Mental Health Problems and Social Media Exposure during the COVID-19 Pandemic among Adult Population of Nepal.

Background The COVID-19 pandemic is a significant global health crisis that poses a threat to a person's psychological well-being. A very large number of people got exposed to social network sites during this period which can be hazardous and cause psychological difficulties. There is no prior research or limited studies in this area during emergencies in Nepal. Objective To assess the mental health issues and examine their relationship with social media exposure in adults. Method A descriptive cross-sectional study was conducted by using a validated scale of Depression, Anxiety, and Stress (DAAS-21) and the Insomnia Severity Index (ISI) among 18 years above adult population. Data were collected through an online survey. Descriptive statistics was used to describe sociodemographic data. Binary logistic regression analysis were performed to examine the relationship between psychological problems and social media exposure. Result Out of 422 participants, the overall prevalence of depression, anxiety, stress, and insomnia among the study population were 32%, 28.4%, 24.5%, and 47% respectively. Additionally, 86.5% of individuals said they were frequently exposed to social media. Age, ethnicity, gender, past health problems, and health status were significantly associated with psychological problems. Further, social media exposure was associated with gender and marital status. There was no evidence of an association of psychological problems with social media exposure. Conclusion Depression, anxiety, stress and insomnia are common mental health problems found in the adult population during the time of the first wave of COVID-19 pandemic and highly affected were under 25 years age. Female and unmarried adults are using more social media.

Managing Heart Failure with Preserved Ejection Fraction; A Short Review of Latest Evidences.

Heart failure with preserved ejection fraction (HFpEF) is a clinical dilemma and various clinical trials so far have failed to give a concrete evidence of reducing mortality and major adverse cardiac events (MACE) in this condition. A detailed analysis of the existing evidences and a future plan for a concrete trial design with long duration of follow up is needed to address the dilemma of Heart failure with preserved ejection fraction. The objective of this short review was to review the latest and major randomized controlled trials and study the primary outcomes. The public database of PubMed, Google Scholar and Cochrane were extensively searched for all randomized controlled trials using keywords of Heart failure with preserved ejection fraction, major adverse cardiac events, Hospitalizations; and studies were included in the review if data were reported for patients with ejection fraction > 40%, did not include congenital heart disease, and demonstrated evidence of diastolic failure on echocardiogram (ECHO), and evaluated hospitalizations, major adverse cardiac events and cardiovascular mortality. Despite the major trials reporting improved primary composite endpoints with newer drugs the results have to be interpreted cautiously since the primary outcome were mostly driven by heart failure hospitalizations and not mortality reduction.

Risk factors and outcome analysis of patients with intraoperative rupture (IOR) of ruptured cerebral aneurysm during microsurgical clipping.

PURPOSE: To analyse baseline characteristics of patients with intraoperative rupture (IOR) or non-IOR who underwent microsurgical clipping for ruptured intracranial aneurysms. Additionally, to asses functional outcome in terms of Glasgow Outcome Scale (GOS) at 6 and 12 months. METHODS: A retrospective analysis of 471 patients who underwent microsurgical clipping for ruptured intracranial aneurysms from 2007 to 2018 in Nepal Mediciti Hospital, Nepal. Patients who underwent surgery for unruptured aneurysm were excluded from the study. The association of the base line characteristic in IOR and non-IOR were analysed. Variables analysed were the Hunt and Hess Scale (HHS) dichotomized as (1-3) and (4-5), Modified Fisher Scale dichotomized as (0-2) and (3-4), type of rupture, use of brain retractor, timing of IOR during surgery, aneurysmal factors (size of the neck, location, lobulation) and time of surgery. Outcome, GOS dichotomized into favourable (4-5) and unfavourable (1-3), assessed at 6 months and 12 months. RESULTS: Out of 471 patients treated for ruptured intracranial aneurysm, IOR occurred in 57 (12.10%) with mean age 49.47 (SD ±12.9), occurred more in smoker than non-smoker (45.6% vs. 18.6%; p=.000) and regular alcohol consumers (36.8% vs. 17.9%; p=.004). Favourable outcome with GOS (4-5) at 6 months was observed among patients with lower HHS (1-3), p=.025 and lower MFS (0-2), p=.04. However, outcome at 12 months was better associated with MFS (p=.013) and aneurysm size (p=.038), with more favourable outcome associated with aneurysm less than 10 mm. CONCLUSIONS: Alcohol consumption and smoking are associated risk factors that may contribute to IOR. HHS and MFS are strong predictors of outcome for IOR patients at 6 months. However, at 12 months, MFS is more predictive of outcome. Aneurysms greater than 10 mm had a strong association with outcome at 12 months than 6 months.

