Sydenham's Chorea with Silent Cardiac Lesions, Mimicking.

Sydenham's chorea is an uncommon neurological manifestation of rheumatic fever and has many and varied differential diagnosis. It may mimic encephalitis when presents as an isolated feature even when silent cardiac lesions are present. Early diagnosis, treatment and penicillin prophylaxis prevents recurrence and progression of cardiac lesions. Prompt symptomatic relief and alleviation of distress is obtained with therapeutic intervention. A case of rheumatic chorea with silent cardiac valve lesions which mimicked herpes simplex encephalitis with choreoathetosis, in a 13 year old girl is presented along with review of literature.

Variation of near surface atmosphere microbial communities at an urban and a suburban site in Philadelphia, PA, USA.

Microorganisms are abundant in the near surface atmosphere and make up a significant fraction of organic aerosols with implications on both human health and ecosystem services. Despite their importance, studies investigating biogeographical patterns of the atmospheric microbiome between urban and suburban areas are limited. Urban and suburban locations (including their microbial communities) vary considerably depending on climate, topography, industrial activities, demographics and other socio-economic factors. Hence, we need more location-specific data to make informed decision affecting air quality, human health, and the implication of a changing climate and policy decisions. The objective of this study was to describe how the atmospheric microbiome varies in composition and function between urban and suburban sites. We used high-throughput sequencing to analyze microbial communities collected at different times from PM2.5 samples collected by active sampling method (using a pump and an impactor) and dust settling of TSP collected by passive sampling method (no pump and no impactor) from an urban and suburban site. We found diverse communities unique in composition at both sites with equivalent functional potential. Taxonomic composition varied significantly with Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Other phyla in greater relative abundance at the urban site. In contrast, Cyanobacteria, Tenericutes, Fusobacteria, and Deinococcus, were enriched at the suburban site. Community diversity also demonstrated a high degree of temporal variation within site. We identified over one-third of the communities as potentially pathogenic taxa (urban: 47.52% ± 14.40%, suburban: 34.53% ± 14.60%) and determined the majority of organisms come from animal-associated host or are environmental non-specific. Potentially pathogenic taxa and source environments were similar between active- and passive- sampling method results. Our research is novel it adds to the underrepresented set of studies on atmospheric microbial structure and function across land types and is the first to compare suburban and urban atmospheric communities.

Visual Outcome after Treatment with High Dose Intravenous Methylprednisolone in Indirect Traumatic Optic Neuropathy.

BACKGROUND: Traumatic optic neuropathy is an acute injury of the optic nerve due to trauma. It is an ocular emergency, requiring early treatment though there is no proven standard treatment protocol for the condition. Various studies have shown improvement in vision after intravenous steroids, but not statistically significant. Studies have revealed even optical decompression surgery is not the ultimate treatment because of no significant improvement of vision. Our study aims to assess visual outcome after high dose (1 gram) of intravenous methylprednisolone in cases with indirect optic neuropathy. METHODS: This was a non-randomized interventional study carried out in Kathmandu Medical College Teaching Hospital from May 1st 2013- June 1st 2014. RESULTS: There were 10 cases with indirect traumatic optic neuropathy included in the study. Four cases received IV methylprednisolone and six cases were observed without steroid treatment. Traumatic optic neuropathy was observed more in males[8 (80%)]with higher number in age group 21-30 years old. The visual recovery after intravenous steroid treatment was rapid and beneficial in cases with vision better than Non Perception of Light (NPL), even in cases presented 4 days after the trauma. CONCLUSIONS: There was rapid and beneficial improvement in visual acuity after high dose of intravenous steroid treatment in cases with indirect traumatic optic neuropathy with vision better than Non Perception of Light (NPL).

Population Growth and Development of the Psocid Liposcelis fusciceps (Psocoptera: Liposcelididae) at Constant Temperatures and Relative Humidities.

