Antimicrobial susceptibility test of pathogens isolated from urinary tract infection suspected cases

Background and objectives: Urinary tract infection (UTI) is associated with multiplication of organisms in urinary tract and is defined by the presence of more than 105 organisms per ml in a midstream sample of urine (MSU). UTI is most commonly acquired bacterial infection in ambulatory and hospitalized populations. E.coli is the most predominant organism to colonise the urethral meatus and perineum before ascending to the bladder. Drug resistance of pathogens is a serious medical problem, because of very fast arise and spread of mutant strains that are insusceptible to medical treatment of UTI. Therefore, this study was carried out to determine the common pathogenic bacteria causing UTI and to determine their antibiotic susceptibility pattern. Material and Methods: Mid stream urine samples of the UTI suspected pateints were collected in the Mid Stream Urine (MSU) samples were collected in the sterile clean dry wide mouthed bottle. Standard protocol was followed to isolate and identify organism which was followed by disc diffusion antibiotic sensitivity tests. Results: A total of 100 samples were collected. Out of 100 samples, 25 samples showed a significant growth E.coli, Citrobacter diversus, Klebsiella pneumoniae, Staphylococcus aureus were isolated. E.coli (84%) was found to be the most prevalent causing UTI. Conclusion: UTI was found more common in female than male and E.coli was found to be main causes of UTI. Ciprofloxacin showed more effective drugs in the treatment of UTI.

Prevalence of Pulmonary Tuberculosis among the suspected patients visiting tertiary care hospital in Birgunj, Nepal

Background and Objectives: Mycobacterial disease continues to cause high morbidity and mortality and is a major public health problem in Nepal. Bacteriological examination of sputum is the cornerstone in the diagnosis of pulmonary tuberculosis in the developing world. This prospective study was carried out with an objective to evaluate the prevalence of pulmonary tuberculosis among the patients visiting National Medical College Teaching Hospital by Ziehl- Neelsen (Zn) staining microscopy. Material and Methods: The study was cross-sectional study. Three consecutive early morning sputum collected from 626 patients were subjected to Zn staining and observed under oil immersion. Results: Among 626 patients, 85 (13.57%) were found to be Acid fast positive by Zn staining microscopy. Of total suspected patients,16.0% of male and 8.7% of female were infected, common among 41-60 years group (17.2%) followed by 21-40 years (12.6%) and multibacillary cases was 71.8%. Conclusion: The prevalence of pulmonary tuberculosis among National medical college teaching hospital was found to be higher than the Nation pulmonary tuberculosis detection rate, most commonly infecting males.

Multi Drug Resistant Pathogens Causing Urinary Tract Infections in Children at Kathmandu Model Hospital.

Introduction: Antibiotic resistance of urinary tract pathogens has increased globally. Updated knowledge of the antibiotic resistance patterns of uropathogens in the health institutes is important for the selection of an appropriate empirical antimicrobial therapy. The aim of this study was to evaluate the multi drug resistant urinary isolates in the children from 1 to15 years and evaluate the options for empiric antibiotic therapy. Materials and Methods: The study was conducted from December 2011 to May 2012 in the Bacteriology laboratory, Kathmandu Model Hospital. Urine samples received in the laboratory were processed for routine, culture and its sensitivity. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute (CLSI) recommended Kirby-Bauer Disc Diffusion method. Results: Of the total 372 urine samples received in the laboratory, 60 (16.13%) showed significant growth; of which 55.0 % (33/60) were MDR isolates. Escherichia coli were the predominant isolate from urine sample. Out of 49 Escherichia coli isolates, 27 (45.0%) were Multi drug resistant. Enterococcus faecalis (N=3) was the most predominant Gram positive isolate and 66.67 % (2/3) of this organism were multi drug resistant. Among the first line drugs used against gram negative isolates, nitrofurantoin was the most effective drug followed by quinolones, while among the second line drugs; meropenem was the most effective drug followed by chloramphenicol and amikacin, whereas; nitrofurantoin (100%) was the most effective drug for Gram positive isolates followed by norfloxacin and cefotaxime. Conclusion: High percentages of multi drug resistant uropathogens were revealed in children. Nitrofurantoin was found to be the most effective drug for gram positive, gram negative and multi drug resistant isolates.

