failure in 77 patients). Out of 58 diabetes mellitus patients, 28 (48.2%) patients were treated with AA. Whereas 39(50.6%) out of 77 patients with clinical heart failure were treated with AA. Overall, 67(49.6%) patients among 135 eligible patients were treated with AA. CONCLUSIONS: As in the international studies AA is under-used in our patient population. We still need some more effort to improve our prescription rate.

Percutaneous transvenous mitral commissurotomy in elderly mitral stenosis patients. A retrospective study at shahid gangalal national heart centre, bansbari, kathmandu, Nepal.

INTRODUCTION: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years). METHODS: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared. RESULTS: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm(2) to 1.6±0.3 cm(2) whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm(2) in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis. CONCLUSIONS: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.

Uptake of human pharmaceuticals by plants grown under hydroponic conditions.

Cabbage (Brassica rapa var. pekinensis) and Wisconsin Fast Plants (Brassica rapa) were chosen for a proof of concept study to determine the potential uptake and accumulation of human pharmaceuticals by plants. These plants were grown hydroponically under high-pressure sodium lamps in one of two groups including a control and test group exposed to pharmaceuticals. The control plants were irrigated with a recirculating Hoagland's nutrient solution while the test plants were irrigated with a Hoagland's nutrient solution fortified with the pharmaceuticals carbamazepine, salbutamol, sulfamethoxazole, and trimethoprim at 232.5 microg L(-1). When plants reached maturity, nine entire plants of each species were separated into components such as roots, leaves, stems, and seedpods where applicable. An analytical method for quantifying pharmaceuticals and personal care products was developed using pressurized liquid extraction and liquid chromatography electrospray ionization mass spectrometry (LC/ESI/MS) in positive and negative ion modes using single ion monitoring. The method detection limits ranged from 3.13 ng g(-1) to 29.78 ng g(-1) with recoveries ranging from 66.83% to 113.62% from plant matrices. All four of the pharmaceuticals were detected in the roots and leaves of the cabbage. The maximum wet weight concentrations of the pharmaceuticals were detected in the root structure of the cabbage plants at 98.87 ng g(-1) carbamazepine, 114.72 ng g(-1) salbutamol, 138.26 ng g(-1) sulfamethoxazole, and 91.33 ng g(-1) trimethoprim. Carbamazepine and salbutamol were detected in the seedpods of the Wisconsin Fast Plants while all four of the pharmaceuticals were detected in the leaf/stem/root of the Wisconsin Fast Plants. Phloroglucinol staining of root cross-sections was used to verify the existence of an intact endodermis, suggesting that pharmaceuticals found in the leaf and seedpods of the plants were transported symplastically.