Analgesic Efficacy of Fascia Iliaca Compartment Block for Positioning During Spinal Anesthesia in Patients with Femur Fractures.

Background Positioning patients with femur fractures for spinal anesthesia is associated with excruciating pain. Fascia iliaca compartment block has the potential to block all nerves supplying the femur and therefore may provide effective analgesia during positioning these patients for spinal anesthesia. Objective To assess the analgesic efficacy of Fascia iliaca compartment block, during positioning patients with femur fracture for spinal anesthesia. We also assessed the duration of analgesia and the requirement for rescue analgesics in the postoperative period. Method Seventy adult patients with fracture femurs were randomly divided into two equal groups (A and B). Patients in both groups received fentanyl one mcg/kg intravenously, 20 minutes before positioning them for spinal anesthesia. Patients of group B additionally, received ultrasound-guided Fascia iliaca compartment block with 40 ml of 0.25% Ropivacaine, immediately after intravenous fentanyl. Numerical rating score (0-10) was used for the assessment of pain at five, 10, and 20 minutes after the block and immediately after positioning patients for spinal anesthesia. Result Immediately after positioning patients for spinal anesthesia, the numerical rating score of pain was 5.06±1.5 in group A and 2.49±1.2 in group B (p<0.001). The duration of analgesia was 799.7±62.1 minutes in group B and 314.65±118.9 minutes in group A (p<0.001). One (2.8%) patient of group B and 18(51.4%) patients of group A required rescue analgesics within four to twelve hours in the postoperative period (p=0.001). In group A, seven patients were satisfied with the analgesia technique while in group B, 17 were satisfied and eight patients were strongly satisfied (p<0.001). Conclusion Ultrasound-guided Fascia iliaca compartment block is effective in reducing pain during positioning patients with femur fractures for spinal anesthesia. Patients receiving this block had a prolonged duration of analgesia, required lesser analgesics, and were more satisfied in the postoperative period as compared to patients not receiving the block.

Undiagnosed and Uncontrolled Hypertension and Access to Health Care among Residents of an Urban Area of Eastern Nepal: a Cross-sectional Study.

Background The burden and complication of hypertension is increasing as most of the people living with hypertension are unaware of their condition and those who are already diagnosed with it do not have their blood pressure under control. Objective To assess the prevalence of undiagnosed and uncontrolled hypertension among residents of Itahari sub metropolitan city of eastern Nepal, along with its associated socio demographic and behavioral risk factors and access to health care services. Method Cross sectional study was conducted in five wards of Itahari, among 1161 participants, using population proportionate to sample size sampling technique. Face to face interview was conducted with participants for data collection applying semi- structured questionnaire and physical measurement like blood pressure, weight and height. Result Prevalence of hypertension was 26.5% includingundiagnosed 11.0% and previously diagnosed 15.5%. Among diagnosed, 76.6% had uncontrolled blood pressure and 56.70% were taking anti-hypertensive medicine, and 7.8% were under Ayurvedic medicine. More than 70% participants preferred private health facility for treatment and 22.7% had faced financial barrier to seek healthcare. About 64% of participants did not visit health services or had visited only once in past six months. Increasing age, Body Mass Index (BMI), smoking status and positive family history were found to be significantly associated with hypertension at < 0.05 level. Conclusion Prevalence of hypertension is high and awareness regarding available health services in local primary health center and its utilization is lacking among participants. Regular screening program for hypertension and awareness program to disseminate the knowledge of availability of primary health center should be conducted.

Prevalence, patterns and contributing factors for tobacco usage amongst Saudi population - analysis from SHIS 2013.

OBJECTIVE: The present study aimed to determine the prevalence, patterns and contributing factors for tobacco usage amongst Saudi population. MATERIALS AND METHODS: Between April and June 2013, a cross-sectional study was organized among 10735 individuals aged 15 years or older. The survey consisted of face-face interview for collecting data on socio-demographics, tobacco usage, diet, physical activity and comorbidities. Univariate and multivariate binary logistic regression was applied to check for the association of prevalence (both smoked and smokeless) with socio-demographic factors. The strength of association was examined by approximating odds ratios (OR) with their 95% CI using SPSS software and p-value set at < 0.05. RESULTS: A total of 10195 respondents aged from 15 to 101 were considered. Overall prevalence of current smoking was 12.8%. Daily smoking was reported by 12% of the population. Sex, age group, education, married and occupation were strong predictors of tobacco use in both univariate and multivariable model. From multivariable model, men were 14.54 times more likely to smoke tobacco (aOR 14.54, 95% CI 11.07-19.11) when compared with women. Respondents between 15 to 30 years, 31 to 45 years, were 3.36 times (aOR 3.36, 95% CI 2.29-4.93) and 3.51 times (aOR 3.51, 95% CI 2.47-4.98) more likely to smoke tobacco when compared to >60 years. CONCLUSIONS: The results of present study indicate a significant, but differing purpose of sex, age group, education, marital status and work status on tobacco usage in the country.

