Role of Endoscopic Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty in Hearing Outcome and Graft Uptake

Background The endoscopes have better optics and magnification with wide angle of view due to angled lenses. It provides the excellent resolution of image in surgeries having many difficult anatomic nooks and corners like; antero-inferior recess of external auditory canal, middle ear cavity and difficult areas to visualize under microspore like sinus tympani. Likewise, the use of cartilage has very low metabolic rate, provide support to prevent retraction and reacts minimally to inflammatory reaction, so it has advantageous role in closure of tympanic membrane perforations. Objective The main objective of our study is to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty with our own modification. Method This is a prospective, cohort study conducted among 37 patients who underwent endoscopic modified inlay butterfly cartilage perichondrium myringoplasty using tragal cartilage. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1KHz, 2KHz, 4KHz). Result Among 42 patients, 37 (88.09%) had graft uptaken. Other five patients had residual perforation because of infection. The post-operative ABG was smaller than pre-operative ABG.(26.41±8.47dB and 36.57±12.13dB respectively). The mean ABG closure was 10.15±10.23dB. The ABG closure was ≤ 10dB in 28(75.6%) patients. Conclusion Endoscopic modified inlay butterfly cartilage perichondrium myringoplasty has advantages in terms of hearing results and graft uptake rate as it is comparable or even better than others. So, it is advisable to perform this technique without any difficulty.

Managing the oral side-effects of medications used to treat multiple sclerosis

BACKGROUND

Many medications used to manage multiple sclerosis (MS) affect oral health. This review aimed to identify the oral side-effects of the current drugs recommended in Australia to treat MS and make dental practitioners aware of the range of symptoms.

METHODS

The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat MS. For each medication, the generic name, class, route of administration, dosage and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (MIMs) database. Meyler's Side-effect of Drugs Encyclopaedia was used to identify any additional oral adverse reactions to medications used to treat MS.

RESULTS

Fourteen drugs were identified for the treatment of MS progression and 13 drugs for the treatment of MS symptoms. For these medications, 18 oral side-effects were documented: xerostomia was the most common, followed by dysgeusia, dysphagia, mouth ulceration and sinusitis. Anticholinergic drugs caused xerostomia while immunosuppressants resulted in more infection-related side-effects.

CONCLUSIONS

Dental practitioners should be aware of the range of symptoms likely to be reported by this population. Clinicians are encouraged to continue providing dental care for their patients who develop MS and refer complex cases to specialists.

Elevated catalase expression in a fungal pathogen is a double-edged sword of iron

Most fungal pathogens of humans display robust protective oxidative stress responses that contribute to their pathogenicity. The induction of enzymes that detoxify reactive oxygen species (ROS) is an essential component of these responses. We showed previously that ectopic expression of the heme-containing catalase enzyme in Candida albicans enhances resistance to oxidative stress, combinatorial oxidative plus cationic stress, and phagocytic killing. Clearly ectopic catalase expression confers fitness advantages in the presence of stress, and therefore in this study we tested whether it enhances fitness in the absence of stress. We addressed this using a set of congenic barcoded C. albicans strains that include doxycycline-conditional tetON-CAT1 expressors. We show that high basal catalase levels, rather than CAT1 induction following stress imposition, reduce ROS accumulation and cell death, thereby promoting resistance to acute peroxide or combinatorial stress. This conclusion is reinforced by our analyses of phenotypically diverse clinical isolates and the impact of stochastic variation in catalase expression upon stress resistance in genetically homogeneous C. albicans populations. Accordingly, cat1Δ cells are more sensitive to neutrophil killing. However, we find that catalase inactivation does not attenuate C. albicans virulence in mouse or invertebrate models of systemic candidiasis. Furthermore, our direct comparisons of fitness in vitro using isogenic barcoded CAT1, cat1Δ and tetON-CAT1 strains show that, while ectopic catalase expression confers a fitness advantage during peroxide stress, it confers a fitness defect in the absence of stress. This fitness defect is suppressed by iron supplementation. Also high basal catalase levels induce key iron assimilatory functions (CFL5, FET3, FRP1, FTR1). We conclude that while high basal catalase levels enhance peroxide stress resistance, they place pressure on iron homeostasis through an elevated cellular demand for iron, thereby reducing the fitness of C. albicans in iron-limiting tissues within the host.

