Prevalence and Risk Factors of Diabetic Peripheral Neuropathy in T2DM Patient Presenting to Community Hospital in Nepal.

Background Diabetic peripheral neuropathy (DPN) is a well-known microvascular complication of type 2 diabetes mellitus (T2DM) attributed to chronic hyperglycemia, and is defined as the presence of peripheral nerve dysfunction in patients with diabetes after exclusion of other causes. Objective To determine the prevalence and risk factors of Diabetic Peripheral Neuropathy among type 2 diabetes mellitus patients. Method A cross sectional study was carried out in a University Teaching Hospital. Type 2 diabetes mellitus patients with diabetes duration of more than 6 months were recruited. Michigan Neuropathy Screening Instrument Scoring was used to diagnose Diabetic Peripheral Neuropathy. Result Among a total of 160 patients who were enrolled, 61 (38.1%) had diabetic peripheral neuropathy and 26 (16%) had diabetic peripheral neuropathy within 1 year of being diagnosed with diabetes. Mean Diabetes duration was 5.56 years and mean age was 57.32 years, with 90 (56%) of the participants being female. The mean HbA1c was 8.33%. Among them 25% of the participants were alcoholics and 30% were smoker. No statistically significant risk factors are evident on multivariate analysis. Conclusion Diabetic peripheral neuropathy was found to be highly prevalent in patients with type 2 diabetes including the patients with relatively shorter diabetes duration. This finding warrants the need of improving the preventive measures and quality of care related to foot complication among patients with type 2 diabetes.

Fine needle aspiration cytology of neck masses in a hospital.

BACKGROUND: Fine needle aspiration cytology is a valuable technique in the work-up of masses arising within neck and represents a screening, inexpensive, and rapid technique to sample masses found in neck. METHODS: This study included 117 cases of neck masses, subjected to fine needle aspiration cytology at the department of Pathology of a hospital in Nepal from January 2013 to December 2013. RESULTS: The study included 117 patients with neck masses with median age of 37 years. The majority of the patients were in the age group of 20-29 yrs with female predominance. The most frequent cause of neck swelling is lymphadenopathy 65 (55.6%), followed by thyroid swelling 36 (30.7%), soft tissue lesion 12 (10.3%) and salivary gland lesions 4 (3.4%). The most common lesion in these patients was non-neoplastic, followed by malignant neoplasm. Tuberculosis is the most common cause of neck lymphadenopathy and colloid goiter is the commonest cause of thyroid swelling. In soft tissue, abscess is the most frequent one. Pleomorphic adenoma is more common than other salivary gland lesions. CONCLUSIONS: Lymphadenopathy is commonest cause of neck mass, followed by thyroid gland & soft tissue swellings. Tuberculosis is the most common diagnosis of neck masses, followed by colloid goiter. Fine needle aspiration cytology is pretty accurate technique to diagnose neck masses and it is helpful to avoid unnecessary surgeries and in general clinical management and it is recommended as a first line of investigation in the diagnosis of neck masses.

Effects of inhibition of prostaglandin F2α biosynthesis during preluteolysis and luteolysis in heifers.

Flunixin meglumine (FM; 2.5 mg/kg) was given to heifers at three 8-h intervals, 16 d after ovulation (first treatment = Hour 0) to inhibit the synthesis of prostaglandin F(2α) (PGF), based on plasma concentrations of a PGF metabolite (PGFM). Blood samples were collected at 8-h intervals from 15 to 18 d in a vehicle (control) and FM group (n = 16/group). Hourly samples were collected from Hours -2 to 28 in 10 heifers in each group. Heifers that were in preluteolysis or luteolysis at Hour 0 based on plasma progesterone (P4) concentrations at 8-h intervals were partitioned into subgroups. Concentration of PGFM was reduced (P < 0.05) by FM treatment in each subgroup. For the preluteolytic subgroup, the first decrease (P < 0.05) in P4 concentration after Hour 0 occurred at Hours 24 and 40 in the vehicle and FM groups, respectively. Plasma P4 concentrations 32 and 40 h after the beginning of luteolysis in the luteolytic subgroup were greater (P < 0.05) in the FM group. Concentration at the peak of a PGFM pulse in the FM group was greater (P < 0.05) in the luteolytic than in the preluteolytic subgroup. The peak of a PGFM pulse occurred more frequently (P < 0.001) at the same hour as the peak of an LH fluctuation than at the ending nadir of an LH fluctuation. In conclusion, a reduction in prominence of PGFM pulses during luteolysis delayed completion of luteolysis, and treatment with FM inhibited PGFM production more during preluteolysis than during luteolysis.

