Screening for Hypertension and Obesity in Rural Population of Nepal.

Background Hypertension is a major non-communicable disease and obesity is a risk factor for non-communicable diseases around the globe. The prevalence of hypertension and obesity is gradually increasing in Nepal. Most cases in the rural population of Nepal remain undiagnosed due to lack of routine screening and awareness. Objective To screen the cases of hypertension and obesity in a rural population of Nepal and also to depict the association between them. Method A cross sectional study was used to collect data on age, sex, height, weight and blood pressure through a screening health camp. Only the respondents who were not already taking antihypertensive drugs were included in this study. The measurement of blood pressure and body mass index was done using standard instruments. Joint National Committee VII classification was used to classify hypertension and World Health Organization classification was used for Body Mass Index. Analysis was done in IBM SPSS version 20. Result Out of the total respondents, 69.8% were female and 30.2% were male, and mean age was 48.73 (±16.25) years. Among them, 375 (30.17%) respondents were found to be hypertensive and 137 (11.02%) were pre-hypertensive. Similarly, 27% male participants and 72 % female participants were obese. Almost three-fifths of the obese participants were hypertensive. Conclusion Pre-hypertension and hypertension were seen in 11.02% and 30.17% of the study population respectively. As routine screening of hypertension and obesity is not done in our country, most of them remain undiagnosed.

A Case of Rare Choroidal Tumor, Choroidal Osteoma.

Choroidal osteoma is a rare benign tumor of unknown etiology, commonly found in young asymptomatic females in their second or third decade of life. It typically appears as an orange-yellow to yellow-white lesion in juxtapapillary region which can extend over to involve macula. Lesion solely located in macular region is less common. Diagnosis is based on fundoscopic appearance and findings of ancillary tests like B scan ultrasonography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and computerized tomography (CT) scan. We report a case of unilateral macular choroidal osteoma in a fifteen-year-old girl with normal vision.

Outcome of treatment of nonunion tibial shaft fracture by intramedullary interlocking nail augmentated with autogenous cancellous bone graft.

To assess results of operative treatment of non union fracture shaft of Tibia by intramedullary interlocking nail augmented with autogenous cancellous bone graft in our setup. A total of 25 nonunion tibial shaft fractures were evaluated among which 20 cases were male and 5 female with the mean age 31.84 years. Hypertrophic non-union were 14 and atrophic non union were 11. Upper one third of tibial diaphysis was involved in 4 cases, middle one third in 14 cases and lower one third in 7 cases. In all cases open reduction, interlocking nailing and autogenous cancellous bone graft was applied. The mean follow up was one year. Mean time for healing was 8.08 months. Mean operation time was 110 minutes (range 70 to 160 minutes). Satisfactory results (excellent and good) were achieved in 88% cases and unsatisfactory (fair and poor) results in 12% cases. This operative treatment option appears to have a high success rate and should be considered in nonunion of tibial diaphysis.

Systemic Wegener's granulomatosis with severe oculo-otological manifestations.

A case of Granulomatosis with Polyangiitis (Wegener's) is described in which the common presenting symptoms were hoarseness, deafness and ocular manifestations including marked redness and congestion of both eyes. The case findings and other systemic involvements are reviewed briefly along with histological and immunological discussions.

Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy.

This article summarises a prospective study to evaluate the long-term results produced by interosseous transfer of the tibialis posterior tendon for the correction of foot drop due to leprosy neuritis. The study was carried out in 120 feet in 69 patients. All patients had closed elongation of the tendo Achillis (ETA) before transfer of the bifurcated tibialis posterior tendon through the interosseous route to the tendons of tibialis anterior and peroneous tertius or brevis over the dorsum of feet. At final follow-up of average 24 months, all the patients with ETA had a significantly greater range of active dorsiflexion of more than 10 degrees above 90 degrees, which was not merely from the tenodesing effect. The results, in terms of improvement in gait and prevention of trophic changes, remained satisfactory. An interosseous route is preferred with split attachment to the tibialis anterior and to the peroneus brevis or tertius tendons.