The pathogenic yeast Candida albicans faces multiple challenges within its human host. These include the need to protect itself against the toxic oxidants used by the host to kill invading microbes, and the need to scavenge iron, an essential micronutrient that is limiting in certain tissues. The iron-containing enzyme, catalase, detoxifies hydrogen peroxide, thereby playing a major role in protecting C. albicans against reactive oxygen species and neutrophil killing. Indeed, we show that high basal catalase expression increases the resistance of this yeast to oxidative and combinatorial (oxidative plus cationic) stresses. Yet, rather than enhancing the virulence of C. albicans as had been predicted, high basal catalase expression decreases fungal colonisation in certain iron-limiting tissues. Furthermore, we demonstrate that catalase inactivation does not significantly perturb the virulence of C. albicans in models of systemic infection. We also show that ectopic catalase expression increases the demand for iron in C. albicans, thereby reducing the fitness of this pathogen in the absence of stress under iron-limiting conditions. Therefore, high basal catalase expression is a double-edged sword: it enhances the fitness of C. albicans in the presence of stress, but reduces fitness in the absence of stress. This explains why catalase overexpression reduces rather than enhances virulence.

Melanotrichoblastoma: A Rare Case Report from B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Melanotrichoblastoma is a variant of pigmented trichoblastoma. It shows heavily pigmented epithelial lobules and differentiaion toward the hair bulb. Abundant dendritic melanocytes are found within the tumor masses. These melanocytes show positivity for S100 protein, HMG45/gp 100 and tyrosinase. The case is being reported because of its rarity.A twenty eight year lady presented to Dermatology OPD with a single nodular lesion on the right temporal region since last five years. Punch biopsy was done. Haematoxylin and eosin stained slides were studied and immunohistochemistry analysis was also done.Variably sized epithelial lobules of basaloid cells spanning the entire dermis was noted on H and E stained slides. Some lobules showed pale looking cells- a reminiscent of follicular germinative cells. Intralesional melanocytes with pigmentation were observed. Immunohistochemistry results showed the melanocytes positive for HMB-45 and S100 and the stroma positive for CD 34. Hence, a definitive diagnosis of Melanotrichoblastoma was made.This case is being presented to emphasize the difficulty posed by adnexal tumors in clinical diagnosis due to their clinical similarity with malignant lesion and rarity.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017

Grading, staging and Nottingham prognostic index scoring of breast carcinoma

Background: Breast carcinoma is the most frequent malignant tumor in women accounting for approximately 15% of female cancer deaths. It is the second most common malignancy among women in Nepal. Our objectives were to study the extent and spread of different histological types breast carcinoma in the eastern region of Nepal, to grade and stage the tumors, score the prognosis.Materials and Methods: A cross-sectional descriptive study of mastectomy specimens with axillary lymph node sampling was done for a period of two years. Diagnosis was done using WHO classification. Modified Bloom Richardson score and TNM system was used to grade and stage the tumors. Nottingham Prognostic index was applied to score the prognosis.Results: Out of 31 total cases, the most common histologic type was Invasive Carcinoma of No Special Type (67.74%). The largest tumor size was of 12cm which had poor NPI score. Most tumors were of grade II and T2. Out of 30 cases with lymph nodes, 13 were negative for metastasis pN0, 10 were pN1 and 7 were pN2. Extranodal spread was observed in 6 out of 17 cases with lymph node metastasis and was associated with higher grades and poor prognosis.Conclusion: Higher grade tumors, lymph node metastasis and extranodal extension are associated with higher Nottingham Prognostic Index score. 