Enteric Fever in Children at Dhulikhel Hospital.

Introduction: Typhoid fever is one of the most common public health problems in Nepal. It occurs in all parts of the world where water supplies and sanitation are sub-standard. In Dhulikhel hospital, this is one of the top acute febrile illnesses in inpatient department. The objectives of this study were to evaluate the clinical and laboratory parameters including culture and sensitivity, the response to therapy, and complications of enteric fever among child cases at Dhulikhel Hospital. Materials and Methods: This retrospective study was conducted at Dhulikhel Hospital, Kathmandu University Teaching Hospital from January 2009 to June 2011. Statistical analysis was done with SPSS. Results: There were total of 138 cases of enteric fever admitted. There were 73 (53%) male and 65 (47%) female. Eighty-one percent were above five years of age. The most common clinical presentation was fever (100%) followed by headache and G I symptoms. Hepatomegaly was the most common sign seen among the cases and was seen in 110cases (79.71%). Most of the patients had normal WBC count 100 (72.46%) Widal test was positive in 70 (50.72%) cases and blood culture was positive in 52(37.68%) cases. Nalidixic acid was found to be resistant in 26 (50%) cases. Complications were seen in only 7 (5%) enteric fever cases. Conclusion: Typhoid fever is predominant in school going children in Nepal with slight male predominance. Fever lasting over 3 days followed by headache and GI symptoms are the major presenting symptoms. In making the diagnosis, the isolation of bacteria from blood is the “gold standard”. Nalidixic acid resistant Salmonella typhi is on the increasing trend. Pneumonia was found to be the most common complication among all other complications seen in enteric cases. In Dhulikhel Hospital this is one of the top acute febrile illnesses in inpatient department.

Clinical Profile and Outcome of Acute Encephalitis Syndrome in Dhulikhel Hospital of Nepal.

Introduction: Acute encephalitis syndrome (AES) is a constellation of clinical signs and or symptoms i.e. acute fever with acute change in mental status. AES may be present as encephalitis, meningoencephalitis or meningitis. It can be associated with severe complication, including impaired consciousness, seizure, limb paresis or death. Materials and Methods: Study consisted of retrospective analysis of hospital records of children up to 16 years of age admitted with diagnosis of AES in the department of Paediatrics Dhulikhel Hospital, Kathmandu University Teaching Hospital, Dhulikhel Kavre from January 2010 to December 2011. Results: During the two years (January 2010 to December 2011), 47 patients of AES were admitted. Among the admitted cases there were 34 male and 13 female patients. Meningitis cases were 29, encephalitis cases were 14 and 4 meningoencephalitis cases. Among the meningitis cases, viral meningitis accounted for 12, bacterial meningitis accounted for 15 and 1 tubercular meningitis.One was eosinopilic meningitis in which the causative organism was found to be fasciolosis by ELISA. Viral encephalitis was found to be the most common cause of encephalitis. Sensorineural hearing loss was seen in 3 cases, subdural effusion in 1 and hydrocephalus in 1. One patient had intracranial hemorrhage with hemiparesis as a complication of eosinophilic meningitis. Conclusion: Acute encephalitis syndrome is one of the most common causes of PICU admission in Dhulikhel hospital. Bacterial meningitis was common among the acute encephalitis syndrome followed by viral meningitis. One case of eosinophilic meningitis with intracranical hemorrhage and hemiparesis was found. Sensorineural hearing loss was found to be commonest complication.

Intraoperative Findings during Canal Wall Down Mastoidectomy in Children.

