Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal.

Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography. Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics. Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 nondiabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI. Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration < 10 years (64.7% vs. 35.3%, P < 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c > 8.5%). 72.2% of the patients with HbA1c > 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c < 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration > 10 years compared to patients with DM duration <10 years.

Epigenetic variation in OPRM1 gene in opioid-exposed mother-infant dyads.

Neonatal abstinence syndrome (NAS) due to in-utero opioid exposure has significant variability of severity. Preliminary studies have suggested that epigenetic variation within the µ-opioid receptor (OPRM1) gene impacts NAS. We aimed to determine if DNA methylation in OPRM1 within opioid-exposed mother-infant dyads is associated with differences in NAS severity in an independent cohort. Full-term opioid-exposed newborns and their mothers (N = 68 pairs) were studied. A DNA sample was obtained and then assessed for level of DNA methylation at 20 CpG sites within the OPRM1 promoter region by next-generation sequencing. Infants were monitored for NAS and treated with replacement opioids according to institutional protocol. The association between DNA methylation level at each CpG site with NAS outcome measures was evaluated using linear and logistic regression models. Higher methylation levels within the infants at the -18 (11.4% vs 4.4%, P = .0001), -14 (46.1% vs 24.0%, P = .002) and +23 (26.3% vs 12.9%, P = .008) CpG sites were associated with higher rates of infant pharmacologic treatment. Higher levels of methylation within the mothers at the -169 (R = 0.43, P = .008), -152 (R = 0.40, P = .002) and +84 (R = 0.44, P = .006) sites were associated point-wise with longer infant length of stay. Maternal associations remained significant point-wise for -169 (ß = 0.07, P = .007) and on an experiment-wise level for +84 (ß = -0.10, P = .003) using regression models. These results suggest an association of higher levels of OPRM1 methylation at specific CpG sites and increased NAS severity, replicating prior findings. These findings have important implications for personalized treatment regimens for infants at high risk for severe NAS.

Prevalence and Risk Factors of Diabetic Peripheral Neuropathy in T2DM Patient Presenting to Community Hospital in Nepal.

Background Diabetic peripheral neuropathy (DPN) is a well-known microvascular complication of type 2 diabetes mellitus (T2DM) attributed to chronic hyperglycemia, and is defined as the presence of peripheral nerve dysfunction in patients with diabetes after exclusion of other causes. Objective To determine the prevalence and risk factors of Diabetic Peripheral Neuropathy among type 2 diabetes mellitus patients. Method A cross sectional study was carried out in a University Teaching Hospital. Type 2 diabetes mellitus patients with diabetes duration of more than 6 months were recruited. Michigan Neuropathy Screening Instrument Scoring was used to diagnose Diabetic Peripheral Neuropathy. Result Among a total of 160 patients who were enrolled, 61 (38.1%) had diabetic peripheral neuropathy and 26 (16%) had diabetic peripheral neuropathy within 1 year of being diagnosed with diabetes. Mean Diabetes duration was 5.56 years and mean age was 57.32 years, with 90 (56%) of the participants being female. The mean HbA1c was 8.33%. Among them 25% of the participants were alcoholics and 30% were smoker. No statistically significant risk factors are evident on multivariate analysis. Conclusion Diabetic peripheral neuropathy was found to be highly prevalent in patients with type 2 diabetes including the patients with relatively shorter diabetes duration. This finding warrants the need of improving the preventive measures and quality of care related to foot complication among patients with type 2 diabetes.

Study of Adherence Pattern of Antidepressants in Patients with Depression.