Pleomorphic adenoma of nasal septum: A case report

Pleomorphic adenomas are the most common benign tumor of the major salivary glands. Other rare sites for the occurrence of pleomorphic adenoma have been described in the larynx, pharynx, nasal cavity, lacrimal glands and trachea. We report here a case of intranasal pleomorphic adenoma arising from the nasal septum causing nasal obstruction which was clinically diagnosed as papilloma. Histopathology confirmed the diagnosis of pleomorphic adenoma.

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme

INTRODUCTION AND HYPOTHESIS

The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS).

METHODS

Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100 %) would recommend the training programme to a friend or colleague. 92 % felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat".

CONCLUSION

Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.

A clinico-histopathological study on skin appendageal tumors

Background: Skin Appendageal tumors are a large and diverse group of tumors that are commonly classified according to their state of appendageal differentiation: follicular, sebaceous, eccrine and apocrine. Objectives of this study were to study the clinic-epidemiological profile of skin appendageal tumors and to correlate the clinico-histopathological diagnosis.Materials and Methods: This was a retrospective and prospective study which included all cases of skin adnexal tumours diagnosed histologically during the period of f

Changing perspective on tissue processing - comparison of microwave histoprocessing method with the conventional method

Background: Histopathological examination of tissues requires sliver of formalin fixed tissue that has been chemically processed and then stained with Haematoxylin and Eosin. The time honored conventional method of tissue processing, which requires 12 to 13 hours for completion, is employed at majority of laboratories but is now seeing the

Atraumatic restorative technique: case report on dental management of a patient with Moebius syndrome

BACKGROUND

Clinical challenges associated with Moebius syndrome, a rare congenital neuromuscular disorder, include orofacial anomalies like microstomia, limited mouth opening and severe gag reflex.

METHODS

This case report presents the dental management of an anxious female with Moebius syndrome. For restorations, atraumatic restorative technique (ART), using glass ionomer cement was used with hand instruments.

RESULTS

All necessary dental treatment was completed in the dental chair, thus avoiding the need for a general anaesthetic, and associated complications with airway management due to orofacial abnormalities.

CONCLUSIONS

ART is an appropriate technique for people with microstomia and/or limited mouth opening, such as those with Moebius syndrome. The application of ART can be extended to other special needs patients (people with physical and intellectual disabilities, extreme anxiety, needle phobia and the frail elderly in aged care facilities), where access or cooperation is difficult or limited.

Maternal and Neonatal Health Knowledge, Service Quality and Utilization: Findings from a Community Based Quasi-experimental Trial in Arghakhanchi District of Nepal

BACKGROUND

As part of the Partnership for Maternal and Newborn Health Project (PMNH), HealthRight International collaborated with Mother and Infant Research Activities (MIRA) to conduct operations research in Arghakhanchi district of Nepal to explore the intervention impact of strengthening health facility, improving community facility linkages along with Community Based Newborn Care Program (CB-NCP) on Maternal Neonatal Care (MNC) service quality, utilization, knowledge and care seeking behavior.

METHODS

This was a quasi-experimental study. Siddahara, Pokharathok, Subarnakhal,Narpani Health Posts (HPs) and Thada Primary Health Care Center(PHCC)in Electoral Constituency-2 were selected as intervention sites and Arghatosh, ,Argha, Khana, Hansapur HPs and Balkot PHCC in Electoral Constituency-1 were chosen as controls. The intervention started in February 2011 and was evaluated in August 2013. To compare MNC knowledge and practice in the community, mothers of children aged 0-23 months were selected from the corresponding Village Development Committees(VDCs) by a two stage cluster sampling design during both baseline (July 2010) and endline (August, 2013) assessments. The difference in difference analysis was used to understand the intervention impact.

RESULTS

Local resource mobilization for MNC, knowledge about MNC and service utilization increased in intervention sites. Though there were improvements, many effects were not significant.

