INDOOR RADON SURVEY IN NEPAL USING PASSIVE TECHNIQUE SOLID STATE NUCLEAR TRACK DETECTOR

Context: It has been proved from many epidemiological studies that the inhalation of the radioactive, inert gas radon (222Rn) is the main cause of lungs cancer after smoking. Objective: The survey was conducted to estimate the indoor radon concentration, the annual effective dose rate and the annual dose equivalent rate to the lung. Material and Methods: Altogether 50 dwellings were chosen randomly at 5 different districts of Nepal. The dosimetric measurements were carried out over a period of 3 months using time-integrated passive radon detectors, CR-39 based on type II Solid State Nuclear Track Detector (SSNTD) technique. The type of houses was concrete with plastered walls and mud house. Results: The minimum concentration of radon in the study areas was found to be <20Bq.m-3 and the maximum concentration was 110±20Bq.m-3. Also the corresponding values of annual effective dose and annual equivalent dose to the lung respectively varied from <0.60 to 3.30mSv.y-1 and 0.16×10-7 to 0.88×10-7 Sv.y-1. The uncertainty was measured at 95% confidence level. Conclusion: The indoor radon concentration varies considerably with the ventilation condition, lifestyle of the people, construction of the dwellings and climate of the areas. The measurements show that the radon concentrations were found to be well below the reference levels of ICRP.

Bradycardia and severe vasospasm caused by intramyometrial injection of vasopressin during myomectomy

Vasopressin is often used locally to reduce blood loss during surgery. Vasopressin has longest clinical effect, but its systemic effects may be profound and pose significant challenges for the anesthesiologist and it can also sometimes cause lethal complications. The loss of peripheral pulse along with bradycardia, non-measurable arterial blood pressure, and cardiac complications have been reported after myometrial injection of vasopressin. Here, we describe a patient with multiple uterine myomas who developed severe bradycardia, non-measurable blood pressure by non-invasive means and loss of peripheral pulse after myometrial injection of vasopressin at a total dose of 20 units [1 unit/ml] with documentation of severe peripheral arterial vasospasm and increased proximal blood pressure. The patient was successfully resuscitated

comparison of conventional endotracheal tube with silicone wire-reinforced tracheal tube for intubation through intubating laryngeal mask airway

A specially designed wire-reinforced endotracheal tube - the Fastrach silicone tube [FTST] designed to facilitate endotracheal intubation through intubating laryngeal mask airway [ILMA] are expensive and not readily available. Hence, it is worth considering alternative such as polyvinyl chloride tracheal tube [PVCT], which is disposable, cheap and easily available. The aim of the present study was to compare the clinical performance of FTST with conventional PVCT for tracheal intubation through ILMA. After informed consent, 60 ASA I-II adults with normal airway undergoing elective surgery were randomly allocated to undergo blind tracheal intubation through ILMA with a FTST or conventional PVCT. Overall success rate, ease of insertion, number of attempts for successful intubation, critical incidence during intubation and post-operative sore throat were compared. The overall success rate with FTST was 96.63% and 93.33% with PVCT; in addition, the first attempt success rate was 86.25% with FTST compared to 82.14% with PVCT. The time taken for intubation was 18.6 +/- 6.8 s. in FTST group and 22.42 +/- 8.5 s. in PVCT group. Incidence of sore throat was 21.42% in PVCT group compared with 6.89% in FTST group. Blind tracheal intubation through an ILMA with the conventional PVCT instead of FTST is a feasible alternative in patients with normal airways.

Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman

We present outcomes of Ahmed Glaucoma Valve [AGV] implantation in treating refractory glaucoma in a tertiary hospital in Oman. Refractory glaucoma was defined as previously failed conventional glaucoma surgery and an uncontrolled intraocular pressure [IOP] of more than 21 mmHg despite treatment with three topical and/or oral therapy. This historical cohort study was conducted in 2010. Details of medical and surgical treatment were recorded. Ophthalmologists examined eyes and performed glaucoma surgeries using AGV. The best corrected distant vision, IOP, and glaucoma medications were prospectively reviewed on 1[st] day, 1[st], 6[th], 12[th] week postoperatively, and at the last follow up. Glaucoma specialists examined and treated 40 eyes with refractory glaucoma of 39 patients [20 males + 19 females]. Neo-vascular glaucoma was present in 23 eyes. Vision before surgery was <3/60 in 21 eyes. At 12 weeks, one eye had vision better than 6/12, seven eyes had vision 6/18 to 6/60, and eight eyes had vision 6/60 to 3/60. Mean IOP was reduced from 42.9 [SD 16] to 14.2 [SD 8] and 19.1 [SD 7.8] mmHg at one and 12 weeks after surgery, respectively. At 12 weeks, five [12.5%] eyes had IOP controlled without medication. In 33 [77.5%] eyes, pressure was controlled by using one or two eye drops. The mean number of preoperative anti-glaucoma medications [2.38; SD 1.1] was reduced compared to the mean number of postoperative medications [1.92; SD 0.9] at 12 weeks. We succeeded in reducing visual disabilities and the number of anti-glaucoma medications used to treat refractory glaucoma by AGV surgery

