Pattern of Ear Diseases in the Patients Attending Ear Outpatient Department of a Tertiary Center in Eastern Nepal.

Introduction: The prevalence of disabling hearing loss for adults and children is greatest in South Asia followed by Asia Pacific and Sub-Saharan Africa. Nepal is one of the least developed nation where hearing loss and ear diseases is very common. Objective: To find out the pattern of ear diseases in the patients attending Ear outpatient department (OPD) of Biratnagar Eye Hospital. Materials and Methods: A retrospective, descriptive review of data retrieved from the medical record section of the Hospital between January 1, 2014 to December 31, 2014 was done. The data were tabulated and analysed. The results are expressed in number and percentage. Results: Chronic suppurative otitis media, mucosal (42.64%) and ear wax/otomycosis (24.39%) were the commonest ear diseases found. Eustachian tube dysfunction (12.89%), acute otitis media (0.74%), acute suppurative otitis media (2.9%), otitis media with effusion (0.54%) were other common diseases. Presbyacusis (10.09%) was found to be a common problem in adults. Various other external auditory canal problems and those of inner ear were also detected. Conclusions: Ear diseases are one of the major health problems in Nepal. This study has found chronic otitis media and ear wax/otomycosis to be commonest problems in children and adults attending the Ear OPD of Biratnagar eye hospital.

Balloon retrograde transvenous occlusion of fundic varix.

A middle-aged woman presented with massive upper gastrointestinal bleed. The source of bleeding was a large fundic varix; a large splenorenal shunt was also present. The fundic varix was treated safely and effectively with balloon retrograde transvenous occlusion.

Endoscopic biliary drainage in patients with amebic liver abscess and biliary communication.

BACKGROUND: Percutaneous drainage or surgery is required when amebic liver abscess (ALA) fails to respond to medical management. In some of these patients, non-response may be due to communication of ALA with the biliary tree. This report describes our experience with the use of endoscopic biliary draining in such patients. METHODS: Medical records of patients with ALA undergoing either needle aspiration or percutaneous pigtail drainage were retrieved; the indications for drainage were: abscess volume exceeding 250 mL, a thin rim of tissue (< 1 cm thick) around the abscess, systemic toxic features and failure to improve on medical treatment. Patients with abscess drain output >25 mL/day persisting for 2 weeks or presence of bile in the drain fluid underwent endoscopic biliary drainage. RESULTS: A total of 115 patients with ALA underwent percutaneous treatment. None of the 25 patients with needle aspiration needed any further treatment. Of the 90 who underwent catheter drainage, the catheter could be removed within one week in 77 patients; the remaining 13 patients (median age 42 years, range 24-65; all men) had an abscess-biliary communication. In them, the median catheter output was 88 mL/day (range 45-347) and 54 mL/day (28-177) at 2 days and 2 weeks after catheter placement. The drain fluid contained bile in all 13 patients and in addition contained pus in 10 patients. Eleven patients had a solitary abscess and two had multiple abscesses. Cholangiogram showed biliary communication in all 13 patients. All patients were treated with placement of 10F biliary endoprosthesis or 10F nasobiliary drain. Pigtail catheter was removed within 1 week in 11 of 13 patients. CONCLUSION: In patients with amebic liver abscess communicating with the biliary tree, biliary stenting may hasten clinical recovery and allow early removal of liver abscess catheter drain.

Profile of chronic small-bowel diarrhea in adults in Western India: a hospital-based study.

BACKGROUND: Small-bowel diarrhea is reported to account for 10% of all cases of chronic diarrhea. Data on the etiology and clinical presentation of chronic small-bowel diarrhea in adult Indians is scarce. METHODS: 50 patients (mean age 32.8 years; 26 men) with chronic small bowel diarrhea were evaluated clinically, and investigated to determine etiology. The diagnosis of small-bowel diarrhea was based on history, stool volume and associated symptoms. RESULTS: Abdominal pain (n=22, 44%) and weight loss (n=37, 74%) were the most common symptoms, apart from diarrhea. Anemia (70%) and hypoalbuminemia (48%) were other important biochemical abnormalities. Intestinal tuberculosis (26%) and celiac disease (26%) were the most common causes of chronic small-bowel diarrhea. CONCLUSION: Tuberculosis of intestine and celiac disease are common causes of small-bowel diarrhea in our population. Tropical sprue seems to be a rare cause.