We investigated the effects of seven temperatures (22.5, 25.0, 27.5, 30.0, 32.5, 35.0, and 37.5°C) and four relative humidities (43, 55, 63, and 75%) on population growth and development of the psocid Liposcelis fusciceps Badonnel (Psocoptera: Liposcelididae). Results demonstrated that L. fusciceps did not survive at 43% RH, at all temperatures tested. At 55% RH, L. fusciceps did not survive at the highest three temperatures and no psocids survived at 37.5°C and 63% RH. The highest population growth was recorded at 30.0°C and 75% RH where populations increased 16-fold from an initial population of five females. L. fusciceps males have two to four nymphal instars, and the percentages of males with two, three, and four instars were 28, 70, and 2%, respectively. Female L. fusciceps have two to five instars, and the percentages of females with two, three, four, and five instars were 2, 33, 63, and 2%, respectively. The total developmental time for males was shorter than females. We developed temperature-dependent development equations for male and female eggs, individual nymphal, combined nymphal, and combined immature stages. Based on 30-d population growth, L. fusciceps can survive and multiply at a relative humidity of 55% at 22.5-30.0°C, but does better at 27.5-32.5°C and a higher relative humidity of 75%. Relative humidities of ≤ 63% and temperatures of ≥ 32.5°C are detrimental to L. fusciceps. These data provide a better understanding of L. fusciceps population dynamics and can be used to develop effective management strategies for this psocid.

Association of Maternal Factors with Low Birth Weight in Selected Hospitals of Nepal.

BACKGROUND: The high prevalence of low birth weight remains a major public health problem around the world. Nepal has prevalence of it as high as 21%. Because of poor dietary intake, majorities of Nepalese women have low body mass index and are anaemic that results in poor pregnancy outcome. METHODS: This hospital based case-control study was carried out in four hospitals of Nepal from August 2012 to September 2013. It sought the association of factors to low birth weight like maternal height, weight, and body mass index, food intake, past history of low birth weight, and preterm delivery. Total sample of 1533 were taken, among them 511 were cases and 1022 were controls. RESULTS: Total of 1533 mothers were interviewed across four hospitals. The study revealed mean height, weight and body mass index of mothers were 150cm (SD:6.6), 49kg (SD:6.8), and 21.5kg/m (SD:3) respectively. On crude odds analysis, mothers with height <145cm had 1.5 times (CI:1.1-2.1), weight <45kg had 2.4 times (CI:1.9-3.1), body mass index <18.5kg/m 2 2 had 2.2 times (CI:1.6-2.9), food taken <2 times had 2 times (CI:1.4-2.9) higher chance of delivering low birth weight babies respectively. On adjusted OR analysis, height <145cm (AOR=0.5, CI:0.3-0.9); weight <45kg (AOR=0.5, CI:0.3-1.0) history of low birth weight (AOR=5.1, CI:2.1-12.8) were associated to current low birth weight. CONCLUSIONS: The study concluded that the chances of delivering low birth weight were higher among mothers who are thin, short, low body mass index, less food intake, had history on low birth weight and preterm birth. Among them, a past history on low birth weight was the strongest predictor in this study.

Corneal edema after phacoemulsification surgery in patients with type II diabetes mellitus.

INTRODUCTION: Corneal edema delays early visual recovery after phacoemulsification surgery in diabetes mellitus. OBJECTIVE: To compare corneal edema of eyes in patients with type II diabetes mellitus and in non-diabetics after phacoemusification surgery. MATERIALS AND METHODS: A hospital-based, retrospective study involving 96 eyes that underwent phacoemulsification surgery for immature cataract at the Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal was carried out. Evaluation was performed of 33 eyes in patients with diabetes mellitus (diabetic group) and of 63 eyes in patients without diabetes mellitus (non-diabetic group). All diabetic patients had controlled blood glucose for at least one week prior to the surgery. The operated eye was examined before surgery and on one day, one week, and one month after surgery. Intraocular pressure was measured on each visit. MAIN OUTCOME MEASURES: The findings of post-operative corneal edema and visual acuity between the diabetic and non-diabetic groups were studied and compared. RESULTS: There was no difference clinically in any pre-operative corneal examination between the diabetic and non-diabetic groups. The corneal edema after surgery was significantly higher in the diabetic group than in the non-diabetic group (p less than 0.001). The number of patients with corneal edema one day and one week after surgery was significantly higher in the diabetic group than in the non-diabetic group (after 1 day, OR = 62.5; 95 % CI = 15.31 - 255.11, p less than 0.000) and after 1 week, OR = 6.77; 95 % CI = 1.28 - 35.76, p less than 0.006). CONCLUSION: Corneal edema following phacoemusification surgery in diabetic eyes is likely to be more frequent than in non-diabetic eyes.

