Knowledge of Dysphagia in Stroke among Nurses Working in Tertiary Care Hospital.

Background Swallowing difficulty occurs in up to 37 to 78% of people experiencing a non-fatal stroke. About one half of dysphagic patients either die or recover spontaneously within the first 14 days of stroke onset leaving half with swallowing deficits that can significantly impair function, recovery and quality of life. It is important for the nurses to efficiently screen dysphagia post-stroke to reduce the odds of negative outcomes. Objective To assess the level of knowledge of Dysphagia among nurses working in Tertiary care hospital and to assess the associations of knowledge with educational level, years of experience and experience in caring for stroke patient with dysphagia. Method Self-Administered Questionnaire developed by Andrea Pickle Voight (2015) was used to collect data among nurses working in Dhulikhel hospital. Descriptive statistics was used to assess the knowledge on dysphagia and chi-square was used to assess the association between the variables. Result We found that nurses have moderate knowledge in dysphagia (62.39%). Knowledge level was significantly associated with experience in caring for stoke patient (p = 0.033) but not associated with educational level (p= 0.366) and years of experience (p= 0.065). Conclusion Nurses at Dhulikhel Hospital have moderate knowledge of dysphagia in stroke. Level of knowledge was significantly associated with caring for stroke patient but not with years of experience and educational level.

A Case of Vulvar Myiasis.

Myiasis occurs in humans and vertebrate animals mostly due to dipterous flies of the genera Chrysomyia and Cochliomyia. There have been reported cases of myiasis of skin, breast, intestine, eyes and ear but very few cases of vulvar myiasis have been reported in the medical literature. We report a case of a 20 years old female with vulvar myiasis. A 20-year old unmarried girl presented to our hospital with complains of vaginal discharge and vulvar irritation for 3 days with evidence of some worms around her vulvar region. Her menstrual history revealed the use of folded cloths instead of sanitary pads during her menstruation. Moreover, she washed those clothes with water and hanged them in the clothesline outside to let them dry before reuse. Examination of the external genitalia multiple ulcers measuring 1X1 cm on the inner surface of the labia minora, heavily infested with large number of maggots. The patient was admitted for 4 days during which she was given antibiotics, analgesics and anti-inflammatory medication. Daily local asepsis of the wound with antiseptic solution, betadine was done. We removed more than 30 larvae by the fourth day after which no more larvae were seen and she gradually recovered in the following days. It is our opinion that the cause of vulvar myiasis in our patient was her poor sanitary hygiene. Simple measures such as washing clothes thoroughly, drying and ironing of clothes are also necessary to reduce the risk of this human myiasis.

[G4-quadruplexes and genome instability].

A comparative analysis in silico of distribution of nucleotide sequences that predispose to formation of non-canonical DNA structure of G-quadruplexes, closely related with gene expression regulation and double strand DNA breaks, within vertebrata and yeast nuclear and mitochondrial genomes was carried out. Data on preferable localization of potential quadruplexes within non-coding sequences, their evolutionary conservation, and existing homology between them in mitochondrial and nuclear genomes were obtained. A possible interrelation between quadruplexes, Pif1 helicase and genomic instability is discussed.

Multiple intestinal strictures with perforation in a patient under antitubercular treatment for abdominal tuberculosis.

UNLABELLED: Abdominal tuberculosis (TB) constitutes about 12% of the extrapulmonaryTB. Abdominal TB can present with varying signs and symptoms likevague abdominal pain, abdominal mass, ascites and intestinal obstruction. Intestinal perforation is a relatively uncommon but a serious complication of abdominal TB. Antitubercular drugs are considered extremely effective but their role in the presence of a stenotic lesion of the bowel is controversial. Once symptoms of bowel obstruction or peritonitis appear, antitubercular drugs are of little use and surgery is inevitable. We report a case of abdominal TB in a patient under antitubercular treatment who later developed multiple intestinal strictures and a perforation. KEYWORDS: perforation; stricture; tuberculosis.