Background Depression is one of the leading psychiatric disorders of the world affecting a person's mood, physical health and behavior. It is not permanent and is neither a character flaw nor a lack in discipline for a person to be ashamed of. It is a disorder that is reliably diagnosed and successfully treated. Antidepressants are the standard and the most efficacious approach to treating people with depression. However, adherence to treatment is necessary for achieving effectiveness. The result of nonadherence is severe and may cause therapeutic failure resulting in poor quality of life. Objective To determine the medication adherence pattern in patients with depression and assess the factors associated with non-adherence to the prescribed antidepressant therapy. Method Patients meeting the inclusion criteria who were diagnosed with depression were taken for the study. Informed consent was taken from the patients or from their relatives in case of their incapability. They were then interviewed using structured questionnaire. Result Among the 60 patients included in the study, 78% of them were females. Most of the patients 43% (n=26) were prescribed with atypical antidepressants. Less number (37%) of the patients were adherent to the antidepressant therapy. 68% of the females were non adherent. 82% of housewives were not adherent to therapy. Forgetfulness was the main reason for missing dose in majority (50%) of the nonadherent patients. Conclusion Majority of the patients with depression were non-adherent to medication. Forgetfulness was the major reason for missing dose in these patients.

Fine needle aspiration cytology of neck masses in a hospital.

BACKGROUND: Fine needle aspiration cytology is a valuable technique in the work-up of masses arising within neck and represents a screening, inexpensive, and rapid technique to sample masses found in neck. METHODS: This study included 117 cases of neck masses, subjected to fine needle aspiration cytology at the department of Pathology of a hospital in Nepal from January 2013 to December 2013. RESULTS: The study included 117 patients with neck masses with median age of 37 years. The majority of the patients were in the age group of 20-29 yrs with female predominance. The most frequent cause of neck swelling is lymphadenopathy 65 (55.6%), followed by thyroid swelling 36 (30.7%), soft tissue lesion 12 (10.3%) and salivary gland lesions 4 (3.4%). The most common lesion in these patients was non-neoplastic, followed by malignant neoplasm. Tuberculosis is the most common cause of neck lymphadenopathy and colloid goiter is the commonest cause of thyroid swelling. In soft tissue, abscess is the most frequent one. Pleomorphic adenoma is more common than other salivary gland lesions. CONCLUSIONS: Lymphadenopathy is commonest cause of neck mass, followed by thyroid gland & soft tissue swellings. Tuberculosis is the most common diagnosis of neck masses, followed by colloid goiter. Fine needle aspiration cytology is pretty accurate technique to diagnose neck masses and it is helpful to avoid unnecessary surgeries and in general clinical management and it is recommended as a first line of investigation in the diagnosis of neck masses.

Histopathologic study of chronic antral gastritis.

BACKGROUND: Gastritis has a broad histopathologic and topographical spectrum and leads to different patterns of disease. The introduction of the Sydney system made it possible to grade histological parameters, identify topographic distribution and provide etiological information which would help to generate reproducible and clincally useful diagnoses. The aim of this study was to determine the prevalence of Helicobacter pylori in non-ulcer dyspepsia, duodenal ulcer and gastric ulcer; and to assess the histopathologic features associated with chronic gastritis. METHODS: Gastric antral biopsy specimens from 200 patients were examined for the prevalence of H. pylori, and were classified and graded histologically. RESULTS: The overall colonization rate of H. pylori was 44%. The colonization rates were 85%, 67% and 41% in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia respectively. There was not much difference between the degree of atrophy and intestinal metaplasia in H. pylori positive and negative cases. CONCLUSIONS: Helicobacter gastritis is the commonest type of gastritis present in patients presenting with dyspeptic symptoms. It is more common in patients presenting with duodenal ulcer. Adequate sampling is a must for accurate diagnosis of H. pylori colonization.

Bullying, mental health, and parental involvement among adolescents in the Caribbean.

OBJECTIVE: To examine the relationships between peer victimization, mental health, and parental involvement among middle school students in the Caribbean. METHODS: Data from the Global School-based Student Health Survey (GSHS) conducted in the Cayman Islands, St Lucia, St Vincent and the Grenadines, and Trinidad and Tobago in 2007 were analysed using age- and gender-adjusted logistic regression models. RESULTS: About one-quarter of the 6780 participants reported having been bullied in the past month. Rates of bullying were similar for boys and girls, and younger children reported higher rates of peer victimization. Nearly 25% of students reported sadness and hopelessness, more than 10% reported loneliness and anxiety and more than 15% reported having seriously considered suicide in the past year. Bullied students were much more likely than non-bullied students to report mental health issues (p < 0.01). Students who felt that their parents were understanding and monitored their free time activities reported fewer mental health issues and were somewhat less likely to report being a victim of a bully. CONCLUSION: The strong association between bullying and poor mental health in the Caribbean emphasizes the need to develop and implement strategies for reducing bullying among children and adolescents.