Analgesic efficacy of peritubal infiltration of ropivacaine versus ropivacaine and morphine in percutaneous nephrolithotomy under ultrasonic guidance

Percutaneous nephrolithotomy is a safe and effective endourologic procedure which is less morbid than open surgery. However, pain around a nephrostomy tube requires good post-operative analgesia. We hypothesize that infiltration of local anesthetic with opioid from the renal capsule to the skin around the nephrostomy tract under ultrasonic guidance would alleviate the postoperative pain for a long period. A total of 60 ASA physical status I to II patients were selected for a prospective randomized double-blind controlled study in percutaneous nephrolithotomy surgeries. Patients were divided into group R [n=30] and group RM [n=30]. Balanced general anesthesia was given. After completion of the surgical procedure, a 23-gauze spinal needle was inserted at 6 and 12 O'clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A 10 ml drug solution was infiltrated in each tract while withdrawing from renal capsule to the skin. After extubation, the patient was shifted to the post-anesthesia care unit for 24 hours. Post-operative pain was assessed using the visual analog scale [VAS] and dynamic visual analog scale [DVAS] [during deep breathing and coughing] rating 0-10 for initial 24 hours. Rescue analgesia was given in the form of injection tramadol 1.0 mg/kg intravenously when VAS >/= 4 and maximum up to 400 mg in 24 hours. Time to 1[st] rescue analgesic, number of doses of tramadol and total consumption of tramadol required in initial 24 hours were noted. Patients were observed for any side effect and treated accordingly. Time to 1[st] rescue analgesic, i.e., duration of analgesia in group RM is more prolonged than group R [P=0.0004]. The number of doses of tramadol in 24 hours in group R were higher as compared to group RM [P=0.0003]. The total amount of tramadol in 24 hours in group R was more than in group RM [P=0.0013]. Side effects like nausea and vomiting and sedation were comparable in both the groups. Addition of morphine to ropivacaine for nephrostomy tract infiltration significantly prolonged the duration of post-operative analgesia and reduced the number of doses and total consumption of rescue analgesic in initial 24 hours in percutaneous nephrolithotomy surgery

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries. A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM [n=30]: 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO [n=30] 30 ml 0.25% bupivacaine and in group C [n=30] 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS [0-100], for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted. Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain [VAS: 23.33 +/- 6.04 vs. 45.5 +/- 8.57]. It also reduces pain at 4 hours after surgery in the BM group [VAS 24 +/- 12.13 vs. 41.17 +/- 7.27 in the BO group]. The time of administration of first rescue analgesic was significantly higher in the BM group [6.15 hours] compared to the BO group [4.51 hours]. The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group. Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events

analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized controlled study

Transversus abdominis plane [TAP] block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound [USG]-guided TAP block for retroperitoneoscopic donor nephrectomy [RDN]. In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group [group S] received inj. Bupivacaine [0.375%], whereas control group [group C] received normal saline. Inj. Tramadol [1 mg/kg] was given as rescue analgesic at visual analog scale [VAS] more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time to first dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed. Patients in group S had significantly lower VAS score, longer time to first dose of rescue analgesic [547.13 +/- 266.96 min vs. 49.17 +/- 24.95 min] and lower tramadol consumption [103.8 +/- 32.18 mg vs. 235.8 +/- 47.5 mg] in 24 h. The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications

Avicenna the first to describe diseases which may be prevented by exercise

In the modern medical era it has been known as well that physical activity and exercise are important factors to prevent from different chronic diseases. Scientifically, there are numerous evidence based studies about protective role of exercise against chronic diseases such as cardio- respiratory diseases, diabetes, and hyperlipidemia etc, which have been completely explained. Historically, ancient physicians such as Avicenna had described this topic several hundred years ago. However, ancient principles of medicine are too different in comparison with modern medicine and description of diseases which Avicenna has talked about them and their managements are too much different, yet reviewing the protective role of sports and physical activity in his masterpiece, "The Canon of Medicine", reveals that Avicenna has made a significant contribution to the evolution of following knowledge. The present review discusses Avicenna's opinion about protective role of exercise against some diseases through a comparison with modern medical views and also emphasizes aspects that need further investigation for these opinions to be useful in clinic in the future

