Correlation of the hand length and stature in adult Musahar females of Nepal; an anthropometric study.

Stature of a person is one of the most important and useful anthropometric parameter for establishing identification of unknown living or a dead person. A descriptive cross sectional study was done on 165 Nepalese adult Musahar females of Aurahi Village of Mahottari district, Nepal to predict the stature from their hand length. Measurement of stature and the length of both right and left hands taken with a standard standing height measuring instrument and a slide caliper respectively showed significant (p<0.001) positive correlation between the stature and hand lengths. The multiplication factor which was obtained by dividing the height of the subject by the respective hand lengths was found appropriate parameter to calculate the stature of a questioned person. The importance of the hand length alone will be of a great value for anthropologists and forensic experts. As an alternative method, the coefficient of regression and intercept which were obtained from the measured height and hand length were also proved to be equally valuable to estimate the height of a questioned person.

Transthoracic echocardiography may be useful for preoperative cardiac evaluation of gynaecological patients undergoing routine surgery.

Echocardiography has been an integral noninvasive tool for [preoperative] cardiac evaluation that provides with echocardiographic details which may also be useful to perioperative clinicians to tailor their anesthetic deliberation while dealing with preoperative patients. The objective of this study is preoperative evaluation of routine gynecological patients echocardiographically after being referred from respective internists or anesthesiologists. This was a prospective, nonrandomized study of elective 68 cases who underwent echocardiographic evaluation preoperatively from 15th July 2009 to 14th July 2012. The mean age of the patients was 52.1 +/- 10.3 years with the age range of 30-79 years. Valvular heart disease was the most common echocardiographic finding (129.4%) followed by left ventricular diastolic dysfunction, LVDD (48.5%) and left ventricular hypertrophy (22.1%). Systolic dysfunction was detected in 2.9% of patients and pulmonary arterial hypertension in 2.9% patients. Amongst patients referred after preoperative anaesthetic evaluation, patients had different cardiac lesions echocardiographically. Preoperative echocardiographic evaluation may provide important cardiac informations and values which might be employed by perioperative physicians to tailor their treatment.

Evaluation of control of blood pressure in chronic kidney disease patients with hypertension attending echo-lab of Nepal Medical College Teaching Hospital.

Hypertension and Chronic kidney disease (CKD) are common in Nepal. Control of blood pressure (BP) in general hypertensive patients is poor. Evaluation of adequacy of BP control in CKD patients with hypertension is rare. All consecutive indoor patients (52) with CKD and hypertension, attending echo-lab of Nepal Medical College Teaching Hospital during prospective study of 3 years period from 16th April 2008 to 15th April 2011, were evaluted. Mean age was 45.3 +/- 16.7 years. Male female ratio was 8:5. Brahman and Chhetri (22, 42.3%) were the usual sufferers. There were two peaks in the age group wise distribution; one in age group 20-29 years and the next in 50-59 years. One hypertensive patient's BP was normalized after starting hemodialysis without antihypertensive therapy and was excluded from this study. Others' BP (n = 51) were followed up during admission for the evaluation of the adequacy of their BP control and their antihypertensive medications were reviewed. The control of hypertension in CKD patients was difficult. More than two third of the patients (68.6%) had BP > 140/90 mm Hg. Intensive BP control was present in less than one tenth (7.9%) of the patients. In comparison to intensive group, uncontrolled group received more antihypertensive agents (3.0 +/- 1.3 vs. 2.0 +/- 0.8, p < 0.05). Amlodipine (39, 76.5%) and frusemide (39, 76.5%) were very popular antihypertensives used followed by Prazocin (20, 39.2%) and Metoprolol (11, 21.6%). Despite good efforts, BP control of Nepalese CKD patients with hypertension, were poor.

Variation in inferior vena cava with persistence of left posterior cardinal vein. A case report.

Left sided single inferior vena cava is a rare developmental anomaly affecting clinical diagnosis, treatment and raising academic quest. Incidentally, a similar case was found in the museum of the Department of Anatomy of Nepal Medical College. Along with the anomaly, there were other associated vascular anomalies. The article discusses the possible causative situations.

Both olfactory epithelial and vomeronasal inputs are essential for activation of the medial amygdala and preoptic neurons of male rats.

Chemosensory inputs signaling volatile and nonvolatile molecules play a pivotal role in sexual and social behavior in rodents. We have demonstrated that olfactory preference in male rats, that is, attraction to receptive female odors, is regulated by the medial amygdala (MeA), the cortical amygdala (CoA), and the preoptic area (POA). In this paper, we investigated the involvement of two chemosensory organs, the olfactory epithelium (OE) and the vomeronasal organ (VNO), in olfactory preference and copulatory behavior in male rats. We found that olfactory preferences were impaired by zinc sulfate lesion of the OE but not surgical removal of the VNO. Copulatory behaviors, especially intromission frequency and ejaculation, were also suppressed by zinc sulfate treatment. Neuronal activation in the accessory olfactory bulb (AOB), the MeA, the CoA, and the POA was analyzed after stimulation by airborne odors or soiled bedding of estrous females using cFos immunohistochemistry. Although the OE and VNO belong to different neural systems, the main and accessory olfactory systems, respectively, both OE lesion and VNO removal almost equally suppressed the number of cFos-immunoreactive cells in those areas that regulate olfactory preference. These results suggest that signals received by the OE and VNO interact and converge in the early stage of olfactory processing, in the AOB and its targets, although they have distinct roles in the regulation of social behaviors.

A morphometric study of human pancreas in Nepalese people.

Considering the seriousness of pancreatic diseases and the utmost importance of its correct diagnosis and treatment, a morphometric study of pancreas among Nepalese population has emerged as a demand of present time. This study was carried out to establish a normal dimension of pancreas which could be a guideline for the correct diagnosis, treatment and research on various diseases related to it. Thus, a descriptive type of study was done within a period of eight years of time (2004-2011) on 40 pancreases of both sexes and different age groups, collected from embalmed cadavers from four medical colleges of Kathmandu, Nepal. The obtained specimens of pancreas were classified according to the age and sex. Simultaneously, the weight and length were measured. The data was statistically analyzed and compared, which revealed that the mean size of pancreas was significantly larger in below forty years of age group. Although, there was no significant difference in the size of pancreas between male and female, the pancreas of male subjects was found larger. Thus, the result of the present study not only provides standard dimension of pancreas in Nepalese peoples but also reveals that it is larger in younger people and males.

Poisonings at Nepal Medical College Teaching Hospital.

Poisoning is an increasingly common social problem in Nepal. Studies on poisoning in semi urban areas of Nepal are minimal. Here we, present a prospective study of poisoning in semi urban area of capital, Kathmandu lasting for six years duration. Altogether there were 354 cases of various poisoning, admitted in Nepal Medical College Teaching Hospital from Baisakh 2062 (April 16, 2005) to Chaitra 2067 (April 15, 2011). Male: Female ratio was 135:219 (1:1.6) and Age +/- SD was age 29.3 +/- 13.8 years. Age group (20-29 years) comprised of 138 patients (38.9% followed by < 20 years age group (92, 25.9%). Brahman/ chhetri (150, 42.4%) and Mongolian (146, 41.2%) ethnic groups were the main sufferers of poisoning, followed by newars (41, 11.6%) patients. Deliberate self harm was the cause for poisoning in maximum number of patients (156, 44.1%), followed by depression (64, 18.1%) and accidental poisoning (42, 11.9%). Organophosphorus (152, 42.9%), medicines (71, 20.1%), and rodenticide poisoning (38, 10.7%) were common poisons. Metacid (Methyl parathion) (46, 15.5%) was the most popular brand of poisoning agent used in Nepal for suicidal purpose. The over all mortality rate of poisoning in general was 7.1% with organophosphorus poisoning topping the list (19, 12.5%). We also present mad honey poisonings in a small group of 9 (3.2%) patients with M:F 8:1, age 26.5 +/- 8.8 years. Due precaution should be undertaken during their management as some of them may go into cardiopulmonary arrest and should not be considered benign when more than 5 tablespoonful wild honey is consumed.

Spirometric evaluation of pulmonary function tests in clinically diagnosed patients of bronchial asthma.

The present study was undertaken to assess the difference between the normal predicted value and observed value of pulmonary function test (PFT) amongst the asthmatic patients and also to compare the aforesaid observed values between male and female asthmatic patients. Clinically diagnosed cases (male 62, female 75) of bronchial asthma attending medical out patient department of Nepal Medical College Teaching Hospital were assessed. All the pulmonary parameters showed significantly less observed values than the normal predicted values except PEFR in female and FVC in male asthmatic patients. Hence, PEFR in female and FVC in male asthmatic patients might not be considered as a valid parameter to indicate bronchial asthma. Present study also revealed that all the pulmonary variables were significantly higher in males than in females.

High fat diet induces obesity in British Angora rabbit: a model for experimental obesity.