Assessment of benzimidazole resistance in Haemonchus contortus in sheep flocks in Ontario, Canada: comparison of detection methods for drug resistance.

In 2011, a field study was conducted to assess drug resistance of gastro-intestinal nematodes in sheep flocks in Ontario, Canada. Benzimidazole resistance in Haemonchus contortus was assessed by genetic analysis of eggs; measurement of resistant allele percentages at codons 167, 198 and 200 in the ß-tubulin gene was determined on pools of H. contortus eggs using pyrosequencing. Susceptibility to benzimidazoles in gastro-intestinal nematodes was also determined using a Faecal Egg Count Reduction Test (FECRT) and a Larval Development Assay (LDA). In total, 16 farms were assessed with the genetic test. Based on resistant allele frequencies, all of the farms (16/16) tested had benzimidazole resistance in H. contortus; the overall percentage of benzimidazole-resistant H. contortus (estimated prior to treatment using the Hardy-Weinberg formula) was 68.5%. The FECRT and LDA were performed on 11 and 13 farms, respectively. Resistance to fenbendazole was detected on 100% (11/11) of the farms where the FECRT was performed. The LDA revealed the presence of thiabendazole resistance in H. contortus in 92% (12/13) of the farms. Estimated percentages of resistant parasites in H. contortus populations obtained with the two biological tests and the genetic test were compared. The results of the genetic test were in agreement with the biological tests and confirmed that benzimidazole resistance in H. contortus is present in Ontario sheep flocks. Differences between the different methods of drug resistance detection are discussed in terms of cost, time and sampling.

A longitudinal study on the effect of lambing season on the periparturient egg rise in Ontario sheep flocks.

The epidemiology of the periparturient egg rise (PPER) of gastrointestinal nematodes (GINs) in sheep remains unclear, and may be influenced by the lambing season. This longitudinal study was performed to determine the effect of out-of-season lambing on the PPER in ewes in Ontario, and whether total plasma protein (TPP) and packed cell volume (PCV) were associated with the PPER. Six farms that practiced out-of-season lambing were enrolled, and sampled for three consecutive lambing seasons (winter, spring and autumn). For each lambing season, all farms were visited five times. On the first visit for each lambing season, 15-20 pregnant ewes and 15-20 non-pregnant/early gestation ewes were randomly selected. At each visit, fecal samples were collected from all selected animals and processed individually to measure GIN fecal egg counts (FECs). Blood samples were collected on three visits in each lambing period and processed to measure TPP and PCV. The ewes were classified into one of five production stages (maintenance [i.e. not pregnant], early or late gestation [<120 d and ≥ 120 d, respectively], and early or late lactation [<40 d and ≥ 40 d, respectively]) based on information collected during farm visits. Linear mixed models were developed for the TPP, PCV and logarithmic-transformed FEC (lnFEC). During the winter and spring lambing season, the FECs increased gradually over the gestation period and peaked during lactation, with these increases being larger in ewes with a low PCV (three-way interaction in the final model). In the autumn lambing season, the FECs started off higher in early gestation, and increased rapidly to peak in late gestation, particularly for animals with low PCV levels. In the TPP model, PCV and lnFEC were positively associated with TPP. During both autumn and winter lambing seasons, the TPP decreased from maintenance throughout gestation and early lactation, followed by an increase in late lactation, except for when there were high FECs. During the spring lambing season, TPP peaked at early gestation, and then decreased in late gestation, to increase more gradually over lactation. In the PCV model, PCV increased with TPP and decreased exponentially with increases in lnFEC. The PPER occurred during all three lambing seasons, and its magnitude and distribution varied with the lambing season, suggesting that the PPER in ewes depends on both environmental and animal physiological factors, an important consideration when implementing preventive parasite control strategies on sheep farms that practice out-of-season lambing.

Anthelmintic resistance in sheep flocks in Ontario, Canada.