Objective: The main objective of this study is to assess the intraoperative finding during canal wall down mastoidectomy in paediatric patients undergoing surgery for unsafe type of chronic suppurative otitis media (CSOM) attending ENT OPD of Kathmandu Medical College. Materials and Methods: Fifty patients of age group 4 to 13 years who were suffering from unsafe type of CSOM with or without cholesteatoma were taken for the study. The study period was two years from April 2007 to March 2009. The operative findings like extent of cholesteatoma in different location of middle ear cleft, mastoid bony landmarks, and ossicular chain condition and otogenic complication were identified during canal wall down mastoidectomy. Result: Of the 50 patients 32 (64%) were boys and 18(36%) were girls. The age ranged from 4 years to 13 years. Majority of patients had cholesteatoma with granulation diseases (72%) followed by granulation diseases (16%). Involvement of disease in attic, aditus, antrum and mesotympanum were found to be high in majority of cases (82%) with high percentage of necrosis of incus (56%). Conclusion: The primary disease found in patients undergoing canal wall down mastoidectomy (CWDM) was cholesteatoma combined with granulation in72%, granulation in 16% and cholesteatoma in 12%.

Wheeze among Pneumonia Patients in Paediatrics Department of Patan Hospital.

Background: Acute respiratory infections are major causes of morbidity and mortality in children in developing countries. It is estimated that 3.9 million children die annually from acute respiratary diseases and most of them in developing countries. In significant cases, wheeze is associated with Pneumonia. This study was done to find out the outcome of pneumonia patients admitted in the paediatric ward with wheeze and without wheeze in terms of hospital stay, age predominance, sex ratio, mortality and morbity of patients. Some comorbidies of patients were also studied, Methods: This was a retrospective study done in the paediatric ward of Patan Hospital from April-June 2004 to March-April 2006 AD with following inclusion and exclusion criteria. All the children presented to Emergency ward up to 14 years with symptoms and sign of pneumonia were included in the study(high grade fever with chills and rigor,cough,fast breathing,creps and wheeze in auscultation)Age more than 14 years,history of Asthma,Tuberculosis,Acute wheeze associated with cardiac problems were excluded from study.Pneumonia patients admitted not from Emergency department were also excluded from study. Pneumonia with wheeze, outcome, and the hospital stay were studied. The outcome was measured in terms of improvement, deterioration or death of patients. Co morbidities associated with Pneumonia were also studied. Results: Out of 4620 children admitted in pediatric ward eleven hundred and sixty four (Twenty five percent) cases were of pneumonia and among them two hundred eighty three(twenty four percent) had wheeze. Majority of patients with pneumonia having wheeze falls on age group in between 2 and 12 months, followed by 1-5 years. The male children were more frequently affected. The co morbidities were febrile seizure, acute gastroenteritis, sepsis and urinary tract infection. Conclusion: The children admitted in Paediatric ward with Pneumonia were eleven hundred and sixty four and with wheeze were two hundred and eight three. Among them male were more than females. Majority of patients falls on age group two to twelve months. and study showed that they had prolonged hospital stay in relation to without wheeze. Three percent of the cases had blood culture positive among eleven hundred and sixty four sample.

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.

Review of Paediatrics In-Patient at Nepal Medical College and Teaching Hospital.

Introduction: This retrospective study was undertaken to analyze the disease pattern in the Pediatric ward in a Medical College. After analyzing the data, our study would emphasize on the prevention and the management modality of the most prevalent diseases in the community. Methodology: This study was carried out retrospectively for one year from January 2008 - December 2008 on the basis of age and sex and the frequency of disease according to the system involved. Results: A total number of 453 patients were admitted during the study period. There were 267(59%) male and 186(41%) female children. Less than five years age group accounted for 180(39.7%) excluding the neonate. In the study period, respiratory tract infections were the commonest cause of admission in all age group 198(43.7%), gastrointestinal including diarrhoeal diseases were 112(24.7%), enteric fever comprised of 22(5%), and other disease comprised of about 143(31.5%) of the total admissions. CNS diseases comprised of 43(9%) of which 7(16%) were meningitis and meningoencephalitis, 26(60%) of the total CNS cases were due to febrile convulsion. Respiratory diseases were found to be the major cause of morbidity in children. Conclusion: Children under five years age being the most common age group amongst all, with infection being the most predominant cause of Pediatric morbidity, the WHO/UNICEF algorithm for Integrated Management of Childhood Illness (IMCI) is specifically suited for the developing country like ours.

