Comparative study on a homemade rapid urease test with gastric biopsy for diagnosis of Helicobacter pylori infection.

The main objective of this study was to determine whether a homemade rapid urease test was reliable when compared to histology in the diagnosis of Helicobacter pylori infection. Endoscopic antral biopsies from 15th August 2004 to 15th July 2005 were studied prospectively. Rapid urease test and histological examination were done on all specimens. Among 160 biopsies, 56 cases showed H. pylori in histological section and 59 cases were rapid urease test positive. Among 56 H. pylori infected patients, the sensitivity, specificity, positive and negative predictive values, percentage of false positive, and percentage of false negative values of rapid urease test were 96.4%, 95.2%, 91.5%, 98.0%, 4.8% and 3.5% respectively. Rapid urease test is positive in significantly higher number (p < 0.001) in histological positive cases. In conclusion our homemade rapid urease test is a test with good sensitivity and specificity for detection of H. pylori infection.

A hospital-based study of bloodstream infections in febrile patients in Dhulikhel Hospital Kathmandu University Teaching Hospital, Nepal.

The etiology of bloodstream infections in febrile patients remain poorly characterized in Nepal. A retrospective study of febrile patients presenting to Dhulikhel Hospital Kathmandu University Teaching Hospital from July 2002 to June 2004 was performed to evaluate the etiology of bloodstream infections and the drug sensitivity patterns of cultured organisms. The medical and laboratory records of all febrile patients with an axillary temperature > or = 38 degrees C who had a blood culture taken (n = 1,774) were retrieved and analyzed. Of these, 122 (6.9%) patients had positive blood cultures, of which 40.1% were age 11 to 20 years. The male to female ratio was 1.7:1. Antibiotics had been taken prior to hospital presentation by 39 (32%) patients. Salmonella enterica serovar Typhi and serovar Paratyphi A were isolated in 50 (41.0%) and 13 (10.7%) cases, respectively. All S. Typhi and S. Paratyphi isolates were susceptible to ceftriaxone, while susceptibility to ciprofloxacin and chloramphenicol was recorded in 94.8% and 94.5% of cases, respectively. Cephalexin and amoxicillin had the lowest rates of susceptibility (64.2% and 54.1%, respectively). Salmonella spp were usually sensitive to chloramphenicol. These findings provide clinicians in this region of Nepal with a better understanding of the spectrum of pathogens causing bloodstream infections and will help guide empiric antibiotic choice.

Harlequin baby--a rare case of keratinization disorder.

Harlequin icthyosis is a very rare inborn error of epidermal keratinization with autosomal recessive inheritance. Abnormal lipid metabolism in mitochondria with defective lamellar body formation is the main defect leading to hyperkeratosis. Prenatal diagnosis can be done by invasive procedures such as fetal skin biopsy and also by ultrasonography.

Cancer: determinants and progression.

Cancer is the combination of uncontrolled cellular proliferation and immortality. It is a multi-step disease with a multi-factorial etiology. The determinants of cancer are many and varied including genetic predisposition, environmental influences, infectious agents, nutritional factors, hormonal and reproductive factors, radiation etc. However, the extent of the genetic involvement and their interaction with environment in tumorigenesis is still elusive. The six essential alterations in cell are proposed which determines the transition from normal cell to malignant. It includes--self-sufficiency in growth signals, insensitivity to growth-inhibitory (antigrowth) signals, evasion of programmed cell death (apoptosis), limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis. Nevertheless, the last two decades have seen rapid improvements in understanding the complex molecular mechanisms underlying tumorigenesis, yet the quest for unraveling the mystery is not over. Further study in this area is indispensable that could hold the promise of increasing our understanding of cancer etiology and possible preventive strategy.

Study on urinary bladder stone cases at Okhaldhunga Hospital, Nepal. 1988--1994.

A retrospective study on urinary bladder stones among the patients seeking treatment in Okhaldunga Hospital was carried out for six calendar years from 1988 to 1994. Forty-six cases of bladder stones were identified during that period. Among them, 43 patients' records were studied (93.0%) in subsequent analysis. Ninety-seven percent were male with mean age 11.53+/-6.9 years. The number of children are significantly higher in 0-9 years of age (p<0.01). The symptoms lasted more than 2 years with the most common presenting symptoms dysuria (86.0%) and poor flow of urine (41.8%). The average hospital stay was 8.7 days. The majority of cases (78.5%) had undergone cystolithotomy without any complications. The study also showed that the majority (97.0%) of urinary bladder stone cases were successfully managed at a rural hospital like Okhaldhunga.