Gastrointestinal nematodes (GIN) are a significant constraint to pasture-based sheep production worldwide. Anthelmintic resistance (AR) has been reported in most sheep-raising areas in the world, yet little is known about the AR status in Canada. This study was conducted to determine the frequency of AR in GIN in sheep flocks in Ontario, Canada. Forty-seven sheep flocks were enrolled in the study, and their level of parasitism was monitored monthly throughout a grazing season by analyzing owner-acquired fecal samples from 15 grazing lambs per flock. When the mean GIN fecal egg count (FEC) reached a threshold of 200 eggs per gram (epg), oral ivermectin was supplied to producers to check ivermectin efficacy; the reduction in mean FEC 14 days after ivermectin treatment was calculated. 'Drench failure' was defined as a reduction in mean FEC of <95%. In those flocks with apparent drench failure, researchers performed a Fecal Egg Count Reduction Test (FECRT), dividing sheep into 4 treatment groups (n=10-15): control (i.e. untreated), ivermectin, and, if sufficient numbers of animals - fenbendazole and levamisole. AR was defined as a reduction in mean FEC <95% and a lower 95% confidence interval <90%. Larval cultures were performed on pooled post-treatment FECRT samples. Larval Development Assays (LDAs) to detect the presence of resistance to thiabendazole and levamisole were performed prior to the ivermectin drench check on pooled owner-acquired fecal samples that reached the 200 epg threshold. Approximately 89% (42/47) of the farms reached the FEC threshold of 200 epg; 93% (39/42) of these farms performed an ivermectin drench check, and 88% (34/39) of these farms had drench failure. The FECRT was performed on 29 of the 34 farms. Resistance to ivermectin, fenbendazole and levamisole was demonstrated on 97% (28/29), 95% (19/20) and 6% (1/17) of the farms tested, respectively, with considerable variability in resistance levels among farms. Haemonchus sp. was the most commonly cultured parasite from post-treatment fecal samples. LDA results for 21 farms were available; of these, 14% (3/21) and 62% (13/21) had low and high levels of thiabendazole resistance, respectively, while none of the farms exhibited resistance to levamisole. Amongst these tested farms, resistance to both ivermectin and benzimidazoles was very common. These findings strongly suggest that AR, particularly in Haemonchus sp., is a serious problem in these sheep flocks. Thus, marked changes in GIN management need to be instituted immediately to mitigate a worsening situation.

Evaluation of immune response to artificial infections of Haemonchus contortus in Gulf Coast Native compared with Suffolk lambs.

The Gulf Coast Native (Native) breed of sheep among many others is identified as being relatively resistant to Haemonchus contortus, an abomasal nematode parasite of small ruminants. Understanding the mode of immune response that helps these breeds of sheep control infection could help design and implement appropriate control programs. In this experiment, the components of the immune response during the early infection period in resistant Native lambs were evaluated and compared with susceptible Suffolk breed of sheep. Groups (n=5) of six month old Native and Suffolk lambs were given infective larvae as one time (single) or trickle experimental infections. Fecal, blood, and serum samples were collected on days 0, 2, 7, 14 and 21 post-infection. Abomasal mucosa and regional lymph node samples were collected at the time of necropsy on days 14 and 21. There was no significant difference in number of worms recovered at necropsy but the ratio of adult versus larvae was significantly greater in single infected Suffolk than Native lambs. Native lambs had significantly greater numbers of mast cells and eosinophils in the abomasal mucosa and serum IgG production was significantly greater compared to Suffolk lambs. Native lambs also showed a trend of increased level of serum IgA and IgE compared to Suffolk lambs.

Effect of feeding sericea lespedeza leaf meal in goats experimentally infected with Haemonchus contortus.

Effect of sericea lespedeza [SL; Lespedeza cuneata (Dum-Cours.) G. Don.] leaf meal feeding was evaluated in two experiments in indoor reared goats with experimental infection of Haemonchus contortus larvae. In the first experiment, ten 8-10 month old male Spanish and Alpine cross kids pair matched for body weight and age were fed SL or bermudagrass [BG; Cynodon dactylon (L.) Pers.] hay one week before infection and were infected with 5000 H. contortus L(3). The animals were maintained on the same diet for the remaining period and were slaughtered 28 days post-infection (DPI) to determine the establishment of incoming infective larvae. Goats fed SL had lower establishment (P<0.05) of H. contortus larvae than that of the control goats fed BG hay. In the second experiment, twenty-five 8-10 months old male Alpine cross, Saanen, Nubian×Saanen and Spanish kids reared in confinement on BG were experimentally infected with 5000 H. contortus L(3). On 35 DPI, the animals were allocated to two groups after blocking by fecal egg count (FEC), and one group was fed SL leaf meal (n=13), and another control group remained on BG (n=12). Four goats/group were slaughtered successively on days 7, 14, and 28 days post SL feeding, except on day 7, when five SL fed goats were slaughtered. Fecal egg counts and blood packed cell volume (PCV) were measured at weekly intervals and worm count, female worm fecundity, worm length and mucosal eosinophils, mast cells and globule leucocytes were measured after slaughter. Goats fed SL had a lower FEC (P<0.05) one week after feeding, as compared to those fed on BG, and the values remained at low level thereafter. Similarly, PCV was also significantly affected by feeding (P<0.01), and feeding and time interaction (P<0.05). However, worm burden, female worm fecundity, parasite length, and mucosal inflammatory cell count were similar between the groups. Feeding SL reduced the establishment of infective larvae and FEC of H. contortus in experimental studies and this plant could be used for biological control of parasite infection under field conditions to limit the harmful effects of the parasites in goats.

