Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation.

Medulloblastomas were originally classified under gliomas of the cerebellum until Bailey and Cushing in 1925 named these tumors as medulloblastoma. At present these tumors are classified under primitive neuroectodermal tumor. Surgical excision followed by craniospinal irradiation is the treatment of choice. A 13-year-old-girl operated for posterior fossa medulloblastoma 5 years ago presented with history of headache and vomiting on and off for 4 days in late August 2008. The MRI showed left frontal tumor which on excision was reported as medulloblastoma. Even after optimal treatment reports of recurrence abound in literature. The most common location is in the posterior fossa, followed by spinal, supratentorial, and uncommonly, systemic metastases. We conclude that medulloblastomas are highly aggressive tumor with high local recurrences if the initial excision is incomplete and that recurrence in the supratentorial area although uncommon is still a possibility. This mandates regular follow up of these children till adulthood to catch early recurrences and metastatic disease.

Oxidative stress, antioxidant status and lipid profile in ischemic heart disease patients from western region of Nepal.

Disturbed lipid profile is one of the most important and potent risk factors in ischemic heart disease (IHD). In recent years, it has been demonstrated that raised oxidative stress promotes several undesirable pathways including the formation of oxidised LDL (O-LDL) and oxidized cholesterol which encourages cholesterol accumulation in arterial tissues. We, therefore, aimed to ascertain the redox balance by measuring oxidative stress (OS) and total antioxidant activity (TAA) along with lipid profile to determine their possible association with IHD. Our study group comprised of 28 confirmed cases of IHD. The inclusion criterion was history of chest pain, ischemic changes in the ECG and good left ventricular (LV) function. Patients with diabetes mellitus, poor LV function, previous infarct and valvular heart disease were excluded. Lipid profile, plasma thiobarbituric acid reactive substances (TBARS), plasma total antioxidant activity (TAA) and urinary TBARS were estimated in these patients by standard procedures and the values were compared with 30 age, sex and socioeconomically matched normal healthy control subjects. Body mass index (BMI) and waist/hip ratio (W/H ratio) was also noted in both the groups. Lipid profile and OS (TBARS levels) were significantly raised in IHD patients. Though statistically not significant but TAA tended to be lower and urinary TBARS levels tended to be higher in patients. BMI, W/H ratio, smoking and alcohol did not show discernible association with lipid profile, OS or TAA. OS is significantly raised in majority of IHD patients. The non association of BMI, W/H ratio, smoking and alcohol with lipid profile, OS and TAA suggest that there are other risk factors which primarily contribute to the initiation and progression of IHD.

A study of oxidative stress, antioxidant status and lipid profile in diabetic patient in the western region of Nepal.

AIMS AND OBJECTIVES: Diabetes mellitus (DM) is often termed as a disease of premature aging. Several studies have indicated lopsided redox balance due to pro oxidant environment as one of the important etiological factors. Some recent researches also indicate a causal relationship with oxidative stress (OS). So far, no study has been undertaken on this aspect in Nepali populations. We, therefore, aimed this maiden study in Nepali population to examine redox balance by measuring OS and antioxidant status along with lipid profile in 37 patients of DM type- 2 and 30 matched normal subjects. METHODOLOGY: Thirty seven patients of DM type-2 without any complications (mean age= 57.6+/- 10.6 years) and 30 normal subjects (mean age= 55.8 +/- 14.8 years) were included in this study. Body Mass Index (BMI) and Waist/Hip (W/H) ratio were measured. Fasting blood sample was collected for the analysis of total antioxidant activity (TAA), plasma and urinary thiobarbituric acid reactive substances (TBARS) and lipid profile by standard procedures in both the groups. The statistical analysis was done with SPSS 10 version. RESULTS: Total cholesterol, triglyceride, VLDL-cholesterol, LDL-cholesterol, plasma and urinary TBARS were significantly raised whereas, plasma TAA was significantly reduced in DM type-2 patients as compared to controls. The comparison of old and fresh cases revealed that though TAA was lower and PTBARS and UTBARS were higher in patients but did not attain the level of significance. W/H ratio is significantly higher in patients compared to normal subjects. But, no significant correlation of BMI and W/H with lipid profile is observed in both control and patients. CONCLUSION: Oxidative stress is raised in type 2 DM patients. This along with deranged lipid profile and decreased antioxidant status could be the risk factors in the development of complications associated with DM.