Clinico-epidemiological Profile of Extra Hepatic Portal Vein Obstruction: A Tertiary Care Hospital Based Retrospective Study.

Background Extra hepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in the developing countries (up to 30% of all variceal bleeders) and is second to cirrhosis in the West (up to 5-10%). Our understanding of the disease is poor compared with other illnesses. Objective To undertake a retrospective study of the clinicoepidemiological profile of Extra hepatic portal vein obstruction in a tertiary care hospital in eastern Nepal. Method All consecutive adult patients whose features were consistent with the diagnosis of extra hepatic portal vein obstruction from June 2014 to June 2016 were retrospectively analyzed to explore the various clinico-epidemiological parameters. Result A total of 58 patients were enrolled in the study with a median age of 24 years (20.5- 40). Portal vein thrombosis was the most common cause of extrahepatic portal vein obstruction. Hematemesis followed by melena were the most common presenting symptoms. All patients had splenomegaly on examination. None of the patients had clinical, biochemical or radiological evidence of chronic liver disease. Conclusion The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis (PVT) is the predominant cause of extra hepatic portal vein obstruction in Nepali patients, as seen at this tertiary care hospital in Nepal.

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.

Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal.

Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.

Characteristic of low vision patients attending an eye hospital in eastern region of Nepal.

INTRODUCTION: Low vision is an important public health problem. OBJECTIVE: To study the profile of low vision patients in a hospital of Nepal. MATERIALS AND METHODS: Information related to the patients' profile, visual status, ocular disease and, low vision devices prescribed were obtained retrospectively from the records of 1,860 visually- impaired patients, regardless of the cause, presenting to the low vision department of the Biratnagar Eye Hospital, Biratnagar, Nepal, over a period of four years. These patients, after a comprehensive ocular examination, underwent low vision examination by an ophthalmologist and a low vision specialist. RESULTS: Of 1,860 patients, males comprised 1298 (70 %), while 562 (30 %) patients were female. Six hundred and one (32.3%) patients were of less than 20 years while 398(21.4%) were more than 60 years of age. Agriculture (500, 27 %), household work (341, 18 %) and students (308, 17 %) were the common occupations. Retinal diseases were the commonest cause of low vision. They were: macular disorders 408 (22 %), retinitis pigmentosa 226 (12.1 %) and other retinal causes 361 (19.4 %) (diabetic retinopathy, choroidal coloboma, post laser for retinal vasculitis and central retinal/branch retinal vein occlusion, healed macular chorioretinal scar secondary to retinochroiditis and choroiditis). Refractive error 215 (11.5 %), amblyopia 49 (2.6 %), optic atrophy 144 (7.8 %) and microphthalmos 105 (5.6 %) were the other causes. Uncorrected distance visual acuity was between 6/24 and 6/60 in 509 (27.4 %) and between 5/60 and PL in 1,327 (71.3 %) patients. Similarly, near visual acuity with vision better than 2.50 M (N 20) and worse than 2.50 M (N20) was present in 643(34.5%) and 1,217(65.5%) patients. About 67% and 54.5% of the patients had some improvement in their distance and near visual acuity with glasses and low vision aids. Distance spectacles 909 (49 %), near spectacles 106 (5.7 %), hand held magnifiers 78 (4 %) and telescopes 18 (1 %) were the optical devices prescribed. CONCLUSION: The prevalence of low vision is common among the people of the younger and older age groups. Retinal diseases are common among the causes for low vision. Adequate prescription and availability of low vision devices can improve the visual acuity.

Predicting outcomes in acute coronary syndrome using biochemical markers.

OBJECTIVES: To assess risk prediction in patients with acute coronary syndrome (ACS) during the hospital stay, at 6 weeks and at 6 months period using high sensitivity C-reactive protein (hs-CRP), serum creatinine, cardiac troponin I, creatine kinase total, and MB levels. METHODS: It was a prospective observational study. The primary outcome was taken as all-cause mortality. Patients with ACS were enrolled and followed up at 6 weeks and 6 months duration from the index event. Mortality and cause of death were recorded. The hs-CRP was estimated on admission, at 6 weeks, and at 6 months. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated modification of diet in renal disease (MDRD) formula at admission, at 6 weeks, and 6 months. RESULTS: There were a total of 108 cases of ACS in the duration of 6 months who completed the follow-up. The hs-CRP level of >5mg/dl was highly significant for predicting mortality during hospital stay and at 6 weeks (p<0.001). There was 11% of in-hospital mortality (p<0.001). At 6 months, the overall mortality was 28% (p<0.001). There was a statistical significance with low eGFR (median eGFR 45ml/min/1.73m(2)) levels during the admission. CONCLUSION: hs-CRP levels above 5mg/dl and the eGFR levels ≤30ml/min/1.73m(2) were significant in predicting mortality of the patients with ACS. This may provide simple assessment tools for predicting outcome in ACS in resource-poor settings if validated further.