Population growth and development of Liposcelis pearmani (Psocoptera: Liposcelididae) at constant temperatures and relative humidities.

Psocids of genus Liposcelis are now considered serious pests of stored products. We investigated the effects of eight temperatures (22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0°C) and four relative humidities (43, 55, 63, and 75%) on population growth and development of the psocid Liposcelis pearmani Lienhard. L. pearmani did not survive at 37.5 and 40.0°C, at all relative humidities tested; at 43% RH, at all temperatures tested; and at 55% RH, at 32.5 and 35°C. The greatest population growth was recorded at 32.5°C and 75% RH (32-fold growth). L. pearmani males have two to four nymphal instars, and the percentages of males with two, three, and four instars were 17, 63, and 20%, respectively. Female L. pearmani have two to five instars, and the percentages of females with two, three, four, and five instars were 5, 39, 55, and 1%, respectively. We developed temperature-dependent development equations for male and female eggs, individual nymphal, combined nymphal, and combined immature stages. Based on 30-d population growth, L. pearmani cannot survive at temperatures >35.0°C; does not thrive at low relative humidities (55%), at temperatures above 25°C; and has a high optimum relative humidity for population growth (75%). Therefore, we expect it to have a more limited distribution compared with other Liposcelis species. These data provide a better understanding of how temperature and RH may influence L. pearmani population dynamics and can be used in population growth models to help develop effective management strategies for this psocid, and to predict its occurrence.

Comparison of microarray preprocessing methods.

Data preprocessing in microarray technology is a crucial initial step before data analysis is performed. Many preprocessing methods have been proposed but none has proved to be ideal to date. Frequently, datasets are limited by laboratory constraints so that the need is for guidelines on quality and robustness, to inform further experimentation while data are yet restricted. In this paper, we compared the performance of four popular methods, namely MAS5, Li & Wong pmonly (LWPM), Li & Wong subtractMM (LWMM), and Robust Multichip Average (RMA). The comparison is based on the analysis carried out on sets of laboratory-generated data from the Bioinformatics Lab, National Institute of Cellular Biotechnology (NICB), Dublin City University, Ireland. These experiments were designed to examine the effect of Bromodeoxyuridine (5-bromo-2-deoxyuridine, BrdU) treatment in deep lamellar keratoplasty (DLKP) cells. The methodology employed is to assess dispersion across the replicates and analyze the false discovery rate. From the dispersion analysis, we found that variability is reduced more effectively by LWPM and RMA methods. From the false positive analysis, and for both parametric and nonparametric approaches, LWMM is found to perform best. Based on a complementary q-value analysis, LWMM approach again is the strongest candidate. The indications are that, while LWMM is marginally less effective than LWPM and RMA in terms of variance reduction, it has considerably improved discrimination overall.

Kartagener syndrome: a rare genetic disorder.

Kartagener Syndrome is a rare autosomal recessive disorder consisting of triad of sinusitis, bronchiectasis and situs inversus with dextrocardia. It is the subset of disorder called primary ciliary dyskinesia in which the cilia have abnormal structure and/or function resulting in multisystem diseases of various severity. Clinical manifestations include lifelong, chronic upper and lower respiratory tract diseases secondary to ineffective mucociliary clearance. Early diagnosis and management of chest infections can prevent irreversible damage to lungs and prevent potential lifelong complications. This case report is on a patient who presented with long standing history of sinusitis, bronchiectasis and on examination situs inversus with dextrocardia.

