Cyclosporine in Stevens Johnson syndrome and toxic epidermal necrolysis and retrospective comparison with systemic corticosteroid.

Background: Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological emergencies. Many immunosuppressive modalities have been tried with variable results. Aims: To determine the efficacy of cyclosporine in cases of SJS and TEN and compare the efficacy with systemic corticosteroid in the same condition. Methods: Study was conducted at a tertiary hospital during 01 July 2011 to 30 June 2012. SCORTEN was assessed at the time of admission. Total body surface area (TBSA) assessment was like any burn patients. Cyclosporine was administered in the dose of 3 mg/kg body weight in three divided dosage for 07 days and then tapered over another 07 days. Data were compared to a historical series of SJS/TEN patients, managed by systemic steroids a year ago. Results: A total of 11 consecutive patients with a mean age of 32.09 and standard deviation (SD 16.17) were enrolled in to cyclosporine group, which were retrospectively compared to 6 patients with a mean age of 27.87 (SD 13.97) years in the corticosteroid group. The mean duration of re-epithelialization was 14.54 (SD 4.08) and 23 days (SD 6.68) in cyclosporine and corticosteroid group respectively (P = 0.009956). Mean hospital stay was 18.09 (SD 5.02) and 26 (SD 6.48) days in cyclosporine and corticosteroid group respectively (P = 0.02597). A total of 1.11 and 0.51 patients were expected to die against no death and two deaths in cyclosporine and corticosteroid group respectively (Standardized mortality ratio = 3.92) (P = 0.04321). Conclusion: This study definitely suggests that cyclosporine has encouraging role in the management of uncomplicated cases of SJS, SJS-TEN overlap or TEN.

Work related complaints among dentists.

The objective of this study was to describe the occurrence of neck pain, shoulder pain and back pain among dentists and to assess the risk factors affecting them. Sixty-eight dentists from Dharan and Biratnagar were interviewed using pretested questionnaires in January 2006. Back pain was the most common complaint affecting almost 80% of the study population, followed by neck pain (58.8%) and shoulder pain (47%). The frequency of shoulder pain among female dentists was nearly double that of males (P=0.009). The mean days of neck pain among males was significantly higher as compared to females (P=0.048). The study suggests that musculoskeletal complaints are common among dentists, though they are not of severe nature. There is a scope for further decreasing the prevalence and severity of these disorders by performing regular specific exercises.

Fungating primary locally malignant giant cell tumor of ulna: a case report.

A giant cell tumor with local aggressiveness and penetration of cartilage is quite rare. We present a case of fungating giant-cell tumor of lower end of the ulna with wrist involvement including penetration of cartilage and diaphysis. Involvement with all these characteristics, according to the literature reviewed, is the first case of its type. We are of the opinion that the fungation may be due to incision and drainage and delayed presentation at tertiary care centre.

Cervical spine injuries in a teaching hospital of eastern region of Nepal: a clinico-epidemiological study.

Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.

Complex elbow dislocation with ipsilateral segmental fracture of radius and ulna in a young boy: a complex injury with multiple fractures.

Complex elbow dislocation1 (fracture of lateral condyle and avulsion fracture of medial epicondyle) with ipsilateral segmental fracture of radius and ulna without distal neurovascular deficit following machinery rolling belt injury in a 14 years boy presenting to emergency room of BP Koirala Institute of Health Sciences, is reported due to its complex nature of injury and good outcome after adequate follow up. The literature is reviewed for complex elbow dislocation to show its rarity.

Treatment of grade IIIB opens tibial fracture by ilizarov hybrid external fixator.