Increase in progesterone and luteal blood flow without a luteolytic response after prostaglandin F2α treatment in early luteal-phase heifers.

Acute changes in circulating progesterone concentration and luteal blood flow in heifers after a conventional dose of prostaglandin F(2α) (PGF; 25mg dinoprost, i.m.) were compared between the early luteal phase (Day 3) and midluteal phase (Day 10; Day 0=ovulation), using four groups (Day-3 control, Day-3 PGF, Day-10 control, and Day-10 PGF; n=6 heifers/group). Blood samples were collected at 0, 2, 5, 10, 15, 30, 60, and 120 min (0 min=treatment). Percentage of luteal area with color-Doppler blood-flow signals was estimated at 0, 10, and 30 min. In the Day-3 and Day-10 PGF groups, progesterone increased to a peak at 15 min. In the Day-3 PGF group, progesterone decreased to the pretreatment concentration by 60 min but did not decrease to below the pretreatment concentration during the 2-h experimental period. In the Day-10 PGF group, progesterone decreased to below pretreatment concentration by 30 min, indicating a luteolytic response. In the Day-3 and Day-10 PGF groups, luteal blood flow increased within 10 min and remained elevated until the last examination at 30 min. The absence of a decrease in progesterone to below pretreatment concentrations in the Day-3 PGF group indicated that luteolysis does not necessarily follow a transient increase in progesterone and a concomitant increase in luteal blood flow. The immediate transient increase in progesterone and an increase in luteal blood flow without a subsequent decrease in progesterone to below pretreatment concentrations after PGF treatment in early luteal-phase heifers are novel findings.

The transition between preluteolysis and luteolysis in cattle.

Novel characterization of the transition between preluteolysis and luteolysis was done in seven heifers. Blood samples were collected hourly and assayed for progesterone (P4), 13-14-dihydro-15-keto-PGF2α (PGFM), and estradiol (E2). The peaks of P4 oscillations were used to designate the transitional hour in each heifer. The interval from the peak of the last PGFM pulse of preluteolysis to the peak of the first pulse during luteolysis (transitional period) was longer (P < 0.0001) than the interval between the first and second pulses during luteolysis (13.4 ± 1.3 h vs. 7.0 ± 0.9 h). The long intervals from the last PGFM pulse of preluteolysis to the transitional hour (4.0 ± 0.9 h) and from the transitional hour to the first PGFM pulse of luteolysis (9.4 ± 1.3 h) resulted in the illusion that the beginning of luteolysis was not associated temporally with a PGFM pulse. The E2 and PGFM concentrations were less (P < 0.05) during the last PGFM pulse of preluteolysis than during the first pulse of luteolysis. Concentration of P4 was suppressed at the peak of the last PGFM pulse of preluteolysis and consistently rebounded at the transitional hour to the concentrations before the PGFM pulse. In four of seven heifers, one or two P4 rebounds occurred between the peak of the PGFM pulse and the rebound at the transitional hour. Results indicated that the prolonged transitional period may be related, at least in part, to increasing concentration of E2, intervening P4 rebounds between the peak of the last PGFM pulse of preluteolysis and the transitional hour, and the complete P4 rebound at the transitional hour.

Concomitance of luteinizing hormone and progesterone oscillations during the transition from preluteolysis to luteolysis in cattle.

