A Recurrent Case of Ameloblastic Fibroma in 37-year Old Male.

Ameloblastic fibroma (AF) is a benign mixed epithelial and mesenchymal odontogenic tumor. This was previously grouped in odontogenic tumor showing odontogenic epithelium with odontogenic ectomesenchyme, with or without hard tissue formation. This report describes a case of ameloblastic fibroma in a 37-yearold male who came with the complain of swelling in the left side of lower jaw since one year. Enucleation of the mass followed by reconstruction was done six years back. However, after two years of initial treatment; radiographic findings suggested recurrence. Histopathological examination confirmed the diagnosis of ameloblastic fibroma. Patient had no clinical and radiographic evidence of recurrence in three and six months' follow-up. Because of the higher proliferative capacity and malignant degree of the mesenchymal component in the recurrent neoplasm, sarcomatous transformation may occur. Hence, a long term clinical and radiographical follow-up is essential due to its transformation into ameloblastic fibrosarcoma.

Sagittal Root Position of Maxillary Anterior Teeth in Nepalese Population Using Cone Beam Computed Tomography.

Background There are no radiographic studies in Nepalese population for determination of sagittal root positioning in maxillary anterior teeth. The sagittal root positioning and root angulation plays a vital role for case selection in immediate implant placement. Objective To evaluate, classify and compare sagittal root position between different maxillary anterior teeth. Method A 2-year retrospective study was conducted on 100 patients (53 males and 47 females) who fulfilled the inclusion criteria using cone beam computed tomographic images. The relationship of root of tooth to its alveolar housing were recorded as Class I to IV. In addition, the root angulation relative to the alveolar process was also measured. Result The sagittal root position (SRP) calculated on six maxillary anterior teeth on average was found to be 87.83% for Class I, 6.67% for Class II, 0.67% for Class III and 5.17% for Class IV respectively. The mean root angulation was found to be higher with canines on both side whereas lateral incisors had lesser mean root angulation. Root angulation of maximum teeth were between 10-20 degrees where immediate implant placement is possible. Conclusion Within the limitations of this study, the sagittal root positioning and root angulation in Nepalese population showed a favorable result for immediate implant placement. Maximum teeth were found to be close to the alveolar process with the exception of few teeth.

Platelet Satellitism in a Patient with Bronchial Asthma.

Platelet satellitism is uncommon phenomenon characterized by formation of platelet rosette around polymorphonuclear leucocytes in blood smear prepared from Ethylenediaminetetraacetic acid anticoagulated blood. This phenomenon may cause reporting of spurious thrombocytopenia unless proper examination of blood smears. Here we describe a case of platelet satellitism in a 29 year old female which has been incidentally found on evaluation of eosinophilia in a bronchial asthma patient.

Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal.

Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.

Assessment of Palatal Throat Form in Lateral Cephalogram and its Correlation with the Skeletal Base and Facial Divergence: An Institutional Based Study.

Background Along with peripheral seal, palatal throat form also has significant value to achieve good retention and stability of maxillary complete denture. The palatal throat form also determines the posterior extention of maxillary dentures and affects the comfortability of the patients. Objective To analyse the palatal throat form in a Nepalese population based on age, gender malocclusion and facial divergence. Method This study consisted of 300 randomly selected radiographs with a mean age of 21.46±5.62 years. Skeletal malocclusion in lateral palatal throat form outlines. Patient were also categorized according to different Schudy's facial divergence angle (SNMP). The obtained data was tabulated based on the age, gender, palatal throat form, type of malocclusion and facial divergence. The results obtained were subjected to a statistical analysis to find the relation between variants of the soft palate and types of malocclusion in different gender groups. Result Proportion between palatal throat form and malocclusion found to be significant. There is no significant difference in proportion of different class of palatal throat form between genders. Whereas Class II palatal throat form found to be most common in all facial divergence. Conclusion It was observed that Class II malocclusion was most common among three types. The relation between palatal throat form and malocclusion, was found to be statistically significant.

Assessment of Sexual Dimorphism in Mandibular Ramus: An Orthopanoramic Study.

Background Mandible is the largest and strongest bone of the face, is very durable, and hence remains well preserved than many other bones. In cases of mass disasters where an intact skull is not found, the mandible may play a vital role in sex determination as it is the most dimorphic bone of the skull. Morphometric analysis of mandibular ramus provides highly accurate data to discriminate sex. This can be accomplished by the use of panoramic radiography which is widely available and is used routinely to assess the mandibular structures. Objective To evaluate and compare the various parameters of the mandibular ramus and to determine the usefulness of the mandibular ramus as an aid in sex determination. Method Orthopantomograms of 140 samples (70 males and 70 females) were collected from the archives and traced manually on matte acetate tracing paper. Various parameters of mandibular ramus were measured on the right and left sides. The obtained measurements were subjected to discriminant function analysis. Result Mandibular measurements on the right side were greater than on the left side. However, only the ramus breath (minimum and maximum) and projective height of ramus were statistically significant (p < 0.05). All the measurements were higher for males than females. F-statistic values indicated that the highest sexual dimorphism was seen with the projective height of ramus and least with minimum ramus breath. Conclusion Mandibular ramus measurements can be a useful tool for gender determination and can be an essential tool in forensic science especially when there is damaged or partially preserved mandibles and may be helpful for medico-legal purpose in Nepal.

Laparoscopic Surgeries in Urology: Initial Burgeoning Experience at National Transplant Centre, Nepal.