Effects of inhibition of prostaglandin F2α biosynthesis during preluteolysis and luteolysis in heifers.

Flunixin meglumine (FM; 2.5 mg/kg) was given to heifers at three 8-h intervals, 16 d after ovulation (first treatment = Hour 0) to inhibit the synthesis of prostaglandin F(2α) (PGF), based on plasma concentrations of a PGF metabolite (PGFM). Blood samples were collected at 8-h intervals from 15 to 18 d in a vehicle (control) and FM group (n = 16/group). Hourly samples were collected from Hours -2 to 28 in 10 heifers in each group. Heifers that were in preluteolysis or luteolysis at Hour 0 based on plasma progesterone (P4) concentrations at 8-h intervals were partitioned into subgroups. Concentration of PGFM was reduced (P < 0.05) by FM treatment in each subgroup. For the preluteolytic subgroup, the first decrease (P < 0.05) in P4 concentration after Hour 0 occurred at Hours 24 and 40 in the vehicle and FM groups, respectively. Plasma P4 concentrations 32 and 40 h after the beginning of luteolysis in the luteolytic subgroup were greater (P < 0.05) in the FM group. Concentration at the peak of a PGFM pulse in the FM group was greater (P < 0.05) in the luteolytic than in the preluteolytic subgroup. The peak of a PGFM pulse occurred more frequently (P < 0.001) at the same hour as the peak of an LH fluctuation than at the ending nadir of an LH fluctuation. In conclusion, a reduction in prominence of PGFM pulses during luteolysis delayed completion of luteolysis, and treatment with FM inhibited PGFM production more during preluteolysis than during luteolysis.

Increase in progesterone and luteal blood flow without a luteolytic response after prostaglandin F2α treatment in early luteal-phase heifers.

Acute changes in circulating progesterone concentration and luteal blood flow in heifers after a conventional dose of prostaglandin F(2α) (PGF; 25mg dinoprost, i.m.) were compared between the early luteal phase (Day 3) and midluteal phase (Day 10; Day 0=ovulation), using four groups (Day-3 control, Day-3 PGF, Day-10 control, and Day-10 PGF; n=6 heifers/group). Blood samples were collected at 0, 2, 5, 10, 15, 30, 60, and 120 min (0 min=treatment). Percentage of luteal area with color-Doppler blood-flow signals was estimated at 0, 10, and 30 min. In the Day-3 and Day-10 PGF groups, progesterone increased to a peak at 15 min. In the Day-3 PGF group, progesterone decreased to the pretreatment concentration by 60 min but did not decrease to below the pretreatment concentration during the 2-h experimental period. In the Day-10 PGF group, progesterone decreased to below pretreatment concentration by 30 min, indicating a luteolytic response. In the Day-3 and Day-10 PGF groups, luteal blood flow increased within 10 min and remained elevated until the last examination at 30 min. The absence of a decrease in progesterone to below pretreatment concentrations in the Day-3 PGF group indicated that luteolysis does not necessarily follow a transient increase in progesterone and a concomitant increase in luteal blood flow. The immediate transient increase in progesterone and an increase in luteal blood flow without a subsequent decrease in progesterone to below pretreatment concentrations after PGF treatment in early luteal-phase heifers are novel findings.

The transition between preluteolysis and luteolysis in cattle.