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal.

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

Clinico-epidemiological Study on Pesticide Poisoning in a Tertiary Care Hospital in Eastern Nepal.

INTRODUCTION: Pesticide poisoning is a major health problem worldwide. In Nepal the most common cause is suicidal and pesticides account for more than fifty percent of cases. The objective of the study was to look in detail regarding the pesticide poisoning cases admitted at BPKIHS; their epidemiological profile, presentation, treatment and their outcome during the hospital stay. METHODS: It was a retrospective study which included 2621 patients with poisoning of which 1661 cases were related to pesticides. RESULTS: The mean duration of hospital stay was 6.7 days. The majority of patients 81.16% showed improvement whereas 6.6% of patients died within 24 hours of admission and 3.54% after 48 hours of admission. Among all the patients 0.5% patients were given ICU care and all others were managed in the different units of medicine ward. The total amount of atropine administered varied considerably. Most of the cases were under the influence of alcohol. All the patients had a psychiatry evaluation before discharge. CONCLUSIONS: Pesticide poisoning is increasing in incidence and it is one of the preventable public health problems and includes mainly the patients' age group 20-30 years. Due to easy availability of pesticides it is the most preferred method of suicide and the main reasons being impulsive act and increased indebtedness in the society.

Human resource assessment for scaling up VL active case detection in Bangladesh, India and Nepal.

OBJECTIVES: To determine whether medical staff at PHC level would have the time to take up additional activities such as 1-day fever camps for active VL case detection. METHODS: This article assessed the workload of health staff of different professional categories working at health facilities in Bangladesh, India and Nepal. Data were collected from different sites in high endemic VL areas. The study population was the health staff of government health facilities at all levels. Workload indicators of staffing need (WISN) software were adopted to carry out the analysis of staff workload and their availability in the selected health facility. The WISN difference and WISN ratio for a particular health facility were calculated from actual staffing available and calculated staffing requirement. RESULTS: The results showed a mixed picture of the availability of health workers. In most settings of Bangladesh and India, physicians with or without laboratory technicians would have time for active case detection. In Nepal, this would be performed by trained nurses and paramedical personnel. CONCLUSION: If all vacant posts were filled, active case detection could be performed more easily. The elimination programme can be scaled up with the current staffing levels in the endemic areas with some short training if and when necessary.

[Cardiovascular cooperation with the BPKIHS Hospital, in Dharan Bazar, Nepal]. / Coopération cardiovasculaire avec l'Hôpital BPKIHS, à Dharan Bazar, Népal.

Thanks to a collaboration project that was developed by Swiss cardiologists, the Coeur de la Tour Foundation, and BPKIHS, a teaching hospital in Dharan, it has been possible, within two years and using a "hybrid approach", to set up the first independent invasive and interventional program in East Nepal. 496 patients have been investigated and/or treated since January 2011, during an initial period of 23 months (coronary angiographies, coronary angioplasties, temporary and permanent pacemaker implantations, pericardiocenteses, etc.). In parallel with this, our Foundation, in the same area of the country, has also supported a pre-existing cardiovascular prevention program and has helped start a population-based study of rheumatic heart disease prevalence and treatment outcome among school children.

Hyperglycemia, glucose intolerance, hypertension and socioeconomic position in eastern Nepal.

