Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital.

Methods:

This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. Convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences.

Results:

Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) case had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney.

Conclusions:

From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

Assessment of oral health status and treatment needs among people of Foklyan area, Dharan, Nepal

Background

Oral diseases are a major public health problem globally due to high prevalence and significant social impact. Foklyan is a peri urban area with people belonging to indigenous population of low socioeconomic status. This study was conducted to assess the oral health status and treatment needs among the people of Foklyan area, Dharan.

Methods

Cross-sectional house to house survey was conducted on 310 randomly selected participants. The participants were stratified into five age groups as per WHO Basic Oral Health Survey Methods 1997 and further categorized by gender. WHO Oral Health Assessment form 1997, WHO oral health assessment questionnaire for adult/children 2013 and questionnaire for oral hygiene practice and cost as a treatment barrier were used. The examinations were done as per WHO standard guidelines.

Results

Most of the participants were from low socioeconomic background (71.3%). About 40% of the participants deferred dental visit due to financial burden. Although 99% of the participants brushed their teeth, there was high caries experience (DMFT: 3.18 ± 5.85; dft: 2.40 ± 2.65). Mean sextant score for bleeding was 5.58 in 35–44 years age group and 5.61 in 65–74 years age group. Tobacco consumption was seen in 70.9% of the adults. Prevalence of alcohol consumption was 58.8% among adult age groups.

Conclusion

The prevalence of dental caries, periodontal diseases, and prosthetic needs were more compared to national data. There is a need for oral health promotion in this area.

A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance

Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications.

Factors Influencing Male Participation in Maternal Health Care among Married Couples in Nepal: A Population-based Cross-sectional Study

Background The male involvement in maternal health care is essential to reduce obstetric complications. However, there is little known about factors contributing to male participation in maternal health in Nepal. Objective To assess predisposing, enabling and reinforcing factors contributing male participation in maternal health care in Nepal. Method A population based cross-sectional study was conducted among 374 married couples. Ethical approval was obtained from Institutional Review Board of Kathmandu Medical College Teaching Hospital. The data was collected, using modified Safe Motherhood and Partnership Family Approach Model. Multivariable logistic regression was applied to account associated paternal factors. Concentration curve and concentration index were computed to measure equity gap between lowest and highest quintiles. Result While four out of ten husbands reported high level of their involvement in maternal health care practices, wives reported relatively less involvement of their husbands. Logistic regression showed that husband having low family income, knows about immunization, contact with family planning providers were more likely to participate. In contrary, according to wives, husbands' who have ever been to health facility, discuss family planning with others, contact with family planning providers and who knows about exclusive breast feeding were less likely to participate. The study also showed that socio-economic factors play a significant role. Conclusion Male involvement in maternal health care practices is low. Predisposing, enabling and reinforcing factors play a significant role; however, some contradictions among husbands' and wives' perspectives provide strong evidence on significance of communication within partners on maternal health care issues.

Adrenal Ganglioneuroma

Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facililate the diagnosis of adrenal ganglioneuroma.

Hormonal Contraceptives Use and Their Adverse Effects: A Cross-sectional Study among the Women Visiting Tertiary Care Center

Background Hormonal contraceptives are one of the most commonly used means of contraception. Lack of contraception may lead to large family size, increased preexisting illness on pregnancy, social and economic instability, risk of unsafe abortion and so on. This may also lead to unintended pregnancies which may alter the outcomes of pregnancies as well. However, improper uses are associated with several serious adverse effects. Therefore, to achieve the optimum benefit with the least adverse effects, safe and effective use of these agents with monitoring of their pattern of use and patient compliance is very essential. Objective To investigate the usage of hormonal contraceptives and the adverse effects associated with them. Method A cross-sectional study was conducted in a family planning center of a tertiary care hospital. All women of reproductive age using hormonal contraceptives for at least 1 month were included in this study. Informed consent was taken from the patients and interviewed using a structured questionnaire. Statistical analysis was performed by using SPSS 20. Result Among the 105 participants under this study, the mean (±SD) age was 29.08 (± 6.12) years. A majority (42, 40.0%) of them were using injectables. The average duration of use of hormonal contraceptives was 25.1 months ± 31.8 while a majority (60, 57.1%) were using contraceptives from < 3 months. Less chance of missed dose was the major reason (26.8%) for choosing injectable. Adverse effects were reported by 75.2% of the patients. The most common adverse effect was menstrual abnormalities (21.7%). Conclusion Among various hormonal contraceptives, injectables were more commonly used. The majority of the participants responded to use injectables because of the least chance of missing the dose. The most common adverse effect reported was menstrual abnormalities.

Localization of Mental Foramen in Panoramic Radiographs of 18-30 Year Olds: A Hospital Based Study

Background The position of the mental foramen demonstrates anatomical variations, although typically it is reported to be either between the apices of the first and second premolars or below the apex of the second premolar. Objective To determine the radiographic position of mental foramen in relation to Premolar crown and apex, in panoramic radiographs. Method Following ethical approval a retrospective study was conducted in 510 panoramic radiographs of 18-30 year olds from archives of Department of Oral Medicine and Radiology. The position of mental foramen was scored using crown and apex scores according to scoring criteria given by Jasser and Nwoku, 1998. Descriptive statistics was calculated and Chi-square test was applied to assess variation in position of mental foramen between genders and right and left side of mandible. Kappa statistics was applied to assess intra-observer reliability. Result The most common scoring for position of mental foramen on right side crown and apex was 3 (49.4%) followed by 4 (45.9%). Similarly, on left side the most common score for crown and apex was 3 (50.8%) followed by 4 (44.3%). There was no statistically significant difference in position between the genders. Comparing the right and left sides, the position was symmetrical in 83.3% for crown and apex scores. The Kappa values indicated good agreement for intraobserver reliability. Conclusion The most common position for the mental foramen is between the first and second premolar teeth; though, anatomical variations are seen.

Study on the efficiency of dsRNAs with increasing length in RNA-based silencing of the Fusarium CYP51 genes

Previously, we have demonstrated that transgenic Arabidopsis and barley plants, expressing a 791 nucleotide (nt) dsRNA (CYP3RNA) that targets all three CYP51 genes (FgCYP51A, FgCYP51B, FgCYP51C) in Fusarium graminearum (Fg), inhibited fungal infection via a process designated as host-induced gene silencing (HIGS). More recently, we have shown that spray applications of CYP3RNA also protect barley from fungal infection via a process termed spray-induced gene silencing (SIGS). Thus, RNAi technology may have the potential to revolutionize plant protection in agriculture. Therefore, successful field application will require optimization of RNAi design necessary to maximize the efficacy of the RNA silencing construct for making RNAi-based strategies a realistic and sustainable approach in agriculture. Previous studies indicate that silencing is correlated with the number of siRNAs generated from a dsRNA precursor. To prove the hypothesis that silencing efficiency is correlated with the number of siRNAs processed out of the dsRNA precursor, we tested in a HIGS and SIGS approach dsRNA precursors of increasing length ranging from 400 nt to 1500 nt to assess gene silencing efficiency of individual FgCYP51 genes. Concerning HIGS-mediated disease control, we found that there is no significant correlation between the length of the dsRNA precursor and the reduction of Fg infection on CYP51-dsRNA-expressing Arabidopsis plants. Importantly and in clear contrast to HIGS, we measured a decrease in SIGS-mediated Fg disease resistance that significantly correlates with the length of the dsRNA construct that was sprayed, indicating that the size of the dsRNA interferes with a sufficient uptake of dsRNAs by the fungus.

Adherence to Iron, Folic Acid and Calcium Supplement and Factors Affecting it among the Antenatal Care Attending Women in a Tertiary Care Hospital: A Cross Sectional Study

Background Pregnancy or gestation is the time during which a single or more children grows and develops inside a woman. Antenatal care improves the pregnancy outcomes under which a group of medication i.e. iron, folic acid and calcium are supplemented. Despite the effectiveness of such supplements, poor clinical outcomes are often encountered because of poor-adherence to the regimen. Objective To determine the adherence pattern and factors affecting adherence in antenatal care patients under iron, folic acid, and calcium therapy. Method A cross-sectional study was conducted in Dhulikhel Hospital, Kathmandu University Hospital. Pregnant women attending antenatal care under iron, folic acid, and calcium therapy fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 191 patients enrolled in this study majority (39.3%) of them belonged to age group 26-30 years. More than half (61.3%) of the patients were illiterate. Of the total 191, 64.40% were non-adherent to the medication. Forgetfulness was the main reason for missing the dose in majority (52.06%) of the non-adherent subjects while adverse effects (55.40%) was the most prominent cause for discontinuing the medication among non-adherent participants. Significant association was found between patients' adherence and busy work schedule, visiting doctor for follow up. Conclusion More than half of the patients had not adhered to the medication under antenatal care. Forgetfulness was the most common factor for missing the dose in nonadherent patients. Illiteracy was associated with poor adherence. Patient-provider relationship, Socio-economic factors were determined as major barrier to medication adherence.