OBJECTIVE: We evaluated the results of patients who were treated with Ilizarov hybrid external fixator for type IIIB open tibial fractures. MATERIALS AND METHODS: 35 Gustilo grade IIIB tibial fractures of age between 18 to 42 years (22 male and 13 female) in which 12 distal fourth tibia (D/4) of C1.1 (6), C1.3 (6), 12 upper fourth Tibia (U/4) of A2 (8) and A3 (4) according to AO classification and 11 Tibial plateau fractures of Schatzker type VI (5) , V(5), IV(1) . All tibial plateau, proximal fourth fractures and lower fourth fractures of tibia and fibula (Reversed Hybrid), treated with Ilizarov hybrid fixator using two Ilizarov 5/8 rings and AO External fixator were followed up to 12-52 months. RESULTS: D/4 fractures were united at 31.16678.3046 wks, U/4 at 24.005.2915 and Tibial plateau at 15.5454.160 weeks (p-0.00). ROM in tibial plateau type IV 130 degrees +/-00, type V 124 degrees +/- 8.94 degrees, type VI 125 degrees +/-7.0711 degrees, D/4 of type C1.1 (50 degrees +/-0.00), type C1.3 (43 degrees +/- 5.7755) whereas full ROM in U/4 fractures. Pin tract infection occurred in 21% of cases. Pain on walking in 20% of cases of type VI tibial plateau fractures and 80% of cases of type IV and V. Problem free in rest of parameter of function of VI and 100% problem in IV and V. Pain at rest observed in 20% of cases in type V. In 66.67% U/4 fractures had pain on walking but no other functions were compromised. In 33% D/4 fractures of C1.1 type had pain on walking only and had 1cm of shortening. CONCLUSION: On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries. This fixator is safe and versatile, effective in providing stability and allowing early rehabilitation, although the indications for its use are very relatively specific.

Polyarticular tuberculosis in a young boy: a rare presentation.

Polyarticular tuberculosis involving bilateral hip and bilateral knee joints without obvious pulmonary or disseminated form of tuberculosis in a young boy is presented along with literature review.

Role of rehabilitation centres in reducing drug abuse problem in a town of Eastern Nepal.

OBJECTIVES: This paper focuses to describe the role and activities of Drug Rehabilitation Centres (DRCs) in reducing the drug-abuse problem in Dharan. It also offers suggestions for increasing the effectiveness of prevention programs. MATERIALS AND METHODS: Records of three DRCs working in Dharan for the past 9 years were analyzed using appropriate statistical tools. RESULTS: The yearly clean rate is significantly higher in these centres. Harm reduction program was currently available only in one centre. Pharmacotherapy along with short-term rehabilitation was available at de-addiction unit of B. P. Koirala Institute of Health Sciences whereas long-term rehabilitation was at others centres. CONCLUSION: Thus, there should be a strong coordination and network with each other to increase the effectiveness of the treatment program for drug abuse. The treatment centres should be increased in number as well as in quality. BPKIHS should take initiation to start long-term management with repeated booster programs.

Predicting cubitus varus in supracondylar fractures of the humerus by Baumann's angles in post reduction X-rays.

OBJECTIVES: The present study presents the technique to predict cubitus varus by post reduction Affected Side and Normal Side Baumann's angle difference (ASBA and NSBA) respectively. It intends to correlate the Baumann's angle to the final carrying angle of the injured elbow and presents the relevant mathematical clinical rule along with its prediction test characteristics. MATERIAL AND METHODS: Total 57 patients of 6.5+/-1.67 yrs, 22 were males and 8 females with 19/30 having left side injury. Isolated closed supracondylar fractures of humerus up to 5 days duration included and previous trauma, pathological fracture, other injury, elbow disease were excluded .30/57 completed >1 year follow-up. RESULTS: The Mean NSBA was 74.4+/-4.14 masculine. The mean normal side carrying angles (NSCA) were 9.56 +/- 2.2 masculine. The NSCA IQR (Inter Quartile Range) was 8.8-10 masculine. The ASBA was 79.9+/-9.1 masculine and affected side carrying angles (ASCA) was 0.20+/-8.7 masculine. The ASCA was best predicted by the difference between ASBA-NSBA (ASCA=3.87-0.65(ASBA- NSBA; F=15.91). At a cut off of 8.8 masculine (the lower limit of IQR for NSCA), a value >0 masculine for ASBA- NSBA was 80% predictive of cubitus varus. With pre test probability of varus at 70%, sensitivity was 0.94 and specificity 0.42. DISCUSSION: A prediction rule to predict the final carrying angle from ASBA NSBA difference is presented with a positive predictive value 0.80, specificity of 0.42, and sensitivity of 0.94 at a pre test probability of 0.70.When the diagnosis of cubitus varus is ASCA<8.8 masculine (Lower limit of the IQR for NSCA). CONCLUSION: If affected side Baumann's Angle - Normal Side Baumann's Angle is equal to or greater than 0 then there was 80% probability of having cubitus varus.

