Status of Prolactin and Thyroid Hormone Level among Primary Infertility Patients Visiting Tertiary Care Hospital, Nepal

Background: Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Hyperprolactinemia and thyroid dysfunction are associated with reproductive dysfunction and infertility. Hypothyroidism and hyperprolactinemia are found to be closely interrelated. This study aimed to observe the level of serum prolactin, free Tri-iodothyronine (fT3), free Thyroxine (fT4) and Thyroid stimulating hormone (TSH) in women with primary infertility and to correlate the level of serum prolactin with TSH. Methods: This study was conducted on patients visiting infertility OPD at the Institute of Medicine (IOM), Nepal from February 2016 to January 2017. Total 50 women with primary infertility were included in this study and 50 age-matched healthy controls were taken. Serum levels of prolactin, fT3, fT4, and TSH were measured in all subjects. Results: The mean age of participants was 26.8 years. The median serum prolactin (21.8) and TSH levels (4.5) were found to be significantly high in the case group (p<0.001). Out of the total subjects with hyperprolactinemia, 51.1% were found to have hypothyroidism. There was a moderately strong, positive and significant correlation between serum prolactin and TSH levels (r=0.62, p<0.05). ROC curve analysis showed that at a cutoff value of 22.5 ng/ mL for serum prolactin, a sensitivity of 86% and specificity of 82% could be achieved for detecting hypothyroidism. Conclusion: The high prevalence of hyperprolactinemia and thyroid disorders in primary infertility stresses the fact that all women coming for consultation due to infertility should be recommended to undergo thyroid function tests and prolactin estimation at early stages of infertility checkup.

Dyslipidemia among patients visiting tertiary care hospital

Background and objectives: The lipid profile is a group of tests that are often ordered together to determine risk of various diseases and is likely to be abnormal (dyslipidemia) in persons suffering from Coronary Heart diseases, Diabetes, Chronic Kidney Disease and Nephrotic Syndrome. This study attempts to compare a lipid profile in normal individuals and those suffering from above diseases visiting Institute of Medicine, Maharajgunj, Kathmandu, Nepal. Material and Methods: Three hundred blood samples were collected from Inpatient and Outpatient Department. Out of which 94 blood samples of healthy individuals were assed as controls and 206 as test. The lipid profile tests were performed. All the data were analyzed using SPSS of 13 version, and the data were evaluated. Results: Out of 206 test samples and 94 controls, 116 were dyslipidemic respectively. The prevalence of dyslipidemia were highest in subjects with Coronary Heart Disease (64%) followed by Diabetes (50%). Similarly the prevalence in Chronic Kidney Disease and Nephrotic Syndrome were 43.90% and 12.50% respectively. Conclusion: Data clearly shows that there is a large variation in the lipid profile among normal and different diseased individuals. In Nepal, dyslipidemia may be more common in individuals suffering from Coronary Heart Disease, Diabetes and Chronic Kidney Disease.

Knowledge about Condoms among Adolescents in Kathmandu Valley.

Introduction: The issues of sexual and reproductive health (SRH) remain the leading cause of ill health among adolescents worldwide and are of growing concern in Nepal. The correct knowledge of condoms is integral part of SRH. The present study was carried out to assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Aim: To study, assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Methods: The study was a cross-sectional questionnaire-based survey. The sample was derived through cluster sampling of the secondary schools in the Kathmandu valley. Schools were selected randomly and two hundred and fifty adolescents were taken from each government and non-government high schools. Result: Altogether 500 adolescents were recruited for this study. A total of 298 (53.0%) participants said that condoms reduced pleasure. Most women don’t like to use condoms was agreed by 291 (55.6%) people and it was statistically significant (p value < 0.05) when compared between males and females. Using condoms with new partner is a good idea was agreed upon by 448 (81.0%) participants. Women should ask their partners to use condoms was answered by 480 (88.1%) and discussing condom use with prospective partner is easy was agreed by 417(79.0%) and both the issues were also statistically significant (p value < 0.05). Conclusion: It was found that the knowledge about condoms was not adequate and the knowledge among male participants was in general better than females.

