Ischemic Stroke as a Manifestation of Cholesterol Embolization Syndrome Following Percutaneous Coronary Intervention.

Cholesterol embolization syndrome (CES) is one of the major, yet underdiagnosed cause of morbidity and mortality following invasive coronary interventions. The major risk factors are elderly, male, atherosclerotic disease, anticoagulation and femoral access route. This multisystem disease affects skin, kidney, brain, eye and gastrointestinal tract. Only few cases of cholesterol embolization syndrome manifesting as an ischemic stroke are reported. We present a case of an elderly man, admitted to our ICU after percutaneous coronary intervention (PCI) who developed neurological deficits along with skin changes and renal failure. cholesterol embolization syndrome was suspected based upon the presence of cardiovascular risk factors, invasive cardiovascular intervention and clinical signs. The diagnosis of ischemic stroke made through plain MRI brain, revealed multiple areas of lacunar infarcts. He was treated with intermittent hemodialysis, statins and anti-platelet agents. On follow up, skin lesions and renal functions were improved; but slurring of speech and paresis persisted.

Epidemiology of Work-Related Musculoskeletal Symptoms and Illnesses among Brick Kiln Workers in Kathmandu Valley, Nepal.

Background Workers in the brick manufacturing industries require to carry heavy loads, do repetitive work and remain in awkward postures for extended periods of time. These activities may cause them to develop work-related musculoskeletal symptoms and disorders. Objective To investigate the epidemiology of musculoskeletal symptoms and disorders among brick manufacturing workers as well as similar exposure groups among brick kiln workers. Method An analytical cross-sectional study was conducted during February - March 2015 in the Kathmandu Valley. From 16 brick kilns, 400 interviewees involving green brick molding, green brick stacking/carrying, red brick loading/carrying, coal crushing/ carrying and firing were recruited. An unmatched equal size of reference group of grocery workers was maintained for comparison. Prevalence of all musculoskeletal symptoms and disorders were computed and compared among brick workers and grocery workers as well as similar exposure groups among brick kiln workers. Result The musculoskeletal symptoms and disorders were prevalent in 90.5% of the exposed and 82.2% of the reference group. Brick kiln workers were about two times more likely to experience musculoskeletal symptoms and disorders compared to the reference group. When the associations among similar exposure groups were evaluated, there were significantly high prevalence of musculoskeletal symptoms and disorders among green brick molders, red brick loaders/carriers and coal crushers/ carriers in comparison to firemen. Conclusion This study showed a high prevalence of musculoskeletal symptoms and disorders among brick kilns workers. Among all similar exposure groups, coal crushing/carrying task significantly elevated with all types of musculoskeletal symptoms and disorders.

Assessment of Nutritional Status of Children Under Five years of age in rural Nepal.

Background Nutritional status of children is one of the major predictors of child survival. However, malnutrition is a major public health problem in most of the developing countries and occurs prominently among under-five children. In context of Nepal, nearly 37% children are suffering from underweight, 41% from stunting and 11% are suffering from wasting. These children are at a substantially greater risk of severe acute malnutrition and death. Objective The objective of the study was to assess the nutritional status of children under five years of age and to find the factors associated with malnutrition. Method A cross-sectional study was conducted in Dolakha and Kavre districts of Nepal for assessing the nutritional status of under-five children and associated factors. A total of 243 under five children were included from two purposively selected village development committees (VDCs) i.e. one from each district. Statistical Package for the Social Sciences (SPSS) 22 Version and ENA Software Version 2011 were used for analyzing the data. Result Out of 243 children, according to WHO based on weight for height assessment, 17 (7.0%) were wasted, in height for age analysis, 97 (39.9%) were stunted and in weight for age assessment, 46 (18.9%) were underweight. Conclusion In the study population, there is high prevalence of malnutrition, especially stunting among under-five. Taking into account weight, height, age, and mid upper arm circumference (MUAC) measurements of malnourished children more than threefifths of them were found below -2SD and nearly one-fourths below -3SD which needs intervention.

Airborne Particulate Matter and Health Condition in Brick Kiln Workers in Kathmandu Valley, Nepal.