The temporal relationships of episodes of luteinizing hormone (LH) oscillations, 13,14-dihydro-15-keto-PGF2α (PGFM) pulses, and progesterone (P4) fluctuations during the latter portion of preluteolysis and the early portion of luteolysis were characterized. In Experiment 1, the detection of LH episodes in blood samples collected every 15 min for 8 h was compared with detection in the samples collected every hour in 4 heifers. The number of independently detected episodes/heifer (total = 7) was the same for the 15-min and hourly collection intervals. In Experiment 2, blood samples were collected every hour (n = 7 heifers) and retrospectively assigned to 15 h before and 15 h after the transitional hour between preluteolysis and luteolysis. During preluteolysis, compared with luteolysis, the amplitude of LH oscillations was greater (0.28 ± 0.03 vs 0.18 ± 0.03 ng/mL; P < 0.02) and the interval between peaks of LH oscillations was shorter (3.3 ± 0.3 h vs 4.3 ± 0.6 h; P < 0.04). The LH peaks occurred at the same hour as the peak of a P4 fluctuation in 77% and 29% of LH oscillations (P < 0.0009) during preluteolysis and luteolysis, respectively. In preluteolysis, synchrony between LH and P4 episodes occurred consistently during the P4 rebound after the peak of a PGFM pulse. In luteolysis, the LH peak preceded the peak of the P4 rebound. On a temporal basis, the hypothesis was supported that episodic LH accounts, at least in part, for the reported P4 rebound that occurs after the P4 suppression at the peak of a PGFM pulse.

Circulating hormone concentrations within a pulse of a metabolite of prostaglandin F2α during preluteolysis and early luteolysis in heifers.

Plasma from hourly blood samples from two previous studies in heifers was assayed for hormones that were not considered in the previous reports. The objective was to determine the intrapulse temporal relationships between a prostaglandin F2α metabolite (PGFM) pulse and various hormones during preluteolysis and luteolysis. Hormone concentrations were centralized to the peak of a PGFM pulse (Hour 0) and evaluated from Hours -3 to 3. Experiment 1 (n=6) was done during early luteolysis. Progesterone decreased during Hours -3 to 0 and then rebounded, but did not return to prepulse concentrations, and concentration of LH increased between Hours -1 and 2. In Experiment 2 (n=7), comparisons were made between the last PGFM pulse of preluteolysis and the first pulse of luteolysis. Intrapulse concentrations of LH increased rapidly between Hours 0 and 1 during preluteolysis and gradually between Hours -2 and 2 during luteolysis. Intrapulse differences in cortisol among hours were not significant for preluteolysis and approached significance (P<0.06) during luteolysis, owing primarily to an apparent increase between Hours -2 and 1. Oxytocin concentrations showed only an hour effect (P<0.0003) from to an increase between Hours -2 and 0 and a decrease between Hours 0 and 2. Results indicated that oxytocin and PGFM concentrations increased and decreased concomitantly and supported the hypothesis that the reported more prominent rebound in progesterone during the descending portion of a PGFM pulse during preluteolysis than during luteolysis involves a greater transient increase in LH.

Intrapulse temporality between pulses of a metabolite of prostaglandin F 2α and circulating concentrations of progesterone before, during, and after spontaneous luteolysis in heifers.

Pulses of the prostaglandin F(2α) (PGF) metabolite 13,14-dihydro-15-keto-PGF(2α) (PGFM) and the intrapulse concentrations of progesterone were characterized hourly during the preluteolytic, luteolytic, and postluteolytic periods in seven heifers. The common hour of the end of preluteolysis and the beginning of luteolysis was based on a progressive progesterone decrease when assessed only at the peaks of successive oscillations. The end of the luteolytic period was defined as a decrease in progesterone to 1 ng/mL. Blood samples were taken hourly from 15 d after ovulation until luteal regression as determined by color-Doppler ultrasonography. Between Hours -2 and 2 (Hour 0 = PGFM peak) of the last PGFM pulse of the preluteolytic period, progesterone decreased between Hours -1 and 0, and then returned to the prepulse concentration. Concentration did not change significantly thereafter until a PGFM pulse early in the luteolytic period; progesterone decreased by Hour 0 and transiently rebounded after Hour 0, but not to the prepulse concentration. In the later portion of the luteolytic period, progesterone also decreased between Hours -1 and 0 but did not rebound. After the defined end of luteolysis, progesterone decreased slightly throughout a PGFM pulse. Results demonstrated for the first time that the patterns of progesterone concentrations within a PGFM pulse differ considerably among the preluteolytic, luteolytic, and postluteolytic periods.