Prevalence of micro and macro vascular complications and their risk factors in type 2 diabetes in Saudi Arabian population: an analysis from SHIS.

OBJECTIVE: Diabetes mellitus is a non-communicable disease (NCD) with metabolic dysfunction that has attained epidemic proportions worldwide. Vascular complications account for the mortality and morbidity associated with diabetes. Hence, the study aimed to estimate the prevalence and risk factors for vascular complications in patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: A cross-sectional national multistage survey, the Saudi Health Interview Survey (SHIS), was used in this study, which surveyed individuals aged 15 years or older. After inclusion and exclusion criteria, 1240 diabetic patients' data were analyzed for sociodemographic data, risk factors, and prevalence of micro and macrovascular complications. Binary logistic regression with stepwise backward elimination was performed to build the optimal model to assess the determinants of macrovascular complications in diabetic patients. The strength of the associations was examined by estimating adjusted odds ratios (aOR) with their 95% CI. p-value < 0.05 was considered statistically significant. R Studio Version 1.2.1093 was used for statistical analysis RESULTS: Prevalence of micro and macrovascular complications in the diabetic patients was 6.05%, in which 3.5% had myocardial infarction, 1.2% had stroke and 1.9% had renal failure. The optimal model showed that for each year increase in age (aOR=1.05, 95%CI 1.02-1.07; p-value=0.000), smoking history (aOR=4.02, 95%CI 2.23-7.26; p-value=0.000), hypertensive patients (aOR=2.71, 95%CI 1.47-4.99; p-value=0.001), patients with low physical activity (aOR=4.32, 95%CI 1.26-14.82; p-value=0.001) were more likely to develop macro and microvascular complications in diabetic patients. CONCLUSIONS: The high prevalence of microvascular and macrovascular complications in diabetic patients poses a serious threat to public health in Saudi Arabia. A multisectoral approach needs to be undertaken to properly control and modify common risk factors at the community level.

Supraclavicular Brachial Plexus Block: Comparison of Varying Doses of Dexmedetomidine with Ropivacaine.

Background Alpha-2 adrenergic receptor agonists have been the focus of interest nowadays as an adjuvant to local anesthesia due to its excellent sedative, analgesic, antihypertensive, anesthetic sparing and hemodynamic stabilizing properties. The ideal dose of dexmedetomidine for brachial plexus block is matter of debate. Objective To find the appropriate minimal dose of dexmedetomidine with desired clinical effects and minimal side-effects, we compared different doses (25 mcg, 50 mcg, 75 mcg and 100 mcg) of dexmedetomidine as an adjuvant to ropivacaine. Method One hundred fifty patients of ASA I and II, aged (18-60) years, weighing (50-60) kilograms undergoing upper limb surgeries under brachial plexus block were enrolled in this prospective, double blind, randomized control study. Patients in all group received 19 ml of 0.5% ropivacaine in common. In addition; group RD25, RD50, RD75 and RD100 received 25 mcg, 50 mcg, 75 mcg and 100 mcg of dexmedetomidine diluted in 1 ml of normal saline (NS) respectively whereas group RD00 received only 1 ml of NS. The duration of analgesia was the primary outcome whereas block characteristics, hemodynamic parameters, oxygen saturation, sedation score and adverse effects were taken as secondary outcome. Statistical analysis was done using ANOVA test, Chi-square test and Scheffe's multiple comparison tests. Result The demographic profile and baseline hemodynamic variables were comparable in all five groups. Increasing dose of dexmedetomidine showed significant improvement in block characteristics but associated with increase in sedation and incidence of bradycardia. Conclusion We conclude that dexmedetomidine 50 mcg would be an appropriate dose as adjuvant to local anesthesia in brachial plexus block.

Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal.

Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care. Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center. Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software. Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality. Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

Multi-drug Resistant and Extended Spectrum ß-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples.