CONCLUSIONS

Extensive trainings followed by reviews and quality monitoring visits increased the knowledge, improved skills and fostered motivation of health facility workers for better MNC service delivery. MNC indicators showed an upsurge in numbers due to the synergistic effects of many interventions.

Osteosarcomas in the upper distal extremities: are their oncological outcomes similar to other sites?

AIMS

To investigate whether the oncological outcomes of patients with osteosarcomas in the upper distal extremity are similar to other sites and assess if limb-salvage surgery is safe in this location.

METHODS

The centre database was used to identify all patients with osteosarcomas in the lower humerus and distally between 1985 and 2012. Patient, tumor, treatment and outcome data was collected.

RESULTS

Twenty-six patients were included in this study. There were 9 males and 17 females with a mean age of 33 years (9-90). Seventeen osteosarcomas were located in the forearm bones (65%), six in the distal humerus (23%), and three (12%) in the hand. The three most common sub-diagnoses were parosteal 7/21 (33%), fibroblastic 4/21 (19%) and osteoblastic osteosarcomas 3/21 (14%). 2 patients (8%) had Paget's disease and 19 patients (73%) had high-grade tumors. Local excision was carried out in 12 patients (48%), 4 patients underwent endoprosthetic replacement (16%) and 9 underwent amputation (36%). The overall risk of local recurrence was 4% in our series. The five-year overall survival rate was 67%, with low tumor grade and parosteal type of osteosarcoma being positive predictors of survival.

CONCLUSION

This series has shown that patients with high-grade osteosarcomas of the upper distal extremities have a higher amputation risk than other limb sites but have favorable outcomes with limb-salvage surgery, comparable to other anatomical sites. Parosteal osteosarcomas in particular have a good prognosis.

Obstetric Outcome of Teenage Pregnancy

Aims: To assess the prevalence of teenage pregnancies and to compare the obstetric performance of teenage pregnant woman with that of adult pregnant woman. Methods: A prospective study was conducted in Nepal Medical College Teaching Hospital from August, 2010 to February, 2012 (one and half year duration). All the teenage pregnancies were included and outcomes were compared with adult (20-24 years) pregnancies, selected randomly who had delivered during the same period of time. The patient characteristics (age, gravidity, parity, gestation age) and obstetric outcome (medical and obstetrical complications, mode of delivery, complications during delivery, fetal outcome, birth weight) were compared between the two groups. Statistical analysis was preformed using PHSTATZ and Z test for proportion. Results: There were total 2708 deliveries during the study period, out of which teenage pregnancy was 264 (9.7%). There were 69(26.1%0) teenage mothers of age 16 to 17 years and 195(73.9%) of age group 18 to 19 years. As expected, maximum patients in the test group i.e. teenagers were primigravida as compared to control group. (90.1% vs. 68.5%). As for mode of delivery, normal delivery in test and control was 82.9% vs 81.1% (p=0.56) and rate of cesarean delivery was similar 10.2% and 10.7%, (p=0.84) in both the groups. The incidence of instrumental delivery was more in control group although it was not statistically significant( 0.7% vs 2.2%, p=0.16). Preterm delivery was 3.0% in teenage as compared to control which is 2.2%. The percentage of intrauterine fetal death was 0.7% vs 0% in test and control group (p=0.15). Proportion of low birth weight babies in test and control group was 7.2% vs 5.9% (p=0.55). Similarly pregnancy related complications were also compared in teenage and control groups. It was found that postpartum hemorrhage occurred more in teenage pregnancy 1.8% vs 0.7% (p=0.84) but statistically not significant. Incidence of hypertensive disorders was 6.4% and 5.6% (p=0.66) in test and control group. Proportion of babies with intrauterine growth restriction was 3.0% in test and 1.1% (p=0.009) in control, the only parameter that is statistically significant. Fetal congenital anomaly was 0.7% vs 0.4% (p=0.54) Conclusions: Teenage pregnancy can have an equally good outcome if we give good obstetric care and encourage institutional delivery. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11139 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 29-32

Crossed Testicular Ectopia

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia.