Background This study focuses on experience of laparoscopic surgery at Shahid Dharma Bhakta National Transplant Centre (SDNTC), Nepal; which could enable us to gain knowledge regarding its benefits over conventional surgery. The present study revealed the frequency of various forms of laparoscopic surgeries done at our centre. Moreover, this study accomplishes laparoscopic donor nephrectomy "a historical milestone achieved in Nepal for kidney transplantation on 18th November 2018" which was the first Laparoscopic donor nephrectomy done in Nepal by Nepalese team. Objective The present study assesses the feasibility and safety of laparoscopic surgery at government hospital of Nepal. Method This hospital based cross-sectional study included all patients of age group 10 to 60 years, coming to outpatient department of SDNTC and those having indications for nephrectomy. We excluded patient having previous history of open surgeries of kidney, bleeding disorders, uncontrolled Diabetes Mellitus and uncontrolled Hypertension. The study duration was 15 months from November 2017 to January 2019. The total number of patients enrolled in the study was fifty where transperitoneal laparoscopic surgery was performed in all 50 patients. The demographic data, indications for surgery, duration of surgery, complications of surgery and perioperative outcomes were analyzed. Result Out of 50 cases, 34 (68%) underwent simple lap nephrectomy, 6 (12%) were lap pyeloplasty, 6 (12%) lap nephrectomy along with ureterectomy of long segment of diseased ureter, 1 (2%) lap radical nephrectomy, 1 (2%) lap donor nephrectomy for kidney transplantation, 1 (2%) lap heminephrectomy and 1 (2%) lap nephrectomy for hydronephrotic non functioning left crossed ectopia. Amongst all nephrectomies, 27 (54%) patients were operated on right side while 23 (46%) patients on left. The median age of the patient was 38.56 years. Out of total cases 32 (64%) were male and 18 (36%) female. The median operative time and hospital stay was 122.3 minutes and 5 days respectively. The median estimated blood loss was 74.1 cc. Only one patient required blood transfusion intra-operatively. 2 (4%) patients were converted to open surgery. Conclusion Laparoscopic surgery is feasible and safe procedure in government setup hospital with less cumbersome procedure and minimum complications associated with it.

Secondary Polycythaemia as an Unusual Cause of Falsely Elevated Prothrombin Time and International Normalized Ratio.

Elevated Prothrombin time is common in conditions such as liver dysfunction and use of Vitamin K antagonists. Polycythaemia is among the uncommon causes of elevated prothrombin time. Elevated hematocrit greater than 55% leads to a decrease in plasma of the blood sample, thereby reducing the coagulating factors available. Hence, it is recommended to adjust the citrate (anticoagulant) concentration for collecting blood sample from patients with high Hematocrit to get correct Hematocrit value.

Pattern of Blood Component Utilization in Tertiary Care Hospital of Central Nepal.

Background Blood component are essential part of patient and hospital for the safety and improvement of health care of patient. Proper transfusion is must to avoid the misuse, overuse and transfusion reaction. Objective The main objective of this study was to provide information regarding current utility of blood component in tertiary care hospital of central Nepal. Method In this descriptive study, details of blood components transfused were recorded that was correlated with patient age, sex, different hospital wards, clinical diagnosis and pretransfusion hemoglobin for the duration of 6 month Result Total blood component utilize were 1,267 for 539 patients. Whole blood was most utilized blood component that is followed by packed red blood cells. Demand of Blood product was highest in patient admitted to Intensive Care Unit (ICU). Bleeding patients due to obstetric and gastrointestinal complication got maximum transfusion of blood component. Majorly transfusion of Whole Blood and Packed red cell was done for pre transfusion hemoglobin level that falls in 7 to 10 gm/dl. Conclusion Analysis of blood component usage in any hospital with blood bank setup is very important to improve the blood utilization pattern for transfusion and maintaining blood stock to meet the future demand of blood component.

Juvenile Ossifying Fibroma of Maxilla.

Ossifying fibroma (OF) is a rare, benign, non-odontogenic tumor of the jaw which comes under the group of fibro-osseous lesions. Ossifying fibromas of the mandible are more common than in the maxillary region. Juvenile ossifying fibroma has been distinguished from conventional ossifying fibroma on the basis of patient's age, site predilection, and clinical behavior. The lesion should be differentiated from other fibro-osseous lesions as its management varies from surgical enucleation to complete resection. Present report describes the case of juvenile ossifying fibroma of anterior maxillary region in a 7 year old male patient, with a detailed description of clinical, radiographic, histopathologic features, and its surgical management.

Assessment of The Relationship of Incisive Papilla to Maxillary Central Incisor and Canine-Papilla-Canine Line among the Dentate population of Central Nepal.

Background Incisive papilla has been used as a fixed anatomical landmark to guide in teeth arrangement. Objective To assess the relationship of distance from central incisor to incisive papilla with various types of arch forms, shapes of incisive papilla and types of canine-papillacanine relation. Method Two hundred maxillary stone casts were prepared. Eighteen casts were excluded as they had voids and the final study was carried out in 182 participants. The arch form was assessed according to Testut L. and shape of incisive papilla was recorded according to Filho IE et al. A digital Vernier caliper was used to measure the distance from posterior point of incisive papilla to the mesio-incisal edge from the labial side of maxillary central incisor. The inter-canine line was drawn and its position with incisive papilla was assessed. The analysis was done using SPSS version 20.0. One way ANOVA was done. Result Result showed that parabolic type of arch was the most common i.e. 76.4%. Mean distance of central incisor to incisive papilla was 11.093±1.894 mm. No significant difference was observed in the distance of Central incisor to Incisive Papilla among different arch forms (p=0.854) and various shapes of incisive papilla (p=0.091). The mean distance of central incisor to incisive papilla was significantly greater when canine-papilla-canine line passed from the middle than from posterior part of incisive papilla. Conclusion These results suggest that incisive papilla is a reliable biometric guide which would help to reduce the clinical time of both the dentist and the patients in placement of the anterior teeth.