Background Emergence of antibiotic resistance among microbes contaminating the fresh meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. Objective The current study was conducted to determine the distribution of antimicrobial resistance among Salmonella species isolated from fresh chicken liver samples with special emphasis on extended spectrum beta-lactamase (ESBL) production. Method A total of 200 fresh chicken liver samples were cultivated for the isolation of Salmonella and further subcultivated to detect extended spectrum beta-lactamase production among them. Antimicrobial susceptibility testing (AST) was done by disk diffusion method using a panel of 7 antimicrobials. Result Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species out of which 15 (7.5%) samples showed the presence of Salmonella Typhi. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers, such as age, sex, literacy rate, practices of washing knives and chopping board, wearing aprons and gloves and type of water used (p < 0.05). Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Sixty (98.4%) isolates were identified as multi-drug resistant (MDR). The total number of extended spectrum betalactamase producers reported among Salmonella isolates was 29 (47.5%). Conclusion The results indicate that the fresh chicken liver samples sold in Bharatpur Metropolis are reservoirs of multi-drug resistant Salmonella, including extended spectrum betalactamase producers, that could potentially be transmitted to the humans by direct contact or through inadequate cooking.

Graded Epidural Anaesthesia for Lower Segment Cesarean in a Parturient with Very Low Ejection Fraction.

Dilated cardiomyopathy is characterized by left or biventricular dilatation with impaired ventricular contractility. It is associated with systolic dysfunction with decreased left ventricular ejection fraction and congestive progressive heart failure. Anaesthetic management of such condition is very challenging and requires highest level of expertise, strategy and precaution. We present such a case of dilated cardiomyopathy with a very low ejection fraction of 12% who underwent lower segment cesarean section under epidural anaesthesia with successful outcome.

Clinical Profile and Survival Rate of Interstitial Lung Disease in a Tertiary Care Center of Eastern Nepal.

Background The clinical profiles of interstitial lung diseases are reported mainly from developed world. There have been no data from Nepal. Objective The objective of this study is to describe clinical profile and survival in Eastern Nepal. Method Prospectively collected clinical, radiological and laboratory data of consecutive patients with Interstitial lung disease from an eastern regional tertiary care center were analyzed. The recommended official criteria for diagnosing different types of interstitial lung diseases were followed accordingly. Result The study revealed that, 68.0% of the patient's age was of above 60 years with male predominance (66.0%). Idiopathic pulmonary fibrosis (79.5%) was the commonest interstitial lung disease followed by connective tissue disease associated interstitial lung disease. Persistent cough (97.7%) and dyspnea (95.5%) were the commonest presentations. Renal impairment, ischemic Heart Disease and anasarca were significant co morbidities contributing to mortality. Survival rate of the patients was found to be maximum at 5 months (95%) and minimum at 24 months (42%) from the diagnosis of the disease. Conclusion Widespread use of High-resolution computed tomography has made early recognition of interstitial lung disease in elderly patients. Well planned large scale multicenter prospective studies are needed to broaden our understanding about this serious pulmonary disorder.

Postoperative Analgesic Effect of Morphine Added to Bupivacaine for Transversus Abdominis Plane (TAP) Block in Appendectomy.

Background Transversus abdominis plane (TAP) block with local anaesthetics produces effective pain relief following lower abdominal surgeries. Although opioids have been found to have effects through peripheral receptors also, reports on their effect when used as additive to local anaesthetics for TAP block are lacking. Objective To assess the analgesic effect of peripherally administered morphine with bupivacaine for ipsilateral TAP block in patients undergoing emergency appendectomy under general anaesthesia. Method Sixty patients undergoing appendectomy were randomized to undergo ipsilateral TAP with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 ml of intravenous (IV) saline (Group TB) or with 20ml of 0.5% bupivacaine plus 2 mg (2 ml) of morphine (total 22 ml) and 2 ml of NS IV (Group TBM) or with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 mg (2 ml) IV morphine (Group TB-IVM). Pain severity was measured using Visual Analogue Scale (VAS) preoperatively (Baseline) and at 30 min, 6h, 12 h and 24 h postoperatively. Inj. tramadol 50 mg IV was used as rescue analgesic when postoperative VAS was 4 or more. The duration of analgesia (time to first analgesic) and the postoperative 24 h tramadol requirement was recorded. Result The mean duration of analgesia in Group TBM was significantly longer (801.50 ± 74.92 min, p=0.002) than in Group TB (720.00 ± 42.17 min) and Group TB-IVM (712.70 ± 40.94 min). The mean postoperative 24 h tramadol requirement was also less in Group TBM (69.23 ± 25.31mg) than in Groups TB (100.00 ± 38.34 mg) and TB-IVM (95.00 ± 39.40 mg) but did not reach the level of statistical significance (p=0.057). Significantly less ondansetron was required in Group TBM (3.80 ± 2.04 mg) than in Group TB (6.80 ± 2.93 mg) and TB-IVM (6.00 ± 2.75 mg) (p=0.002). Conclusion Morphine added to bupivacaine effectively prolongs the analgesic duration of TAP block in appendectomy.