Intrapulse changes in progesterone and LH concentrations and luteal blood flow during an estradiol-induced pulse of a metabolite of prostaglandin F2alpha in heifers.

Physiologic doses (0.1 mg followed by 0.05 mg 1h later) of estradiol-17beta in sesame-oil vehicle or vehicle alone (n=6/group) were given to heifers on day 14 after ovulation (preluteolysis) to study the effect of estradiol (E2) on circulating 13,14-dihydro-15-keto-PGF2alpha (PGFM) and on PGFM pulses. Blood samples were collected hourly for 10h after the 0.1-mg treatment. The E2 group had an increase (P<0.03) in PGFM concentration by 4h and greater (P<0.0001) prominence of the PGFM pulses. Changes in progesterone and LH concentrations and luteal blood flow within a PGFM pulse were characterized. Within a PGFM pulse in the E2 group, progesterone decreased (P<0.04) between Hours -2 and 0 (ascending portion; Hour 0=peak of pulse) and increased (P<0.04) between Hours 0 and 2 (descending portion). Intrapulse changes in progesterone were not detected in the vehicle group. Concentration of LH in the E2 group increased (P<0.05) between Hours -1 and 1 and in the vehicle group decreased (P<0.03) between Hours -1 and 0 and increased (P<0.06) between Hours 0 and 1. The percentage of luteal area with blood-flow signals increased (P<0.02) between Hours 0 and 1 in the E2 group, and there were no other differences between hours in either group. Results were consistent with reports of changes in progesterone concentration within a PGFM pulse in cattle and demonstrated intrapulse changes in LH concentration and luteal blood flow during an E2-induced PGFM pulse.

Stimulation of pulses of 13,14-dihydro-15-keto-PGF2alpha (PGFM) with estradiol-17beta and changes in circulating progesterone concentrations within a PGFM pulse in heifers.

A single physiologic dose (0.1 mg) of estradiol-17beta in sesame-oil vehicle or vehicle alone (n = 8) was given to heifers on day 14 after ovulation to study the effect on circulating 13-14-dihydro-15-keto-PGF2alpha (PGFM), PGFM pulses, and changes in progesterone concentrations within a PGFM pulse. Blood samples were collected hourly for 16 h after treatment. The estradiol group had a greater mean concentration of PGFM, greater number of heifers with PGFM pulses and number of pulses/heifer, and greater prominence of the PGFM pulses. Changes in progesterone concentrations were not detected during the 16 h sampling session in the vehicle group, indicating that the heifers were in preluteolysis. Progesterone decreased after 12 h in the estradiol group, indicating a luteolytic effect of the estradiol-induced PGF secretion as represented by PGFM concentrations. Intrapulse changes in progesterone were detected during a PGFM pulse in the estradiol group (P < 0.006), but not in the vehicle group. Progesterone increased (P < 0.01) between Hours -2 and -1 of an estradiol-induced PGFM pulse (Hour 0 = peak of pulse), decreased (P < 0.004) between Hours -1 and 0, and increased (P < 0.01) or rebounded between Hours 0 and 1. Results were compatible with previous reports of a role for estradiol in the induction of PGFM pulses in cattle and demonstrated intrapulse changes in progesterone concentrations during an induced PGFM pulse.

Characteristics of pulses of 13,14-dihydro-15-keto-prostaglandin f2alpha before, during, and after spontaneous luteolysis and temporal intrapulse relationships with progesterone concentrations in cattle.