A Th2 type of immune response is associated with increased resistance to Haemonchus contortus in naturally infected Gulf Coast Native lambs.

Haemonchus contortus is one of the major nematode parasites causing substantial economic losses in small ruminant farming worldwide. Recently, effectiveness of anthelmintic treatment has decreased due to an increasing problem of nematode populations that have developed resistance to anthelmintics. Efforts to develop effective vaccines have had limited success. There are certain breeds of sheep that are relatively resistant to the parasite including Gulf Coast Native (Native) sheep. Understanding the protective nature of the immune response that helps these breeds of sheep control infection could enable the development of vaccines to enhance control programs. This experiment was designed to compare the immunological responses of resistant Native versus susceptible Suffolk sheep in order to identify the mechanisms responsible for this resistance. Immune responses were evaluated in naturally infected Native and Suffolk lambs that grazed pasture contaminated predominantly with H. contortus. Ten lambs of each breed grazed together for 42 days. Fecal, blood and serum samples were collected on 0, 2, 4, 7, 10, 14, 21, 28, 35 and 42 days of exposure. Five lambs of each breed were necropsied on day 35 and five on day 42 for nematode recovery and abomasal tissue sample collection. Throughout the course of infection, Native lambs had significantly lower FEC, significantly lower PCV reduction percent, and significantly higher serum IgE after day 14 and increased expression of IL-4 on day 10 post-exposure compared to Suffolk lambs. At both necropsy time points, Native lambs had significantly greater numbers of mucosal mast cells, eosinophils and globule leukocytes in abomasal mucosa than Suffolk lambs. Results indicated that Native lambs had a more pronounced immune response to infection with H. contortus than Suffolk lambs which may be responsible for the observed resistance to infection.

Association between diabetic retinopathy and serum lipoproteins level.

INTRODUCTION: diabetic retinopathy is the leading cause of blindness of working-age patients in the urban areas. OBJECTIVE: to find out the association between diabetic retinopathy and serum lipoproteins in patients with diabetes mellitus MATERIALS AND METHODS: a community-based cross-sectional study involving 100 subjects with type II diabetes living in the cities of Kathmandu, Bhaktapur and Lalitpur of Nepal was carried out using a purposive sampling method. The retinopathy was classified according to the modified Airlie House classification of diabetic retinopathy. The patients with systolic hypertension were excluded. The blood sugar level was assessed by using glycosylated hemoglobin. The fasting serum lipoproteins were assessed by photometric enzymatic methods. STATISTICS: the SPSS version 10.0 software was used. The p value of <0.05 was considered significant. RESULTS: the majority (n=91) of the patients were in the age group 31-60 years with the mean of 48.2 +/- 9.5. The mean duration of diabetes mellitus in the patients with no-diabetic-retinopathy was 4 +/- 3.4 years and that in those with the retinopathy was 6.4 +/- 4years, (p =0.006). The mean glycosylated hemoglobin level for no-diabetic-retinopathy group was 6.9 1.1%, whereas for the diabetic retinopathy group, it was 7.7 +/- 1.5% (p = 0.004). The mean values of serum lipoproteins when taken together were slightly higher in the diabetic retinopathy group than in the group with no-diabetic-retinopathy. The serum triglyceride value was higher in the group with diabetic retinopathy than in the group with no retinopathy. Serum triglyceride had a low degree of positive correlation with HbA lc value. CONCLUSION: there is no significant association between the serum lipoprotein levels and diabetic retinopathy in patients with type II diabetes mellitus. Serum triglyceride level has a low degree of positive correlation with HbA lc value.

Therapeutic drug monitoring of antiepileptic drugs.