A Study of Occupational Characteristics and their Association with Cardiovascular Disease among Industrial Workers in Eastern Nepal.

Background An understanding of occupational characteristics of a worker is essential to establish policies, legislation in order to protect the health of the worker. The concept of Occupational Safety and Health is in initial stage in our country. Work-related cardiovascular disease (CVD) is caused by occupational factors that increase the oxygen requirements of the heart or decrease the capacity of the heart to use oxygen. It can be very difficult to link a specific work-related exposure to the development of cardiovascular disease in an individual person. This is because of issues of latency, multiple possible risk factors, lack of specific work-related features and various factors that influence diagnosis. Objective To study occupational characteristics and their association with cardiovascular disease among relatively young male industrial workers between 20-59 years of age in Sunsari-Morang industrial corridor of Eastern Nepal. Method A cross sectional study was conducted among men between 20 -59 years of age in two randomly selected industries in the Sunsari-Morang corridor of Eastern Nepal from July 2012 to July 2013. The data was collected using a pre-tested semi-structured questionnaire. Systematic random sampling was done to select the required number of samples. Chi-square and Fisher Exact tests were used. Crude and adjusted analyses were done. Result Majority (85%) were day shift workers. About 40% of the workers worked for 70-80 hrs/week. Most of them have stress sometimes at work. Noise was experienced by 40.9% of the workers. Earplug was used by only 5% of the workers. Hypertriglyceridaemia was seen in 49.3% of the workers. Long working hours, not using earplug and financial stress were seen to be associated with cardiovascular disease on bi-variate analysis. However, only earplug was significant in multivariate analysis. Conclusion Risk of cardiovascular disease was seen more among those who worked for more hours; those who did not use earplug and those who had financial stress. The results need further exploration to establish a causal association between occupational characteristics of the workers and cardiovascular disease in industrial set-up of eastern Nepal.

Self-prescription of Paracetamol by Undergraduate Students in BP Koirala Institution of Health Sciences.

INTRODUCTION: Self-prescription of medicines are common especially in low income countries.Paracetamol is a common medicine that is self-prescribed also among university students. Incorrect use of paracetamol can lead to ill effects on health including liver failure. There is scarce evidence of the use of paracetamol by self-medication in Nepal. The objective of this study is to evaluate the paracetamol use by self-prescription among the undergraduate students of BPKIHS. METHODS: A cross-sectional study was conducted among 570 undergraduate students of BPKIHS from February 2016 till July 2016. Pretested semi-structured, self-administered questionnaire was used to collect information regarding socio-demographic characteristics, paracetamol use and perception regarding paracetamol use. Systematic random sampling was done from a list of all medical dental and nursing students to select the study sample. RESULTS: Most (86%) students are in the category of 20-24 years. Female students are slightly more than male. Majority of the students are from Nepal. More than half of the students are from medical stream. Self-prescription of paracetamol is seen among 90.1% of the students in our study. Correct dose of paracetamol was mentioned by less than half (49.3%) of the students. Self-prescription of paracetamol is considered beneficial by all participants of this study. CONCLUSIONS: Self-prescription of paracetamol by health sciences students of B P Koirala Institute of Health Sciences is high, while the knowledge of correct dose of paracetamol for adults is low. There is a need to further explore this gap and possibly conduct further studies for other medicines as well.

Analgesia before Performing Subarachnoid Block in the Sitting Position in Patients with Proximal Femoral Fracture: A Comparison between Fascia Iliaca Block and Femoral Nerve Block.