Abstract. The present study was undertaken to evaluate differences between urban and rural Nepali populations in terms of hyperglycemia, socioeconomic position (SEP) and hypertension, through a community based survey in Sunsari District, eastern Nepal. Blood glucose levels were measured in participants (N = 2,006) S30 years old from urban and rural communities and were classified according to WHO criteria (1998) into normoglycemia (NGY), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and hyperglycemia (HGY). SEP was assessed by structured health interview along with anthropometric measurements and behavioral variables. Hypertension was classified per Joint National Committee (JNC-VII) criteria. Ten point three percent and 11.9% of subjects in this survey (13.3% urban and 11.0% rural) gave a family history and personal history of diabetes mellitus, respectively. Of urban participants (n = 736) with no history of diabetes 70 (9.5%) had HGY and 143 (19.4%) had glucose intolerance (IFG and IGT). Of rural participants (n = 1,270) 114 (9.0%) had HGY and 176 (13.9%) had glucose intolerance. There was an increasing trend in numbers of cases of hyperglycemia and intolerance with increasing age (chi2 198.2, p < 0.001), body mass index (BMI) (chi2 35.1, p < 0.001), SEP (chi2 48.5, p < 0.001) and hypertension (chi2 130.6, p < 0.001). Rural participants had a lower odds ratio [0.706; 95% confidence interval (CI) 0.455-1.096] of having hyperglycemia than urban participants. Individuals with medium and higher SEP had a lower odds ratio (0.878; CI 0.543-1.868) and higher odds ratio (1.405; CI 0.798-2.474), respectively, compared to individuals with lower SEP of having HGY. Both urban and rural populations are at risk for hyperglycemia and glucose intolerance. Individuals having a medium SEP had lower risk of diabetes mellitus than individuals from lower and higher SEP.

Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal.

One hundred and five (72 males; 33 females) consecutive patients who met the inclusion criteria were studied. The mean age of the patients was 49.06 +/- 11.27 years (range 23-73 years). Ninety patients were adult cirrhotics (age > or = 35 yrs) and the remaining 15 patients were young (age < or = 35 yrs). Ninety out of 105 patients were having alcohol related cirrhosis. The commonest presenting symptoms were abdomen distension (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and jaundice (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics). The most common presenting signs were ascites (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and icterus (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics), followed by loss of body hair (73.3% vs. 71.1% in young and adult cirrhotics respectively) and spider naevi (46.7% vs. 61.1% in young and adult cirrhotics respectively). Sixty percent of young cirrhotics and 52% of adult cirrhotics were in Child's grade C at the time of presentation. Most of the deaths were seen in Child's grade C of liver disease. Alcoholic cirrhosis is common in the eastern part of Nepal. Cirrhosis is not uncommon in younger age group. Abdomen distension and jaundice were most common clinical presentations. Most patients were in Child's grade C and most deaths were due to hepatic failure.

Malarial nephropathy in a tertiary care setup--an observational study.

Malaria is endemic in Nepal. Its poor outcome is associated with acute renal failure (ARF), hepatopathy and cerebral malaria. The clinical profiles, biochemical parameters and outcome of 25 patients of falciparum malaria diagnosed either by optimal test, peripheral blood smear (PBS) or Quantitative buffy coat (QBC) admitted in BP Koirala Institute of Health Sciences were studied. Majority of patients (84%) was from the age group 15-45 years. Mean age was 33 +/- 16 years. There were 16 males and 9 females. All had history of fever. Twenty patients were optimal positive, 9 positive in PBS and 12 were QBC positive for Plasmodium falciparum. Mean duration of fever was 13 +/- 9 days. Patients with renal or hepatic involvement presented earlier. Renal dysfunction (S. creatinine > 1.5 mg/dl) was present in 60%. Ten patients had ARF (S. creatinine > 3 mg/dl); five out of them were oliguric/anuric. S. creatinine in patients without renal dysfunction, with renal dysfunction but without renal replacement therapy (RRT) and who underwent RRT were 1.1 +/- 0.24, 3.98 +/- 1.9 and 4.53 +/- 1.72 mg/dL respectively. Serum creatinine of patients with and without hepatic dysfunction respectively were 3.26 +/- 1.98 and 1.26 +/- 0.48 mg/dL (p = 0.001 (CI 0.9-3.10)). Total bilirubin of > 2.5 mg/dl was present in 77%. Total bilirubin of patients with renal dysfunction who underwent and who did not undergo RRT were 10.3 vs. 3.76 mg/dL (p = 0.024 (CI 1.07-12.0)). Fourteen patients had cerebral malaria. Eight patients underwent RRT (hemodialysis or peritoneal dialysis). Six patients died. Five died within 48 hrs of presentation. Patients who had renal and/or hepatic dysfunction had increased morbidity and mortality.

Effectiveness of intra-operative and post-operative use of 5-fluorouracil in trabeculectomy--a randomized clinical trial.