[Effects of beta-glucan on the growth, survival, and the efficacy of Anti-streptococcus iniae vaccine in rainbow trout [onchorhynchus mykiss]]

Glucans are complex polysaccharide components of yeast and fungal cell walls. This compounds can stimulate the fish immune system. The present study investigated the effects of Beta glucan[Macrogard] on growth, survival and some immunological parameters of rainbow trout [10 mg] and also on the efficiency of Streptococcus vaccine. Treatments of macrogard [1 g/kg food/day for 42 days], macrogard [macrogard 1 g/kg diet] with 15 minutes bathin vaccine, vaccine bath without macrogard and control were examined in a 42 daysperiod. In all treatments the fish growth [weight] showed a significant increase [p<0.05] compared to the control, while there was no significant difference among the treatments. The lyzosyme level of the blood serum showed a significant difference between control and the other treatments, the highest level was observed in the macrogaurd with vaccine treatment [2.7 micro g/ml] and the lowest level was observed in the control[0.5 micro g/ml]. Leukocytes count also had a significant difference between the control [3.3%Nuetrophil] and other treatments [6.6% Nuetrophil] [p<0.05]. The result of survival of fish challenged with Streptococcus iniae via bath route was 55%, while those for vaccine treatment, macrogard plus vaccine, macrogard every day and macrogard every 10 days interval were 75%, 86%, 60 and and 55%, respectively. The results of this study showed that supplement of macrogard has positive effect on growth and non-specific immune responses of rainbow trout and can enhance efficacy of anti-streptococcus iniae vaccine in this fish

[Prevalence of Staphylococcus aureus resistant to methicillin in traditional cheese and cream: a study in city of Tabriz, Iran]

In recent years isolation of antibiotic resistant Staphylococcus aureus, especially methicillin resistant Staphylococcus aureus in food and food-producing animals has become more frequent. The aim of this study was to determine the prevalence of MRSAin traditional white cheese and butter presented in Tabriz by culture and PCR techniques, as well as the determination of their antibiotical susceptibility. In the present study, 250 traditional white cheese and butter samples were collected from different producers across Tabriz. Evaluation for contamination by coagulase positive Staphylococcus aureus was done using the Culturing method. The isolates were subjected to the PCR technique according to the Nuc gene in order to confirm Staphylococcus aureusand methicillin resistance to the gene [mecA] and the antibiotic resistance trend of the isolates were studied by the Disc Diffusion Agar method. The culture of the samples indicated that 26 cheese and 24 butter samples were contaminated by Coagulase Positive Staphylococcus aureus. Nineteen cheese samples and 11 butter samples were confirmed to be Staphulococcus aureus based on PCR using the Nuc primer gene. From a total number of 30 isolates containing the nuc gene, 11 had the resistant mec-Agene. In overall, from the evaluated samples 100% of the isolates demonstrated simultaneous resistance to more than 3 antibiotics. It can be stated that there was a considerable amount of Staphylococcus aureus which was resistant to a variety of antibiotics, most importantly methicillin resistant. Staphylococcus aureus in the evaluated samples

[Assessing effectiveness of a cardiac rehabilitation program on outcomes of myocardial infarction]

Cardiovascular diseases are among the major mortality causes world widely. Cardiac rehabilitation reduces cardiovascular mortality and improves cardiovascular and mental status of cardiac patients. The aim of this study was to assess the effectiveness of a cardiac rehabilitation program on myocardial infraction outcome. An experimental study was conducted with a sample of 170 patients [85 patients in each group of experiment and control] with myocardial infraction drawn from Amir Kabir hospital affiliated to Arak University of Medical Sciences. Data was gathered by a questionnaire and an observational check list before and after the intervention for both group. The experiment group participated in two-session cardiac rehabilitation program, once during discharge and one after 2-3 weeks of discharge. Statistical analysis was done by Chi-square test, Fisher's exact test and Ttest. There was a significant relationship between cardiac rehabilitation program and chest pain, dyspnea, fatigue, peripheral edema, palpitation and rehospitalization of patients [P<0.05]. It was demonstrated cardiac rehabilitation program could result less frequent chest pain, dyspnea, fatigue, peripheral edema, palpitation and rehospitalization of the patients as well as quicker normalization of inverted T wave. It calls more attention to cardiac rehabilitation program