Strengthening national health systems for improving efficiency of health service delivery in Nepal.

The success of Nepal's community-based health programmes in promoting maternal and child health has been achieved due to an overall improvement in service delivery facilities and health support systems. This article assesses the progress made by the Government of Nepal in improving health service delivery by introducing three key components: an improved health logistics management, facility-based maternal and neonatal health services, and decentralized health facility management.

Internet addiction in a group of medical students: a cross sectional study.

The use of Internet for education, recreation and communication is increasing day by day. Nevertheless, the possibility of exploitation and addiction leading to impairment in academic performance and emotional balance cannot be denied, especially among young population. The study was aimed to measure the degree of Internet addiction among a group of medical students. Internet addiction test questionnaire developed by Young was used to assess mild, moderate and severe addiction. Amongst the study population (n=130, age 19-23 years), 40% had mild addiction. Moderate and severe addiction was found in 41.53% and 3.07% of the participants respectively. The study revealed that 24% often and 19.2% always found themselves using Internet longer than they had planned or thought. Late night Internet surfing leading to sleep deprivation was found in 31.53% of the participants. Almost one fourth of them (25.38%) occasionally tried to cut down the time they spent on the Internet but failed and 31.53% sometimes experienced restlessness when deprived of Internet access. Results reflected that a significant number of participants suffered from mild to moderate addiction. The role of counseling and education should be emphasized for prevention of Internet addiction.

Prediction of individuals prone to suffer from early onset of hypertension.

The present study was undertaken to predict the persons prone to suffer from early onset of hypertension. Healthy sedentary volunteers (age 18-25 years) having normal blood pressure were asked about their history of familial hypertension, smoking-habit, alcohol consumption, existing worries/anxieties; these being the predisposing factors of hypertension. The blood pressure of them was recorded (casual baseline blood pressure). Maximum voluntary contraction (MVC) was noted as maximum pressure (in Kg) sustained during 3 sec of handgrip using a handgrip dynamometer. Thereafter, the participant was asked to sustain isometric handgrip at one third of MVC for one minute with the same instrument (isometric handgrip-test). Then, blood pressure was measured and the subject was allowed to rest. Three minutes after the handgrip test, the blood pressure was noted again (recovery blood pressure). Handgrip-test produced a rise in systolic blood pressure in all male volunteers. Amongst them, with predisposing factors of hypertension, diastolic blood pressure remained significantly higher than casual baseline diastolic blood pressure even after 3 minutes of withdrawal of stressor. Whereas, in males with no predisposing factors of hypertension, the diastolic blood pressure approached almost the baseline casual blood pressure. In all female participants, no significant difference was noted between the casual baseline blood pressure and blood pressure after recovery. Results indicated that the young men who presented prolonged elevated diastolic blood pressure, in response to handgrip test would be at high risk of early onset of hypertension, as sympathetic over-activity prevails in them for longer time.

Significance of adenosine deaminase in diagnosing tuberculous pleural effusion.

Tuberculosis (TB) is a major public health problem in developing countries including Nepal. One of the common presentations of TB is pleural effusion. The diagnosis of tubercular pleural effusion can be difficult because of the low rate of detecting tubercule bacilli by direct stain and culture of pleural fluid for acid-fast bacilli (AFB). Pleural biopsy can be useful but is invasive and requires experts. In this context, pleural fluid Adenosine Deaminase (ADA) level has been proposed as easy, cheap and highly sensitive test for diagnosis of TB pleural effusion. The present study was undertaken to define the role ofpleural fluid ADA value in accurate diagnosis of TB pleural effusion. A Prospective analysis of 100 patients admitted in Nepal Medical College and teaching Hospital with pleural effusion was done. Pleural fluid ADA level was evaluated in all patients, and significance of pleural fluid ADA level in TB pleural effusion was studied. It was found that mean ADA level in pleural fluid was 105.8 +/- 67.23 U/L in cases of TB, as compared to 16.83 +/- 8.91 U/L in malignancy, 44.53 +/- 32.84 U/L in parapneumonic effusion and 15.94 +/- 4.88 U/L in patients with miscellaneous diagnosis. For a cut-off value of 42.19 U/L for diagnosis of TB pleural effusion, sensitivity was found to be 90.8% and specificity 82.8%. Almost all patients diagnosed to have TB pleural effusion responded completely to anti-tubercular treatment. So, we concluded that pleural fluid ADA analysis could be easy, cheap and highly sensitive and specific test for diagnosis of TB pleural effusion.