BACKGROUND: Positioning for subarachnoid block (SAB) in patients with femoral fracture is painful and may remain suboptimal requiring use of large doses of opioids. These patients generally being elderly with multiple comorbidities and frailty are likely to have many undesirable effects of opioids including respiratory depression and confusion. OBJECTIVE: The objective was to compare the feasibility and effectiveness of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) in reducing pain associated with positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedures. METHOD: Group FICB patients (n=15) received fascia iliaca block with 30 ml of 1.5% lignocaine with adrenaline and group FNB patients (n=15) received femoral nerve block with 15 ml of 1.5% lignocaine with adrenaline. After the study blocks, patients were kept on supine position for at least 20 minutes before shifting them to the operation theatre. Pain was assessed by using visual analog scale values before the block and during the position for subarachnoid block. Time to perform subarachnoid block, quality of positioning and acceptance was recorded. RESULT: Visual analog scale values during positioning for SAB were lower in FIB group than in FNB (1.0±1.1 versus 2.1±0.8; P< 0.05). Time to perform SAB was shorter in FIB than in FNB (109.6±28.2 seconds versus 134.8±31.9 seconds; P< 0.05). Quality of patient positioning for SAB was comparable between the groups. Patient acceptance was less in group FNB (P< 0.05). CONCLUSION: Fascia iliaca compartment block provides better analgesia than femoral nerve block in terms of facilitating optimal positioning for subarachnoid block in patients undergoing proximal femoral fracture fixation procedure.

Adherence to Antihypertensive Medications: Population Based Follow up in Eastern Nepal.

BACKGROUND: Poor adherence toward antihypertensive drugs is a worldwide problem that results in poor health outcomes and increased health care costs. Community based study related to adherence to antihypertensive medication is limited in context of Nepal. METHODS: This study was conducted to explore the extent of adherence towards prescribed antihypertensive treatment and to identify the factors of non adherence. Community based cross sectional study was conducted in Dharan Municipality of Eastern Region of Nepal from September 2009 to February 2010. Out of 975 hypertensive patients, 154 calculated samples were selected following simple random sampling method. Data was collected by interview method and adherence was measured by using four items Morisky Medicine adherence scale. Data was analyzed using SPSS by descriptive and inferential (Chi square and logistic regression analysis) Statistical method. RESULTS: Among the 154 hypertensive patients, only 56.5% patients were adherent to antihypertensive medication. The important predictors of non adherence by logistic regression analysis at 95% Confidence Interval were illiteracy (OR 5.34, CI= 1.23 -23 , P=0.025), expensive price of medicine (OR 5.14, CI=1.1-23.9, P=0.037), missed medicine due to cost (OR 0.143,CI=0.02-0.78, P= 0.025), no family history of hypertension (OR 4.46,CI= 1.21-16.4, P=0.024), irregular follow up (OR 6.39,CI=1.22-33.3, P=0.028), more than one pills per day ( OR 5.33,CI=1.19-23.7, P= 0.028). CONCLUSIONS: Around half of the population was non adherent towards antihypertensive medications so identified gap need to be addressed to increase adherence level.

The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial.

Transversus abdominis plane block (TAP) has been shown to produce effective pain relief following lower abdominal surgeries but is yet to be routinized in different type of surgeries including appendectomy. The main risk of visceral injury can be logically avoided when the block is performed with the abdomen open using landmark technique in the absence of ultrasound guidance. Objective To assess the effectiveness of TAP block with bupivacaine for postoperative analgesia using landmark technique (performed with the abdomen open) in adult patients undergoing appendectomy. Method Forty patients undergoing appendectomy were randomized to undergo ipsilateral TAP block with bupivacaine (n=20) versus control (n=20) in addition to standard postoperative analgesia. All patients received standard general anaesthesia. The block was performed using the landmark technique with 20 ml of 0.5% bupivacaine or isotonic saline on ipsilateral side just before abdominal closure. Pain severity was measured using Visual Analogue Scale (VAS). Tramadol 50 mg was administered as rescue analgesic intravenously when VAS was four or more postoperatively. The duration of analgesia and the requirement of tramadol in 24 hours postoperatively were recorded. Result Mean duration of analgesia in the TAP block with bupivacaine was longer as compared with placebo (724.00±299.07 min vs 168.25±55.18 min; p< 0.01). The TAP block with bupivacaine compared with saline significantly reduced postoperative VAS pain scores. Mean tramadol requirement in the first 24 hours was also reduced (42.50±37.25 mg vs 120.00±55.18 mg; p<0.01). There were no significant complications attributable to the TAP block. Conclusion Ipsilateral TAP block with bupivacaine using landmark technique with the abdomen open in appendectomy provides effective postoperative analgesia and opioids sparing effect.

Tracheostomy in tertiary care health institution.

