Rotavirus and its Genotype Distribution among Children Lessthan Three Years Presenting with Acute Watery Diarrhoea to a General Hospital in Urban Nepal.

Introduction: Viruses are the most common cause for diarrhoea in infants and small children. Rotavirus is the most frequent viral etiology, causing 125 million episodes of infantile diarrhoea and over 600,000 deaths per year. Materials and methods: A cross sectional study between January and March 2008 was conducted at Patan Hospital, Kathmandu to find out the prevalence of rotavirus among children < 3 years with watery diarrhoea and to identify common strains of rotavirus in the study population. Testing for rotavirus was undertaken by using Rota/Adeno screen Dipstick M583CE. Rotavirus strain identification was done at Nagasaki University Japan. Data was analyzed using SPSS® for Windows V 15.0 software. Results: 119 children with acute watery diarrhoea were enrolled. Rotavirus antigen was found in 63 cases (53%). The highest percentage of rotavirus infection was found in the second six months of life. Among the children with positive rotavirus antigen, the median age was 10 months (IRQ 8.00). The most predominant strain of rotavirus identified was G12 followed by G9 and G1. Most predominant G and P combination was G9 P[8] followed by G12P[6]. Conclusion: The study has shown the prevalence of unusual serotypes of rotavirus. Though rotavirus vaccine has been studied, used widely and found to be very effective, none of the vaccine efficacy studies have included common serotypes identified in Nepal. Level of protection conferred by infant immunization with the current rotavirus vaccines against the strains circulating in Nepal is unknown and careful surveillance through vaccine implementation is needed.

Percutaneous extensor tenotomy for chronic tennis elbow using an 18G needle.

INTRODUCTION: Tennis elbow is a common orthopaedic problem presenting in office orthopaedics, but its exact patho-aetiology has not been identified to date. It is treated operatively when conservative measures including multiple local steroid injections are not helpful to the patients. MATERIAL AND METHOD: This was a retrospective study to assess the outcome of tennis elbow patients on whom percutaneous release of the common extensor origin was performed using an 18 gauge hypodermic needle. 17 patients with 21 elbows were included in the study. Data was collected by going through the patients' medical records, and follow -up by questionnaire mailed to the patient's home, to assess the outcome and patient satisfaction with the procedure. RESULTS: 14 of the 21 (66.7%) elbows became completely pain free. The time taken to achieve a completely pain free elbow ranged from 1 day to 3 months (average 60.3 days). Those that did not achieve a pain free elbow had a residual pain of 1.5 to 8.5 on the VAS (average 2.64). 9 elbows (42.9%) had an excellent outcome, 7(33.3%) had good, 4(19%) had satisfactory and 1(4.8%) had poor outcomes. CONCLUSION: Tennis elbow probably results from degenerative tear of common extensor origin and a percutaneous tenotomy using an 18 gauge hypodermic needle is a simple, safe, patient friendly, effective and easily reproducible method of treating it in those who require surgery and can be done as an office procedure.

Ultrasound: an extension of clinical examination.

AIMS AND OBJECTIVES: To study the impact the use of portable ultrasound can have for the benefit of the patients when used by doctors other than radiologist, in this case surgeons. METHODS: Ultrasound performed by surgeons in the pre-operative, operative and post-operative period was studied. Patients presenting to the Hospital with acute abdomen was subjected to ultrasound. They were either pre-operative or post-operative patients. Five patients were scanned intraoperatively. The impact of these scans to the patients as well as the clinicians was studied. RESULTS: This is an ongoing study and preliminary results of the scans show two pre-operative diagnosis of acute appendicular collection and one acute hydronephrosis. In the operation room, ultrasound was done on 5 cases. On three occasions, it was to locate renal stones so that it could be extracted with ease. On two of the case, it was t to confirm the adequacy of common bile duct exploration thereby allowing primary closure of the common bile duct. Post-operatively, it was used in four cases of which in two cases post-operative hemorrhage were detected timely within hours. In the other two cases, the surgical team was assured that the patient's complaint was not surgically related. CONCLUSION: Ultrasound should be an extension of the clinical examination when indicated and all clinicians should be proficient in its use in their respective fields.