INTRODUCTION: The success rate of trabeculectomy is limited by postoperative scarring. OBJECTIVE: To evaluate the effectiveness of intra-operative and post-operative use of 5-Fluorouracil (5-FU) in trabeculectomy. MATERIALS AND METHODS: Thirty consecutive eyes undergoing trabeculectomy were randomized systematically into 3 groups of ten patients each. Group A served as a control; in Group B intraoperative 5-FU was used, whereas Group C received post-operative sub-conjunctival 5-FU. The variables studied were pre- and post-operative intraocular pressure, post-operative bleb characteristics and complications. STATISTICS: Data were evaluated using the SPSS ver 10.0 program. ANOVA, paired t test and chi2 tests were performed. RESULTS: The means of age in years of patients in group A, B and C were 49 +/- 9.23, 56.50 +/- 8.39 and 52.10 +/- 8.96 respectively (p = 0.222). The means of pre-operative IOP in groups A, B and C were 37.80 +/- 10 mmHg, 42.00 +/- 11.22 mmHg and 29.40 +/- 12.82 mmHg respectively. The medians of pre-operative anterior chamber depth (ACD) in groups B and C were 3 and 2 in group A according to van Herrick's grading. The mean values of final IOP were 11.90 +/- 3.50, 11.70 +/- 4.24, 11.00 +/- 2.83 mmHg (p = 0.841). The median post-operative anterior chamber depth in all the groups was similar compared to the pre-operative anterior chamber depth (p = 0.510). The final bleb scores in all the groups were similar (p = 0.873). CONCLUSION: The intra-operative and post-operative use of 5-FU in trabeculectomy is almost equally effective in terms of IOP control and bleb characteristics.

Association between pregnancy-induced hypertensive fundus changes and fetal outcomes.

BACKGROUND: Ocular involvement in pregnancy-induced hypertension (PIH) is common. OBJECTIVE: To study the association between pregnancy-induced hypertensive fundus changes and fetal outcomes. SUBJECTS AND METHODS: A prospective cohort study was carried out including 153 subjects with the diagnosis of PIH. The subjects were evaluated for hypertensive fundus changes. Fetal outcomes were assessed in terms of gestational age, birth weight, 1 minute Apgar score, stillbirth and neonatal death. STATISTICS: The chi2 test was used to evaluate the association between the various fundus changes and fetal outcomes using SPSS version 10 software program. RESULTS: Fundus changes were found in 13.7% of the subjects. The means of systolic and diastolic BP of the subjects with hypertensive fundus changes were 182.86 +/- 33.64 and 125.24 +/- 21.36 respectively, whereas those values without fundus changes were 150.72 +/- 12.86 and 100.07 +/- 9.51.Vitreous hemorrhage, serous retinal detachment and macular star were not found in this study. Fetal outcomes in PIH patients with vascular changes alone were similar to those with no fundus changes. Retinal and optic nerve head changes were found to be associated (p = 0.016) with low birth weight (< 2.5 kg). Choroidal changes and optic nerve head changes were associated with low Apgar score. CONCLUSION: Retinal and optic nerve head changes are associated with low birth weight. Choroidal changes and optic nerve head changes are associated with low Apgar score. Fundus evaluation in patients with PIH is an important procedure to predict adverse fetal outcomes.

Chronic cough in thymoma.

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.

Cardiovascular autonomic neuropathy in chronic kidney diseases.

INTRODUCTION: This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients. METHODS: Autonomic function using five standard tests was examined in 20 diabetic patients with CKD, 20 age and sex matched diabetic patients without CKD and 20 age and sex matched controls. Analysis of difference between the autonomic function was done in the three groups using Chi-square test or Fischer's test. RESULTS: Total 20 (100%) diabetic CKD patients were found to have autonomic neuropathy. Of these, 2 (10%) patients had early parasympathetic damage, 8 (40%) patients had definite parasympathetic damage, and 10 (50%) patients had combined damage. Heart rate response to standing was statistically significant (p = 0.014) among diabetic CKD patients when compared with diabetic patients without CKD. Combined form of autonomic dysfunction was more frequent in advanced stages of diabetic CKD. Three (42.85%) patients in stage 3 CKD, 4 (66.66%) patients in stage 4 CKD and 5 (71.42%) patients in stage 5 CKD, had combined autonomic failure. CONCLUSIONS: Autonomic neuropathy is common in native Nepalese diabetic CKD patients. Heart rate response to standing is significantly abnormal in diabetic CKD patients in comparison with diabetes mellitus patient without CKD. Severity of autonomic dysfunction increases with severity of CKD..

Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients.

BACKGROUND: Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. OBJECTIVE: The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. MATERIAL AND METHODS: 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. RESULTS: Left ventricular mass was analyzed as a continuous variable. In males body mass index (r = .35, p < .004) and stroke volume(r = -.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r = .36, p < .02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. CONCLUSION: In untreated patients with hypertension patient's body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients.