Retrospective histopathological analysis of various neoplasms of different parts of the gastrointestinal tract seen at the Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Nepal.

OBJECTIVE: To find out the spectrum of various histopathologic types of primary neoplasms of different parts of the gastrointestinal tract (oesophagus, stomach, small intestine, colorectum, anal canal) seen at the Kathmandu University Teaching Hospital (KUTH), Dhulikhel as there exists a worldwide wide variation in the distribution of various neoplasms of different parts of the gastrointestinal tract, which appears largely due to exogenous factors rather than due to inherent differences between populations. MATERIALS AND METHODS: This was a retrospective study. It was carried out at Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Kavre, Nepal. All neoplasms of the gastrointestinal tract seen at the KUTH during the period 1st January 2004 to 31st December 2004 were included in this study and examined by light microscope (LM). RESULTS: A total number of 18 cases of neoplasms of the gastrointestinal tract were seen. Out of these, 3 (16.7%) were of the oesophagus (all squamous cell carcinoma), 10 (55.5%) were of the stomach (six intestinal type and four diffuse type), 2 (11.1%) were of the small intestine (one was lymphoma of the mucosa associated lymphoid tissue--MALTOMA and other was a malignant gastrointestinal stromal tumour--GIST), 3 (16.7%) were of the colorectum (all adenocarcinoma), and none was of the anal canal. CONCLUSION: Relatively large number of cases of the carcinoma of the stomach were found in our this small series of the cases of the gastrointestinal tract in comparison to the Western countries.

Retrospective histopathological analysis of various neoplasms of the female reproductive system (FRS) seen at the Kathmandu University Teaching Hospital, (KUTH) Dhulikhel, Nepal.

OBJECTIVE: To find out the spectrum of various histopathological types of primary neoplasms of different parts/organs of the female reproductive system seen at the Kathmandu University Teaching Hospital (KUTH) as there exists a worldwide wide variation in the distribution of various neoplasms, which appears largely due to exogenous factors rather than due to inherent differences between populations. MATERIAL AND METHOD: This was a retrospective study. It was carried out at KUTH. All neoplasms of the female reproductive system seen at the KUTH during the period of 20 months from 1st January 2004 to 31st August 2005 were included in this study and examined by light microscope (LM). RESULTS: A total number of 60 cases of neoplasms of the female reproductive system were seen. Out of these, 1 (1.7%) was of the vagina (squamous cell carcinoma, papillary variant); 16 (26.7%) were of the cervix of the uterus (all squamous cell carcinoma in advanced stage); none were of the endometrium; 20 (33.3%) were of the body of the uterus/uterine muscle (all liomyomas); 16 (26.7%) were of the ovary, (11 benign, consisting of nine mature cystic tertoma, also known as dermoid cyst, one serous papillary cystdenoma and one mucinous cystadenoma; and, five malignant, consisting of two serous cystadenocarcinoma, two mucinous cystadenocarcinoma and one mixed mucinous and serous cystadenocarcinoma); and, 7 (11.6%) were of the breast (two benign, consisting of fibroadenoma and five malignant, all consisting of infiltrating ductal carcinoma in advanced stage). CONCLUSION: There were relatively a large number of cases of advanced stage of cancer of uterine cervix. All breast cancers seen were also in advanced stage. Endometrial carcinoma was conspicuously absent in our this small series of cases.

Prevalence of Helicobacter pylori in Dhulikhel Hospital, Kathmandu University Teaching Hospital: a retrospective histopathologic study.

OBJECTIVE: The main objective of this study was to determine prevalence of Helicobacter pylori infection in Dhulikhel Hospital, Kathmandu University Teaching Hospital. METHODOLOGY: Endoscopic antral biopsies from January 1, 2004 to August 31, 2005 were studied retrospectively. Hematoxylin and eosin and Giemsa stained histological sections were examined. RESULTS: Out of 224 patients (Male 125 and female 99) who underwent endoscopic biopsy and included in the study, a total of 76 (33.9%) patients (Male 50 and female 26) were infected by H. pylori. The mean age of the H. pylori infected patients was 40.2 years (SD 16.0). The infection by H. pylori was significantly higher in males than females (p<0.05) with male to female ratio of 1.9:1. The most common (31.3%) histopathologic finding was chronic superficial gastritis followed by normal histology (30.8%). A total of 10 cases (4.5%) of adenocarcinoma and 16 cases (7.1%) of intestinal metaplasia were detected and neither of them showed presence of H. pylori. Two cases (0.9%) were diagnosed as suspected malignancy and both were negative for H. pylori infection. Among gastritis, H. pylori was most frequently observed in chronic active gastritis (86.1%). Two of 69 cases (2.9%) of normal gastric mucosa showed H. pylori.

An outbreak of El Tor cholera in Kavre district, Nepal.

Outbreak of cholera still remains major public health problem in most of the developing countries including Nepal. A prospective study was carried out at Dhulikhel Hospital, Kathmandu University Teaching Hospital, Kavrepalanchok during 1st May 2004 to 31st October 2004. A total of 148 stool samples from patients with acute diarrhea were collected and further investigated for cholera. The study was conducted to establish the causes of the outbreak of acute diarrheal disease, antimicrobial profiles of the stool isolates and parasitic co-infection in cholera cases. The samples were subjected to standard recommended microbial procedures and confirmation of the isolates was done by seroagglutination using V.cholerae polyvalent O1 and 0139 antisera and monovalent Ogawa and Inaba antisera. Out of the 148 stool samples, 46 cases (31%) were found to be positive for V.cholerae serogroup O1, biotype ElTor, serotype Ogawa. Both sexes were equally affected. Young age group of less than 30 years were mostly affected. Brahmin was the most affected ethnic group. The isolates were sensitive to all the antibiotics tested except co-trimoxazole. Among the laboratory confirmed cholera cases 30% exhibited co-infection with other parasites among which Giardia lamblia and Ascaris lumbricoides were the most common.

Prevalence of Moraxella catarrhalis infections of the lower respiratory tract in elderly patients.

OBJECTIVES: To determine: *rate of isolation of Moraxella catarrhalis in elderly patients having lower respiratory tract infection *The antibiotic susceptibility pattern of Moraxella catarrhalis isolates. *The predisposing factors responsible for Moraxella catarrhalis infections of lower respiratory tract. MATERIAL AND METHOD: This is a prospective study carried out at Manipal Teaching Hospital, Pokhara during May 2002 to April 2003. A total of 716 sputum samples collected from patients with suspected lower respiratory tract infection were investigated. The samples were subjected to Gram stain, culture and sensitivity. Sputum samples were inoculated on blood and chocolate agar and incubated at 37 degrees C for 18 to 24 hours in candle jar containing 3-5% Co2. For the identification of bacterial isolates, the cultural and colonial characteristics were recorded and identified with the use of biochemical test. The susceptibility of bacterial isolates to antimicrobial agent was performed following Kirby-Bauer method. RESULT: Out of the 716 samples, 355 (49.58%) grew normal commensals of the upper respiratory tract. Respiratory pathogens were recovered from 361 (50.41%) samples. The most common respiratory pathogen was H. influenzae (26. 86%), followed by S. pneumoniae (21.16%). Moraxella catarrhalis accounted for 6.90%. Rate of isolation of Moraxella catarrhalis was higher in males than in females. Out of 25 isolates 16 were from males and 9 were from females. Frequency of isolation of Moraxella catarrhalis was more frequently seen in age group 61-70 years. It was most commonly recovered in winter. The most effective antibiotics were amoxicillin-clavulanate and ceftriaxone and least was ampicillin. CONCLUSION: Moraxella catarrhalis isolation from sputum especially in persons above 60 years of age and in the absence of other well established pathogens should not be disregarded as they can cause lower respiratory tract infection in these individuals.

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.