Reduction of acute anterior shoulder dislocations: comparing intraarticular lignocaine with intravenous anesthesia.

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of anesthesia are available for reduction. The objective of this study was to compare the application of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder dislocation. This study was conducted at Kathmandu Medical College Teaching Hospital (KMCTH) and Kathmandu Hospital and comprised of patients coming with anterior dislocation of shoulder from July 2001 to June 2005. Forty-five patients aged 17-55 years with no associated fractures of adjoining bones were included in the study. In twenty-three patients, reduction was done using intra-articular anesthesia and in 22 patients intravenous anesthesia was given. In five patients (three in intra-articular group and two in intravenous group) the reduction technique had to be changed to the Hippocratic method. In these three patients intravenous anesthesia had to be given after intra-articular anesthesia failed to relieve pain and spasm. In the intravenous group two patients had to be admitted overnight while in the intra-articular group none had to be admitted to the hospital. However, in the intra-articular group the average time taken from injection to reduction was significantly longer (<.001). The use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective especially when patients present early. In patients presenting late (more than 5 hours) intravenous anesthesia should be primarily considered as the method for shoulder reduction.

Pre-operative assessment of K-nail length in fracture shaft of femur.

INTRODUCTION: Internal fixation of diaphyseal fracture of shaft of femur in an adult by Kuntscher nail is the most common operative method of treatment in Nepal where operative facilities for the same exist. Since the complete range of K-nail sizes and length are not available in most operation theatres in Nepal, most orthopaedic surgeons assess the size and length of the K-nail pre-operatively by various methods and keep one size above and below the assessed length for the planned surgery. MATERIALS AND METHODS: The following measurements were taken in five hundred people involved in the study: Measurement No. 1: Tip of the greater trochanter to lateral knee joint line minus 2 cm. Measurement No. 2: Tip of the olecranon process to the tip of little finger, and Measurement No. 3: Tip of the greater trochanter to the upper pole of patella. An average of all three lengths were analysed to see if there were any differences in their mean lengths. RESULTS: Analysis showed that there were significant differences between the mean lengths measured by the three different methods. The average length of measurement no: 2 was 3 cm longer than the average length of measurement no: 1, which is the reference pre-operative length of K.nail. CONCLUSION: However, in practice since measurement no:2 is more convenient to perform and can also be used when the patient has sustained bilateral fractures of femur, an accurate pre-operative K-nail length assessment can be done by subtracting 3 cm from measurement no:2, i.e. the tip of the olecranon process to the tip of the little finger.

Isokinetic external rotation strength of shoulder : correlation with age and muscle size.

The purpose of this study was to determine the correlation between quantitative (cross sectional areas) evaluation of the posterior cuff muscles and mechanical strength in asymptomatic shoulders with special reference to aging. The cross-sectional area of the combined infraspinatus and teres minor muscles were measured, in the sagittal oblique magnetic resonance images, in eighty-one patients with a mean age of 44.06 years (range 19 - 74). These areas were correlated with the measured isokinetic strength in external rotation at angular velocities of 60 deg/s and 180 deg/s using Cybex 770 NORM. The results show that there was a gradual decrease in size of the muscles as the age of the individual increases. A strong correlation was found between aging and combined cross-sectional area and peak torque as well. The correlation between combined cross-sectional area and peak torques at both angular velocities were less strong. Further, the correlation between the peak torque/cross-sectional area ratio with aging was also less significant, which may imply that the decrease in the muscle strength was greater than the change in muscle area. Our results suggest that there may be other qualitative and biochemical factors that may determine the true strength of the muscles in the aged population.

Results of autogenous trephine biopsy needle bone grafting in fractures of radius and ulna.

