Visual Evoked Potentials (VEPs) in Patients with Type 2 Diabetes Mellitus.

Background Type 2 diabetes constitutes about 85-95% of all diabetes in developed countries, and accounts for an even higher percentage in developing countries. Diabetic retinopathy is probable the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss. Objective To study P100 latencies and inter ocular latency difference in diabetic group and compared it with a control group and study the correlation between P100 and inter ocular latency difference with the duration of disease in diabetic group. Method A comparative, cross sectional study was done from September 2016 to January 2018 in Neurophysiology Lab, Basic and Clinical Physiology, BP Koirala Institute of Health Sciences. The sample size was 64 and random sampling technique was used. Subjects were divided into three groups according to the duration of disease. Anthropometric and visual evoked potentials were recorded. Descriptive analysis, analysis of covariance and Post Hoc multiple comparison analyses were done using SPSS 11.5. Pearson's correlation was applied between P100 latency and inter ocular latency difference with the duration of disease. Result On using analysis of covariance, P100 latencies were significantly prolonged in diabetic as compared to healthy controls (p < 0.001). Post Hoc multiple comparison showed significant differences in both left and right P100 latencies within diabetic groups and between diabetic groups and healthy controls. Left inter ocular latency difference showed positive correlation with the duration of disease. Conclusion P100 latencies are significantly prolonged in diabetes patients and is positively correlated with duration of disease. Visual evoked potential test can be useful for detecting retinal dysfunction before the appearance of symptoms of retinopathy.

A Study of F Wave Latencies, Chronodispersion and Persistence in Healthy Medical Undergraduates at BPKIHS.

Background The F wave is a CMAP (compound muscle action potential) evoked by a supramaximal stimulation of a motor nerve. F waves are particularly useful for the diagnoses of polyneuropathies at a very early stage and proximal nerve lesions. F waves have a very high diagnostic role in neurophysiology; we would like to study different F wave parameters and effect of anthropometric variables on F wave parameters in normal healthy individuals. Objective To study the effect of anthropometric variables on F wave latencies, chronodispersion and persistence Method Healthy males (n=64) and females (n=26) medical students of BPKIHS with age 21.64±1.19 years were enrolled in the study. Anthropometric parameters and maximum and minimum F wave latencies, F persistence and chronodispersion of bilateral median, ulnar and tibial nerves were recorded in Neurophysiology Lab II of BPKIHS. Descriptive analysis was done for anthropometric and F wave parameters. Unpaired t test was applied for comparing anthropometric and F wave variables between males and females. Pearson correlation was applied between anthropometric variables and F wave parameters. Result Age, height and weight of the subjects were 21.64±1.19 years, 165.61±5.4 cms and 64.07±5.5 kg respectively. Minimum F wave latencies (ms) of right median, ulnar and tibial nerves were 24.09±1.95, 24.02±1.76 and 44.34±3.02 while on the left side were 23.92±1.96, 24.11±1.92 and 44.07±2.83 respectively. Anthropometric variables of male and females were statistically significant. Also, F wave latencies between groups were different which were statistically significant. F persistence was above 80% for all tested peripheral nerves. Height and weight showed a significant effect on F wave latencies (p<0.001). However, age did not show any significant effect on F wave parameters. Conclusion Males have prolonged latencies as compared to females. Height and weight showed a significant relationship with the F wave latencies of the tested peripheral nerves.

The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal.

Background The worldwide prevalence of diabetic retinopathy (DR) was found to be 34.6%. WHO estimates that DR is responsible for 4.8% of the 37 million cases of blindness throughout the world. In a study undertaken in urban population in Nepal, M.D. Bhattarai found the prevalence of diabetes among people aged 20 years and above to be 14.6% and the prevalence among people aged 40 years and above to be 19%. Studies on DR, to our knowledge, have mostly been hospital based in Nepal. Little information is available about prevalence of DR at the community level in Nepal. Objective To investigate the prevalence of diabetic retinopathy and associated risk factors among known diabetic population of Nepal. Method A descriptive cross sectional study was conducted among individuals aged 30 and more using cluster sampling method. The study sites were Kathmandu metropolitan city and Birgunj sub-metropolitan city. A sample size of 5400 was calculated assuming 5% prevalence rate with 95% confidence level, 5% worst acceptable level and 1.5 cluster sampling design effect. Study participants were interviewed, anthropometric measurements and fundus photograph was taken from participants with diabetes. Fundus photographs were used to grade retinopathy. Result Around 12% of the respondents were diabetic, mean age 55.43±11.86 years, of which slightly more than half were females (50.2%). Among these diabetic respondents 9.9% had some forms of diabetic retinopathy, mean age 54.08±10.34 years, 56.7% were male. When severe grade of retinopathy in any eye was considered as overall grade of retinopathy for the individual, prevalence of Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy and complete vision loss was found to be 9.1%, 0.5% and 0.3%. Prevalence of Diabetic Macular Edema was 5.5%. Duration of diabetes, family history of diabetes and blood pressure at the day of survey was found to be associated with having any retinopathy. Conclusion Diabetic retinopathy is emerging as a public health threat in Nepal. With increasing diabetes, DR can be expected to increase more. Existing eye care services may require upgrading to provide quality and affordable retinopathy services to address this emerging problem.

Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital.

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Ovarian hemangioma: A rare encounter.

Ovarian hemangioma, though rare and asymptomatic, can mimic malignant ovarian tumors, thus it is necessary for comprehensive histopathological and immunohistochemical evaluation for accurate diagnosis and appropriate management.

Onset of a propagating self-sustained spin reversal front in a magnetic system.

The energy released in a magnetic material by reversing spins as they relax toward equilibrium can lead to a dynamical instability that ignites self-sustained rapid relaxation along a deflagration front that propagates at a constant subsonic speed. Using a trigger heat pulse and transverse and longitudinal magnetic fields, we investigate and control the crossover between thermally driven magnetic relaxation and magnetic deflagration in single crystals of Mn(12)-acetate.

Robustness of Tomato Quality Evaluation Using a Portable Vis-SWNIRS for Dry Matter and Colour.

The utility of a handheld visible-short wave near infrared spectrophotometer utilising an interactance optical geometry was assessed in context of the noninvasive determination of intact tomato dry matter content, as an index of final ripe soluble solids content, and colouration, as an index of maturation to guide a decision to harvest. Partial least squares regression model robustness was demonstrated through the use of populations of different harvest dates or growing conditions for calibration and prediction. Dry matter predictions of independent populations of fruit achieved R2 ranging from 0.86 to 0.92 and bias from -0.14 to 0.03%. For a CIE a⁎ colour model, prediction R2 ranged from 0.85 to 0.96 and bias from -1.18 to -0.08. Updating the calibration model with new samples to extend range in the attribute of interest and in sample matrix is key to better prediction performance. The handheld spectrometry system is recommended for practical implementation in tomato cultivation.

Evaluation of latent tuberculous infection and treatment completion for refugees in Philadelphia, PA, 2010-2012.

SETTING: Philadelphia, PA, USA. OBJECTIVES: To compare the evaluation and treatment of latent tuberculous infection (LTBI) in refugees seen at member clinics of the Philadelphia Refugee Health Collaborative (PRHC) vs. non-PRHC clinics. DESIGN: Refugees with Class B (non-communicable) tuberculosis (TB) admitted to the United States from 2010 to 2012 who were being treated at PRHC clinics were compared to those treated at non-PRHC clinics. Odds ratios (ORs) for attending a follow-up appointment, completing treatment, and time from arrival to the United States to the first TB screening test were calculated. RESULTS: Of the 2094 refugees who arrived in Philadelphia in 2010-2012, the Philadelphia Department of Public Health was notified of 149 who required additional evaluation for TB. Among these, 57 (38.3%) were confirmed to have LTBI, and none were diagnosed with active TB. All LTBI cases were recommended for anti-tuberculosis prophylaxis and 43 (75.4%) completed treatment. Refugees receiving care from PRHC clinics were more likely to be screened within 30 days of arrival (OR 4.70, 95%CI 2.12-10.44), attend a follow-up appointment (OR 4.53, 95%CI 1.36-16.27), and complete treatment (OR 9.44, 95%CI 2.39-37.3). CONCLUSION: Refugees who attended PRHC clinics were more likely to be evaluated promptly and to complete LTBI treatment. The PRHC clinics serve as a model for communities seeking to improve refugee health care.

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal.

INTRODUCTION: Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here. METHODS: This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed. RESULTS: Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients. CONCLUSIONS: Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function.

Selection of clinical, patient-reported, and economic end points in acute exacerbation of chronic bronchitis.

