Stroke: a case series study in Nepal Medical College Teaching Hospital.

Stroke is a major public health burden worldwide. Prevention programme are essential to reduce the incidence of stroke and to prevent the all but inevitable stroke epidemic, which will hit our population (developing countries) hard as our population age and adopt lifestyle of the more developed countries. In this study we have tried to find the clinical characteristics of the stroke patients admitted in NMCTH and the commonest risk factors and its magnitude in our population. In these retrospective clinical case series study, we included the cases which were admitted in NMCTH over the past 2 years (from 1st April 2003 to 31st march 2005). All these patients were confirmed cases of stroke (CT scan was done in all these cases). Clinical profiles of all these patients were studied and analyzed using SPSS 11.0 version software. Seventy two patients were diagnosed as having cerebrovascular accident. The mean age of the patients having stroke in our study was 61 years. The commonest symptom was unable to move one side of the body (90.0%), other common symptoms were slurring of speech (33.0%), loss of consciousness (29.0%), headache (23.0%) and deviation of mouth (22.0%). 70 patients (97.0%) had 2 or more than 2 symptoms (i.e. multiple symptoms). Smoking (61.0%), hypertension (60.0%) and atrial fibrillation (8.0%) were the commonest modifiable risk factors, while increased age (mean 61 years) was the commonest nonmodifiable risk factor. Ischemic stroke (68.0%) was common than hemorrhagic (32.0%) stroke. In this study we found that smoking and hypertension was the commonest risk factor in our study group. Atrial fibrillation (8.0%) and diabetes mellitus (8.0%) were among the less common risk factors, whereas alcoholism and hypercholesterolemia were negligible in our study population. Multiple clinical features are common with unable to move the one side of the body being the commonest. The commonest form of stroke detected in our study group was ischemic type which is comparable to the study done in the past. Despite of these findings a bigger epidemiological study is needed to generalize this view over our community.

DOTS centre at a tertiary care teaching hospital.

In April 2002 Directly Observed Treatment - Short course (DOTS) centre was established in Nepal medical college teaching hospital(NMCTH) by National tuberculosis centre(NTC) with the aim to expand the services of DOTS to the general population. In this communication, we describe the experience of establishing a DOTS centre at Nepal's one of the premier medical institute and discuss the lessons learned. Since April 2002 to July 2004 (28 months), patients diagnosed with tuberculosis were enrolled for the treatment at the NMC DOTS clinic. 103 patients were diagnosed as suffering from tuberculosis, of them 8 patients were transferred out and 95 patients were given treatment at NMC DOTS clinic. Forty Patients were sputum positive cases, out of which 35 were new sputum positive cases and 5 were relapsed patients.20 patients had sputum negative pulmonary tuberculosis and 35 patients were diagnosed as having extra pulmonary tuberculosis. Cure rate of 97.0% (34/35) were achieved in the new sputum positive cases and 92.0% (37/40) in overall sputum positive cases. Despite tremendous patient load at tertiary care facility, it is possible to achieve a good sputum conversion and cure rate, by using DOTS.

Sleep apnoea syndrome in Nepal.

Sleep apnoea syndrome is a well recognized entity. Sleep studies of diagnosed patients with sleep apnoea were analyzed to understand the clinical profiles of Nepalese patients with this disorder. Eighty nine patients were diagnosed to have sleep apnoea syndrome during the period of 15 months starting from November 2003. All these patients were subjected to a detailed clinical evaluation including symptoms, presence or absence of other risk factors and co-morbidities, general physical and systemic examination and relevant investigations before performing polysomnography. Clinical profiles of patients who were confirmed to have sleep apnoea syndrome with apnoea hypopnoea index (AHI) more than five were included in the study. Forty one patients (46.1%) were found to have mild disease (AHI 6-20), 22 patients (24.7%) had moderate disease (AHI 21-40) and 26 patients (29.2%) were found to have severe disease. The common symptoms were snoring, excessive daytime sleepiness, frequent awakenings, nocturia, and choking spells during sleep. Obesity was found to be the most important risk factor associated with sleep apnoea. Males having collar size more than 16 inches and females with collar size more than 14.5 inches were found to have an increased risk to develop this problem. Hypertension (66.3%), chronic obstructive pulmonary disease (43.2%) and cardiac diseases (19.1%) were the common co-morbidities associated with this disorder. Sleep apnoea syndrome is not an uncommon problem in Nepalese population. It could be the cause of various cardiovascular problems and may complicate patients with chronic obstructive pulmonary disease.