Cortico-Cancellous bone graft harvested from the anterior iliac crest by the conventional open method is associated with more morbidity and is more time consuming as compared to the percutaneous method using trephine biopsy needle. The aim of the study was to determine whether cancellous bone graft harvested from anterior iliac crest using trephine biopsy needle consistently achieved bone union in comminuted fractures and fractures of more than 3 weeks duration of radius and ulna and also to determine the morbidity at the donor site. Autogenous cancellous bone graft was harvested percutaneously from 28 iliac crests in 16 patients and applied at fracture sites of 30 forearm bones using a 4mm trephine biopsy needle after the fractures had been fixed with plate and screws. The patients were followed up regularly upto 6 to 9 months post - operatively in the OPD to determine the union status of the fractured bones and the morbidity at the donor site. 29 of the 30 fractures of the forearm bones united without any problems. The shaft of a trephine got bent during the harvesting procedure at the beginning of the study due to improper technique. Cancellous bone graft harvested from the anterior iliac crest results in predictable good union results in comminuted fractures of forearm bones and also fractures presenting after 3 weeks of injury. It is also an easier and quicker way of harvesting bone graft and is associated with lesser morbidity and earlier recovery as compared to conventional open method.

Acute sacrococcygeal dislocation (anterior type): a case report.

Sacrococcygeal dislocation is a rare injury. A twenty nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics.

Assessment of iodine deficiency disorders in urban areas of Udaipur District, Rajasthan.

The present study was conducted on 6-12 years school going children of urban areas of Udaipur to assess the prevalence of iodine deficiency disorders. The study revealed a goiter prevalence of 8.4 percent and biochemical deficiency of nearly 8 per cent but the median iodine levels of the study population was 20 mcg/dL. Iodometric titration of salt samples collected from the beneficiaries revealed that more than 85 per cent of the salt samples had within or more than the stipulated levels of iodine 15 ppm. It appears that the population is in the transition phase from iodine deficiency to iodine sufficiency due to successful implementation of salt iodisation program.

Cholecystoduodenoplasty for high-output duodenal fistula.

External duodenal fistulae from sutured duodenal ulcer perforation sites are difficult to manage and most patients succumb to septicemia and undernutrition. This is due to failure of closure of the perforation site in the duodenum. Most techniques described in the past to facilitate closure have failed to give satisfactory results. We have devised a new procedure where the duodenal ulcer perforation is closed by mobilizing the gall bladder. A hole is made in the fundus of the gall bladder and it is anastomosed to the freshened edges of the duodenal opening. We have treated six patients by this technique. In five patients the leak was satisfactorily sealed. Three patients died - one due to persistent leak and two due to jejunostomy leak.

Integrated child development services scheme (ICDS) in India: its activities, present status and future strategy to reduce malnutrition.

Integrated Child Development Services Scheme (ICDS) provides an integrated approach for converging all the basic services for improved child care, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. Its objectives are: To improve nutritional and health status of children of 0-6 years; to reduce the incidence of mortality, morbidity, malnutrition and school dropout; to achieve effective co-ordination amongst various departments to promote child development; to lay foundation of proper psychological,physical and social development of the child; to enahance mother's capability to look after normal health and nutritional needs of the child. ICDS services are provided through a village based centre ie, the Anganwadicentre for the services of: Supplementary nutrition, immunisation, health check-up, referral services, treatment of minor illnesses, nutrition and health education to women, preschool education to children and supports for water supply, sanitation, etc. Several government departments and their services are co-ordinated at village, block, district, state and central levels. The Anganwadiworker is the most peripheral functionary which implements the programme services at the village/community level. In projects where able leadership has been provided, ICDS has been reported to be better. Though there are some shortcomings in ICDS, till future thrust of the programme is necessary for aiming of the upliftment of underprivileged section of the population. Operative research in various areas is suggested which can help in improving the efficiency of ICDS.

Micronutrient deficiency disorders amongst pregnant women in three urban slum communities of Delhi.