Pulses of the prostaglandin F2alpha (PGF) metabolite 13,14-dihydro-15-keto-PGF (PGFM) were compared among heifers that were in the preluteolytic, luteolytic, and postluteolytic periods (n = 7 or 8 heifers/period). Hourly blood sampling was done in 18-h sessions 15, 16, or 17 days after ovulation. Hourly sampling and statistical identification of a PGFM pulse allowed novel comparisons of PGFM pulses among the three periods. Each period had a similar number of PGFM pulses (2.3 +/- 0.2). The pulses were more prominent during the luteolytic period than during the other periods, as indicated by significantly greater concentration for the peak and amplitude between nadir and peak. Significantly more fluctuations that did not meet the definition of a pulse occurred at the beginning of the preluteolytic period and end of the postluteolytic period than during the luteolytic period. The same nadir ended a pulse and began the next pulse in 85% of adjacent pulses. Seven heifers were selected objectively, based on a progesterone concentration >5 ng/ml at Hour -3 (Hour 0 = peak of PGFM pulse) and a progressive decrease in progesterone from Hours -3 to 0. Progesterone increased (P < 0.03) between Hours 0 and 1, remained at a mean plateau at Hours 1 and 2, and then decreased. Results support the hypothesis of a transient intrapulse rebound in progesterone during an individual PGFM pulse, but only during the first portion of luteolysis. These findings should be considered in future proposals on the mechanisms involved in the effects of PGF on progesterone concentrations.

Dynamic progesterone responses to simulation of a natural pulse of a metabolite of prostaglandin F(2alpha) in heifers.

The effects of prostaglandin F(2alpha) (PGF) on circulating progesterone concentration were studied in four groups (n=4) of Holstein heifers 9d after ovulation. The progesterone response to simulation of a pulse of 13,14-dihydro-15-keto-PGF (PGFM) by a 2-h intrauterine (IU) infusion of 0.5mg of PGF was compared with the response to a PGF-bolus IU injection of 4mg. The beginning of infusion and time of injection were designated Minute 0. Progesterone concentration did not change significantly between Minute 0 and Hour 48 in control or IU vehicle-treated groups. In the PGF-bolus group, progesterone concentration increased (P<0.05) between Minutes 0 and 10 and then decreased. In the PGF-infusion group, simulation of a PGFM pulse was not associated with an initial transient increase in progesterone. The first significant decrease (P<0.05) in progesterone began at Minute 20 and continued until Hour 1. The progesterone concentration then began to rebound (P<0.05) at Hour 1 and peaked at Hour 3 at almost the same concentration as at the start of PGF infusion. The progesterone again decreased after Hour 3 and increased again between Hours 24 and 48. In summary: (1) an initial transient increase in progesterone was not detected in association with an individual simulated pulse of PGF, indicating that the frequently reported pronounced transient increase after a bolus luteolytic dose of PGF is a nonphysiological response and (2) simulation of a PGFM pulse resulted in a distinct transient rebound in progesterone beginning at Hour 1 of the PGF infusion.

Luteal blood flow and concentrations of circulating progesterone and other hormones associated with a simulated pulse of 13,14-dihydro-15-keto-prostaglandin F2alpha in heifers.

Progesterone and luteal blood flow effects of an i.u. 2-h infusion of 0.25 mg/h of prostaglandin F(2)(alpha) (PGF) that simulated a natural pulse of 13,14-dihydro-15-keto-PGF (PGFM) were compared to the effects of a single bolus i.u. injection of PGF (4 mg) that induced complete luteolysis in heifers. Blood sampling and an estimate of the percentage of luteal area with colour-Doppler signals of blood flow were performed every 2 min for 20 min and less frequently thereafter for 6 h. After the beginning of PGF infusion or a bolus injection, progesterone increased to a peak at 14 and 10 min respectively, and was accompanied by an increase in blood flow in the bolus group but not in the infusion group. Progesterone then decreased for 1 or 2 h and was accompanied by a continued elevation in blood flow in the PGF bolus group and by a slight increase in the PGF infusion group. Progesterone then rebounded in both groups, but the rebound was greater in the infusion group. Blood flow decreased during the descending arm of the progesterone rebound. Cortisol and prolactin began to increase 6 min after the bolus PGF injection but did not increase during or after PGF infusion. The increases in cortisol, prolactin and blood flow after a PGF bolus treatment but not during a simulated PGFM pulse indicated that the bolus treatment was pharmacologic, and its use may lead to faulty conclusions on the nature of physiologic luteolysis. The comparisons between progesterone and blood flow are novel.