Survey of external cephalic version services in the East of England region: comparison of services in 2007 and 2012

External cephalic version (ECV) has been recognised by the Royal college of Obstetricians and Gynaecologists (RCOG) as a safe procedure for the conversion of breech presentations to cephalic presentation. The need to reduce the incidence of breech presentations is due to the associated increase in complications for both mother and baby in a breech delivery. The RCOG published the Green-top Guideline No. 20a in December 2006 and revised it in December 2010. In our study, we conducted a survey across all hospitals in the East of England (EoE) region in 2007 and 2012 to assess the ECV service and to determine if this fulfils the RCOG recommendations.

Abdominal cocoon in an adolescent male

Abdominal cocoon is an uncommon peritoneal condition characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions. Only few cases of this disease have been reported in world literature. The etiology of this condition is unknown, and most often it is found in adolescent girls from tropical or subtropical countries, and usually diagnosed incidentally on exploration. Surgery (membrane dissection and extensive adhesiolysis) is the treatment of choice. Here, we report a case of abdominal cocoon in a 20-year-old male patient, with a brief review of the literature.

Quantitative Mueller matrix fluorescence spectroscopy for precancer detection

Quantitative fluorescence spectroscopic Mueller matrix measurements from the connective tissue regions of human cervical tissue reveal intriguing fluorescence diattenuation and polarizance effects. Interestingly, the estimated fluorescence linear diattenuation and polarizance parameters were considerably reduced in the precancerous tissues as compared to the normal ones. These polarimetry effects of the autofluorescence were found to originate from anisotropically organized collagen molecular structures present in the connective tissues. Consequently, the reduction of the magnitude of these polarimetric parameters at higher grades of precancer was attributed to the loss of anisotropic organization of collagen, which was also confirmed by control experiments. These results indicate that fluorescence spectral diattenuation and polarizance parameters may serve as potentially useful diagnostic metrics.

Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair

PURPOSE

Recent meta-analyses have shown reduced re-rupture rates for the surgical management of Achilles ruptures. However, percutaneous repair has been demonstrated to lead to improved function and patient satisfaction but greater complications than open repair. In the current economic climate, it is reasonable to consider the financial cost of rupture management for both the patient and the provider. The cost-effectiveness of operative treatment of ruptures of the Achilles tendon was determined based upon theatre occupancy, clinic attendance and cast changes, operative complications and functional assessment score.

METHODS

The cost-effectiveness of the surgical management of Achilles tendon ruptures between 2005 and 2011 in our unit was audited by comparing 49 patients receiving percutaneous repair to 35 patients whom had open repairs.

RESULTS

There was no significant difference in complications between the two surgical techniques: (Open vs. Percutaneous) overall rates 14.3 versus 10.4 %: infection; 2.7 versus 2.0 %, transient sural nerve damage: 5.6 versus 8.1 %, wound breakdown: 2.8 versus 0.0 %, re-rupture: 2.8 versus 2.0 %. Achilles Total Rupture Scores (ATRS) were comparable [Open 89 (65-100) at 49 months vs. Percutaneous 88.8 (33-100) at 12 months (n.s.)]. Theatre occupancy (P < 0.00) and hospital stay (P < 0.00) were significantly longer with open repair [43 min (26-70) and 2.9 days (0-4)] compared to percutaneous repair [15 min (12-43) and 1.2 days (0-2)]. Excluding the costs of running the operating theatre, we have estimated the costs of surgery for open repair to be £ 935 and percutaneous repair to be £ 574.

CONCLUSIONS

This study suggests that percutaneous repair of the Achilles tendon resulted in reduced costs and yet had comparable outcome and complications rates to open repair in surgical management of the Achilles tendon. Percutaneous repair should be considered as the primary method of cost-effective surgical management of Achilles tendon rupture.