OBJECTIVE: To assess the prevalence of three micronutrient deficiency disorders (MDDs), i.e., iron deficiency, iodine deficiency and vitamin-A deficiency individually and in combination amongst pregnant women. METHODS: A hospital based study was conducted amongst 829 pregnant women of II and III trimester attending antenatal clinic, Rural Health Training Center (RHTC), Najafgarh, New Delhi. Anemia was assessed by the presence of clinical signs and by hemoglobin levels. Iodine deficiency disorders (IDD) were assessed by clinical examination of thyroid gland and by urinary iodine excretion levels. Iodine content of the salt consumed by the pregnant women was also assessed by iodometric titration method. Vitamin A deficiency (VAD) was assessed by the presence of clinical symptoms of nightblindness. Current dietary intake, morbidity conditions on the day of survey and anthropometric measurements of pregnant women were also documented. RESULTS: Prevalence of anemia, IDD and VAD amongst pregnant women was 78.8%, 22.9% and 4.8%, respectively. One per cent of the pregnant women had concomitant presence of all the three MDDs. Pregnant women having combined prevalence of IDD and anemia, IDD and VAD, and VAD and anemia was 15.1%, 0.18% and 2.69%, respecively. Eighty nine per cent of the pregnant women were consuming salt with iodine content of more than 15 ppm which was recommended at household level. Results on dietary intake showed that 18%, 34%, 85% and 57% of the pregnant women were consuming less than 50% of calories, proteins, iron and b-carotene, respectively as compared to their RDA. Forty per cent of the pregnant women were suffering from various morbidity conditions on the day of survey. CONCLUSIONS: The prevalence of micronutrient deficiencies amongst pregnant women of urban slum communities is high.

Integrated Child Development Services scheme (ICDS) and its impact on nutritional status of children in India and recent initiatives.

Integrated Child Development Services (ICDS) scheme is the largest national programme for the promotion of the mother and child health and their development in the world. The beneficiaries include children below 6 years, pregnant and lactating mothers, and other women in the age group of 15 to 44 years. The package of services provided by the ICDS scheme includes supplementary nutrition, immunization, health check-up, referral services, nutrition and health education, and pre-school education. The distribution of iron and folic acid tablets and megadose of vitamin A is also undertaken, to prevent iron deficiency anaemia and xerophthalmia respectively. The scheme services are rendered essentially through the Anganwadi worker (AWW) at a village centre called "Anganwadi". The ICDS had led to (i) reduction in prevalence of severe grades of malnutrition and (ii) better utilization of services of national nutritional anaemia prophylaxis programme and the national programme for prevention of nutritional blindness due to vitamin A deficiency by ICDS beneficiaries. The ICDS scheme is being modified continuously to strengthen the programme.

Comparative study of rice-based oral rehydration salt solution versus glucose-based oral rehydration salt solution (WHO) in children with acute dehydrating diarrhoea.

One hundred children with acute dehydrating diarrhoea were studied. They were divided into two groups: Group A (n = 50) were given rice-based oral rehydration salt (ORS) solution and group B (n = 50) were given glucose-based ORS solution (WHO). There was no significant decrease in mean stool output and percentage weight gain with rice-based ORS. Both the groups were comparable for volume of ORS solution consumed, time taken for initial rehydration, mean stool output and for correcting biochemical abnormalities.

Cataract induced glaucoma--an insight into management.

The problem of phacomorphic glaucoma is a rather common entity in rural India owing to the delay in getting the cataract removed and the preponderance of cortical matter, compared with the Western world. The authors in India, South East Asia and Australia, have managed the problem differently leading to controversies. The pathogenesis has been investigated and is well understood. An aspect of phacomorphic glaucoma that remains quite unanswered, is of the relatively poor visual outcome and increased incidence of operative and post-operative complications. We endeavour to evaluate the management, intraoperative and post-operative complications of phacomorphic glaucoma (senile cataract induced). The effect of high intraocular pressure (I.O.P) and surgical trauma on the corneal endothelium is also assessed.