The proximal femur--a second look at rational of implant design.

UNLABELLED: Twenty five pairs (50 bones) of cadaveric femora were studied morphologically and radio logically using standardized techniques to obtain anthropometric data to evaluate the applicability of internationally designed implant and to generate a database for proximal femur to help in design for future implant if these were found unsuitable. MEASUREMENTS: femoral head diameter, femoral neck diameter, diameter of proximal femur, canal width at above and below lesser trochanter and 7.5 cm below lower margin of lesser trochanter, endosteal and extracortical width, isthmus position from lesser trochanter, femoral neck anteversion, neck shaft angle and intramedullary axis of femur. The mean +/- SD of these values were calculated. These values were compared with those reported in the literature for Hong Kong Chinese, Caucasians and were found to be different. The implant designed for western population should be used judiciously and facture implant designed should be specific for (ours) bones. We found the pyriformis fossa is usually not in line with the intramedullary axis. Thus antegrade itramedullary nailing portal should be anterior and lateral to pyriformis fossa.

Anti-stress and anti-oxidant effects of roots of Chlorophytum borivilianum (Santa Pau & Fernandes).

The aqueous extract of C. borivilianum (250 mg/kg for 7 days) significantly reverted the elevated levels of plasma glucose, triglycerides, cholesterol and serum corticosterone and also reduced the ulcer index, adrenal gland weight more as effectively as the standard drug (diazepam) in rats. At 125 mg/kg po, it showed a mild anti-stress activity. Under in vitro 1,1-diphenyl-2-picrylhydrazyl (DPPH*) free radical scavenging assay and lipid peroxidation assay the extract considerably inhibited, in a dose-dependent manner, the levels of DPPH* free radicals and thiobarbituric acid reactive substances, respectively thus showing significant antioxidant property. The results suggested that it could be used for the treatment of oxidative stress-induced disorders.

Effect of rehabilitation facility location on outcomes in head and neck surgical patients.

The objective of this study was to determine the significance of in-hospital rehabilitation facility vs. distant rehabilitation facilities in the outcomes and complications of post-operative head and neck surgical patients. Retrospective review of head and neck surgical patients was conducted over a 5-year period at a tertiary care medical centre. Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma and eight patients had other primary malignancies of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles). Seventeen patients (34%) had complications including infection/drainage (seven patients), fistula (six patients), pneumonia (two patients), wound dehiscence (two patients) and other minor complications. The difference complication rate among the two groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P=0.496). The rate of hospital re-admission was not statistically significant (25% in-hospital rehabilitation patients, 16.7% distant rehabilitation patients; P=0.505). The average length of stay of patients without complications was 18.5 days (SD=5.8) for in-hospital rehabilitation and 12.9 days (SD=17) for distant rehabilitation. This difference was not statistically significant (P=0.346). In summary, one-third of post-operative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate and frequency of complications does not correlate with the proximity of the rehabilitation facility to the hospital where the patients received their surgery.

Improvement of the quality of whole wheat bread by supplementation of xylanase from Aspergillus foetidus.

The possible use of xylanase from Aspergillus foetidus MTCC 4898 as a bread improver was tested in whole wheat bread. The partially purified xylanase was used as an additive at 12 U/g during mixing of wheat flour. The effects of xylanase addition on the fermentation stage and the final bread quality were analyzed. Remarkable decrease (11%) in water absorption and increase in dough rising (28.5%) were noticed. Final moisture content of the bread was higher (40.5%) than control (32.3%). Improvements in volume (53%) and specific volume (56%) were also significant. Sensory evaluation indicated better flavour, taste, softness and overall acceptability. Texture profile analysis confirmed the rheological changes. Firmness was decreased by more than four folds. Improvements in cohesiveness and decline in springiness and gumminess were observed.