Osteosarcoma in pregnancy.

Osteosarcoma in pregnant women is rare. Delay in diagnosis may be due to lack of any signs or symptoms during gestation, clinical misdiagnoses, religious attitude and refusal of the patients. Most cases soft-tissue and bone tumors during pregnancy can be managed successfully with surgery during gestation. Therapies with fetal toxicity were more likely to be deferred to postpartum period. This case is rare and liable to be missed, hence is reported.

Fungal osteomyelitis of tibia and fibula with bony ankylosis of ankle; Intertarsal and tarsometatarsal joints- A rare presentation

We present a rare case of fungal osteomyelitis of tibia and fibula with extensive involvement of ankle; intertarsal and tarsometatarsal joints leading to bony ankylosis of all joints over a four years duration. Diagnosis was confirmed with histological and microbiological examinations; which showed Aspergillosis osteomyelitis. The patient was treated with Amphotericin B for 6 weeks. The outcomeafter the therapy was good after adequate follow up. The clinical; pathologic; and therapeutic features of aspergillosis osteomyelitis are described and compared with previously published cases

Kawasaki disease: an update.

Kawasaki disease is the leading cause of acquired heart disease in children in many parts of the world. It is an acute systemic vasculitis of unknown etiology predominantly affecting children under 5 years of age. It is diagnosed clinically by the presence of a constellation of manifestations and exclusion of other diseases with similar findings. Children develop a spectrum of cardiovascular manifestations including coronary artery involvement in 30-35% of untreated cases with myocardial infarction and death in < or = 2% of them. Acute stage treatment is by administration of intravenous immunoglobulin and aspirin. Those with coronary artery involvement need long-term cardiac risk stratification and management because many of them will become the part of a growing pool of adults with ischemic heart disease.

Spindle cell carcinoma of right lower alveolus. A case report.

A case report of spindle cell carcinoma of the right mandibular alveolus is reported, which clinically mimicked a squamous cell carcinoma. Careful histological interpretation is necessary for successful treatment of such tumors. The use of radiation therapy after radical neck dissection is also stressed upon.

Perinatal mortality in urban slums in Lucknow.

OBJECTIVES: To determine the perinatal mortality rate (PNMR) in the urban slums of Lucknow DESIGN: Cross-sectional survey. SETTING: Twenty five Anganwadi centres of urban Lucknow, with a population of 25,901. METHODS: Data was collected on birth and early neonatal deaths, gestational age of the neonate (determined at birth) and maternal variables like socio-economic status, maternal age, parity, and bad obstetrical history from January 1992 to March 1993. RESULTS: There were 966 births with a still-birth rate of 37.2 and PNMR of 59.0 per 1000. The relative risk of perinatal mortality with lower socio-economic status was 1.87, bad obstetrical history 2.18, and gestational age < 37 weeks 1.95. CONCLUSIONS: Further reduction in PNMR may be possible with focussed medical services to women of low socio-economic status having bad obstetrical history and those delivering before term.

"A retrospective cohort study for prognostic significance of visual acuity for near over that for distance in anisometropic amblyopia.".

A cohort of 50 anisometropic amblyopes, between the ages of 2.5 to 10 years, was studied retrospectively to assess the prognostic significance of visual acuity for near over that for distance. There is ample evidence in the literature for a significantly lower accommodative response in the anisometropic amblyopic eye. It has been proposed that the efferent accommodative dysfunction may be a fundamental and causative factor in anisometropic amblyopia. A reduced visual acuity for near over that for distance was found in 17 [34%] patients and in 11 out of these the near vision improved after an addition of +3.0D sph. When a reduced visual acuity for near, was obtained it was difficult to determine whether the visual afferent system (due to insufficient visual input), or the accommodation efferent mechanism was responsible. However an improvement in corrected near vision by addition of +3.0D sph. suggested an accommodative dysfunction. In patients with reduced visual acuity for near over that for distance, not only was the final visual outcome poor but also the onset of visual improvement in response to amblyopia therapy was delayed.