Clinical Profile and Outcome of Childhood Tuberculosis at Dhulikhel Hospital.

Background: Children contribute a significant proportion of the tuberculosis (TB) burden in Nepal and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary TB (EPTB) is challenging. Objectives: The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis. Methods: A prospective analysis of 60 cases of TB children within three years period was conducted at Pediatric Department, Dhulikhel Hospital and followed up till child completely recovered. Results: In the present study 60 children had clinical and lab evidence of tuberculosis and received anti tubercular therapy. Extra pulmonary tuberculosis was common (78.3%) than pulmonary tuberculosis (21.6%). BCG scar was absent in eight (13.33%) and absent BCG vaccination was significantly associated with disseminated TB (p<0.05). The most frequently seen symptoms were fever (65 %), cough (46.67 %) and abdominal distension (36.67%). Hepatomegaly (45%), ascites (33.33%), lymphadenopathy (23.33 %) and splenomegaly (11.67 %), and are common signs. Malnutrition seen in (33.3%) with more malnourished children with disseminated TB than in other diagnosis (p<0.001). Mantoux test was positive in (48.3%). Isolation of AFB was possible only in (8.33%). Among 60 cases (60%) were recovered completely with the primary regimen, (5%) recovered with extending the duration of primary regimen to three more months. (25%) failed to follow up, while (6.67%) died. Conclusion: EPTB is common than pulmonary TB. Among 60 cases 36 (60%) recovered completely with the primary regimen, three cases (5%) recovered with extending the duration with primary regimen. Fifteen cases (25%) failed to follow up, while four cases (6.67%) died.

Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study.

Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia.

Role of CSF Analysis for the First Episode of Febrile Seizure among Children between Six Months to Five Years of Age.

Introduction: A febrile convulsion is defined as a seizure that occurs in association with fever in children from six months to five years of age, with no evidence of a central nervous system infection or other identifiable causes of seizure and no history of an afebrile seizure. Simple febrile seizures are brief (<15 minutes), generalized, and occur in association with fever and only once during a 24-hour period without postictal pathology. Febrile Seizures have longer duration (>15 min), or have focal features or if they recur within 24 hours are defined as complex. In May 1996, the American Academy of Paediatrics (AAP) issued practice parameters regarding the neurodiagnostic evaluation of children with a first simple febrile seizure, who present within 12 hours after the seizure. It may be due to meningitis. This study was done to find out role of cerebro spinal fluid (CSF) analysis to rule out the meningitis in different age group of children presenting with first episode of fever with seizure. Design: A prospective study was carried out from June 2008 to July 2009 at the Western Regional hospital, Department of Paediatrics, Pokhara, Nepal. A total of 110 hospitalized children between the age group five months to 5 years were included in the study. Results: 16 (14.54%) children were diagnosed to have meningitis. In the age group of 6 – 12 months, 6 (21.4%) had meningitis while in 12-18 months, 6 out of 31 (19.3%) had meningitis and in more than 18 months age group only 4 out of 51 (7.84%) were detected with meningitis. Conclusion: In cases of apparent febrile seizure, meningitis should always be considered as a differential diagnosis. Lumbar puncture is must to rule out meningitis in all children between the ages of six months to eighteen months presenting with first episode of fever with seizure to rule out meningitis, even in the absence of meningeal signs.

Japanese Encephalitis in Children admitted at Patan Hospital.

This is a hospital based retrospective study, which was done in Pediatric ward of Patan hospital. Study period was one and half year (from Srawan 2063 to 2064 poush).Data were taken from discharge book of Pediatric ward, from the record section of this hospital, and from JE surveillance office, WHO, Kathmandu. All children from 1 month to 14 years ,who were admitted in Pediatric ward with symptoms of Meningitis, Meningoencephalitis and Encephalitis were included in this study and patients more than 14 years of age and symptoms not suggestive of meningitis, meningoencephalitis or encephalitis were excluded from the study. Headache; vomiting and fever were the chief complaints of patients. Two patients died during study period. There were 16 patients with serologically confirmed Japanese encephalitis.