Novel characterization of the transition between preluteolysis and luteolysis was done in seven heifers. Blood samples were collected hourly and assayed for progesterone (P4), 13-14-dihydro-15-keto-PGF2α (PGFM), and estradiol (E2). The peaks of P4 oscillations were used to designate the transitional hour in each heifer. The interval from the peak of the last PGFM pulse of preluteolysis to the peak of the first pulse during luteolysis (transitional period) was longer (P < 0.0001) than the interval between the first and second pulses during luteolysis (13.4 ± 1.3 h vs. 7.0 ± 0.9 h). The long intervals from the last PGFM pulse of preluteolysis to the transitional hour (4.0 ± 0.9 h) and from the transitional hour to the first PGFM pulse of luteolysis (9.4 ± 1.3 h) resulted in the illusion that the beginning of luteolysis was not associated temporally with a PGFM pulse. The E2 and PGFM concentrations were less (P < 0.05) during the last PGFM pulse of preluteolysis than during the first pulse of luteolysis. Concentration of P4 was suppressed at the peak of the last PGFM pulse of preluteolysis and consistently rebounded at the transitional hour to the concentrations before the PGFM pulse. In four of seven heifers, one or two P4 rebounds occurred between the peak of the PGFM pulse and the rebound at the transitional hour. Results indicated that the prolonged transitional period may be related, at least in part, to increasing concentration of E2, intervening P4 rebounds between the peak of the last PGFM pulse of preluteolysis and the transitional hour, and the complete P4 rebound at the transitional hour.

Concomitance of luteinizing hormone and progesterone oscillations during the transition from preluteolysis to luteolysis in cattle.

The temporal relationships of episodes of luteinizing hormone (LH) oscillations, 13,14-dihydro-15-keto-PGF2α (PGFM) pulses, and progesterone (P4) fluctuations during the latter portion of preluteolysis and the early portion of luteolysis were characterized. In Experiment 1, the detection of LH episodes in blood samples collected every 15 min for 8 h was compared with detection in the samples collected every hour in 4 heifers. The number of independently detected episodes/heifer (total = 7) was the same for the 15-min and hourly collection intervals. In Experiment 2, blood samples were collected every hour (n = 7 heifers) and retrospectively assigned to 15 h before and 15 h after the transitional hour between preluteolysis and luteolysis. During preluteolysis, compared with luteolysis, the amplitude of LH oscillations was greater (0.28 ± 0.03 vs 0.18 ± 0.03 ng/mL; P < 0.02) and the interval between peaks of LH oscillations was shorter (3.3 ± 0.3 h vs 4.3 ± 0.6 h; P < 0.04). The LH peaks occurred at the same hour as the peak of a P4 fluctuation in 77% and 29% of LH oscillations (P < 0.0009) during preluteolysis and luteolysis, respectively. In preluteolysis, synchrony between LH and P4 episodes occurred consistently during the P4 rebound after the peak of a PGFM pulse. In luteolysis, the LH peak preceded the peak of the P4 rebound. On a temporal basis, the hypothesis was supported that episodic LH accounts, at least in part, for the reported P4 rebound that occurs after the P4 suppression at the peak of a PGFM pulse.

Circulating hormone concentrations within a pulse of a metabolite of prostaglandin F2α during preluteolysis and early luteolysis in heifers.

Plasma from hourly blood samples from two previous studies in heifers was assayed for hormones that were not considered in the previous reports. The objective was to determine the intrapulse temporal relationships between a prostaglandin F2α metabolite (PGFM) pulse and various hormones during preluteolysis and luteolysis. Hormone concentrations were centralized to the peak of a PGFM pulse (Hour 0) and evaluated from Hours -3 to 3. Experiment 1 (n=6) was done during early luteolysis. Progesterone decreased during Hours -3 to 0 and then rebounded, but did not return to prepulse concentrations, and concentration of LH increased between Hours -1 and 2. In Experiment 2 (n=7), comparisons were made between the last PGFM pulse of preluteolysis and the first pulse of luteolysis. Intrapulse concentrations of LH increased rapidly between Hours 0 and 1 during preluteolysis and gradually between Hours -2 and 2 during luteolysis. Intrapulse differences in cortisol among hours were not significant for preluteolysis and approached significance (P<0.06) during luteolysis, owing primarily to an apparent increase between Hours -2 and 1. Oxytocin concentrations showed only an hour effect (P<0.0003) from to an increase between Hours -2 and 0 and a decrease between Hours 0 and 2. Results indicated that oxytocin and PGFM concentrations increased and decreased concomitantly and supported the hypothesis that the reported more prominent rebound in progesterone during the descending portion of a PGFM pulse during preluteolysis than during luteolysis involves a greater transient increase in LH.

Intrapulse temporality between pulses of a metabolite of prostaglandin F 2α and circulating concentrations of progesterone before, during, and after spontaneous luteolysis in heifers.

Pulses of the prostaglandin F(2α) (PGF) metabolite 13,14-dihydro-15-keto-PGF(2α) (PGFM) and the intrapulse concentrations of progesterone were characterized hourly during the preluteolytic, luteolytic, and postluteolytic periods in seven heifers. The common hour of the end of preluteolysis and the beginning of luteolysis was based on a progressive progesterone decrease when assessed only at the peaks of successive oscillations. The end of the luteolytic period was defined as a decrease in progesterone to 1 ng/mL. Blood samples were taken hourly from 15 d after ovulation until luteal regression as determined by color-Doppler ultrasonography. Between Hours -2 and 2 (Hour 0 = PGFM peak) of the last PGFM pulse of the preluteolytic period, progesterone decreased between Hours -1 and 0, and then returned to the prepulse concentration. Concentration did not change significantly thereafter until a PGFM pulse early in the luteolytic period; progesterone decreased by Hour 0 and transiently rebounded after Hour 0, but not to the prepulse concentration. In the later portion of the luteolytic period, progesterone also decreased between Hours -1 and 0 but did not rebound. After the defined end of luteolysis, progesterone decreased slightly throughout a PGFM pulse. Results demonstrated for the first time that the patterns of progesterone concentrations within a PGFM pulse differ considerably among the preluteolytic, luteolytic, and postluteolytic periods.

Intrapulse changes in progesterone and LH concentrations and luteal blood flow during an estradiol-induced pulse of a metabolite of prostaglandin F2alpha in heifers.

Physiologic doses (0.1 mg followed by 0.05 mg 1h later) of estradiol-17beta in sesame-oil vehicle or vehicle alone (n=6/group) were given to heifers on day 14 after ovulation (preluteolysis) to study the effect of estradiol (E2) on circulating 13,14-dihydro-15-keto-PGF2alpha (PGFM) and on PGFM pulses. Blood samples were collected hourly for 10h after the 0.1-mg treatment. The E2 group had an increase (P<0.03) in PGFM concentration by 4h and greater (P<0.0001) prominence of the PGFM pulses. Changes in progesterone and LH concentrations and luteal blood flow within a PGFM pulse were characterized. Within a PGFM pulse in the E2 group, progesterone decreased (P<0.04) between Hours -2 and 0 (ascending portion; Hour 0=peak of pulse) and increased (P<0.04) between Hours 0 and 2 (descending portion). Intrapulse changes in progesterone were not detected in the vehicle group. Concentration of LH in the E2 group increased (P<0.05) between Hours -1 and 1 and in the vehicle group decreased (P<0.03) between Hours -1 and 0 and increased (P<0.06) between Hours 0 and 1. The percentage of luteal area with blood-flow signals increased (P<0.02) between Hours 0 and 1 in the E2 group, and there were no other differences between hours in either group. Results were consistent with reports of changes in progesterone concentration within a PGFM pulse in cattle and demonstrated intrapulse changes in LH concentration and luteal blood flow during an E2-induced PGFM pulse.

Stimulation of pulses of 13,14-dihydro-15-keto-PGF2alpha (PGFM) with estradiol-17beta and changes in circulating progesterone concentrations within a PGFM pulse in heifers.

A single physiologic dose (0.1 mg) of estradiol-17beta in sesame-oil vehicle or vehicle alone (n = 8) was given to heifers on day 14 after ovulation to study the effect on circulating 13-14-dihydro-15-keto-PGF2alpha (PGFM), PGFM pulses, and changes in progesterone concentrations within a PGFM pulse. Blood samples were collected hourly for 16 h after treatment. The estradiol group had a greater mean concentration of PGFM, greater number of heifers with PGFM pulses and number of pulses/heifer, and greater prominence of the PGFM pulses. Changes in progesterone concentrations were not detected during the 16 h sampling session in the vehicle group, indicating that the heifers were in preluteolysis. Progesterone decreased after 12 h in the estradiol group, indicating a luteolytic effect of the estradiol-induced PGF secretion as represented by PGFM concentrations. Intrapulse changes in progesterone were detected during a PGFM pulse in the estradiol group (P < 0.006), but not in the vehicle group. Progesterone increased (P < 0.01) between Hours -2 and -1 of an estradiol-induced PGFM pulse (Hour 0 = peak of pulse), decreased (P < 0.004) between Hours -1 and 0, and increased (P < 0.01) or rebounded between Hours 0 and 1. Results were compatible with previous reports of a role for estradiol in the induction of PGFM pulses in cattle and demonstrated intrapulse changes in progesterone concentrations during an induced PGFM pulse.

Characteristics of pulses of 13,14-dihydro-15-keto-prostaglandin f2alpha before, during, and after spontaneous luteolysis and temporal intrapulse relationships with progesterone concentrations in cattle.

Pulses of the prostaglandin F2alpha (PGF) metabolite 13,14-dihydro-15-keto-PGF (PGFM) were compared among heifers that were in the preluteolytic, luteolytic, and postluteolytic periods (n = 7 or 8 heifers/period). Hourly blood sampling was done in 18-h sessions 15, 16, or 17 days after ovulation. Hourly sampling and statistical identification of a PGFM pulse allowed novel comparisons of PGFM pulses among the three periods. Each period had a similar number of PGFM pulses (2.3 +/- 0.2). The pulses were more prominent during the luteolytic period than during the other periods, as indicated by significantly greater concentration for the peak and amplitude between nadir and peak. Significantly more fluctuations that did not meet the definition of a pulse occurred at the beginning of the preluteolytic period and end of the postluteolytic period than during the luteolytic period. The same nadir ended a pulse and began the next pulse in 85% of adjacent pulses. Seven heifers were selected objectively, based on a progesterone concentration >5 ng/ml at Hour -3 (Hour 0 = peak of PGFM pulse) and a progressive decrease in progesterone from Hours -3 to 0. Progesterone increased (P < 0.03) between Hours 0 and 1, remained at a mean plateau at Hours 1 and 2, and then decreased. Results support the hypothesis of a transient intrapulse rebound in progesterone during an individual PGFM pulse, but only during the first portion of luteolysis. These findings should be considered in future proposals on the mechanisms involved in the effects of PGF on progesterone concentrations.

Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens.

Cholecystectomized specimens are one of the frequently encountered specimens in daily routine histopathological work in the pathology department. With the expectation that most of the gallbladder specimens harbor benign disease, it is at times surprising to find occult malignancy. This study aims to find out the frequency of primary gallbladder carcinoma and incidental primary carcinoma, detected during routine histological examination of gallbladder specimen that were submitted in pathology department of Nepal Medical College Teaching Hospital (NMCTH) as well as to assess the need of histopathological examination of cholecystectomy specimens. Retrospective study was done in total 668 cases of cholecystectomies specimens submitted in NMCTH histopathology department during 5 yrs of duration from Jan 2003 to Dec 2007. There were total 22 cases of primary gallbladder carcinoma and 2 cases of metastatic cholangiocarcinoma in gallbladder. The incidence rate of primary malignancy was 3.3% and was commonly found in female at 7th decade of their life. Adenocarcinomas were the most common histological type with poor differentiation and diagnosed frequently at stage IIA. The rate of incidental primary carcinoma of gallbladder was 1.4%, detected commonly at stage I. Combined preoperative and intraoperatively, only 55.0% of histologically proven gallbladder malignancies were correctly identified. Intraoperative findings of incidental carcinomas included thickened GB (3 cases), distended GB (2 cases), GB polyp (1 case) and no obvious abnormality were mentioned in 3 cases. Therefore, every cholecystectomy specimen should be examined histopathologically to detect possible incidental carcinomas.

Clinicopathologic profile of bronchogenic carcinoma.

INTRODUCTION: Bronchogenic carcinoma is the most common cancer in the world. It can present in many ways. Accurate diagnosis and categorization into different types is important because of its effect on prognosis and management. We conducted this study to find out the frequency of various histological types of bronchogenic carcinoma and correlate with their clinicopathologic profile. METHODS: This is a retrospective study conducted in 174 histopathologically proven cases of bronchogenic carcinoma that were referred from different parts of the country to a private hospital in Kathmandu over a period of 4 years. RESULTS: The mean age of the patients developing bronchogenic carcinoma was 64 years. Squamous cell carcinoma was the commonest histologic subtype followed by small cell carcinoma. Adenocarcinoma was more common in females. Clinical history was available in 133 cases. Among them, almost all patients had a history of smoking, the average number of pack years being 39.99. Most of the patients consulted doctor for chief complaint of cough and shortness of breath, the average duration of symptoms being 117.53 days. CONCLUSIONS: The lung cancer must be ruled out in all patients who have persistent signs and symptoms of pulmonary disease with a history of smoking.

Peritonitis in Continuous ambulatory peritoneal dialysis.

INTRODUCTION: Access to hemodialysis is limited in Nepal due to geographical terrain and hemodialysis centers being mostly limited to major city. Therefore, continuous ambulatory peritoneal dialysis is likely to be a better option in Nepal. In 1998, CAPD was initiated in Nepal without success. High rate of peritonitis was cited for failure. Hot tropical climate and poor sense of hygiene among patients was thought to be responsible for the high rate of peritonitis. A new CPD program was started in 2002 in our institute. We reviewed the incidence of peritonitis and factors predisposing. METHODS: All chronic renal failure patients on CAPD since 2002 to 2007 were included in the study. They were followed up for complications and treatment outcome. Patients complicated with peritonitis (N=19) and patients without peritonitis (N=31) were compared. RESULTS: A total of 50 patients were enrolled and mean duration of dialysis was 12 month per patients (Total patients month=600). Twenty six episodes of peritonitis in 19 patients were recorded during this period. Fourteen episode of peritonitis were culture positive. Culture sterile peritonitis was recorded in 12 episodes. Low serum albumin was predisposing factors for peritonitis and peritonitis rate was higher in end stage disease related due to diabetes mellitus. CONCLUSION: Peritonitis rate was comparable in our new program. Thus peritonitis is not a limiting factor for growth of CAPD in Nepal. Hypoalbuminemic and diabetic patients are prone for CAPD related peritonitis.

Dynamic progesterone responses to simulation of a natural pulse of a metabolite of prostaglandin F(2alpha) in heifers.

The effects of prostaglandin F(2alpha) (PGF) on circulating progesterone concentration were studied in four groups (n=4) of Holstein heifers 9d after ovulation. The progesterone response to simulation of a pulse of 13,14-dihydro-15-keto-PGF (PGFM) by a 2-h intrauterine (IU) infusion of 0.5mg of PGF was compared with the response to a PGF-bolus IU injection of 4mg. The beginning of infusion and time of injection were designated Minute 0. Progesterone concentration did not change significantly between Minute 0 and Hour 48 in control or IU vehicle-treated groups. In the PGF-bolus group, progesterone concentration increased (P<0.05) between Minutes 0 and 10 and then decreased. In the PGF-infusion group, simulation of a PGFM pulse was not associated with an initial transient increase in progesterone. The first significant decrease (P<0.05) in progesterone began at Minute 20 and continued until Hour 1. The progesterone concentration then began to rebound (P<0.05) at Hour 1 and peaked at Hour 3 at almost the same concentration as at the start of PGF infusion. The progesterone again decreased after Hour 3 and increased again between Hours 24 and 48. In summary: (1) an initial transient increase in progesterone was not detected in association with an individual simulated pulse of PGF, indicating that the frequently reported pronounced transient increase after a bolus luteolytic dose of PGF is a nonphysiological response and (2) simulation of a PGFM pulse resulted in a distinct transient rebound in progesterone beginning at Hour 1 of the PGF infusion.