Background Air quality monitoring in brick kilns indicates very high concentrations of airborne particulate matter. Air pollution from brick kilns poses an enhanced threat to the environment and to human health. Objective To evaluate airborne particulate matter concentration and health status of brick kiln workers. Method A cross-sectional comparative study was conducted in the Kathmandu valley targeting all brick industries and their workers during January - March 2015 and March - April 2016. A total of 16 brick kilns and 800 participants (400 brick workers as exposed and 400 grocery workers as referent) were selected for study. A direct-reading, Dusttrak model 8533 was used for air sampling. Nepali version questionnaire was applied to obtain epidemiological data. SPSS version 16 was used to perform statistical analysis. Median, mean, range and proportion were calculated and Mann-Whitney U test, Kruskal-Wallis test and chi square (c2) test were applied to test significance. Result Mean values of particulate matter concentrations for brickfields were as follows: Total Suspended Particulate Matter (TSPM): 5.179 mg/m3, PM10: 4.958 mg/m3, respirable suspended particulate matter (RSPM): 4.140 mg/m3, PM2.5: 3.965 mg/m3, and PM1: 3.954 mg/m3. The mean concentrations for grocery workers were; TSPM: 0.089 mg/ m3, PM10: 0.089 mg/m3, RSPM: 0.085 mg/m3, PM2.5: 0.082 mg/m3 and PM1: 0.082 mg/m3. Among brickfield workers, red and green brick loading zones had results that exceeded the ACGIH Threshold Limit Values for TSPM and RSPM. Workers complaints of injury were 52% and 44.2%, and illnesses were 88.5% and 82.2%, respectively among exposed and referent. The occurrence of injuries/illnesses during work showed significant association between exposed and the referent groups at 0.05 level. Conclusion The high level of airborne particulate matter in the brick fields requires action for the protection of workers. The availability of health services within brick industries needs to be enhanced.

Assessment of Knowledge Regarding Oral Hygiene among Parents of Pre-School Children Attending Pediatric Out Patient Department in Dhulikhel Hospital.

BACKGROUND: Level of knowledge regarding oral hygiene among the parents of pre-school children plays an important role on maintaining the good oral hygiene of their children. In Nepal, sufficient research has not been carried out on this area. OBJECTIVE: Objective of this study is to assess the level of knowledge on oral hygiene of preschool children's parents attending pediatric outpatient department in Dhulikhel Hospital. METHOD: A descriptive study was conducted from November 2012 to January 2013 among one hundred parents of preschool children visiting pediatrics outpatient department of Dhulikhel Hospital. Paper and pencil based semi structured questionnaire was used for collecting data. Questions related to demographic information and knowledge were asked. Thirty questions were used for assessing knowledge level. Knowledge score was calculated by allocating one point for each correct answer and zero point for each wrong answer. Analyzed data were presented in terms of numbers and percentages. Total knowledge scores were categorized based on percentage. Knowledge score was categorized on four group - exclusive intervals - namely-poor (0-40%), moderate (40-60%), good (60-80%) and excellent (80-100%). Mann-Whitney U test and Kruskal-Wallis test were applied to check significance difference and chisquare test was used to check association among different background characteristic. RESULT: It was found that 81% had moderate knowledge, 15% had poor knowledge and 4% had good knowledge about oral hygiene. Median knowledge score was found to be 15 with range 10 to 21. Following variables were found to be significant difference on knowledge category: Education status (p<0.001), education level (p= 0.041), past experience about oral health problem (p = 0.008), Further significant association was found between knowledge category and educational status (p<0.001) and between knowledge category and past experience (p< 0.001). CONCLUSION: Knowledge regarding oral hygiene was found satisfactory among the parents of preschool children visiting pediatric OPD of Dhulikhel Hospital.

School Teachers' Knowledge about Epilepsy in Kathmandu Metropolitan City.

Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child. Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers. Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A selfadministrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher's socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge. Result Teacher's age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019). Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers.

Prevalence and Associated Factors of Hypertension among Adults in Rural Nepal: A Community Based Study.

Background Hypertension is a major health problem throughout the world and is one of the major risk factors for cardiovascular mortality. It is important to detect and manage prehypertension and hypertension to reduce the risk of correlated complications especially cardiovascular diseases. Objective The objective of the study was to find the prevalence and risk factors of hypertension among the adults in rural Nepal. Method A community based cross-sectional study was conducted among 648 respondents. The information was obtained using pre-tested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity and diet preference. Height, weight and blood pressure were recorded and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Result The overall prevalence of hypertension was 20.5 % and pre-hypertension was 46.6%. The males had higher prevalence of hypertension (30.6%) compared to females (13.8%). Bivariate analysis showed male gender, smoking and non vegetarian diet have association with hypertension. Male gender [OR 2.50 (1.68 - 3.74)] and non vegetarian diet [OR 0.11 (0.01 - 0.85)] were found to be significantly associated with hypertension in multivariate analysis. Conclusion The prevalence of hypertension and prehypertension was high in the study population. In absence of life style modification and risk reduction the individuals categorized as prehypertension have great risk of developing hypertension in the future which may pose a great challenge in the future. Hence, there is a big scope for screening and primary prevention strategies to curb the epidemic of hypertension.

Reproductive morbidity in a village of Kathmandu.

BACKGROUND: Reproductive morbidity has been a less studied area in developing countries. Prevalence of reproductive morbidity and health seeking behavior pertaining to it is little known. To reveal the magnitude, this study was carried out in a village of Kathmandu district. The objective of the study was to find out prevalence of reproductive morbidity and service utilized for them. METHODS: A random cross-sectional study was carried out among 200 women of reproductive age years in a village using household survey and structured questionnaire. RESULTS: The study revealed that 72 percent (144) women of reproductive age years have experienced reproductive problem. Gynecological problems contributed for 81 (40%) women and obstetric problems for about 51% of the married women (48 out of 94). Service seeking was found to be very low for gynecological morbidity. CONCLUSIONS: Reproductive morbidity was found to be very high in the community. The prevalence of obstetric morbidity was almost in half the study population, whereas gynaecological morbidity was about forty percent among the women of reproductive age group. However, seeking care for reproductive morbidity was low which requires more attention.

Association of cardiovascular risk factors and coronary artery lesion among coronary artery disease patients.

BACKGROUND: Coronary artery disease (CAD) is associated with the numbers of risk factors causing coronary atherosclerosis. Coronary artery stenosis is mostly caused by coronary atherosclerosis. OBJECTIVE: This study aims to analyze the association between coronary artery stenosis and cardiovascular risk factors. METHODS: An observational study was conducted among CAD patients. The diagnostic coronary angiogram was performed from femoral approach using standard catheters and techniques to find out any abnormalities. RESULT: A total 73 patients (44 male and 29 female) with coronary artery disease undergoing diagnostic coronary angiography was included with the documented cardiovascular risk factors. The coronary stenosis was found in 40 patients on the basis of stenosis grading. Among the established cardiovascular risk factors, sex, diabetes mellitus and smokers show are significantly associated with coronary stenosis among CAD patients. The present study shows the significant association of coronary stenosis among male CAD patients (OR 2.47; CI 0.94-6.48, p<0.05) and similar association has been observed in diabetes mellitus (OR 3.32; CI 1.12-9.84, p<0.05) and smoking (OR 4.10; CI 1.45-11.61, p<0.01). CONCLUSION: The prevalence of CAD is increased with numbers of presence of cardiovascular risk factors. Male gender, diabetes mellitus and smoking are significantly associated with coronary stenosis among CAD patients. However, hypertension and dyslipidemia are comparable between coronary stenosis and no significant stenosis group.

Variations in total facial index among students of Kathmandu University School of Medical Sciences.

The total facial index exhibits sexual differences and different shapes of face. Facial anthropometry has its well known implications for forensic scientists, anatomists, human biologists, criminologists and physical anthropologists. Facial index is the ratio of the morphological facial height to facial width and multiplied by 100. The present study aimed to examine the facial length, facial width, facial index and to find out the facial type in students of Kathmandu University School of Medical Sciences. The present study was conducted on 300 medical, dental and human biology students of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Of the total 300 students 150 students were male and 150 students were female and were between the age group 18-25 years. The study had been approved by the Institutional review committee of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The study result showed that the mean facial index of Nepalese students was 87.01. The mean facial index of Nepalese male was found to be 87.20 and female was found to be 86.81. The dominant facial type in students of Kathmandu University School of Medical Sciences was found to be mesoproscopic and least common was hyperleptoproscopic. The dominant facial type in male was euriproscopic and the dominant type in female face was mesoproscopic.

Education: the key to curb HIV and AIDS epidemic.

