Development of a hybrid undergraduate portfolio for the AETCOM module.

Background: A structured Attitude Ethics and Communication (AETCOM) module for undergraduates exists. For ensuring that the module achieves what it is intended to achieve, there was a felt need to develop a learning portfolio with an emphasis on reflections and with a scope for assessment. Methods: The AETCOM module by NMC has laid out objectives, lesson plans, and case-based scenarios. Hybrid portfolio development was necessary to align the sessions to the objectives and lesson plans and to help students capture their learning process with self-reflection, and at the same time, ensure the scope of assessment of these activities. Hence, writing reflections was considered the most important step. Measures were taken to train students in writing reflections, and faculty development workshops were also conducted. An evaluation was done using Kirkpatrick model level I-III using student's feedback form, scores of rubric matrix for assessment of reflections and one-on-one interaction with students by trained faculty. Faculty perspectives on portfolio development were collected. Results: A significant improvement in students' self-assessment scores on AETCOM module was seen (p <0.05). An assessment of reflections using a rubric matrix showed that all the students reached at least grade B by the end of three months. More than 90% of faculty members felt that the faculty is vital for assessing AETCOM. Conclusion: The development of a hybrid portfolio for AETCOM requires faculty development and special sessions for students on writing reflections. The hybrid portfolio provides the learner to self reflect, and a rubric matrix can be used to assess reflections.

The Great Imitator - Disseminated Tuberculosis Presenting as Baker's Cyst: A Case Report.

Tuberculosis is known to be a great mimicker, and it can present in a myriad of ways, which often result in an incorrect diagnosis. In a country that is endemic to tuberculosis, the presentation can take many forms ranging from tumour to trauma. We present a case of Baker's cyst that was provisionally diagnosed as pigmented villonodular synovitis (PVNS) of the knee and eventually turned out to be tuberculous arthritis. A 46-year-old male presented with an insidious swelling on the posterior aspect of his knee for one year. Magnetic resonance imaging was suggestive of PVNS as the likely diagnosis. The patient presented 21 days later with a foot drop. On following-up with further investigations, he was found to have a lesion at the level of the L4-L5 spine. Chest radiograph changes were suggestive of tuberculosis. A synovial biopsy of the knee was done, and the tuberculosis culture report was positive. The patient was started on anti-tubercular treatment and then operated on, with arthroscopic synovectomy and posterior open cyst excision. The histology report was positive for tuberculous synovitis. The patient completed the course of antitubercular drugs and had physiotherapy. He demonstrated a clinically and radiologically healed disease at the final follow-up with a good functional outcome. Clinicians must have a high index of suspicion for tuberculosis, especially in endemic areas. Getting a chest radiograph is recommended in every case. Early diagnosis with the appropriate treatment will give a good functional outcome for the patient.

The Great Imitator - Disseminated Tuberculosis Presenting as Baker’s Cyst: A Case Report

@#Tuberculosis is known to be a great mimicker, and it can present in a myriad of ways, which often result in an incorrect diagnosis. In a country that is endemic to tuberculosis, the presentation can take many forms ranging from tumour to trauma. We present a case of Baker’s cyst that was provisionally diagnosed as pigmented villonodular synovitis (PVNS) of the knee and eventually turned out to be tuberculous arthritis. A 46-year-old male presented with an insidious swelling on the posterior aspect of his knee for one year. Magnetic resonance imaging was suggestive of PVNS as the likely diagnosis. The patient presented 21 days later with a foot drop. On following-up with further investigations, he was found to have a lesion at the level of the L4-L5 spine. Chest radiograph changes were suggestive of tuberculosis. A synovial biopsy of the knee was done, and the tuberculosis culture report was positive. The patient was started on anti-tubercular treatment and then operated on, with arthroscopic synovectomy and posterior open cyst excision. The histology report was positive for tuberculous synovitis. The patient completed the course of antitubercular drugs and had physiotherapy. He demonstrated a clinically and radiologically healed disease at the final follow-up with a good functional outcome. Clinicians must have a high index of suspicion for tuberculosis, especially in endemic areas. Getting a chest radiograph is recommended in every case. Early diagnosis with the appropriate treatment will give a good functional outcome for the patient.

Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: Experience in a Tertiary Oncology Centre.

Background Ovarian cancer is the second most common type of female genital tract malignancy. Treatment planning differs for benign, borderline and malignant subtypes of surface epithelial tumours and depends on accurate histopathological diagnosis. A pre-operative diagnosis of the nature of ovarian tumors is not always reliable. Frozen section is a valuable diagnostic tool in rapid intraoperative categorization of ovarian masses and thereby helps in planning the surgical management. Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary to have a high level of accuracy. Objective To assess the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasm conducted in Rajiv Gandhi Cancer Institute and Research Centre. Method Intra-operative frozen sections for suspected ovarian neoplasm that underwent surgery as primary line of therapy at this institution were analyzed retrospectively from Jan. 2014 - Dec. 2015. The results of frozen section were compared with the final histopathology diagnosis on paraffin sections and the overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Result The study included 159 cases and the mean age of patients was 44.72±14.28 years (Range 19-75 years). The mean size of tumor was 12.5±5.9 cm. Sensitivity of frozen section for benign, borderline and malignant tumors was 98.53%, 73.33% and 94.74% respectively and the related specificities were 95.60%, 96.53% and 100% respectively. There were 150 concordant cases and 9 discordant cases. Overall diagnostic accuracy of frozen section was 94.33%. Conclusion Intra-operative frozen section diagnosis appeared to be an accurate and comparable technique for the histopathology diagnosis of ovarian tumors.

Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal.

INTRODUCTION: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy. METHODS: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol. RESULTS: Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth. CONCLUSIONS: Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females.

Clinical characteristics of children with febrile seizure.

BACKGROUND: Febrile seizure is common in children below five years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizure in a teaching hospital. METHODS: This was a descriptive retrospective study among children presenting with febrile seizure in a teaching hospital from July 2009 to June 2013. Children between six months to six years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient's demographic and clinical data were collected from the in-patients records and analyzed. RESULTS: This study included 103 children with febrile seizure. Out of which 67% were male. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. Majority of children (71.8%)had generalized tonic clonic seizure followed by tonic seizures. Most of children (72.8%) who developed first episode of seizure were below 24 months of age with the mean age of 20.7 (±12.1) months. Overall 33% of patients developed recurrence of febrile seizure and first episode of febrile seizure at age one year or below was associated with the seizure recurrence. Upper respiratory tract infections were the commonest cause of fever in these children. CONCLUSIONS: Febrile seizure was observed predominantly in children below age of two years and simple febrile seizure was the ommonest variety. Recurrence of febrile seizure was common and significantly associated with the first episode of febrile seizure at the age of one year or below.

An assessment of candidal colonization and species differentiation in head and neck cancer patients receiving radiation.

BACKGROUND: Oral colonization with Candida species has been observed in upto 93% of patients receiving radiation for head and neck cancer. With immunosuppression there is a trend of emergence of rare species. The present study aimed to assess species and colonization of candida at different stages of radiation therapy for head and neck cancer. METHODS: Oral rinses of thirty cancer patients receiving a six weeks course of radiation therapy for head and neck cancer were taken at two intervals; first at the start of radiation (0 Grays), and second at completion of radiation (60 Grays). The oral rinse was streaked onto a differential media (CHROMagar®) plates and incubated at 37ºC for 48 hours. Colony forming units (CFU) were counted and species were differentiated. Fifteen healthy controls were compared. RESULTS: The candida albicans colony count (CFU/ml) at baseline, 0 Grays radiation ranged from 50 to 1820 CFU/ml in cases and from 0 to 300 CFU/ml in controls. C. albicans was seen in all cases (100%) and most of the controls (86.66%). Other species such as C. Krusei, C. parapsilosis, C .tropicalis, and C. glabrata were observed with a frequency of 10%, 6.66%, 3.33%, and 3.33% respectively in the cases. However, no species other than C. albicans was observed in controls. CONCLUSIONS: Immunosupression of radiation therapy patients led to the development of species other than Candida albicans, which is the most prevalent species. Thus it can be inferred that there is emergence of the opportunistic fungal pathogens in patients with immunosupression.