Evaluation of urogynaecology care of an elderly population in a specialist urogynaecology centre

The ageing population of the UK means that demand for urogynaecology services is expected to increase substantially, particularly in patients aged over 65 years. To assess service provision and predict future needs, we reviewed the demographic profile and service requirements of elderly patients referred to our urogynaecology service. We performed a retrospective review of case notes of 125 patients over 65 years of age who attended our urogynaecology clinic within a 6 month period, including comorbidity scoring using a validated instrument. A substantial proportion (56%) of patients did not require hospital-based management, and none of the patients had an adult comorbidity evaluation (ACE-27) score >2. Hence, we recommend assessing patients using the ACE-27 score and not on chronological age alone. A restructuring of urogynaecology services towards better access to community-based clinics is required to reflect the treatment needs of the patient population. This would be in line with national continence care guidance.

Childbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England, 2002-2008

OBJECTIVE

To report the numbers of patients having childbirth after pelvic floor surgery in England.

DESIGN

Retrospective analysis of Hospital Episode Statistics data.

SETTING

Hospital Episode Statistics database.

POPULATION

Women, aged 20-44 years, undergoing childbirth after pelvic floor surgery between the years 2002 and 2008.

METHODS

Analysis of the Hospital Episode Statistics database using Office of Population, Censuses and Surveys: Classification of Interventions and Procedures, 4th Revision (OPCS-4) code at the four-character level for pelvic floor surgery and delivery, in women aged 20-44 years, between the years 2002 and 2008.

MAIN OUTCOME MEASURES

Numbers of women having delivery episodes after previous pelvic floor surgery, and numbers having further pelvic floor surgery after delivery.

RESULTS

Six hundred and three women had a delivery episode after previous pelvic floor surgery in the time period 2002-2008. In this group of 603 women, 42 had a further pelvic floor surgery episode following delivery in the same time period. The incidence of repeat surgery episode following delivery was higher in the group delivered vaginally than in those delivered by caesarean (13.6 versus 4.4%; odds ratio, 3.38; 95% confidence interval, 1.87-6.10).

CONCLUSIONS

There were 603 women having childbirth after pelvic floor surgery in the time period 2002-2008. The incidence of further pelvic floor surgery after childbirth was lower after caesarean delivery than after vaginal delivery, and this may indicate a protective effect of abdominal delivery.

Histopathological patterns of ovarian tumors at BPKIHS

Introduction: Ovarian tumors account for fifth most common cause of cancer related death in females involving a variety of histological diagnosis. It accounts for 6% of all cancers. Though it is one of the treatable cancers due to its sensitivity to anticancer therapies, it frequently does not result in symptoms until the cancer has spread extensively.Objectives: To study the incidence, histopathological spectrum and clinical correlates of ovarian tumours at B.P. Koirala Institute of Health Sciences (BPKIHS).Methods: A cross-sectional study was undertaken during a period of one year (1st Jan. 31st Dec 2006). The tumors were classified according to WHO classification after thorough examination of H&E slides under light microscope. Data on clinical presentation and physical findings were also recorded in each case.Results: There were a total of 83 cases. Surface epithelial tumors emerged as the commonest variety accounting for 47%, followed by Germ cell tumors (45.8%). Sex . cord stromal tumors and metastatic tumors accounted 3.6% each. The age range was 10 . 86 years. Metastatic tumors involved younger age groups. Abdominal mass was the commonest clinical presentation followed by pain abdomen.Conclusion: At BPKIHS, ovarian tumors were found to occur in wide range of age (10-86years) with abdominal mass and pain abdomen being the commonest mode of clinical presentation .Histology revealed that surface epithelial tumors and germ cell tumors together constitute the large majority of the case (92.8%). An accurate histological diagnosis and staging is therapeutically and prognostically important.DOI: http://dx.doi.org/10.3126/hren.v10i2.6570 Health Renaissance 2012; Vol 10 (No.2); 87-97 