Endoscopic Management of Foreign Body Impaction in the Upper Gastrointestinal Tract in a Tertiary Care Centre of Nepal

Background Ingested foreign body impaction on upper gastrointestinal tract is common incidence among children, older age group, mentally challenged individuals, and people the influence of alcohol. In most cases, the foreign bodies pass spontaneously and uneventfully but when this does not occur; endoscopic management to ensure removal under direct visualization is required. Relief upon removal of foreign body and prevention of complications is essential. Objective To assess the endoscopic management and outcome of foreign body impacted in the upper gastrointestinal tract. Method This is a hospital based observational retrospective cross sectional study involving 165 patients at Endoscopy Department of Dhulikhel Hospital in Nepal between November 2015 and October 2019. The data regarding the demographic profile, clinical characteristics and endoscopic findings were retrieved and analyzed to determine endoscopic interventions performed, complications and outcomes. Result One hundred and sixty five patients presenting with history of ingestion of foreign body were included in the study. The mean age of the patients was 46.8 ± 19.1 years with male predominance (60%). The most common site of foreign body impaction was oesophagus (70%). The most common foreign body encountered was bone (62.2%) among which chicken bones (91.1%) were most frequent. For the retrieval of sharp-pointed foreign bodies, rat forceps and graspers (45.7%) were most commonly used. Total 14 cases required rigid oesophagoscopy as the foreign body could not be retrieved by flexible endoscopy. Conclusion Foreign body ingestion and its impaction in the upper gastrointestinal tract has been found to be common in endoscopic practise. Early detection and timely removal of foreign bodies is of utmost importance to avoid discomfort to the patient as well as to ensure successful removal without complications.

Endometrial Tuberculosis a Treatable Cause of Infertility

We present a case of 29 years lady with secondary infertility and amenorrhea. Her clinical findings were normal. Her hormone assays and ultrasonography was normal. She underwent hysteroscopy which showed atrophic endometrium and PCR for mycobacterium tuberculosis was sent which was reported positive for Mycobacterium tuberculosis. She was diagnosed as a case of Endometrial tuberculosis. Anti tuberculosis therapy was started for six months. After the completion of medical therapy she spontaneously conceived and delivered a healthy full term baby. Tuberculosis is a major public health problem among developing country like Nepal.

Study on the efficiency of dsRNAs with increasing length in RNA-based silencing of the Fusarium CYP51 genes

Previously, we have demonstrated that transgenic Arabidopsis and barley plants, expressing a 791 nucleotide (nt) dsRNA (CYP3RNA) that targets all three CYP51 genes (FgCYP51A, FgCYP51B, FgCYP51C) in Fusarium graminearum (Fg), inhibited fungal infection via a process designated as host-induced gene silencing (HIGS). More recently, we have shown that spray applications of CYP3RNA also protect barley from fungal infection via a process termed spray-induced gene silencing (SIGS). Thus, RNAi technology may have the potential to revolutionize plant protection in agriculture. Therefore, successful field application will require optimization of RNAi design necessary to maximize the efficacy of the RNA silencing construct for making RNAi-based strategies a realistic and sustainable approach in agriculture. Previous studies indicate that silencing is correlated with the number of siRNAs generated from a dsRNA precursor. To prove the hypothesis that silencing efficiency is correlated with the number of siRNAs processed out of the dsRNA precursor, we tested in a HIGS and SIGS approach dsRNA precursors of increasing length ranging from 400 nt to 1500 nt to assess gene silencing efficiency of individual FgCYP51 genes. Concerning HIGS-mediated disease control, we found that there is no significant correlation between the length of the dsRNA precursor and the reduction of Fg infection on CYP51-dsRNA-expressing Arabidopsis plants. Importantly and in clear contrast to HIGS, we measured a decrease in SIGS-mediated Fg disease resistance that significantly correlates with the length of the dsRNA construct that was sprayed, indicating that the size of the dsRNA interferes with a sufficient uptake of dsRNAs by the fungus.