A reliable and cost-effective animal model for human obesity with its manifested disorders is yet to be established in the context of increased morbidity and mortality due to obesity and its related problems. Therefore, an attempt was made to produce obesity in locally available British Angora Rabbits (BAR) and examine the effect on metabolic and cardiovascular parameters. Adult male BARs weighing nearly 2 kg were randomly divided into two groups, one of the groups was fed with high fat diet (HFD) ad libitum for 10 weeks and the control group received standard normal rabbit chow for same period. Body weight, skinfold thickness, serum cholesterol, serum glucose and resting heart rate were measured before and after the dietary regimens. After 10 weeks, HFD group of rabbits demonstrated significant (P < 0.05) increase in body weight (+24%) and skinfold thickness (+37%). The gain in body weight was positively correlated to skinfold thickness (r = 0.61). Serum cholesterol, serum glucose and resting heart rate were also increased by 46%, 52% and 15%, respectively. Whereas no such increases in any of these parameters were observed in control group of rabbits. Our results suggest that obesity can be produced in BARs by feeding HFD. The obesity manifests with cardiovascular and metabolic changes. It is proposed that this may serve as a valid and reliable model of experimental obesity.

Obesity attenuates formalin-induced tonic pain in British Angora rabbits.

Obesity is known to alter various physiological parameters including the pain sensitivity. There are conflicting reports on the pain sensitivity in obesity. In this context, the present study was aimed to investigate the tonic pain response in obese rabbit model. To achieve this aim, two groups of adult male British Angora rabbits were used. One of the groups was fed with standard rabbit chow and served as control. The other group was fed high fat diet (HFD) for 10 weeks to produce obesity. The standard formalin test was performed at the start and after 10 weeks of dietary regimen in both the groups. Timed behavioral responses (limping, elevation of paw, licking, biting, grooming etc.) were categorized and quantified with the help of standard pain rating scale. The total average pain rating score decreased significantly from 2.01 +/- 0.02 to 1.47 +/- 0.08 (P < 0.05) in HFD group after 10 weeks of dietary regimen, whereas there was no change in the control group. A significant negative correlation was observed between body weight and pain rating score in HFD group of rabbits (P < 0.05, r = -0.62). Results suggest that obesity attenuates the tonic pain responses induced by formalin in British Angora rabbits.

Echocardiography based cardiac evaluation in the patients suffering from chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the most common medical problem in Nepal. Echocardiography based cardiac evaluation in COPD is rare in Nepal. The purpose of this study is to evaluate the echocardiography based cardiac function in consecutively admitted COPD patients (507) in medical wards of Nepal Medical College Teaching Hospital during 13th April 2007 to 12th April 2008. Male female ratio was 0.9:1. Age (mean +/- SD) was 66.1 +/- 10.9 yr. Brahman and Chhetri ethnic group comprised of more than half of total COPD patients followed by similar number of patients in Newar (22.1%) and Mongolian ethnic groups (21.5%). More than half of the COPD patients were in age group 60-75 years, followed by less number of patients (approximately 20.0%) in both 45-59 years and 75-89 years age groups. Of the total patients (507), 141 patients underwent echocardiographic evaluation. Among them significant number of patients had poor LVEF (29, 20.6%) with statistically significant difference in LVEF (36.0 +/- 10.5 vs. 64.3 +/- 8.5%, p value < 0.01). More than half of the total patients showed features of chronic cor pulmonale (56.3%), followed by valvular heart disease (49.3%), diastolic dysfunction (38.7%) and left ventricular hypertrophy (14.1%). Mild pulmonary artery hypertension (PAH) was detected in approximately half of patients (49.1%), followed by moderate PAH in 17.6% patients. Transthoracic echocardiography was found to be very useful to identify various concomitant cardiac abnormalities demanding special treatment consideration in managing clinically COPD like patients.

Screening for hepatitis B, C and non-alcoholic fatty liver disease: a survey of community-based physicians.

BACKGROUND: Screening guidelines for hepatitis B (HBV) and hepatitis C viruses (HCV) as well as a position statement for non-alcoholic fatty liver disease (NAFLD) have been put forth by different sources, but awareness of these guidelines and their impact on the physician practices have not been assessed. AIM: To assess the attitudes of primary care physicians (PCPs), gastroenterologists (GEs) and hepatologists (HEPs) regarding screening for HBV, HCV and NAFLD. DESIGN: A survey questionnaire was sent to community-based PCPs and GEs to assess issues related to HBV, HCV and NAFLD. The same questionnaire was sent to hepatologists (HEPs). The questionnaire contained 10 items related to demographic and practice patterns of these physicians, 35 items related to HBV, 35 items related to HCV and 29 items related to NAFLD. RESULTS: A total of 214 physicians (103 PCPs, 59 GEs and 52 HEPs) completed the survey. A majority of PCPs, GEs and HEPs agreed on most screening issues for these causes of liver disease. Nevertheless, within group comparison of physicians (guideline aware versus guideline unaware) showed significant differences in accurate response between those who were aware of guidelines and those who were not aware. CONCLUSIONS: A large percentage of PCPs and GEs were unaware of official guidelines for viral hepatitis B and hepatitis C. Those aware of guidelines were more likely to screen appropriately and avoid unnecessary testing. More needs to be done to assess awareness and the impact implementation of guidelines in hepatology.