A report of near fatal ceftriaxone induced anaphylaxis in a child with review of literature.

Ceftriaxone is a widely used antibiotic in pediatric clinical practice. Usually ceftriaxone is well tolerated and serious adverse effect like anaphylaxis is rare. We report a near fatal anaphylaxis reaction in a child after the first dose of intravenous ceftriaxone who revived successfully.

Spectrum of pediatric dermatoses in tertiary care center in Nepal.

Children with dermatological problems constitute a major group presenting to the Outpatient Department. This study was done to see the pattern of skin disorder among the pediatric age group in a tertiary care center in Nepal. To determine the pattern of skin disorders among children visiting the Department of Dermatology and Pediatrics in a tertiary care center in Nepal. All the patients visiting the Dermatological Out patient Department in the age group 0-14 years were enrolled in the study during the time period of 3 years (2009-2011). The cases were diagnosed based on the detailed clinical history and clinical examination, and the patients were investigated as needed. A total of 1086 (22.64%) patients out of 4795 patients were having skin disorder and among them 584 (53.77%) were males and 502 (46.23%) were females. The age range was 0-14 with the mean age of 7 years. Dermatitis and eczema were the most frequently encountered disease 298 (26.46%), followed by bacterial infections 156 (16.13%), urticarial 190 (15.71%), viral infection (14.12%), fungal infection 76 (7.3%), scabies 54 (5.03%), miliaria 25 (2.75%), vitiligo 27 (2%) and others 87 (6.53%). Nutritional disorders, vascular, pigmentary, nevi, drug eruptions had a comparatively low incidence.

Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity.

BACKGROUND: Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. OBJECTIVE: The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. MATERIALS AND METHODS: It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twenty-two days (11th November 2004 to 30 th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. RESULTS: There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. CONCLUSION: A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section.

Acute appendicitis: analysis of 518 histopathologically diagnosed cases at the Kathmandu University Hospital, Nepal.

BACKGROUND: Appendicitis is important as it is a common surgical emergency. There is no medical treatment for it, timely surgery is mandatory to prevent morbidity and mortality. OBJECTIVES: The objective of this study was to analyse the pathologic findings, the demographics, and, look for the existence of the so called aetiopathogenetic factors in the context of current prevailing beliefs regarding acute appendicitis, the most common current reason for emergency abdominal surgery. MATERIALS AND METHODS: This was a retrospective study. It was carried out at the Kathmandu University Hospital, Dhulikhel, Kavre, Nepal. All histopathologically diagnosed cases of acute appendicitis during the period January 1, 2004 to April 30, 2010 were included. Their macrospcopic and light microscopic examination findings were analyzed. RESULTS: A total of 518 histopathologically diagnosed cases of acute appendicitis were found. Age distribution of these cases was between 6 to 84 years. Mean age was 30. 94+ 15.75 years. Sex distribution consisted of 313 (60.42%) cases in males and 205 (39.58%) cases in females. Fecalith in the appendiceal lumen was seen only in 8 (1.54%) of cases. Granuloma and carcinoid was seen in 3 (0.58%) and 1 (0.19%) cases respectively. Perforation was seen in 11 (2.12%) cases. Foreign bodies, gallstones, strictures, helminthic infection, carcinoma or any other obvious/apparent aetiologic/ pathogenetic lesions/findings were not seen in any of the cases. Histopathologically staged distribution revealed that 180 (34.75%) cases were of early acute appendicitis, 250 (48.26%) cases were of acute suppurative appendicitis, and 88 (16.99%) cases were of acute gangrenous appendicitis. CONCLUSION: This study did not confirm the existing popular notion that luminal obstruction is the pathogenetic hallmark for acute appendicitis. Therefore, further research on this common surgical emergency is surely warranted.