Association between maternal body mass index and the birth weight of neonates.

Birth weight (BW) is an important determinant of infant's well being. Several factors such as mothers' genetic characteristics, socio-cultural, demographic, behavioral factors, prepregnancy body mass index (BMI), gestational weight gain (GWG) etc contribute to birth weight. This study assesses the anthropometric measurement of ethnic Nepalese women belonging to Sherpa/Tamang community and Brahmin/Chhetri community and the neonatal outcome in this population. A retrospective study was done in singleton pregnant women of Sherpa/Tamang and Brahmin/Chhetri community who delivered baby in Nepal Medical College and Teaching Hospital from April 2007 to March 2008 to examine the association between the maternal Body Mass Index (BMI) and the gestational weight gain among the two ethnic communities and the birth weight of newborns. Among 206 Sherpa women who met the eligibility criteria, the mean BMI of Sherpa/Tamang community was 23.53 +/- 2.28 which was statistically higher than the Brahmin/Chhetri community (21.6 +/- 2.32). Among Sherpa/Tamang community, the mean gestational weight gain was 12.8 +/- 3.4 kg and the mean birth weight was 3460 +/- 410 grams. Similarly among Brahmin/Chhetri community, mean gestation weight gain was 10.3 +/- 3.1 kg and the mean birth weight was 2960 +/- 340 gm. Maternal BMI, gestational weight gain and birth weight of the newborn was significantly higher in Sherpa/Tamang community and the Increasing BMI and the gestational weight gain was found to have strong association with the birth weight of the newborns among this ethnic community.

Incidence of hypertension in patients undergoing surgery at Dhulikhel Hospital-Kathmandu University Hospital.

BACKGROUND: Hypertension is an important public health challenge worldwide and is most important modifiable risk factor for cardiovascular, cerebrovascular and renal disease. Blood pressure determination forms an integral part of anaesthesiologist evaluation of his patient condition prior to and during surgery. Data are not available which indicate changes in blood pressure occurring preanaesthetically in hospitalized patients. There are several risks from untreated preoperative hypertension in perioperative and postoperative phase. OBJECTIVE: To know the incidence of hypertension in preoperative patients undergoing major surgery. METHODS: This retrospective observational study was based on the data collected from preanaesthetic checkup record book from January 2010 to December 2010. RESULTS: A total of 955 patients were studied and analyzed in terms of hypertension and demographic characteristics. The total incidence of hypertension in preoperative phase was 10.16%. Among them 64.9% being male and 35.1% female. Maximum incidence was found in age group 50-59 years i.e. 26.6%. Among the case detected maximum patients i.e. 52% were patients with newly diagnosed hypertension and among those under medications 61.1% were using calcium channel blockers. CONCLUSION: Knowing the incidence will help in proper preoperative optimization of the hypertensive patients and also help in decreasing the incidence of postoperative complications.

Color vison deficiency among medical students: an unnoticed problem.

