Obesity attenuates formalin-induced tonic pain in British Angora Rabbits.

Obesity is known to alter various physiological parameters including the pain sensitivity. There are conflicting reports on the pain sensitivity in obesity. In this context, the present study was aimed to investigate the tonic pain response in obese rabbit model. To achieve this aim, two groups of adult male British Angora rabbits were used. One of the groups was fed with standard rabbit chow and served as control. The other group was fed high fat diet (HFD) for 10 weeks to produce obesity. The standard formalin test was performed at the start and after 10 weeks of dietary regimen in both the groups. Timed behavioral responses (limping, elevation of paw, licking, biting, grooming etc.) were categorized and quantified with the help of standard pain rating scale. The total average pain rating score decreased significantly from 2.01 ± 0.02 to 1.47 ± 0.08 (P<0.05) in HFD group after 10 weeks of dietary regimen, whereas there was no change in the control group. A significant negative correlation was observed between body weight and pain rating score in HFD group of rabbits (P<0.05, r=–0.62). Results suggest that obesity attenuates the tonic pain responses induced by formalin in British Angora rabbits.

High fat diet induces obesity in British Angora Rabbit : A model for experimental obesity.

A reliable and cost-effective animal model for human obesity with its manifested disorders is yet to be established in the context of increased morbidity and mortality due to obesity and its related problems. Therefore, an attempt was made to produce obesity in locally available British Angora Rabbits (BAR) and examine the effect on metabolic and cardiovascular parameters. Adult male BARs weighing nearly 2 kg were randomly divided into two groups, one of the groups was fed with high fat diet (HFD) ad libitum for 10 weeks and the control group received standard normal rabbit chow for same period. Body weight, skinfold thickness, serum cholesterol, serum glucose and resting heart rate were measured before and after the dietary regimens. After 10 weeks, HFD group of rabbits demonstrated significant (P<0.05) increase in body weight (+24%) and skinfold thickness (+37%). The gain in body weight was positively correlated to skinfold thickness (r=0.61). Serum cholesterol, serum glucose and resting heart rate were also increased by 46%, 52% and 15%, respectively. Whereas no such increases in any of these parameters were observed in control group of rabbits. Our results suggest that obesity can be produced in BARs by feeding HFD. The obesity manifests with cardiovascular and metabolic changes. It is proposed that this may serve as a valid and reliable model of experimental obesity.

Prevalence of methicillin resistant Staphylococcus aureus in school children of Pokhara.

Present study was carried out to find out the prevalence of methicillin resistant Staphylococcus aureus (MRSA) in school children of Pokhara city in western, Nepal. A total of 184 randomly selected children younger than 15 years were included in the study. Nasal swabs collected were subjected to standard bacteriological culture. S. aureus isolates were identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on muller-hinton agar (MHA) by modified Kirby-Bauer disc diffusion method. Out of total 184 nasal swabs, S. aureus was isolated in 31.0% (n=57). Among the isolates, 35.1% (n=20) were from male children whereas 64.9% (n=37) were from female. There was no significant sex difference in colonization of S. aureus. Out of 57 isolates, 56.1% (n=32) were MRSA. MRSA isolates indicated relatively high rate of resistance to antibiotic cloxacillin (68.7%) followed by ofloxacin (40.6%), tetracycline (15.6%), erythromycin (9.4%), ciprofloxacin (6.2%) and vancomycin (3.1%).This study showed a high prevalence of MRSA carriage in school children indicating the spread of MRSA in the community.

Sarcoidosis--three clinical vignettes with a short review.

Sarcoidosis is a multi system disorder of unknown cause most commonly affecting the young and middle age adults and frequently presents bilateral hilar lymph-adenopathy. The diagnosis of sarcoidosis is often delayed following the onset of symptoms. The reason being first, the disease is often sub clinical; second as the disease affects any system, the diagnosis of sarcoidosis may not be considered; third, the symptoms are not disease specific hence often treated as other chronic pulmonary diseases; finally economic issues or barriers to access for further workup may affect the timeliness of the diagnosis. No laboratory diagnosis is specific for diagnosing sarcoidosis but histological confirmation from the lymph nodes accessible for biopsy either direct or by intervention may be more specific.

Parkisonism with Shy-Drager syndrome--a case report.

A previously healthy 60 years old female patient presented with bradykinesia, postural instability and increased rigidity of both upper and lower limbs for 2 years and was diagnosed as Parkinsonism for last years. Later on she developed features of autonomic dysfunction including postural hypotension, hyperhydrosis and urinary incontinence so was diagnosed as Shy-Drager Syndrome. She was treated with fludrocortisone and nefidipine for the management of postural hypotension. Patient developed aspiration pneumonia during oral feeding, despite of ICU management for the same cause patient died of respiratory arrest.

Why treat? Better prevent: adult immunization.