Mid-frequency sensorineural hearing loss: aetiology and prognosis.

OBJECTIVES: An audiometric finding of mid-frequency sensorineural hearing loss (MFSNHL), or a U-shaped pattern, is uncommon. The objective of this study is to investigate the aetiology and prognostic significance of MFSNHL. DESIGN: Tertiary academic referral centre-based retrospective case review and review of audiograms to determine the prevalence of this audiometric finding. METHODS: Patients with a pure tone threshold average at 1, 2, and 4 kHz at least 10 dB greater than the average at 0.5 and 8 kHz were included in this study; 35 patients met these criteria. The mean age of the patients was 34.6 years old (range 4-71 years). Twelve patients (33 per cent) were under 18 years of age. Serial audiograms were obtained for 14 patients. The notes were reviewed for any pertinent otologic history, subsequent diagnoses, management and disease course. RESULTS: The prevalence of MFSNHL in this practice setting is less than 1 per cent. The average hearing threshold in the mid-frequencies was 44 dB, which was 17 dB and 20 dB lower than at 0.5 Hz and 8 kHz, respectively. The pure tone average (0.5, 1, 2 kHz) was 40 dB. Sixteen patients (44 per cent) required amplification. Of all patients, 22 had hereditary hearing loss, eight had idiopathic hearing loss, and five adults had vestibular schwannomas. CONCLUSIONS: MFSNHL is an infrequent audiometric finding. The great majority of these cases are of presumed hereditary or idiopathic aetiology, although 22 per cent of adults had vestibular schwannomas. This series presents the causes and prognosis of this audiometric pattern.

Treatment of fracture dislocation of talus by primary tibiotalar arthrodesis (Blair fusion).

We present a retrospective clinical and radiological study of eight patients who underwent primary Blair tibiotalar arthrodesis for Hawkins' grade III fractures of the neck of talus. The average age of the patients was 23 years and the average follow-up, was 2 years. Results were good in six patients, fair in one and poor in one. It is concluded that the displaced talar fractures with late presentation are challenging to treat and Blair fusion is a reasonable procedure.

Acute pyogenic iliopsoas abscess in children in Nepal.

We describe a prospective study of twenty-four cases of acute pyogenic abscess of the iliopsoas in children treated conservatively and operatively. Eight patients were managed conservatively with antibiotics alone while sixteen others were managed operatively by open drainage. All made a complete recovery.

Adrenal oncocytoma: US and CT findings.

We describe a case of an oncocytoma occurring in the adrenal gland, a rare location, and describe US and CT findings of this tumor in our patient. The mass was well marginated but heterogeneous on both CT and US and unfortunately the imaging findings of the tumor are non-specific.

Surgical Implant Generation Network (SIGN) intramedullary nailing of open fractures of the tibia.

We treated 36 open tibial fractures (32 patients) by primary intramedullary nailing and debridement and treatment of open wounds. There were 13 grade I, 14 grade II and 9 grade III according to Gustilo-Anderson classification. After a minimum follow-up of 8 months, there were two cases of superficial infection and one of deep infection. Thirty-one fractures united within 6 months with a mean period to union of 22 weeks. There were four delayed unions and one non-union. There was a longer union time and a higher rate of delayed or non-union in the complex and/or comminuted grade IIIB fractures. Intramedullary nailing, with appropriate soft-tissue treatment, gives good results in the treatment of open tibial fractures.

Improving primary orthopaedic and trauma care in Nepal.

PURPOSE: To evaluate the efficacy of training programmes for the village health practitioners aimed at improving primary orthopaedic and trauma care in our rural setting. MATERIALS & METHODS: Six year prospective study of training workshops in local health institutions was carried out using locally available manpower and materials. RESULTS: After 6 years the evaluation of this programme shows a significantly improved (p < 0.05) knowledge base and working skills after completion of training workshop. SUMMARY: To avoid unnecessary complications, effective primary health care provided by an appropriately trained person should be available at the peripheral level. This training programme seems successful in achieving this goal and hence needs adoption for wider use in Nepal.