Cranio facial anthropometric measurements among Rai and Limbu community of Sunsari District, Nepal.

Anthropometry is applied to obtain measurements of living subjects for identifying age, stature, and various dimensions related to particular race or an individual. Population based cross sectional study was carried out in Dharan and its neighbouring areas with the help of departments of Anatomy and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan. This study included 444 healthy people aged 25-50 years belonging to pure race of Rai and Limbu communities. Head length, nasal ergonomics and total stature were measured for each selected individual. Student't' test was applied to identify significance of the variables. Except nasal breadth of Limbu, the results showed a significant variation (p < 0.001) in all parameters between male and female of both the communities. It was also revealed that Limnbu males and females were taller with larger head length, longer nasal length and nasal height. Similarly nasal breadths of Limbu females were broader where as in males, Rai had broader nose than that of the Limnbu. Therefore it was concluded that anthropometric measurements can play significant role in determining the sex and ethnicity of characteristic pure races of national importance.

Effect of maternal alcohol consumption on cerebellum of rat pups: a histological study.

Consumption of alcohol during pregnancy results in fetal alcohol syndrome (FAS) in newborn affecting the central nervous system which is more sensitive to deleterious effect of alcohol. This study was conducted to observe the histological alterations in cerebellum of rat pups born to alcohol consuming mother rats. Virgin female albino rats were given 20.0% (v/v) alcohol through oral route two weeks prior to mating and continued till the weaning of their offspring. On postnatal day 27 (PND27), rat pups were sacrificed. Their brains were collected and weighed. The cerebellums were isolated and processed for histological study. The diameter of Purkinje cell and width of molecular and granular layers of the cerebellar hemisphere were measured. Results showed significantly decreased brain weight in rat pups of experimental group when compared to control. The diameter of Purkinje cells, width of molecular and granular layers were also found to be decreased in the experimental group. These results suggest that the maternal consumption of alcohol affects the brain growth and induces significant alterations in the histological architecture of cerebellum of growing rats.

Ambulatory blood pressure monitoring: a useful tool to diagnose hypertension and supervise it's treatment.

Automatic ambulatory blood pressure monitoring (ABPM) for the diagnosis and treatment ofhypertension(HTN) is not common in Nepal. The purpose of this study is to evaluate various characteristics of hypertensive patients undergoing ABPM before starting antihypertensive treatment and evaluate the adequacy of the blood pressure (BP) control during antihypertensive treatment. ABPM was performed in 108 consecutive patients attending the hypertension clinic of Nepal Medical College Teaching Hospital from 1st March 2005 to 30th April 2007 with DynaPulse 5000A (version 3.20q ) for approximately 24 hours. Male female ratio was 59:49 and age (mean +/- SD) was 47.8 +/- 16.4 years. The maximum use of ABPM (25.9%) was noted in the age group of 40-49 years. Body mass index was 25.7 +/- 3.8. Diabetes was noted in 13% patients. Maximum use of ABPM was observed in Newar ethnic group (56.5%). ABPM was used for the diagnosis of HTN in 62.0% patients and for follow up in 38.0% patients. Severe HTN was seen in approximately half (47.2%) of the hypertensive patients. Majority of the patients (88.0%) had dipper type of HTN. Beta-blocker (35.6%), ACE inhibitor/Losartan (31.1%) and calcium channel antagonist (26.7%) were the usual antihypertensive agents used. Single antihypertensive agent was used in the majority of patients (64.1%). In a small number of patients (42, 38.9%) undergoing ABPM during antihypertensive therapy, the adequacy of control of HTN was very poor.

Role of PGL-I of M. leprae in TNF-alpha production by in vitro whole blood assay.