Color vision deficiency, most of the time remains an unnoticed problem; although it is not very rare. The faculty of appreciation of color is essential for our smooth daily activities. Unfortunately, even many doctors do not know the severity of their color vision deficiency and tend to assume it as slight, and a few, as in the general population, do not know about their disability. Some common difficulties reported by medical practitioners and medical students were in recognizing- widespread body color changes (pallor, cyanosis, jaundice, rashes, erythema of skin), colorful charts, slides, test-strips for blood and urine, body products: blood or bile in urine, faeces, sputum, vomit, microscopy, mouth and throat conditions, impressions presented in the Ishihara chart, titration end-points, tissue identification (surgery) etc. The present study was undertaken to evaluate the presence of congenital color vision deficiencies among the medical students. The study was carried out among the 1st and 2nd year medical students of Nepal Medical College and Teaching Hospital (n= 120) with the help of Ishihara chart, that was shown to all participants. They were asked to read the impressions in the color chart. The impression perceived by a person with normal color vision was different from the impression perceived by a person with color vision deficiency. It was noted that, among the study population (n=120) 5.83% of the volunteers were color weak. Amongst the color-deficient volunteers, 57.0% were protanopic while 43.0% were deuteranopic. Medical students must be made aware of their congenital color vision deficiency and its effects on their work. Screening will enable the student and later the doctor to become aware of limitations in their powers of observation and devise ways of overcoming them; the patient will be protected from harm and litigation may be avoided when doctors have adapted their practice to their deficiency. Medical students and physicians must be screened for color vision deficiency and advised about it so they can take special care in clinical practice.

Different hematologic responses to hypoxia in Sherpas and Quechua Indians.

Previous studies of the erythropoietic response to hypoxia in high-altitude natives suggest that the hematocrit and hemoglobin values in Himalayan natives (Sherpas) are lower than expected for the altitude, perhaps because of a genetic adaptation. However, differences in sampling techniques and experimental methods make comparisons difficult. Our studies were carried out to compare the erythropoietic response with the same altitude in age-matched natives of the Himalayas and Andes by the same experimental techniques. Healthy male subjects were selected in Ollagüe, Chile (n = 29, 27.3 +/- 5.9 yr) and in Khunde, Nepal (n = 30, 24.7 +/- 3.8 yr). Both of these villages are located at 3,700 m above sea level. Hematologic measurements confirmed lower hematocrit values in Nepal (48.4 +/- 4.5%) than in Chile (52.2 +/- 4.6%) (P less than 0.003). When subjects were matched for hematocrit, erythropoietin concentrations in Chile were higher than in Nepal (P less than 0.01). Detailed measurements of blood O2 affinity in Nepal showed no differences in shape or position of the O2 equilibrium curve between Sherpas and Western sojourners. Our results indicate that although Quechua Indians have higher hematocrits than Sherpas living at the same altitude, nevertheless they may be functionally anemic.

Dependence of high altitude sleep apnea on ventilatory sensitivity to hypoxia.

Respiration in man exposed to 5400 m was studied during sleep over a period of 6-8 h at night. Subjects were adult males, and belonged to distinct groups: one was Sherpa high altitude residents of the Himalayas and the other consisted of causasian sojourners from near sea level. All the volunteers had spent at least 32 days at or above 5400 m before the study. The subjects were instrumented for the measurements of breath-by-breath ventilation, SaO2%, eye-movement and heart rate. Nasal prongs were secured for the administration of mixtures of O2, N2 or CO2. Also, ventilatory sensitivity to hypoxia was studied in the awake state by the transient N2 and O2 tests. The lowlanders who showed high respiratory sensitivity to hypoxia also manifested periodic breathing with apnea during sleep. A raised PIO2 and SaO2% decreased ventilation, raised PACO2, attenuated respiratory oscillations and eliminated apnea in the sojourners. CO2 inhalation in air also eliminated apnea but not the periodicity, indicating that respiratory alkalosis caused apnea but periodic breathing was independent of central stimulation by CO2-H+. None of the Sherpa highlanders with low ventilatory sensitivity to hypoxia showed any sustained periodic breathing with apnea. The large breathing oscillations and periodic apnea correlated well with the ventilatory sensitivity to hypoxia (r = 0.85), supporting the hypothesis that a high gain of the peripheral chemoreflex is conductive to periodic breathing. Sherpas by attenuating chemoreflexes have reduced instability as well as cost of breathing at high altitude.