Outcome of supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning.

Supracondylar fractures of humerus in children are common injuries. Displaced fractures are inherently unstable. Conservative treatment results in malunion. Open reduction and internal fixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102 displaced supracondylar fractures of humerus, aged between one and half year to 13 years, were treated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wires were put. Above elbow plaster of paris back slab was applied in all cases for at least four weeks. Back slab, K-wires were removed after four weeks and elbow range of motion exercise was started. Results were analyzed using Flynn's criteria. All patients were followed up to 14th week postoperatively. In cross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively. We recommend this procedure for displaced supracondylar fractures in children as it is safe and cost effective procedure with acceptable complication rates.

Assessment of quality of life in patients of end stage renal disease on different modalities of treatment.

This study was conducted to measure quality of life of patients with end stage renal disease on different modalities of treatment. A total of 30 diagnosed cases of end stage renal disease (ESRD) attending BPKIHS were included in the study. Group 1 included 10 patients on regular maintenance hemodialysis, group 2 included 10 patients on continuous ambulatory peritoneal dialysis (CAPD) and group 3 included 10 patients on regular conservative drugs. The inclusion criteria were all diagnosed cases of ESRD based on the guidelines given by K/DOQI, 2002. A detailed history relating to the disease condition as per the designed proforma was taken, which included demographic data and clinical characteristics of the patients. For assessment of quality of life, KDQOL-SF questionnaire was used. Strata 8.0 software program was used for the analysis of collected data. Physical health was found to be the most severely affected domain of the KDQOL. The mean score for physical health was least in group 1 (33.36 +/- 16.14). Mental health was better in group 2 (54.93 +/- 9.92) than in group 1 (39.50 +/- 14.27) ( "p" value 0.01). Variables like haemoglobin, hematocrit and adequacy of dialysis have positive correlation with all the four domains of the KDQOL. There was a statistically significant correlation of physical health with mental health (p value 0.001), physical health with kidney disease issues (p value 0.001) and mental health with kidney disease issues (p value 0.007). Our study has shown that patients of ESRD have a poor quality of life despite being in some form of dialysis and the most affected domain of the KDQOL scale is physical health. Patients on CAPD have better quality of life than patients on maintenance haemodialysis especially in terms of mental health. Variables like haemoglobin, hematocrit and adequacy of dialysis have a positive correlation with all the four domains of the KDQOL scale i.e. optimizing these variables improves the overall quality of life.

Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block.

This is a prospective, randomized, double blind study to evaluate the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an admixture to bupivacaine in upper extremity surgery. Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups; one group received Tramadol (2 mg/kg) and the other group received Dexamethasone (8 mg) as an admixture to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesics. The mean duration of postoperative analgesia in the Dexamethasone group was 1028.00 minutes while in the tramadol group it was 453.17 minutes We concluded that Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

Diagnostic variability and therapeutic efficacy of ECT in Nepalese sample.