Hanging: nature of ligature material applied and type of hanging according to point of suspension

One of the most common manners of unnatural death that has been rapidly increasing in Nepal is suicide. The choice of method depends on the accessibility and availability of the means. Therefore suicide by hanging with the ligature material ranging from torn clothing, bed sheet to a shoelace is incorporated. Objective of this study is to find the choice of the type of ligature material used by the victims and the type of hanging found in relation to the point of suspension in both genders. This prospective study was conducted in all cases of death due to hanging (44 cases) during the year January 2007to April 2008 coming for post mortem examination at BPKIHS Dharan Nepal. Nearly half of the hanging victims (21 or 47.72%) used rope for hanging and nearly one third victims (14 or 31.81%) used shawl, rest of victims 4 (9.09%) used sari, 2 (4.54%) victims used either bed sheet or woolen muffler in each and belt was used as ligature by one (2.27%) of the victims. It was observed that in more than half of the cases (25 or 56.81%) hanging was partial (i.e. some body parts were touching the ground). Amongst partial hanging cases, female victims (16 or 64%) outnumbered the male victims (9 or 47.37%).While rest 19 (43.18%) cases were complete hanging (i.e. body was not touching the ground).

SU-E-T-313: Probe-Type Experimental Dosimetry in Terms of Absorbed Dose to Water in Photon-Brachytherapy a Proposal for a Radiation-Quality Index

PURPOSE

In photon-brachytherapy (BT), all data for clinical dosimetry (e.g., the dose-rate constant) are not measured in water, but calculated, based on MC-simulation. To enable the measurement of absorbed dose to water, DW, in the vicinity of a source, the complex energy-dependence and other influence quantities must be considered.

METHODS

The detectors response, R=M/D, is understood as product of a detector-material dependent 'absorbed dose response', Ren, and Rin, the 'intrinsic response'. Ren is described by the Burlin-theory and because of dissimilarities between the detector-material and water, will have energy dependent correction factors which convert Ren into the clinically relevant DW,Qo=MQo × ND,W,Qo. To characterize BT- source-types, we propose a new 'radiation-quality index' QBT=Dprim(2cm)/Dprim(1cm), the ratio of the primary-dose to water at r=2cm to that at the reference distance r=1cm, similar to external beam dosimetry. Although QBT cannot be measured directly, it can be derived from primary and scatter separated dose-data, published as consensus data e.g., in the Carlton AAPM-TG-43-database.

RESULTS

Mean QBT-values are: for nine HDR and four PDR 192Ir-sources: 0.2258±0.5%; one 169Yb- source: 0.2142; and one 125I-source: 0.1544.

CONCLUSIONS

The main benefit of this new QBT-concept is that a type of BT-dosimetry-detector needs to be calibrated only for one reference radiation-quality, e.g., for Q0=192Ir. To measure the dose for different source-types, DW can be determined using calculated radiation-quality conversion factors kQ,QoBT, to be included in the AAPM-database and to be provided by the manufacturer for each detector-type. Typical BT-dosimetry-detectors are plastic scintillation detectors, radiochromic film, thermoluminescence detectors, optically stimulated detectors, and small volume ionization chambers. Recently, different DW(1cm)-primary standards have been developed in several European NMIs, enabling to calibrate BT-radiation- sources and BT-dosimetry-detectors and allowing to verify MC-calculated dose-rate constant values. The proposed definition of QBT has to be discussed internationally to find broad consensus.

Intrauterine growth curves for singleton live babies in Paropakar Maternity and Women's Hospital in Nepal

BACKGROUND

To construct birth weight, crown heel length and head circumference centile chart referenced to gestational age for Nepalese infants.

METHODS

The study was conducted over a period of six months. It included consecutive live births from 28 to 42 weeks of gestation. Their birth weight, crown-heel length and head circumference were recorded. Smoothed percentile values along with curves were created using the Lambda Mu Sigma (LMS) method. The curves were compared with one of the Indian study.