BACKGROUND: Acute exacerbation of chronic bronchitis (AECB) places tremendous burden on patients, providers, employers, and health care systems. OBJECTIVE: The purpose of this paper is to (1) review the clinical, patient-reported, and economic measures used to evaluate disease burden and treatment effectiveness in AECB in clinical trials and (2) propose a guide for selecting study end points in AECB that will help capture all the relevant disease outcomes. METHODS: Two literature searches of the PubMed database were conducted to identify studies of clinical trials in bronchitis and evaluate the clinical, patient-reported, and economic end points used in these studies. RESULTS: Previous studies have focused primarily on clinician-assessed outcomes, which do not capture the full impact of AECB on patients' lives. Reporting mechanisms for most end points have been inconsistent, limiting the ability to compare information or interpret differences. Previous studies have given limited attention to patient-reported outcomes and the economic implications of AECB. Patient-reported outcomes such as speed of symptom relief and work productivity are important parameters for assessing treatment effectiveness and provide practical information for treatment evaluation. CONCLUSIONS: Additional research is needed to develop, examine, and validate patient-reported outcomes and the indirect costs of AECB. Measuring the relevant clinical, economic, and patient-reported outcomes in AECB patients using standardized methods may lead to a clearer understanding of the disease burden and the role, effectiveness, and cost-effectiveness of antibiotic treatment.

Nephron sparing surgery in a tertiary care center in Nepal--an initial experience.

BACKGROUND: Malignant renal mass accounts for 2 to 3% of all malignant diseases in adults. Radical surgery used to be the treatment of choice with high propensity to develop chronic kidney disease in the compromised contralateral kidney. Currently, nephron sparing surgery is considered to be the standard of care with equivalent oncological outcome. METHODS: This was a retrospective chart review of patients with renal mass less than seven cm in size who had open nephron sparing surgery from July 2012 to Sep 2013 at Tribhuvan university teaching hospital, Nepal. Latest follow up either from record or over telephone was documented. RESULTS: Eight patients (mean age 45 years, male: female ratio1:1.6) underwent nephron sparing surgery over the specified period. Mean size of tumor was 4.75 cm. Mean ischemia time was 16.37 min. Histopathological diagnosis was benign in two and renal cell carcinoma in six patients. CONCLUSIONS: Nephron sparing surgery is safe in low stage renal tumors. It also prevents unnecessary nephrectomy in benign lesions and prevents negative sequelae of long term chronic renal impairment in remaining contralateral kidney.

Impact evaluation of uterine prolapse surgery in Nepalese women.

BACKGROUND: The problem of uterine prolapse exists throughout Nepal and negatively affects women's health and quality of life (QOL). The Government of Nepal recognizes it as a priority problem. METHODS: This study was conducted in eight districts to examine the status and problems of women who have undergone prolapse surgery. Qualitative and quantitative methods were used to examine the issues of prolapse. Survey method was used to administer the questionnaire. RESULTS: Sixty-six percent women reported pelvic organ prolapse at an early age. The mean age of its occurrence was 28 years. In the hill/mountain districts, 52% women among the non-poor and 72% among the poor went to health camps for surgery indicating that the camps were fulfilling the demands of the poor. Majority (>75%) of them from remote districts went to health camps for surgery indicating the camps were more beneficial to women in remote areas. Counseling was weak in the health camps and the use of IEC materials was minimal. Majority had improved health status after surgery. The incidence of post-surgery problems were as follows: 10.1% in government hospitals, 11.1% in non-government hospitals and 15.1% in health camps. CONCLUSIONS: Despite improved performance of health camps, the program for prolapse management still seems weak due to lack of ownership of local health institutions and lack of proper coordination among the stakeholders/ partners. However, these camps need to be scaled up for the benefit of the unreached population.

Does earlier headache response equate to earlier return to functioning in patients suffering from migraine?

This study explored the association between headache response and return to functioning, and identified migraine-associated symptoms related to functional status and acceptability of migraine treatment as reported by patients. Data from migraineurs enrolled in the active arms of a randomized, double-blind, parallel group, placebo-controlled, clinical trial were analysed. The relationships between headache response and functional response, and clinical factors and treatment acceptability were assessed using chi(2) tests of proportions and logistic regressions. A greater proportion of patients with headache response at 0.5 h were functioning at 0.5, 1 and 2 h compared with patients who did not attain a headache response at 0.5 h (P < 0.0001). These patients also were more likely to find their treatment acceptable (P < 0.05). The results suggest a direct temporal relationship among the key determinants of migraine resolution. Rapid headache response is associated with faster return to functioning; rapid headache and functional responses are significant attributes of treatment acceptability.