Commonly used conventional antiepileptic drugs for pharmacotherapy in epilepsy are phenytoin, carbamazepine and valproic acid. These drugs have complex pharmacokinetic properties leading to fluctuation in their plasma level at given same therapeutic dose. The present study was done to monitor their plasma levels. A prospective observational study was conducted at National Public Health Laboratory. After taking detail history, blood samples were taken from epileptic patients of all age groups and both gender who were on usual therapeutic dose of one or two combined antiepileptic drugs. Plasma level of these drugs were analyzed by using Fluorescence Polarization Immuno Assay (FPIA) technique. Out of total 417 testing, 81 were tested for phenytoin , 241 for carbamazepine and 95 for valproic acid. Their levels were further analyzed to find therapeutic, subtherapeutic and toxic levels. Out of total 81 blood samples tested for phenytoin, 38.8% had plasma drug at therapeutic level, 38.8% at subtherapeutic level and 28.4% had toxic level. Carbamazepine was tested in 241 samples and 79.3% cases had at therapeutic drug level, 15.8% had subtherapeutic drug level and 4.9% had toxic level. Out of 95 samples tested for valproic acid, 62% had therapeutic level and 20% had subtherapeutic and 18% had toxic level of drug. Therapeutic drug monitoring of phenytoin showed wide fluctuation in its plasma level. Its toxic and subtherapeutic levels were quite high. It is suggested that the dose of phenytoin should be adjusted after regular plasma level monitoring only. Monitoring of carbamazepine and valproic acid were also helpful when their toxicity and efficacy are doubtful.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Impact of heavy metals (copper, zinc, and lead) on the chlorophyll content of some mosses.

The effects of the heavy metals copper (Cu), zinc (Zn), and lead (Pb) on the chlorophyll content of two mosses Thuidium delicatulum (L.) Mitt. and T. sparsifolium (Mitt.) Jaeg., as well as leafy liverwort Ptychanthus striatus (Lehm. & Linderb.) were examined to understand the impact of metal accumulation on the chlorophyll content of mosses and leafy liverwort, which are found only in uncontaminated sites of the Kathmandu valley. These plants were treated with different concentrations of CuCl(2, )ZnCl(2), and Pb(NO(3))(2), ranging from 10(-10) M to 10(-2) M, in isolation and in combination under experimental conditions. Metal accumulation in the plant bodies increased with metal concentrations. Cu accumulation showed a significant inhibitory effect on chlorophyll-a, chlorophyll-b, and total chlorophyll in the mosses and the leafy liverwort. An insignificant decrease in chlorophyll content in both Thuidium species, but a significant decrease in leafy liverwort, was observed after Zn and Pb accumulation. Chlorophyll-a decreased significantly in T. sparsifolium; chlorophyll-b and total chlorophyll decreased significantly in T. delicatulum; and all chlorophyll contents decreased insignificantly in P. striatus after accumulation of Cu+Zn+Pb ions together from mixed metal solution. The ratio of chlorophyll-a to -b decreased more rapidly in both Thuidium species, with higher concentrations occurring when Cu+Zn+Pb ions were together than when Cu, Zn, or Pb ions were alone. This indicated a more destructive effect of Cu metals on the chlorophyll contents of both Thuidium species. High concentrations of Cu are known to activate oxidative damage and alter cell-membrane properties by lipid peroxidation, thereby demonstrating the inhibitory effect on the enzymes involved in chlorophyll production. The greater loss of chlorophyll from heavy-metal accumulation in P. striatus than in T. delicatulum and T. sparsifolium may have been caused by relatively more K(+) efflux in leafy liverwort than in the mosses, thus indicating their differences in membrane integrity.

A study of the first 350 cases referred for EEG in Kathmandu Medical College Teaching Hospital.

UNLABELLED: Electroencephalography or EEG is a neurological test that uses an electronic monitoring device to measure and record electrical activity in the brain. Epilepsy is defined as a recurrent tendency to unprovoked seizure. About 0.5% to 2% of the population has epilepsy. MATERIAL AND METHODS: This is a retrospective study of the first 350 odd cases referred for EEG at Kathmandu Medical College Teaching Hospital, Kathmandu during period November 2002- September 2002 (Mangsir 2058- Bhadra 2059). RESULTS: Most patients fall in the age group of 11-20 years and more than 50% referred cases fall in the prime of life, i.e., 11-30) years. 16% of patients with the history of seizure did not use any AED and 32% who though had no history of seizures were actually using AED. It is seen that out of 149 reported normal, 57 (38%) had history of seizure; but out of 208 reported abnormal in EEG only 92 (42%) had history of seizure. DISCUSSION: EEG is not a very sensitive or a specific tool; however, in our study it was seen to be more sensitive than specific. It is till very useful in classifying seizure types, in locating epileptic focus prior to surgery or in some confusing situation when movement disorder may simulate seizure disorder or vice versa. CONCLUSION: Although EEG is not a very sensitive or specific investigation, it is more sensitive than specific.