Effect of yoga (unilateral nostril breathing) on autonomic nervous system activity in medical students – A randomized parallel group study

Background: Practice of Pranayama and “swara” have been found to affect cardiovascular, respiratory, and autonomic functions. The regulation of autonomic functions in a positive direction helps reduce anxiety and stress. Studies have suggested that right and left nostril breathing produce specific autonomic changes. Aim and Objectives: The aim of the study was to find the relationship between right unilateral nostril breathing (RUNB) and sympathetic arousal and that between left unilateral nostril breathing (LUNB) and parasympathetic arousal. Materials and Methods: This is a randomized parallel-group study. Fifty consenting students were chosen by simple random sampling technique and divided into two groups of 25 each, randomly. One group was made to practice RUNB and the other, LUNB for ten minutes daily for 2 months. Systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure, heart rate (HR), and respiratory rates were measured before and after the intervention. Results were analyzed using SPSS version 21. Comparisons were made by conducting a repeated-measures ANOVA. Results: The RUNB intervention contributed statistically significant changes in SBP and HR after 2-month practice. LUNB did not result in statistically significant changes in the studied parameters. Conclusions: RUNB was found to have significant sympathetic arousal but LUNB could not be linked to parasympathetic arousal.

Fatal cryptococcosis involving multiple sites in an immunocompetent child.

Disseminated cryptococcosis is less common in immunocompetent individuals. Herein, we report a fatal case of cryptococcosis in apparently immunocompetent child with multiple site involvement. The yeast isolated from cerebrospinal fl uid, blood, endotracheal, gastric and lymph node aspirate was identifi ed by molecular method as Cryptococcus neoformans var. grubii.

Malrotation of Gut and Hiatus Hernia in a Child with Familial Dyskeratosis Congenita.

Dyskeratosis congenita (DKC) is a rare inherited genodermatosis. We report familial occurrence of the disease. The index patient 12 years old had all classical features of DKC. There are 4 other siblings in the family suffering from similar disease. In additions to the features of DKC, the index patient presented with pain abdomen and vomiting. On investigation he had malrotation of gut and hiatus hernia. To the best of our knowledge this is being documented for the first time in association with DKC.

Celiac Disease Presenting As Pancytopenia.

Celiac disease is a systemic immune-mediated disorder that can have multiple hematological manifestations. We report a ten years male, who presented with recurrent episodes of loose stools, poor weight gain and on investigations was diagnosed to have celiac disease with pancytopenia which responded dramatically to gluten free diet and hematinic supplements. Pancytopenia is not a common presentation of celiac disease.

Manual Reduction of Incarcerated Inguinal Hernia in Children.

Introduction: Incarceration of an indirect inguinal hernia in children is an acute emergency and one of the common complications that may occur before herniotomy. Inguinal hernias rarely go away, and therefore, virtually all should be repaired at any age of presentation. Incarcerated inguinal hernia can be reduced successfully by manual reduction if performed by experienced hands on time. The objective of this study was to assess the safety and efficacy of manual reduction of incarcerated indirect inguinal hernia. Materials and Methods: Thirty six patients who attended Emergency Department of Kanti Children’s Hospital over 30 months period from January 2009 to July 2011 were studied prospectively. All patients were diagnosed case of inguinal hernia and waiting for elective herniotomy. Results: There were 30(83.33%) males and 6(16.66%) females, with male-to-female ratio of 5:1. Right sided inguinal hernia was 20(55.5%) and left 16(44.44%). The ages ranged from 1.5 months to 28 months with mean age of 15 months. Time of incarceration ranged from 3 hours to 30 hours. Manual reduction was successful in 30(83.33%). Remaining six had to undergo emergency surgery. Four patients with edematous but viable hernial contents had successful surgical reduction. Two patients with gangrenous small bowel loops had bowel resection and anastomosis. Conclusion: Manual reduction is safe and effective when performed timely. Herniotomy should be done without delay once diagnosed to avoid unnecessary complications.

Molecular Characterization of Citrobacter freundii Isolated from Neonates in Neonatal Intensive Care Unit of Nepal.

Introduction: Nosocomial Citrobacter spp. is emerging as a successful nosocomial pathogen in neonates in Nepal. The important risk factor being poor infection prevention and control practices. The objective of this study was to investigate the clonal relatedness of Citrobacter freundii isolated from clinical and nonclinical sources in Neonatal Intensive Care Unit (NICU) and to determine the presence of Extended Spectrum Beta-Lactamase (ESBL) genes and class 1 integron element. Materials and Methods: Polymerase chain Reaction (PCR) and PCR-Randomly Amplified Polymorphic DNA typing of the isolates were performed in three isolates to amplify class 1 integron element integrase gene, ESBL genes, and to study the clonal relatedness, respectively. Results: Two isolates harbored class 1 integron element. The blaCTX-M was present in all isolates and blaTEM-1 was present in one isolate. An isolate carried blaCTX-M and blaTEM-1 genes. All of these isolates were not clonally related. Conclusion: The study for the first time documented the emergence and spread of ESBL genes and class 1 integron element in multidrug resistant C. freundii in Nepal and urge for monitoring and surveillance of these strains.