Introduction: The issues of sexual and reproductive health (SRH) remain the leading cause of ill health among adolescents worldwide and are of growing concern in Nepal. The correct knowledge of condoms is integral part of SRH. The present study was carried out to assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Aim: To study, assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Methods: The study was a cross-sectional questionnaire-based survey. The sample was derived through cluster sampling of the secondary schools in the Kathmandu valley. Schools were selected randomly and two hundred and fifty adolescents were taken from each government and non-government high schools. Result: Altogether 500 adolescents were recruited for this study. A total of 298 (53.0%) participants said that condoms reduced pleasure. Most women don’t like to use condoms was agreed by 291 (55.6%) people and it was statistically significant (p value < 0.05) when compared between males and females. Using condoms with new partner is a good idea was agreed upon by 448 (81.0%) participants. Women should ask their partners to use condoms was answered by 480 (88.1%) and discussing condom use with prospective partner is easy was agreed by 417(79.0%) and both the issues were also statistically significant (p value < 0.05). Conclusion: It was found that the knowledge about condoms was not adequate and the knowledge among male participants was in general better than females.

Practice in anesthesia: intrathecal morphine for off pump coronary artery bypass graft.

Off pump coronary artery bypass grafting is gaining popularity because of its beneficial effects like reduced inflammatory response, early extubation, reduced hospital & ICU stay, less homologous blood transfusion & reduced cost. Here we report a case of left anterior descending artery blockade who had undergone off pump coronary artery bypass grafting. In this case we used intrathecal morphine with heavy bupivcaine to provide intraoperative as well as post operative analgesia. Though intrathecal morphine has been used as analgesia in cardiac surgeries, the use of intrathecal morphine with bupivacaine is less reported. It not only provides intense analgesia which helps for early extubation & hemodynamic stability but also provides calm & quiet surgical field with slow beating heart & aids in critical time of vessel anastomosis. We have also discussed the other aspects of anesthetic management with little elaboration in surgical aspect as well.

Occurrence of soil-transmitted helminths in women at the Himalayan region of Nepal.

OBJECTIVE: To find the occurrence pattern and prevalence of the soil transmitted helminths in women of child bearing age group. METHODS AND MATERIALS: The study was conducted in Jiri , an area of Dolakha district at the altitude of 2100 meter from sea level. The faecal sample of 478 women of childbearing age (15 to 45 years) were taken randomly and examined for the ova of soil transmitted helianthus. RESULT: The occurrence pattern was 53.0%, 20.0% and 2.7% for Hookworms, Ascaries lumbricoids and Trichuris Trichuria respectively. Both Ascaries and Hookworm prevalence rates noticeably increased with increasing age, with the highest infection rate between the age of 36-45 years while trichuris infection reached the highest in women of 15-25 years of age. CONCLUSION: There is a high prevalence of hookworm and ascaries in women of childbearing age and necessary intervention is needed according to WHO guidelines.

Characterization of Candida species isolated from cases of lower respiratory tract infection.

OBJECTIVES: (1) To identify and characterize the Candida species isolates from lower respiratory tract infection. (2) to determine the rate of isolation of Candida species from sputum samples. METHODS: This study was carried out in the Department of Microbiology, Manipal Teaching Hospital, Pokhara, Nepal from June 2002 to January 2003. A total of 462 sputum samples were collected from patients suspected lower respiratory tract infection. The samples were processed as Gram staining to find out the suitability of the specimen, cultured on Sabouraud's Dextrose Agar (SDA) and also on blood agar and chocolate agar to identify the potential lower respiratory tract pathogens. For the identification of Candida, sputum samples were processed for Gram stain, culture, germ tube test, production of chlamydospore, sugar fermentation and assimilation test. For the identification of bacteria, Gram stain, culture, and biochemical tests were performed by standardized procedure. RESULT: Out of 462 samples, 246 (53.24%) samples grew potential pathogens of lower respiratory tract. Among them Haemophilus influenzae 61(24.79%) and Streptococcus pneumoniae 57 (23.17%) were the predominant bacterial pathogens. Candida species were isolated from 30 samples (12.2%). The majority of Candida species amongst the Candida isolates were Candida albicans 21(70%) followed by Candida tropicalis 4(13.33%). Candida krusei 3(10%), Candida parapsilosis 1(3.33%) and Candida stellatoidea 1(3.33%). The highest rate of isolation of Candida was between the age of 71 and 80. CONCLUSION: Candida isolation from sputum samples is important as found in the present study in which Candida species were the third most common pathogen isolated from patients with lower respiratory tract infection.