Dengue fever; clinico-pathologic correlations and their association with poor outcome

One of the major health hazards that has erupted in Pakistan within the recent past years and has caused loss of life of many young people is Dengue Fever. Main objective was to find clinico-pathologic parameters which are essentially associated with complications and contribute to the adverse outcome. This prospective study was conducted on 106 seropositive cases of dengue fever. Patients were taken from Abbasi Shaheed Hospital, Karachi from June 2008 to March 2009. The most common 3 hematological abnormalities were thrombocytopenia and leucopenia. Platelets count below 50 x 10 / microL was seen in [78%] cases and 49% 3 patients had total white cell count below 4 x10 /microL. Partial thromboplastin time was significantly prolonged in [26%] cases whereas prothrombin time was normal in all patients. Liver enzymes both Aspartate Aminotransferase [AST] and Alanine Amino-transferase were significantly elevated in [60%] patients. Blood urea nitrogen [BUN] and creatinine was deranged in [23%] patients. Fever was the most common clinical presentation [86% of the patients]. Hematological parameters [low platelet count, low total leucocytes count, prolonged APTT and raised hematocrit] and biochemical parameters [raised aminotransferases, blood urea nitrogen] have strong association with the complications of dengue fever and hence are associated with the poor outcome of disease

[ effect of interleukin 28 B polymorphism on sustained virology response [SVR] in Patients with chronic hepatitis C]

The effect of IL 28 B polymorphism on sustained virology response [SVR] in patients with Hepatitis C genotype 1 varies among races. Multiple studies have shown that the SVR is two or three times higher in patients with CC genotype compared to those with TT genotype. This study aims to assess the relationship between IL 28 B polymorphism and SVR in Iranian patients. Materials and In a cross-sectional study, 48 patients with Hepatitis C genotype 1 who underwent PCR testing six months following treatment were divided into two groups, SVR positive and negative in order to compare IL 28 B polymorphism. The SVR rate was higher in patients who presented with high baseline ALT levels, independent of IL 28 B genotype [p=0.023]. Logistic regression analysis showed a higher SVR rate in patients with CC genotype compared to TT genotype [p=0.007, OR=29.333, CI=2.558-336.387], however no significant difference was noted between TC and TT genotypes [p=0.177, OR=2.887, CI=0.618-13.496]. Additionally, there was a significant difference between CC and non-CC groups [TC, TT] in SVR rate [p=0.017, OR=13.750, CI=1.602- 118.061]. A high SVR rate was seen in the C group [CC, TC] when compared with the TT genotype [p=0.036, OR=4.923, CI=1.111-21.816]. The sensitivity, specificity, PPV and NPV of the IL 28 B genotype in predicting SVR was 88.8%, 38%, 64.8% and 72.8%, respectively. In addition; although the CC genotype was positive, the sensitivity and NPV were increased to 91.6% and 95.2% respectively. This study confirms the relationship between IL 28 B genotype and SVR rate in the patients with Hepatitis C genotype 1. It seems; IL 28 B genotype could be the reasonable Lab. test for treatment plan of the problematic cases of the patients with Chronic Hepatitis C

Oman Eye Study 2005: prevalence and determinants of glaucoma

This community-based study was carried out to estimate the prevalence and identify the determinants of glaucoma in the Omani population in 2005-06. Residents of 75 randomly selected houses in 25 clusters participated in the survey. We interviewed and examined 3324 individuals aged >/= 30 years in their homes and in eye clinics to note personal details, glaucoma status and presence of selected risk factors: 180 were diagnosed as having glaucoma. Projected prevalence of glaucoma among the Omani population >/= 30 years was 4.75%. Open angle and angle closure types of glaucoma contributed 40.6% and 37.8% respectively. History of hypertension was negatively, and older age and family history of glaucoma were positively, associated with glaucoma

Anaemia in second trimester of pregnancy

The prevalence of anaemia during second trimester of pregnancy was studied among 1830 women, who utilized the antenatal services of Shaikh Zayed Hospital, Lahore. The duration of pregnancy among these women was between 13 and 24 months. The mean age was 25.9'4.6 years and mean gravidity was 2.6 WHO's definition of anaemia of second trimester [Hb < 10.5 g/dl] was used as a cut-off point. According to this definition, 14.5% women were anaemic. The results have been compared with other studies

simple design of a pediatric chest stand

The chest stand we have designed has produced consistently good results. Radiation exposure measurements are well below ICRP recommendations [Annals o ICPR, 1977]