Detection of tubal abnormalities by HSG in Nepalese subfertile women.

Fallopian tube defects are responsible for subfertility in 12.0-33.0% of subfertile couple. Hysterosalpingography (HSG) is a safe and less invasive method of detecting both the tubal and uterine defects. The objective of this study was to find out the incidence of tubal blockage including its site and side diagnosed by HSG in subfertile Nepalese women and to find out the incidence of uterine and other abnormalities detected by this test. This was a prospective study of 1000 cases of subfertility, conducted in Om Hospital, Kathmandu. A short history and HSG report of these cases were obtained from the Radiology department of the hospital. Size and shape of the uterine cavity, evidence of cervical incompetence, tubal visualization, spillage of dye, tubal block with its side and site, evidence of peritoneal adhesion and intravasation of dye in vessels were noted. Quick spillage of the dye in the peritoneal cavity or spillage only after pushing the dye with pressure was also noted. Results were entered in simple tabulations and analyzed. Among 1000 cases, 65.8% had primary and 34.2% had secondary subfertility. 29.0% of the total 1000 cases had abnormal HSG findings. 19.0% of total 1000 cases had tubal blockage. Incidence of tubal blockage in both primary (19.1%) and secondary subfertilty (18.7%) was almost same, in contrary to previous belief. Mullerian defect was present in 3.2% of primary subfertility and 2.0% of secondary subfertility cases. Cervical incompetence was not detected in any case. Evidence of uterine infection was present in 0.7% of primary subfertility and 0.2% of secondary subfertility cases. Abnormal size of uterine cavity was present in 1.2% of primary subfertility and 0.5% of secondary subfertility. Features of phimosis of fimbrial opening, localized spill and intravasation of dye were present respectively in 5.6%, 1.5%, 1.2% in primary subfertility and 4.9%, 1.7% and 1.7% in secondary subfertility.In conclusion; the incidence of tubal blockage detectable by HSG in this study was 19.0%.

Eradication of virulent footrot from sheep and goats in an endemic area of Nepal and an evaluation of specific vaccination.

Programmes based on the identification and treatment of cases and the culling of animals refractory to treatment had failed to eradicate virulent footrot from two districts in the western region of Nepal. From 1993 to 1996 vaccination against two endemic virulent strains of Dichelobacter nodosus was tested for its potential to contribute to the eradication of footrot from the region. Only sheep and goats which had been free of signs of footrot at three inspections at monthly intervals before their annual migration to alpine pastures were eligible for inclusion. From November 1992, the treatment of cases identified during inspections included the injection of specific vaccine. Successfully treated cases migrated with their flocks but were excluded from the vaccine trial. Non-responding cases were culled. Forty combined flocks of sheep and goats (approximately 9500 animals) were used initially to compare three vaccination regimens. Eleven flocks (sheep and goats) were treated with two doses of specific vaccine (group A), nine (sheep and goats) were treated with commercial vaccine followed by specific vaccine (group B) and 10 (sheep and goats) were treated with two doses of commercial vaccine (group C) in March to April 1993 before the annual migration; 10 flocks (sheep and goats) remained unvaccinated (group D). Only sheep and goats free of signs of footrot were allowed to migrate. Nevertheless, virulent footrot recurred in many flocks three months later. However, its prevalence was significantly lower in group A than in the other three groups combined. Groups A, B and C then received the specific vaccine before their migrations in 1994 to 1996; group D remained unvaccinated. The annual programme of inspection and identification and treatment of cases continued for seven years, but the vaccinations ceased after four years. There was no recurrence of virulent footrot after November 1993. After the first season the virulent strains of D nodosus used in the specific vaccine could no longer be isolated, although antigenically distinct, benign strains of the organism persisted in cases of benign footrot.