An unusual injury from a toothbrush: a case report.

The use of toothbrushes has significantly improved oral hygiene. However, if brushing of the teeth is not done judiciously, it could result in severe trauma to the soft tissues of the oral cavity. This is particularly true in the young age group, since children tend to be very playful while brushing their teeth. This article describes the case report of a child who sustained a penetrating injury while brushing his teeth. A detailed plan for the management of such injuries is also presented.

Cigarette smoke induced oxidative insult in local population of Pokhara.

OBJECTIVES: To assess the effect of cigarette smoking on lipid peroxidation induced oxidative stress, antioxidants, uric acid and blood sugar in normal subjects. METHODS: The study included 61 normal subjects with regular smoking habit and 57 never-smokers normal subjects matched in respect to socio-economic status, age and BMI. Information regarding smoking habit and other personal details were collected by oral questionnaire. Total antioxidant activity (TAA), reduced glutathione (GSH), alpha-tocopherol (alpha-T), ascorbic acid (AA), uric acid (UA), plasma and urinary thiobarbituric acid reactive substances (TBARS), fasting blood sugar (FBS) and urinary creatinine (Cr) were estimated by standard procedures in both the groups. Ferric Reducing Antioxidant Power (FRAP) procedure is used to estimate TAA which measures total dietary antioxidants. Statistical analysis was done with SPSS version 10. RESULTS: The mean pack years smoked by smokers was 14.4 +/- 15.8. The plasma TBARS level in smokers and never-smokers was 2.6 +/- 0.8 and 2.5 +/- 0.6 micromol/L respectively. The respective figure for urinary TBARS level was 4.6 +/- 2.7 and 3.7 +/- 1.4 micromol/gmCr. Smokers did not show any significant difference from never-smokers with respect to GSH, alpha-T, AA, plasma TBARS and FBS. However, the smokers had significantly lower levels of TAA (p<0.05) and raised level of urinary TBARS (p<0.05) and uric acid (p<0.01) as compared to never-smokers. CONCLUSION: Our study suggests that smoking induces mild lipid peroxidation but the body is able to compensate for it by removing its adducts. Importantly it also indicates enhanced oxidation of purines which are essential components of both DNA and RNA. Dietary antioxidants are consumed to scavenge free radicals (FR) and other reactive species (RS) in smoke. Female smokers are more prone to oxidative insult than male smokers. In summary RS present in smoke induce mild lipid peroxidation but are not the major contributors of redox imbalance in smoke induced toxicity in the selected subjects.

Vitamin C status in cancer patients and healthy subjects from the local population of Pokhara.

OBJECTIVES: To assess vitamin C status by determining plasma ascorbic acid level in 55 cancer patients and 55 matched normal subjects serving as control. METHODS: The proven cancer patients were selected from those attending Manipal Teaching Hospital, Pokhara. Matched controls were from the staff of Manipal Teaching Hospital or attendants of the patients. Plasma ascorbic acid was determined by the method of Natelson. Unpaired student 't' test was used for the statistical evaluation. Statistical analysis was done by SPSS version 9 software. RESULTS: The mean level of vitamin C in normal subjects and patients was 1.03+/-0.26 mg/dl and 0.90+/-0.30 mg/dl respectively. None of the subjects in either group had deficient status (<0.2 mg/dl). Although its status was normal in both the groups but patients had lower level than normal subjects. Smokers and alcohol consumers had significantly lower level than non-smoker and non-alcoholics. CONCLUSION: In the local population, vitamin C deficiency is not an etiologic factor in malignancy. Smoking and alcohol adversely affects the status of this vitamin.

Oxidative stress and antioxidant status in cardiovascular diseases in population of western Nepal.