Amitriptyline and Sertraline in Diabetic Neuropathy: a Comparative View

Purpose: To investigate the effect of amitriptyline (Ami) and sertraline (Sert) in diabetes neuropathy. Methods: Diabetes was induced in 3 groups of rats (n=6) with streptozotocin (STZ; 55mg/kg; i.p.). Two of the groups of diabetic rats received amitriptyline (15 mg/kg; p.o) and sertraline (30 mg/kg; p.o.) while another 2 groups (n=6) received the same drug treatment without prior administration of STZ. A normal group (n=6) of rats and STZ-induced group (n=6) of diabetic rats served as controls.The blood glucose; glycosylated hemoglobin (GHb); pain sensitivity and neuromuscular strength in all the rats were determined. Results: Ami (15mg/kg; p.o.) produced severe hyperglycemia (p 0.01) whereas Sert (30mg/kg; p.o.) produced significant hypoglycaemia in the diabetic rats. Ami significantly increased the GHblevel while Sert had no significant effect. Both Ami and Sert raised the grip strength that was significantly reduced by STZ. When administered for 3 weeks; Ami and Sert increased the STZ induced reduction of the grip strength in the diabetic rats (p 0.01). STZ (55mg/kg; i.p) increased the pain sensitivity. Pain sensitivity was significantly reduced by Ami (15 mg/kg; p.o; administered for 3 weeks) in the diabetic rats but marginally reduced in the normal group. However 3-week administration of Sert (30 mg/kg; p.o.) significantly reduced the pain sensitivity in both the diabetic and normal rats (p 0.01) when compared with STZ treated group. Conclusion: Sertraline could offer a good choice in the treatment of diabetic neuropathy particularly in patients with depression being treated with amitriptyline

Synthesis and biological evaluation of novel 2-[substituted acetyl]-amino-5-alkyl-1,3,4-thiadiazoles [corrected].

Sixteen novel 2-substituted acetyl amino-5-alkyl-1,3,4-thiadiazole were synthesized and screened for their pharmacological activities. A few of the compounds namely 11, 12 and 16 showed anti-inflammatory activities comparable to phenylbutazone. Compound 12 also showed significant non-specific spasmolytic activity. Diuretic activity of compound 15 at a dose level of 90 mg/kg p.o. was two fold higher compared to 50 mg/kg p.o. of furosemide. Comparable diuresis was also produced by compounds 9, 10 and 16.

Anti-inflammatory and diuretic activity of a new class of compounds--Schiff bases of 3-amino-2-methylquinazolin 4(3H)-ones.

Eighteen Schiff Bases of 3-amino-2-methylquinazolin-4(3H)-ones were synthesised and screened for anti-inflammatory and diuretic activity. Anti-inflammatory activity was identified in PNG-1, PNG-13, PNG-14, PNG-15 and PNG-17.

Pharmacological screening of few new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles.

Nine new 2-(substituted acetyl) amino-5-alkyl-1,3,4-oxadiazoles were synthesised and confirmed on the basis of IR and nitrogen analysis. These were screened for spasmolytic, anti-inflammatory and their effects on blood pressure after determining ALD50. Compounds GK-4 i.e. 2-(diethylaminoacetyl)- amino-5-methyl-1,3,4-oxadiazole and GK-8 i.e. 2-(din-propylamino acetyl)-amino-5-ethyl-1,3,4-oxadiazole were found to be spasmolytic. Compound GK-6 i.e. 2-(diethylaminoacetyl)-amino-5-n-propyl-1,3,4-oxadiazole was found to be a potent hypotensive agent with the effect lasting for more than two hours.