Prevalence of Moraxella catarrhalis infections of the lower respiratory tract in elderly patients.

OBJECTIVES: To determine: *rate of isolation of Moraxella catarrhalis in elderly patients having lower respiratory tract infection *The antibiotic susceptibility pattern of Moraxella catarrhalis isolates. *The predisposing factors responsible for Moraxella catarrhalis infections of lower respiratory tract. MATERIAL AND METHOD: This is a prospective study carried out at Manipal Teaching Hospital, Pokhara during May 2002 to April 2003. A total of 716 sputum samples collected from patients with suspected lower respiratory tract infection were investigated. The samples were subjected to Gram stain, culture and sensitivity. Sputum samples were inoculated on blood and chocolate agar and incubated at 37 degrees C for 18 to 24 hours in candle jar containing 3-5% Co2. For the identification of bacterial isolates, the cultural and colonial characteristics were recorded and identified with the use of biochemical test. The susceptibility of bacterial isolates to antimicrobial agent was performed following Kirby-Bauer method. RESULT: Out of the 716 samples, 355 (49.58%) grew normal commensals of the upper respiratory tract. Respiratory pathogens were recovered from 361 (50.41%) samples. The most common respiratory pathogen was H. influenzae (26. 86%), followed by S. pneumoniae (21.16%). Moraxella catarrhalis accounted for 6.90%. Rate of isolation of Moraxella catarrhalis was higher in males than in females. Out of 25 isolates 16 were from males and 9 were from females. Frequency of isolation of Moraxella catarrhalis was more frequently seen in age group 61-70 years. It was most commonly recovered in winter. The most effective antibiotics were amoxicillin-clavulanate and ceftriaxone and least was ampicillin. CONCLUSION: Moraxella catarrhalis isolation from sputum especially in persons above 60 years of age and in the absence of other well established pathogens should not be disregarded as they can cause lower respiratory tract infection in these individuals.

Treatment of recurrent attacks of supraventricular tachycardia during pregnancy causing complications in both mother and fetus.

Cardiac arrhythmias including supraventricular tachycardia are commonly encountered during pregnancy. The case of a young Indian woman with recurrent attacks of supraventricular tachycardia during pregnancy which was managed with adenosine and verapamil is reported. The possible mechanisms of maternal and fetal complications are discussed.

Histobiochemical changes in lung of protein deficient rats following repeated exposures of MIC vapour.

Adult male albino rats, maintained on normal or protein deficient diets from weanling, were exposed to repeated doses of MIC vapour (0.32 mg/L for 8 min for 5 consecutive days) under static conditions. Histopathology and the activities of alkaline and acid phosphatases and GSH content of lung were studied upto day 14 after exposure. Mild but repeated exposures of MIC vapour caused severe pulmonary lesions like denudation of bronchiolar epithelial lining tissue, cellular infiltration, edema, emphysema followed by hyperplasia, hypertrophy, fibrosis and intraluminal fibroplasia. The activities of alkaline and acid phosphatases were increased at earlier intervals while GSH content decreased significantly and remained low throughout the experimental duration. Protein deficiency was found to aggravate the toxic potentials of MIC in present condition.