BACKGROUND: Though electroconvulsive therapy (ECT) has been used in Nepal for last twenty years, researches regarding its use, its efficacy and other data are non-existent. AIMS: The objective of this study was to know about diagnostic variability and therapeutic efficacy of the use of ECT in hospitalized patients. METHODS: This is a prospective comparative study between patients who received ECT and who did not using ICD-10 as diagnostic confirmation. Psychopathology was evaluated using Brief Psychiatric Research Scale (BPRS), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Functional assessment of patients was done using Global Assessment of Function (GAF). Modified ECT was performed using general anaesthetic agent. RESULTS: 47 patients received ECT as compared to 78 patients who were non-receivers. The patients with most common five diagnosis were paranoid schizophrenia (14.4%); psychotic depression (13.6%) ; undifferentiated schizophrenia (8.8%) ; bipolar mania (7.2% ) ;severe depression without psychosis (5.6%) . There was significant decrease in BPRS in ECT receiver as compared to non-receivers at discharge (p=0.0001), 1st month (p=0.0001), 6th month (p=0.0001) and 12th month (p=0.0001) ; in YMRS at discharge (p=.008), 1st month (p=.002) and at 12th month (p=.015) ; in HAMD-M at discharge (p=0.0001), at 1st month (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001) ; in GAF at discharge (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001). CONCLUSION: There was significant improvement in overall psychopathology of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in BPRS, YMRS, HDRS and GAF at the time of discharge, 1st month, 6th month and 12th month which were statistically significant. Day to day functional status of patients also improved as shown by GAF. The efficacy of ECT was very significantly shown in this study with all the psychiatric spectrum disorders.

Effect of methotrexate (MTX) administration on spermatogenesis: an experimental on animal model.

An experiment was conducted to observe histomorphometric and cellular toxicity on rat testes after sixty days of methotrexate administration intraperitoneally (ip). Total 30 adult male rats were divided into one control and two experimental groups containing 10 rats in each group. Experimental groups received methotrexate in two different doses i.e 25 ig and 50 ig, whereas control one received normal saline intraperitoneally. At the end of the experiment, animals were sacrificed and testes were processed for paraffin sectioning and stained in haematoxylin and eosin. Further microscopic study of seminiferous tubules, interstitial spaces, primary spermatocytes and spermatids were carriedout. Results revealed decreased diameter of seminiferous tubules, increased interstiial spaces in experimental groups in dose dependent manner and found to be statistically significant (p < 0.05) as well as distortion of morphology of Leydig cells in experimental group. Therefore, it can be concluded that these qualitative and quantitative changes in male gonads may alter the reproductive performance of animals.

Prevalence of refractive error in mentally retarded students of Kathmandu Valley.

Mental retardation also known as 'mentally handicap' means a delay or insufficient development of mental capacities. The prevalence of mental retardation in Nepal is 4.1%. Vision being the best sense for their education and daily activities, a cross-sectional and descriptive study was conducted to find out the refractive error among the students in the schools for mentally retarded people. A total of 134 clinically diagnosed cases of mentally retarded students from three different schools of Kathmandu Valley were examined. Distance visual acuity was taken with the help of Cat Ford Vision Drum, SG chart and Kay Picture Test method but first preference was given to SG chart. Cyclo-retinoscopy and fundus examination under mydriasis were done in all the cases. Examination revealed that more than half of the examined had one or more ocular disorders with refractive error being the most common type of ocular morbidity followed by ocular motility disorders. Refractive errors were found in 34.4% in which the most common type of refractive error was simple hypermetropia. In conclusion refractive error was seen commonly among mentally retarded people of Kathmandu Valley.

Utility of phenotypic dermal indices in the detection of Down syndrome patients.

Down syndrome (DS) is the most common cause of mental retardation. The frequency of DS patients is about 1:800 and is mainly because of the presence of extra copy of chromosome number 21. Dermatoglyphic has been well established as a diagnostic aid in number of diseases having hereditary basis. Dermatoglyphic data was obtained by the use of ink and prints on a paper, from 15 cytogenetically confirmed patients of Down syndrome attending to the genetic clinic at BPKIHS. The data were correlated and compared with equal number of controls. Dermatoglyphic prints were used to evaluate the variation in the fingerprint patterns, the presence of simian crease and the difference in 'atd' 'dat' and 'adt' angles between the control and the DS patients. The results showed that both the 'atd' and 'adt' angles differed significantly from the control group. The dactylography study revealed higher incidence of loops and lower incidence of whorls in the DS patients as compared with the controls. This method is non-invasive and cost effective. The observed changes in the 'atd' and 'adt' angles plus the fingerprint patterns in the dermatoglyphic study proved that this simple technique could be a valuable tool for selecting patients of DS for cytogenetics analysis.