Clinical Analysis, Management and Outcome of Intussusception in Children.

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and management is essential to reduce morbidity and mortality. The objective was to To review the diagnostic criteria of intussusception in infants and children to increase awareness of attending personnel for effective management decrease the rate of operative treatment and complications. Materials and Methods: The data collected of all 38 patients admitted in Kanti Childrens Hospital between 2008 September to 2009 September were studied prospectively. Each patient was evaluated in regard to age at presentation, sex, signs and symptoms, diagnostic method, treatment (operative, non-operative). Results: During study period of one year there were a total of 20 (52%) males and 18 (48%) females of age 3 months to 6 years. Pain abdomen was seen in 25(66%), vomiting 16(42%), diarrhea 15(40%), blood mixed with stool 10(26%). These symptoms were seen in different combination. X-ray erect abdomen was done in 15 and ultrasound in all 38 cases. Ten out of 15 (66.6%) patients with early presentation and diagnosis had successful barium enema reduction.10 (66.6%) had successful reduction and admitted to our hospital. 28(74%) patients were undergone laparatomy. Among 28 (74%) patents that had lapartotomy, manual reduction was successful in 18 and 10 required bowel resection and anastomosis. Conclusion: The awareness of early features of intussusception is important for early referral to tertiary centers for successful non-operative barium reduction and reduce the need of laparotomies in children.

Nosocomial Citrobacter Infection in Neonatal Intensive Care Unit in a Hospital of Nepal.

Introduction: Neonatal Citrobacter infection is either acquired horizontally or vertically as a nosocomial infection. The source of nosocomial Citrobacter is either hands of medical staff or the innate objects. Objective: The aim of this study was to study nosocomial Citrobacter infection in neonates admitted in Neonatal Intensive Care Unit (NICU) and trace the source of infection. Methods: The study was conducted in NICU in a hospital in Kathmandu, Nepal during a period of January to March 2010. Specimens were collected from neonates, hands of medical staff and innate objects and were processed using a standard microbiological method. Results: The prevalence of neonatal nosocomial infection was 32.6% (29/89). Citrobacter spp. was isolated in 11 neonates admitted in NICU with the prevalence rate of 37.9% (11/29) among other pathogens. Umbilical cord infection was most common (n=8). These isolates were grouped into five antibiotypes (I, 4; II, 3; III, 2; IV, I; V, 1). All of these isolates were multi-drug resistant showing susceptibility towards quinolones. The isolate of Citrobacter spp. was also recovered from a nasal prong which was grouped with 4 other clinical strains. Conclusion: Multi-drug resistant nosocomial Citrobacter spp. was inflicting neonates in NICU and the source of this pathogen was traced to nasal prong. Nosocomial Citrobacter infection is a common problem of neonates in NICU. This will lead to increase neonatal mortality if infection prevention and control practices are not initiated.

Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach.

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 – 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided.

Embolization of congenital intrahepatic porto-systemic shunt by n-butyl cyanoacrylate.

Congenital intrahepatic portosystemic venous shunt (IHPSVS) is rare vascular anomaly. We present one case of a 14- month male child who presented with global developmental delay. Child had high ammonia levels with low glutamine and high bile salts on the previous investigations and had history of neonatal seizures since day 13 of life. On admission, serum ammonia levels were elevated to 112μmol/L. Other laboratory investigations including liver and renal function test, and electrolytes were normal. He was, diagnosed to have IHPSVS on the basis of Doppler and CT, and treated by embolization with n-butyl cyanoacrylate (glue). A brief review of diagnostic modalities and endovascular management for the IHPSVS is presented including the present case.

Role of colostrum in gastrointestinal infections.

Colostrum is breast milk produced after the birth of the newborn and lasts for 2-4 days. Colostrum is very important part of breast milk and lays down the immune system and confers growth factors and other protective factors for the young ones in mammals. This is the source of passive immunity transferred to the baby from the mother. The biological value of bovine colostrum in present day medical practice is documented in clinical trials and large databases containing case reports and anecdotal findings. The main actions include an antibacterial effect and modulation of immune response with the ability to neutralize lipopolysaccharides arising from gram negative bacterial pathogens. It has been found to be effective in infantile hemorrhagic diarrheas, other diarrheas and reduces the likelihood of disease progressing to hemolytic uremic syndrome. It has also been tested in H. pylori infection and diarrhea in immunodeficiency. Side effects of clinical relevance are limited to possible intolerance due to lactose and sensitivity to milk proteins.