OBJECTIVES: To observe if there is any connectivity between oxidative stress and cardiovascular diseases (CVDs). MATERIALS AND METHODS: Patients suffering from different cardiovascular diseases (hypertension, ischemic heart disease, rheumatic heart disease) attending Manipal Teaching Hospital, Pokhara and strictly matched controls were selected for this study. Oxidative stress (OS) was measured by plasma thiobarbituric acid reacting substances (TBARS) where as antioxidant status was measured by estimating vitamin E, vitamin C and total antioxidant activity (TAA) in plasma. RESULTS: The mean level of TBARS, TAA, vitamin C and E were 2.20+0.43 nmol/ml, 547+98 mol/l, 0.88+0.15 mg/dl and 0.75+0.20 mg/dl respectively in patients. The respective values in controls were 1.86+0.43 nmol/ml, 859+139 mol/l, 0.94+0.15 mg/dl and 1.10+0.30 mg/dl. Although the OS seems to be raised in patients, is practically insufficient to oxidize biomolecules and induce CVDs. Despite vitamin C and E levels being well within normal limits, the TAA was significantly and considerably lower in patients. This is a highly interesting observation suggesting that dietary antioxidants other than these vitamins were preferentially consumed to control OS because procedure for TAA used in this study practically measures only total dietary antioxidants. CONCLUSION: OS does not appear to be an etiological factor for the cardiovascular diseases; rather slightly raised OS in patients seems to be a consequence. Further the raised OS was not due to lower nutrient antioxidant (vit. C and vit. E) in the local population studied herein.

Typhoid fever in Dhulikhel hospital, Nepal.

One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time was significantly better with ofloxacin compared to ciprofloxacin (p < 0.05) and ceftriaxone compared to chloramphenicol (p < 0.05). The release from treatment was significantly shorter with ceftriaxone compared to ofloxacin, ciprofloxacin and chloramphenicol (p < 0.01). Ceftriaxone was found to be 100% sensitive to salmonella typhi. Amoxicillin was only 52.1% sensitive to Salmonella typhi. Early diagnosis and institution of appropriate antibiotic therapy is of paramount importance in the management of typhoid patients.

Efficacy and safety of oral iron chelating agent deferiprone in beta-thalassemia and hemoglobin E-beta thalassemia.

OBJECTIVES: To assess efficacy and safety of oral iron chelating agent deferiprone (DFP) in patients with beta thalassemia and hemoglobin E-beta thalassemia. DESIGN: Non-randomized study. SETTING: Hematology Out-Patient Department. SUBJECTS: Forty-one patients of beta thalassemia and hemoglobin E-beta thalassemia. INTERVENTIONS: DFP was given to 20 patients, 10 patients of beta thalassemia and 10 with hemoglobin E-beta thalassemia; the rest were taken as controls. RESULTS: A significant fall in serum ferritin was observed in the study group along with rise in urinary iron excretion (p < 0.05). Adverse effects of DFP were nausea and vomiting (30%), significant arthropathy requiring stopping of the drug (30%), and reversible neutropenia in one patient. All these complications could be managed easily with medical supervision and no death or permanent disability was seen. CONCLUSIONS: DFP is an effective and fairly well tolerated oral iron chelating agent. The side effects that occur can be tackled easily if monitored properly.

Prevalence of hepatitis B virus (HBV) markers and human immunodeficiency virus (HIV) in employees of a blood transfusion centre.

Blood bank staff, 8 out of 25 (32%) have been exposed to hepatitis B virus (HBV) and the prevalence of HBV markers in blood bank employees handling high risk subjects show hepatitis B surface antigen (n = 1), hepatitis B surface antibody (n = 7), hepatitis B core antibody (n = 6) and combined hepatitis B surface antibody and hepatitis B core antibody (n = 6) seropositivity but all are negative to human immunodeficiency virus (HIV). Serum alanine aminotransferase was raised in the employees than normal subjects and it is suggestive of sub-clinical hepatitis. The employees of blood bank should be trained for proper handling of test materials and must be periodically monitored for HBV and HIV. Immunisation for HBV is mandatory only for the employees of transfusion centre which handles high risk subjects.