Overwhelming impact has been established among different aspects and burden of incurable HIV and AIDS is increasing day-by-day globally. The aim of this article is to discuss the potential benefits and strengths of an education system in the absence of remedy and help to develop future strategies. Education has great impact on HIV and AIDS and vice-versa. An education plays a vital role to curb the transmission of HIV and AIDS thorough capacity building, provides information, reduces vulnerability, empowerment, improve life skill, maintain equity, reduce dependence, stigma, and discrimination, where are abundance foundations for HIV infection. HIV and AIDS has role for devastation of education system and level which has great impact on productivity, economic growth, demand, supply and daily life of human being. Low and middle income countries needs to be improve recording and reporting systems related to impact of HIV and AIDS on education. By analyzing preceding evidences, policy makers or governance feels to reformulate policies relating to education and health. Evidence based policy and program will be more useful to address distressing squall of epidemic.

Thyroid hormone levels in highlanders- a comparison between residents of two altitudes in Nepal.

BACKGROUND: The endocrine changes related to altitude adaptation in human have attracted physiologists around the globe for long. A number of high altitude studies to detect the physiological changes have been performed now and then. But, the study to see the hormonal changes to compare populations residing at different high altitudes is a scarce. Hence, we have performed a study in native populations of different high altitude comparing changes in thyroid hormones in western Nepal. The Jharkot population included in this study is at altitude of 3760 m and Jomsom population at 2800 m height from sea bed. OBJECTIVE: The study is to compare changes in thyroid hormones at two different high altitude natives. METHODS: To compare thyroid status between high altitude natives at two different altitudes a cross sectional study is performed by random sampling method. The blood sample was collected in a vacutainer from fifty eight individuals after obtaining the informed consent of participants. The blood collected from antecubital vein was centrifuged in an hour and the serum obtained was used for biochemical analysis of free triiodothyronine, free thyroxine and thyroid stimulating hormone. RESULTS: Mean free thyroxine (fT4) of Jharkot population is significantly larger (p = 0.001) than Jomsom population. Mean thyroid stimulating hormone (TSH) with p = 0.597, does not indicate the difference between this two population. There is no significant difference between mean free triiodothyronine (fT3) of Jharkot and Jomsom population (p = 0.345). CONCLUSION: The rise in free thyroid hormone at high altitude is not dependent on the thyroid stimulating hormone released from anterior pituitary. The rise in free thyroxine is found at higher altitude and no difference in fT3 level is detected in population studied at high altitudes.

Abortifacient effect of metoclopramide in female albino rats.

BACKGROUND: Metoclopramide a dopamine receptor antagonist is commonly used to treat nausea and vomiting. Long term use can cause parkinsonism, galactorrhoea and gynaecomastia. As it is lipid soluble, it enters the brain, easily crosses the placental barrier and can affect the fetus. Hence, the present study is designed to assess the risk of metoclopramide in pregnant albino rats. OBJECTIVES: To study the abortifacient effect of metoclopramide in pregnant albino rats. METHODS: Eighteen pregnant rats were divided into three groups of six rats each. The abortifacient activities of metoclopramide were studied in the doses of 1 mg/kg and 3 mg/kg intramuscularly. The treatments were started on the 6th day of pregnancy and continued till the 15th day. Rats were laparotomised on 19th day of pregnancy for evaluation of abortifacient action. In both the horns of the uterus, number of implantation sites, resorption sites, dead and live fetuses were observed. RESULTS: The mean percentage of aborted fetus was 17.22 +/= 21.13 33.88 +/= 37.73 after 1mg/kg and 85.21 +/=18.93 after 3mg/kg of metoclopramide. The abortifacient effect of higher dose was significantly larger compared to both control group and low dose group, but there was no significant difference between the mean percentage of abortion in control group and the low dose group of metoclopramide. CONCLUSION: Metoclopramide at 3mg/kg intra muscular has abortifacient effects in female albino rats.

Awareness regarding preventive measures of avian influenza among the adult people of Thimi Municipality, Nepal.