Mammographic diagnosis of breast carcinoma: an institutional experience.

Mammogram is a common diagnostic modality for breast carcinoma. Diagnostic mammogram is available at only few centers in Nepal. The aim of this study was to determine the accuracy of diagnostic mammogram in Nepalese women suffering from breast carcinoma. A retrospective analysis of the breast carcinoma was carried out in the Department of Surgery, Tribhuwan University Teaching Hospital from October 1995 to October 2007. Out of 556 patients with histologically proven breast carcinoma, 378 patients (68%) had undergone mammography. Breast carcinoma was identified on mammography in 328 (87%) cases while 50 cases (13%) were reported as normal or benign lesions. Diagnostic mammogram had a sensitivity of 86.8%, a specificity of 98.6% with a positive predictive value of 68.8% and a negative predictive value of 99.5%. In mammographically missed breast carcinoma, 34% were less than 40 years of age (P<0.05), 60% were premenopausal (P<0.05) and 88% patients presented with a painless lump. The study shows that the diagnostic accuracy of the mammogram is very high. However, there is a chance of missing the breast carcinoma in young and premenopausal women.

Liver function tests and their interpretation.

Liver function tests (LFT) are a helpful screening tool, which are an effective modality to detect hepatic dysfunction. Since the liver performs a variety of functions so no single test is sufficient to provide complete estimate of function of liver. Often clinicians are faced with reports that do not tally with the clinical condition of the patient and they face difficulty in interpreting the LFT. An attempt is being made to study and understand the LFT and simplify their interpretation with algorithms.

Mitochondrial neuro-gastrointestinal encephalopathy syndrome.

Mitochondrial neurogastrointestinal encephalomyopathy is a rare disorder affecting the pediatric age group with a heterogeneous multisystem involvement. We happen to manage a young child with symptoms of constipation since infancy along with cachexia, seizures and peripheral neuropathy. The child later went into encephalopathy preterminally. This clinical syndrome fitted very well with mitochondrial neurogastrointestinal encephalomyopathy. The child had elevated lactate levels and electron microscopy of the rectal biopsy was suggestive of a mitochondrial disorder To the best of our knowledge there is no case report of this syndrome from India and since this presents with diagnostic difficulties so is being reported.

Pancytopenia in a child associated with hepatitis A infection.

Pancytopenia is a very rare condition associated with hepatitis A infection. We managed a 12 year old boy who had hepatitis A infection with anemia. His hemogram and bone marrow examination were suggestive of pancytopenia. Pancytopenia recovered without any specific therapy. There are case reports of severe aplastic anemia with hepatitis A infection that required immunosuppressive therapy. The present case did not require any aggressive therapy and recovered. In a young child with hepatitis A infection and anemia, bone marrow depression should be suspected. The pancytopenia may be transient as exemplified by the present case.

Therapeutic potentials of bovine colostrums.

Colostrum is the first milk produced by mammals for their young ones. This transfers the passive immunity gained by the mother to the baby. The bovine colostrum (BC) can be obtained in large quantity and has properties similar to human colostrum. It has been used for various disorders of the body. It has properties to stimulate immune system, contains growth factors and many bioactive substances needed for the body to combat with wear and tear. The BC has been used for various gastrointestinal disorders, respiratory tract infection, rheumatoid arthritis, healing injured tissues of body etc. There are not much double blind placebo-controlled trials to prove its efficacy, though a lot of experience about its good effects in various disorders is available in the literature. The dosage and duration of therapy need to be worked up. The BC has potential to treat as well to prevent certain diseases in the body. In future this will prove to be a very useful product to treat and control diseases in a natural way.

Health factors in colostrum.

Colostrum is a breast milk produced after the birth of the newborn and lasts for 2-4 days. Colostrum is very important part of breast milk and lays down the immune system and confers growth factors and other protective factors for the young ones in mammals. This is the source of passive immunity achieved by the mother and is transferred to the baby. This is the major source of secretory IgA and gives protection against gastrointestinal infections. In view of so many health factors through colostrum, the use of colostrum has been extended to so many health problems of mankind. Human and bovine colostrums have many similarities barring that bovine colostrum can be obtained in large quantity, so bovine colostrum has been used in various disorders in human beings. This is the nature's gift that is for the young ones to grow as well as for the treatment of many health problems in older age group.