RESULTS

A total of 9710 newborns were measured. The mean birth weight, crown-heel length, head circumference at 40 weeks were 3023g, 49.22cm and 33.61cm respectively. Smoothed percentile values calculated gave the cutoffs for defining small and large gestational age for Nepalese newborns. Comparison with Indian study showed significant difference (p<0.01) in weight. The Indian babies weighed less than Nepalese babies.

CONCLUSIONS

The referenced growth standards help in clinical assessment, defining and identifying high risk newborns, thus, leading to improved care and management of neonates. It should help public health policy makers to track population difference due to several factors, intervene and find response over time.

Oncological outcomes of patients with Ewing's sarcoma: is there a difference between skeletal and extra-skeletal Ewing's sarcoma?

The aim of this study was to identify whether there was any difference in patient, tumour, treatment or outcome characteristics between patients with skeletal or extra-skeletal Ewing's sarcoma. We identified 300 patients with new primary Ewing's sarcoma diagnosed between 1980 and 2005 from the centres' local database. There were 253 (84%) with skeletal and 47 (16%) with extra-skeletal Ewing's sarcomas. Although patients with skeletal Ewing's were younger (mean age 16.8 years) than those with extra-skeletal Ewing's sarcoma (mean age 27.5 years), there was little difference between the groups in terms of tumour stage or treatment. Nearly all the patients were treated with chemotherapy and most had surgery. There was no difference in the overall survival of patients with skeletal (64%) and extra-skeletal Ewing's sarcoma (61%) (p = 0.85), and this was also the case when both groups were split by whether they had metastases or not. This large series has shown that the oncological outcomes of Ewing's sarcoma are related to tumour characteristics and patient age, and not determined by whether they arise in bone or soft tissue.

Fitting ordinal regression analysis to anthropometric data

BACKGROUND

National level surveys on nutritional status since 1975 to 2006 in Nepal do not indicate the satisfying level of nutrition. Nepal demographic and health survey 2006 uncover that the percent prevalence for underweight and wasted children of under five years of age are 39% and 13% and 49 % of the under five children are stunted. Understanding the factors that affect the nutrition of children is essential. Some studies in other countries show wealth index, size at birth and education as significant contributors. This analysis analyze the factors associated with nutritional status among children of under five years of age.

METHODS

This study was cross sectional which used secondary data of the Demographic and Health Survey, 2006 conducted in Nepal. STATA 9, SPSS 13 and SPSS 17 are used for analysis. In this analysis, the outcome variables namely stunting, underweight and wasting are in ordered form. Hence ordinal regression is considered as suitable method.

RESULTS

Ordinal regression well suit the data to model nutritional status through different predictors in case of underweight and wasting however stunting model fails to satisfy the assumption behind ordinal regression. Hence for stunting, model with constraints imposed to certain variables is formed.

CONCLUSIONS

Underweight is seen significantly less in households with high wealth index, among children of big and average size at birth and among educated women. Education, wealth index and size at birth are found important factors affecting wasting among children. Wealth index and education of mothers are significantly affecting for stunting among children.

Fertility desire of working women in Kathmandu

BACKGROUND

This study is done to describe the fertility pattern and factors associated with unmet desire for additional children among women working in formal and informal sector in Kathmandu, Nepal.

METHODS

This is a cross-sectional study. Married 177 women in reproductive age group, with at least one child are selected using purposive sampling. Housewives without paid job are excluded. Interview using semi structured questionnaire is conducted.

RESULTS

Around 14 percent of women want additional children, however due to various reasons they do not intend to have another. Women in age group of 25-29 followed by 30-34 years of age have higher desire for more children as compared to women in more than 40 years of age. Women who earn 25000-33000 Rupees per month have significantly more desire for another child.

CONCLUSIONS

Childcare time and economic conditions play vital role in fertility desire among working women. Family help is available to most of the women to care their children. These women wish more facilities at workplace during child bearing and rearing period.