BACKGROUND: Tracheostomy is the most obliging and one of the oldest operations in the history of surgery. It is channel between the trachea and skin in the midline in the neck. Most common indications are upper airway obstruction, mechanical respiratory insufficiency and pulmonary toileting etc. METHODS: It is a retrospective study done in a teaching hospital in eastern Nepal from 2005-2008. Medical records of 175 tracheostomized patients were reviewed. Demographic variations, indications and outcome were recorded and analyzed. RESULTS: Age ranged from 1 to 88 years. Most common age group was 21-30 years followed by 51-60 years. Common indications for tracheostomy were upper air way obstruction (34.3%), prolonged intubation (20%). Common diagnoses were tumor of larynx/hypopharynx (26.3%), infectious causes (20.6%) and cut throat (13.7%). CONCLUSIONS: Most common indication for tracheostomy in tertiary care health institution in Eastern Nepal was upper airway obstruction. Procedure is safe if done properly.

An open label study to compare the efficacy of topical mometasone furoate with topical placental extract versus topical mometasone furoate with topical tacrolimus in patients with vitiligo involving less than 10% body surface area.

Vitiligo is a common skin disorder affecting about 1 to 2% of the world population. The prevalence in Nepal is 2-3%. This disease is associated with profound psychological distress. Though many treatment options are available none of these are universally effective. The main objective of the study is to compare the efficacy and rate of repigmentation with use of topical steroid and topical placental extract versus topical steroid and topical tacrolimus 0.1% in treating patients with localized vitiligo. One hundred patients visiting the dermatology outpatient department of Nepal Medical College and Teaching Hospital with the diagnosis of vitiligo involving less than 10% of body surface area were taken. 50 of these patients (Category A) were randomly selected and treated with topical steroid (Mometasone furoate 0.1% cream) and Topical placental extract gel. Other 50 patients (Category B) were given the same topical steroid with Topical Tacrolimus 0.1% cream. The patients were examined every month and final outcome was seen at the end of 3 months. Of the total 100 patients 51% were male and 49% were female. Seventeen percent of patients had lesions over face and neck, 49% had lesions over the extremities and 34% had lesions over trunk. At the end of 3 months the rate of repigmentation was better in patients of Category B than Category A and the result was statistically significant. Topical Tacrolimus 0.1% ointment could be better option for the treatment of localized vitiligo when compared to topical placental extract but in combination with a steroid cream.

Smoking habit among male medical and dental students of B.P.Koirala Institute of Health Sciences, Nepal.

BACKGROUND: Smoking and health are intimately related and thus, smoking among future health care personnel is an important issue. As future physicians and dentists who will witness the continued burden of smoking-related diseases among their patients, represent a primary target for smoking prevention programs. OBJECTIVES: To explore the magnitude of smoking problem and assess the major causes aggravating the burden of smoking among medical and dental students. METHODS; A cross sectional study was conducted between June and July 2009 among 345 medical and dental students. Pre-tested self-administered questionnaire containing questions regarding smoking and its various correlates were used to collect the data. Chi square test was used for testing hypothesis. RESULTS: Prevalence of smoking was estimated as 38.4%, among whom majority started smoking during 15 to 19 years of life. Peer pressure was the major cause behind smoking (29.5%). Nearly one third of the participants used to consume alcohol along with smoking. Presence of parental smoking and use of other drugs were significantly associated with smoking among the students. CONCLUSION: Tobacco smoking is a significant health problem among the male medical and dental students. Medical and dental students were approached as they are the treatment providers for smoking and disease related to it in the future. The results in our study are discouraging and reveal that the medical knowledge regarding ill effects of smoking has not been able to check its use.

Trans-septal suturing following septoplasty: an alternative for nasal packing.

Septoplasty is one of the most common otorhinolaryngologic surgical procedure. It is customary to place a pack in the nose as a part of nasal surgery to stop bleeding, enhance apposition of mucosal flaps, and stabilize the operated septal cartilage and bones. But nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty with nasal pack is the pain and discomfort in post operative period. The study has been performed to compare the complications and outcome of septoplasty with or without nasal packing. Forty four patients were randomly allocated into two groups, Group A (n = 21) and Group B (n = 23). In Group A trans-septal suture and in Group B intranasal pack was used following septoplasty. Both groups were compared for postoperative pain, postoperative complications and surgical outcome. Among 44 patients 31 patients were male and 13 patients were female. Most of the patients ie 79.5% were operated for nasal obstruction. Only one patient had postoperative nasal bleeding requiring nasal pack in Group A. Higher Postoperative pain score, longer hospital stay and more complications were observed in Group B patients. No difference was found in patients' satisfaction after the operation. Septoplasty can be safely performed without postoperative nasal packing and is preferred to avoid postoperative pain, discomfort and other complications.