BACKGROUND: Avian influenza is considered as a threat to global public health. Prevention and control depends on the awareness of the general population as well as high risk-groups. The avian influenza should be viewed more seriously because it may lead to pandemic influenza when the virus mutates its strain with the common human influenza. Thus, this study aims to explore the awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. OBJECTIVE: The objective of this study was to explore awareness regarding preventive measures of avian influenza among the adult population of Thimi Municipality. METHODS: It is a cross-sectional, population based study. It was carried out in Thimi Municipality from May 15 to June 15, 2012. Pre tested structured questionnaire was used for face to face interview with randomly selected 250 subjects. RESULTS: Out of 250 subjects, 123 (49.2 %) were males. The mean age of subjects was 36 ± 11.8 year. Among total subjects, 94.4 percent had heard about avian influenza. The main source of information was television (94.1%). Majority of subjects (84.9 %) thought that keeping infected birds and poultry as the mode of transmission followed by eating not well cooked poultry meat (82.8 %). Out of total study subjects, 165 (66.0 percent) mentioned fever and 138 (55.2 percent) thought fatigue as the signs and symptoms. As for knowledge about preventive measures, majority (85.6%) stated that cleaning the surfaces that had come in contact with the poultry could prevent the disease and 83.2 % had knowledge that the infection could be prevented by washing hands with soap and water after poultry handling. Awareness regarding preventive measures was found significantly low in females, middle adults, illiterates, and house wives. CONCLUSION: The awareness regarding avian influenza was quite satisfactory among the adult people of Thimi Municipality. However level of awareness was seen lower in female, illiterate and middle adult. So that along with large scale mass education, there should be specific health education program for the specific group of population.

Sharing the ideas of meta - science to improve quality of research.

Meta-Science is an interdisciplinary science which provides plenty of oppurtunity to cooperate on better understanding of micro-social dimension of science. It plays vital role to justify the conclusion, which helps to improve quality of research as well as to health services. There are various applications of meta-science for improving quality of research namely: applying theories of philosophy and different disciplines, the use of triangulation ,inductive and deductive reasoning ,ethical issues and finally fundamentals of scientific research.

Histomorphological profile of colonoscopic biopsies and pattern of colorectal carcinoma in Kavre district.

BACKGROUND: Colonoscopy is the method to visualize the mucosa of the entire colon and terminal ileum to detect the intestinal abnormalities and obtain biopsy for definitive diagnosis. For clinical decisions in the diagnosis of various colonic lesions unambiguous interpretation of colorectal biopsies is necessary. OBJECTIVES: To assess the prevalence pattern of colonic diseases and to correlate the incidence of colorectal carcinoma with age, sex, site and symptoms presented at Dhulikhel Hospital. METHODS: The materials consisted of 126 biopsies which were submitted to the Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, during the period of July 2011-July 2012. Data collected and entered in MS-Excel and were analyzed using SPSS-16. RESULTS: Out of 126 colonoscopic biopsies 34(27%) showed chronic nonspecific inflammation, followed by carcinoma 25(19.8%), non-neoplastic polyps 21(16.7%), granulomatous inflammation 14(11.1%), neoplastic polyps 8(6.3%), ulcerative colitis 4(3.2%). Miscellaneous lesions; acute focal colitis, eosinophilic colitis were also observed in 19 (15.1%). A higher frequency of colonic diseases in males with a male to female ratio of 1.4:1 and age range of two years to 84 years was observed. Out of 25 patients diagnosed with colorectal carcinoma,48% (n=12) were males and 52% (n=13) were females with a mean age of 55.17 years in men and 59.46 years in females. Male and female ratio among cancer groups was 1:1.08. Total 36% (n=9) were diagnosed with cancer before the age of 50. Out of these nine cases, 6( 66.7%) were males and 3(33.3%) were females. The male and female ratio in younger and older age groups were 2:1 and 1:1.7 . 17( 68%) of the lesions were left sided and 8(32%) were right sided. Below age 50 , left to Right sided lesions in males were 2:1 and in females 1:2. However, above 50 years the ratio among proximal and distal lesions were 5:1 in males and 2.3:1 in females. A statistically significant association was seen between the growth (p=0.000) and per rectal bleeding (p= 0.006) with carcinoma. CONCLUSION: The most prevalent lesion in colorectal biopsies was non-specific colitis followed by carcinoma colon. The incidence of colorectal carcinoma is on rise in Nepalese society. Although colorectal carcinoma is more common in older age group the incidence are also increasing among young especially among women.

Knowledge and practices on preventive measures of blood borne diseases among non-medical attendants working in Dhulikhel Hospital, Kathmandu University Hospital.