Immunization is a safe, effective and simple way to prevent life threatening illnesses not only in children but also in adults. Vaccines are some of the safest medicines available which can relieve suffering costs related to these preventable diseases. The reason for underutilization of vaccines in adults are 1) Low prioritization of the importance of vaccines preventable diseases among adults 2) Uncertainty or lack of knowledge about the safety and efficacy 3) Lack of universal recommendations for all adults and 4) Financial constraints, especially in developing countries. Adult immunizations are administered in primary series like previously immunized, booster doses and periodic doses. Agents include Toxoids (Diphtheria and Tetanus), Live Virus Vaccines (Measles, Mumps and Rubella), and inactivated virus vaccines (Influenza), Inactive viral particles (Hepatitis B), inactivated bacterial polysaccharide vaccine (Pneumococcal) and Conjugate / Polysaccharide vaccine (Meningococcal). And also vaccines like Hepatitis A, Polio and Varicella may be recommended in some. Since the economy and literacy rate has shown a steady rise in the South Asia and people are being aware of different health problems through the recently advanced global communication, the education and awareness for immunization not only in children but also in adults need a special consideration. Keeping in view the statistical data of suffering costs related to the non-utilization of immunization in adults, the need of hour has come for utilization of immunization to emphasize its importance.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role.

INTRODUCTION: As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD. OBJECTIVE: The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development. MATERIAL AND METHODS: It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital. RESULTS: The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients. CONCLUSION: Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.

Can homemade alcohol (Raksi) be useful for preserving dead bodies? An experiment on wistar albino rats.

INTRODUCTION: Embalming is the through disinfection and art of preserving bodies after death using chemical substances. It keeps a body life like in appearance during the time it lies in a state prior to funeral. OBJECTIVE: This study was undertaken to investigate the effectiveness of Raksi in sacrificed rats in arresting postmortem changes and establishing scientific fact whether Raksi can be an alternative to standard embalming constituent if it is not available. MATERIAL AND METHODS: 50 albino rats were systematically randomized into control and experiment groups. Raksi and distilled water were injected for embalming purpose intraventricularly in experiment and control groups of rats respectively and kept for 48 to 96 hours for observation for postmortem changes. RESULT: Observations made at 48 and 72 hours of embalming revealed that Raksi can arrest postmortem changes in the rats up to 72 hours (3rd day) successfully in the experimental group whereas moderate to severe postmortem changes were seen in the control group. The experimental group showed mild degree of putrefactive changes, liberation of gases and liquefaction of tissues only at 96 hours (4th day) of embalming. DISCUSSION: The Raksi used in this experiment contained 34% of alcohol, which was determined by an alcohol hydrometer. Experiment clearly demonstrated from its result that raksi can be utilised temporarily for embalming since it contains alcohol and has preservative, bactericidal and disinfectant properties. CONCLUSION: It is concluded from the study that this knowledge if applied to dead human subjects, may preserve dead bodies temporarily allowing delayed funeral.

Two faces of major lower limb amputations.

OBJECTIVES: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. MATERIAL AND METHODS: We retrospectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH), Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC. Major amputation was defined as any amputation at or proximal to wrist and ankle. RESULTS: Major lower limb amputations constituted 73.58%(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54%) followed by Congenital limb conditions (22.72%), Spina bifida with trophic ulcers ( 20.45%), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. CONCLUSION: Main causes of major lower limb amputation in both population is largely preventable by instituting safety measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults.

Results of simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip.

OBJECTIVES: To assess the results of simultaneous open reduction and Salter Innominate Osteotomy for developmental dysplasia of the hip in our context where there is a tendency for these cases to present late without having undergone any treatment previously. MATERIAL AND METHOD: We retrospectively reviewed the record files and radiographs of 22 dislocated hips of 20 patients managed with simultaneous open reduction and Salter osteotomy at Hospital and Rehabilitation Centre for Disabled Children from 1999 to 2001. Only eight patients with 9 hips with purely developmental dysplasia of hip aged one to seven years were included. The acetabular index on the initial and final radiographs was measured. The neck shaft angle was also measured. All radiographs were evaluated to determine the presence of avascular necrosis of the femoral head and position of the head after the operation. Clinical results were determined using modification of the McKay criteria (Pain, ROM, LLD, Containtment and Gait) . Follow-up ranged from a minimum of 1 year to a maximum of 5 years (average 3 years and 1 month). RESULTS: The results were excellent in 7 hips (77.77%) good in 1 hip (11.11%) and poor in 1 hip (11.11%) according to modified McKay criteria.. No complications related to infection, graft fracture, vascular or neural injury were encountered. CONCLUSION: When case selection for surgical treatment is appropriate, a reasonable excellent to good result can be expected even in cases such as ours which present late.

Effect of graded head-up tilt on parasympathetic reactivity.

Thirteen healthy subjects were tested for parasympathetic reactivity during head-up tilt and reversal of the tilt. Head-up tilt (70 degrees) resulted in significant increase in baseline heart rate and diastolic blood pressure. Head-up tilt also led to increased parasympathetic reactivity as measured by Valsalva manoeuvre and hand grip test. Heart rate response to deep breathing test did not change. The reversal of the tilt led to returning of heart responses to original values. Responses indicate towards enhanced parasympathetic reactivity during head-up tilt position.