Pulsed-dye laser and retinoic acid delay progression of oral squamous cell carcinoma: a murine model.

OBJECTIVES/HYPOTHESIS: This study examined the role of the pulsed-dye laser (PDL) at 585 nm coupled with retinoic acid at therapeutic (5.0 mg/kg) and nontherapeutic (0.5 mg/kg) doses to delay the progression of cancer with a two-hit approach. The existing vasculature is selectively targeted by the laser, whereas retinoic acid inhibits future angiogenesis. STUDY DESIGN: Randomized, prospective study in a murine model. METHODS: Twenty-five athymic nude mice were inoculated with oral squamous cell cancers on six flank sites and randomly divided into five groups: 1) control subjects, 2) treatment with 0.5 mg/kg retinoic acid (RA 0.5), 3) treatment with 5.0 mg/kg retinoic acid (RA 5.0), 4) treatment with RA 0.5 + PDL, and 5) treatment with RA 5.0 + PDL. The PDL groups received irradiation after inoculation. The retinoic acid was administered daily. The tumors were counted and measured for 14 days. RESULTS: The control group developed visible tumors in 50% of the inoculation sites at 3 days compared with 3 days (RA 0.5) and 4 days (RA 5.0) for the retinoic acid groups and 9 days (RA 0.5 + PDL) and 10 days (RA 5.0 + PDL) for the laser treatment groups. There was no tumor growth until day 7 in the RA 5.0 + PDL group. The tumor volume was statistically different between the treatment groups. CONCLUSION: This study demonstrated the superiority of a single treatment with the PDL coupled with retinoic acid to delay the progression of cancer when compared with treatment with retinoic acid alone, thus introducing a novel strategy in cancer control.

Optical-thermal simulation of tonsillar tissue irradiation.

BACKGROUND AND OBJECTIVE: Despite laser applications targetted toward tonsillar tissue, there has been no characterization of underlying optical and thermal events during laser irradiation of tonsillar tissue. STUDY DESIGN/MATERIALS AND METHODS: The optical properties of canine and human tonsils were determined at 805 nm (diode laser) and 1,064 nm (Nd:YAG laser). An optical-thermal simulation was developed to predict the temperature rise in irradiated human tonsils. RESULTS: The optical properties of human and canine tonsillar tissue are similar at both wavelengths. The optical-thermal simulation was validated and predicts that at 10 W and 1 minute of irradiation, the heat will be contained within the human tonsil. The diode laser causes more superficial heating than the Nd:YAG laser. CONCLUSIONS: The safety of irradiating human tonsils was shown. The diode laser is superior to the Nd:YAG laser because less heat affects collateral structures. The optical-thermal simulation detailed in this study can be used to predict the temperature rise in tissues undergoing irradiation.

Optical-thermal simulation of human tonsillar tissue irradiation: clinical implications.

BACKGROUND AND OBJECTIVE: Mucosa intact laser tonsillar ablation is an alternative to conventional tonsillectomy. The efficacy of this procedure was demonstrated in canines, but establishing the safety of irradiating human tonsils is paramount. STUDY DESIGN/MATERIALS AND METHODS: An optical-thermal simulation of tonsillar tissue irradiation was previously developed, but the effect of varying parameters was not investigated. The tissue response to irradiation at 5-25 watts for 1 minute and 10 watts for 10 seconds to 162 seconds is simulated. RESULTS: At 15 watts and greater, the peak temperature is over 100 degrees C and the mucosal temperature is over 70 degrees C. At the depth of the tonsil, the temperature does not vary significantly. The peak temperature is at 1 mm. The radial temperature profile is not significantly altered by longer irradiation times. CONCLUSIONS: The optimal dosimetry parameters for irradiation of human tonsillar tissue at 805 nm with the MILTA technique is under 15 watts for approximately 1 minute.