BACKGROUND: Blood and certain body fluids pose the greatest threat to health due to sharp injuries spreading blood borne pathogens that cause serious illness when transmitted. Despite the high sickness rate, sanitation staff lacked awareness regarding protections from contacting soiled materials while handling biomedical wastes. OBJECTIVE: The study aims to find out the knowledge and practices on preventive measures of blood borne diseases among non-medical attendants. Method Descriptive cross-sectional study was conducted to find out the knowledge and practices on preventive measures on blood borne diseases among all the 53 non-medical personnel in Dhulikhel Hospital, Kathmandu University Hospital. Respondents scoring ≥50% on knowledge score were taken as having adequate knowledge. A Nepali version of pre-tested structured and semi-structured questionnaire was used to conduct interview. Participation in the study was voluntary and written consent was taken before inquiry. Outcomes were measured in both descriptive and inferential ways. RESULT: The adequate knowledge was found among 86.8% of the respondents on the blood borne diseases whereas 50.9% of them had proper practice on it. Although, there is poor positive correlation between the mean knowledge score and literacy, the correlation was significant (r = 0.341, p < 0.05). Alike, the mean practice score and work experience demonstrated significant correlation (r = 0.319, p <0.05). CONCLUSION: Although knowledge score of male was high, female had higher practices score. Both knowledge and practice score increased due to the participation in the training programs and increment in experience. There was significant positive correlation between the mean knowledge score and literacy, and the mean practice score and work experience.

Nuchal translucency in normal fetus and its variation with increasing crown rump length (CRL) and gestational age.

BACKGROUND: Nuchal translucency (NT) is the fluid collection behind the fetal neck which can be measured by ultrasound at 11-14 weeks of gestation. Increase in the nuchal translucency thickness is associated with various congenital anomalies. OBJECTIVE: To study the relationship between nuchal translucency thickness, crown rump length and gestational age in normal fetus. METHODS: Prospective analytical study conducted on 211 pregnant women from March 2011 to August 2012. Measurement of Nuchal translucency thickness and crown rump length was performed by ultrasound at 11-14 weeks of gestation. The relationship between nuchal translucency thickness, crown rump length and gestational age was studied by using linear regression analysis. RESULTS: The mean CRL was 63.67+13.48mm (range 41.2-88mm) and mean NT thickness was 1.55+0.35mm (range 0.8-2.7mm), respectively. The median gestational age was 12.9 weeks. The regression equation which shows relation between median NT thickness and CRL was described as follows: expected NT thickness = 0.013CRL+0.725, (R2 = 0.258, p <0.001). There was increase in the incidence of NT thickness more than or equal to 2.5mm; 1.7% in fetus between 12-12.9 weeks of gestation to 15.1% in fetus between 14.0-14.9 weeks. CONCLUSION: Our study offers normative data of NT thickness in normal fetus, which can be used as reference to screen various chromosomal and congenital abnormalities between 11- 14 weeks of gestation. NT thickness increased with increasing CRL and a false positive rate increases with increasing gestational age.

Clinicoradiologic evaluation of Eagle's syndrome and its management.

BACKGROUND: Eagle's syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities. OBJECTIVE: To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle's syndrome. METHOD: Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle's syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and postoperative symptoms scores. RESULT: Significant positive correlation was found between the medial angulation of styloid process on right side and left side (? =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) . CONCLUSION: Possibility of Eagle's syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation.

Variation of carrying angle with age, sex, height and special reference to side.

BACKGROUND: The carrying angle is defined as the acute angle made by the median axis of arm and median axis of forearm in full extension and supination. This angle permits the forearms to clear the hips in swinging movements during walking and is important when carrying objects. OBJECTIVE: The purpose of this study was to determine the values of carrying angle in both the sexes according to the age group in relation with height and special reference to side. METHODS: To evaluate the elbow carrying angle in normal children between 5-15 years by a manual goniometer, measurements were performed in 532 children (Male- 335, Female- 197), with the elbow in full extension and forearm in supination. Carrying angle was measured on right and left upper limbs to find out the difference on both the limbs. Their height, ages and sexes are also recorded. Bicipital groove, biceps brachii tendon at its insertion and palmaris longus tendon at the wrist were palpated and marked as anatomical landmarks to demarcate the median axes of arm and forearm respectively. RESULTS: The mean carrying angle of male on the left limb was 7.0359° and the female was 7.8030° and the mean carrying angle of male on the right limb was 4.5509° and the female was 4.9545°. We observed the greater carrying angle in non-dominant limb than the dominant limbs. There was significant positive correlation between height of students and carrying angle left (r =0.0866, p= 0.048<0.05), negative correlation between height and carrying angle right (r= -0.082, p= 0.058 >0.05). CONCLUSION: The present study showed that the carrying angle was greater in female than in male and was greater in non-dominant arm than in dominant arm and the carrying angle was not inversely related to the height of the person.