Phenolic glycolipid-I (PGL-I) is known to be a major antigen of Mycobacterium leprae. We have studied the influence of PGL-I on the production of Tumour Necrosis Factor alpha (TNF-alpha) using the in vitro whole blood assay. Armadillo-derived M. leprae (ADML) are thought to be depleted of PGL-I during the purification process. M. leprae obtained from mouse foot pad material (MFPML) has been subjected to a less rigorous purification process; their PGL-I coating is therefore believed to be more intact than that of ADML. PGL-I or ADML alone induced the secretion of minimal levels of TNF-alpha in whole blood assay; when added in combination, higher levels of this cytokine were observed. The highest TNF-alpha response was seen following stimulation with MFPML. MFP material not infected with ML did not elicit any response. The difference in TNF-alpha response shown by ADML and MFPML was postulated to be largely due to the presence of higher levels of PGL-I in MFPML. This increase in TNF-alpha production suggests that PGL-I may play a significant role in the induction of TNF-alpha during natural infection.

Effect of prenatal exposure of alcohol in the morphology of developing rat embryo.

The objective this study was to observe the morphological changes in developing rat embryo exposed to alcohol in utero. Virgin female Wistar rats in experimental group (n=15) were given 20% (v/v) alcohol two weeks before mating and throughout the gestational period through oral route. The controls (n=15) were also maintained and were given the tap water. On gestational day 15 (GD15) and 19 (GD19), five rats from each group were sacrificed by cervical dislocation and the abdomen was incised to expose the uterine horn. The number of implantation sites and resorptions were counted and recorded. The body weight and length of the fetuses were also recorded. The litter size and body weight of the newborn were also recorded at the time of birth from the remaining dam. The incidence of resorption was higher in alcohol treated group than in control which was found to be 25% and 8.7% at days 15 and 19 respectively. The body weight and length of fetuses were found to be decreased and was significant at GD15 (p<0.001 for weight and p<0.05 for length). Similarly, the litter size and body weight of newborn were also found to be decreased significantly (p<0.05 for litter size and p<0.01 for body weight). The present study shows that the maternal consumption of alcohol during pregnancy has adverse effect on fetal viability and development of growing embryo.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role.

INTRODUCTION: As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD. OBJECTIVE: The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development. MATERIAL AND METHODS: It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital. RESULTS: The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients. CONCLUSION: Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.

Experience of newly constructed echocardiography-database with video clips and color still images at the Echocardiography Lab of Nepal Medical College Teaching Hospital.

Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still color snaps are converted into JPEG format. Window media player can be used later on to review the video clips. All together 1059 patients including pediatric, adults and geriatric patients underwent echocardiographic evaluation at the Echo-lab of Nepal Medical College Teaching Hospital during 10th January 2007 to 9th May 2008. Age ranged from 2 months to 98 years. Mean+SD was 52.4 +/- 18.5 years. Male/female ratio was 0.8:1. More than half of the patients (64.3%) came from Kathmandu. Brahman/Chhetri (478, 45.1%), Tamang, Sherpa etc 278 (26.3%) and Newar (226, 21.3%) were the main echo-users. Elderly age group (>60 yr) comprised of more than one third of the patients (42.0%) followed by the age group of 45-59 yr (27.7%). No abnormality was detected in 133 (12.6%) patients. Valvular heart disease was noticed in more than half of patients (60.7%), followed by diastolic dysfunction (393, 14.0%) and left ventricular hypertrophy (210, 7.5%). This database is not very expensive but demand minimal extra time and energy. It will be a valuable tool to increase diagnostic accuracy and a great resource for academic purpose aiding in the improvement of cardiac care in Nepal.

Utility of phenotypic dermal indices in the detection of Down syndrome patients.

Down syndrome (DS) is the most common cause of mental retardation. The frequency of DS patients is about 1:800 and is mainly because of the presence of extra copy of chromosome number 21. Dermatoglyphic has been well established as a diagnostic aid in number of diseases having hereditary basis. Dermatoglyphic data was obtained by the use of ink and prints on a paper, from 15 cytogenetically confirmed patients of Down syndrome attending to the genetic clinic at BPKIHS. The data were correlated and compared with equal number of controls. Dermatoglyphic prints were used to evaluate the variation in the fingerprint patterns, the presence of simian crease and the difference in 'atd' 'dat' and 'adt' angles between the control and the DS patients. The results showed that both the 'atd' and 'adt' angles differed significantly from the control group. The dactylography study revealed higher incidence of loops and lower incidence of whorls in the DS patients as compared with the controls. This method is non-invasive and cost effective. The observed changes in the 'atd' and 'adt' angles plus the fingerprint patterns in the dermatoglyphic study proved that this simple technique could be a valuable tool for selecting patients of DS for cytogenetics analysis.