NS1 DNA vaccination protects against Zika infection through T cell-mediated immunity in immunocompetent mice

The causal association of Zika virus (ZIKV) with microcephaly, congenital malformations in infants, and Guillain-Barré syndrome in adults highlights the need for effective vaccines. Thus far, efforts to develop ZIKV vaccines have focused on the viral envelope. ZIKV NS1 as a vaccine immunogen has not been fully explored, although it can circumvent the risk of antibody-dependent enhancement of ZIKV infection, associated with envelope antibodies. Here, we describe a novel DNA vaccine encoding a secreted ZIKV NS1, that confers rapid protection from systemic ZIKV infection in immunocompetent mice. We identify novel NS1 T cell epitopes in vivo and show that functional NS1-specific T cell responses are critical for protection against ZIKV infection. We demonstrate that vaccine-induced anti-NS1 antibodies fail to confer protection in the absence of a functional T cell response. This highlights the importance of using NS1 as a target for T cell-based ZIKV vaccines.

Patient Satisfaction with Nursing Care in Five Major Departments in a Tertiary Care Centre

Introduction:

Patient satisfaction is an important component of quality nursing care and is often determined by the nursing care in any health institution. The aim of the study is to find the presence of satisfaction among in-ward patients of five major wards at a tertiary care hospital regarding the quality of care provided by nursing staff.

Methods:

A descriptive cross-sectional study was conducted among 105 patients of Patan Hospital from 3rd July to 3rd August, 2015 after obtaining ethical clearance from Institutional Review Committee. Sample size was calculated and stratified random sampling was done. Data was collected in Microsoft Excel and analyzed in Sta 13.0. Point estimate at 95% Confidence Interval was calculated and frequency and percentage was calculated for binary data. Subgroup analysis was done on the basis of demographic variables.

Results:

Among 105 patients, 99 (94.3%) [94.93-95.07 at 95%CI] were satisfied with the nursing care provided at a tertiary care center in Nepal. Among them, 60 (60.6%) were females and 39 (39.4%) were males. Age of the patients ranged from 1 year to 85 years. The length of the stay in the hospital ranged from 2 to 17 days (mean = 5.6 days).

Conclusions:

Most of the patients were satisfied with the nursing care provided in a tertiary care centre. Routine nursing care surveys and immediate feedbacks would keep the authorities updated and deliver good health care.

Permcath - A Vascular Access for Hemodialysis, Our Experience in Last Two Years

Background The double lumen tunneled catheter (Permcath) is mostly used as an alternative access, not as a temporary access in End Stage Renal Disease patients requiring hemodialysis. If there is no possibility of other access modalities, failed or unable to create native arteriovenous fistula (AVF), Permcath can be a very good alternative. Objective To find the indications, complications and results of Permcath insertion. Method We reviewed the results of 92 Permcath inserted under ultrasound guidance in two different hospitals, 45 in Sahid Dharma Bhakta National Transplant Center (SDNTC), Bhaktapur and 47 in Nidan Hospital Pvt. Ltd., Lalitpur from April 2016 to April 2018 retrospectively. Result We had inserted 55 Permcath (59.78%) in right internal jugular vein (IJV), 25 (27.17%) in left internal jugular vein and 12(13.04%) in femoral vein. In terms of major complications, two (2.17%) patients had profound hypotension, bradycardia and cardiac arrest due to left internal jugular vein tear. Three patients (3.26%) died within a week due to septicemia and 23 patients (25%) died with multiple causes within one year. Of the cases, till now in 39 cases (42.39%) Permcath has been removed. Major reasons of removal of Permcath are post renal transplant in 18 cases (19.57%), Arterio Venous Fistula maturation in 13 cases (14.13%), Infection in six patients (6.52%) and non functioning Permcath in two patients (2.17%). Conclusion Permcath remains a reliable method for short term vascular access, hence can be used as a bridge to renal transplant or arteriovenous fistula maturation.

Effect of Honey on Healing Process of Extraction Socket in Rabbits

Background Honey is regarded as the oldest wound dressing. It accelerates wound healing in burn, infected and open wounds. Its effect on wound healing process in extraction socket is not fully established till today. Objective To evaluate the effect of honey on the healing process of socket after tooth extraction in New Zealand White rabbits. Method Extraction of first premolar tooth on both sides of lower jaw in six rabbits was done under general anesthesia produced by ketamine and Xylazine followed by local application of honey on one socket (honey group) and normal saline (control group) in the opposite socket. On 7th day, biopsy was taken from the extraction site and histopathological examination was done. Student's t-test was used for comparison between the groups and the differences were considered to be statistically significant at P-value less than 0.05. Result There was a significant difference between control group and honey group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups and it was statistically not significant (p=1.0000). Overlying epithelium was hyperplastic in the both groups. Conclusion Local application of honey promoted the healing process by increasing fibroblast proliferation and bony trabeculae formation. Further studies in larger animals and human should be conducted to confirm the efficacy of honey in extraction socket healing.

Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus

Background The clustering of risk factors in metabolic syndrome increases the risk of atherosclerotic cardiovascular disease and all-cause mortality. The prevalence of coronary heart disease is high in diabetic patients with metabolic syndrome than non diabetic patients with metabolic syndrome. Objective To determine the prevalence of metabolic syndrome in new onset Type 2 Diabetes Mellitus (T2DM) and to study the risk components of metabolic syndrome. Method This is a hospital based cross sectional study conducted in 132 newly diagnosed T2DM patients at Dhulikhel Hospital, Kathmandu University Hospital in Nepal in 2018. The socio-demographic profile, clinical characteristics, and biochemical parameters were analyzed to study the prevalence, risk factors, and concordance between various definitions of metabolic syndrome. Statistical analysis was done using Student's t-test, Chi-square test and Kappa statistics. Result One hundred and thirty two newly diagnosed T2DM patients were included in the study. Majority of the patients (58.9%) were in the age group of 40-60 years with the mean age of 49.72±12.44 years. The prevalence of metabolic syndrome was 111 (84.1%), 106 (80.3.%), 94 (71.2%) and 82 (62.1%) using World Health Organization(WHO), Harmonized, National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) definitions respectively. One hundred and six patients (80.3%) had 3 or more individual components of metabolic syndrome. There was substantial agreement between NCEP ATP III-Harmonized (k=0.714, p<0.001) and Harmonized-WHO (k=0.716, p<0.001) definitions for diagnosing metabolic syndrome. The increased prevalence of metabolic syndrome in females than males is due to increased prevalence of abdominal obesity (p<0.05), dyslipidemia (low HDL cholesterol (p<0.05)) and presence of diabetes. Conclusion The prevalence of metabolic syndrome in newly diagnosed T2DM is high in the Nepalese population. The central obesity and low HDL cholesterol were significant risk factors in female diabetic patients predisposing to metabolic syndrome.

Effect of Dexmedetomidine with Ropivacaine in Supraclavicular Brachial Plexus Block

Background Brachial plexus block is popular choice for upper limb surgeries and offers good and relatively safe anesthesia. Among various approaches supraclavicular approach is the most consistent method for anaesthesia and postoperative pain management in surgery below the elbow joint. Many drugs are used as adjuvants in brachial plexus block for faster onset, denser block and for prolongation of postoperative analgesia. Dexmedetomidine also has been shown to prolong the sensory and motor duration when added as an adjuvant to local anaesthetic in nerve blocks. Objective To assess the effect of adding dexmedetomidine to ropivacaine in brachial block. Method Sixty patients, planned for upper limb surgeries under ultrasound guided brachial block were randomly allocated into two groups. Group RS (n=30) received 30 ml of 0.5% Ropivacaine + 1 ml Normal Saline and Group RD (n=30) received 30 ml of 0.5% Ropivacaine + 0.75 mcg/kg Dexmedetomidine diluted to 1 ml solution. The onset time to sensory and motor blockade were recorded. The duration of sensory and motor block and duration of analgesia were recorded. Result The mean time to onset of sensory block (12.60±2.67 min Vs 22.17±2.81 min) and motor block (14.20±3.22 min Vs 22.53±3.97) in Group RD was significantly faster in Group RD than Group RS. The mean duration of sensory block (838.70±164.11 min Vs 670.20±145.16 min), motor block (804.16±148.71 min Vs 594.93±53.89 min) and duration of analgesia (1193.80±223.11 min Vs 828.23±136.30 min) were significantly longer in Group RD compared to Group RS. The incidence of side effects in both groups were comparable. Conclusion From this study, it can be concluded that addition of Dexmedetomidine 0.75 mcg/ kg to 0.5% Ropivacaine results in early onset of sensory and motor blockade, prolongation of duration of sensory and motor blockade and duration of analgesia postoperatively without any significant side effects.

Prehypertension and its Risk Factors in Suburban Nepal -Findings from the Dhulikhel Heart Study

Background Prehypertension, defined as a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg, leads to higher rates of incident hypertension, and is associated with excess morbidity and deaths from cardiovascular diseases. Objective To estimate the prevalence of and examine the factors associated with prehypertension in Dhulikhel. Method This cross-sectional study utilized data from the 752 participants of the Dhulikhel Heart Study (DHS). The data collectors interviewed the participants at their home using a tablet based structured pre-tested questionnaire and measured blood pressure using a standard digital blood pressure machine (Microlife, Switzerland). Multivariate analysis was conducted using generalized estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, marital status, income, education, alcohol consumption, smoking, physical activity, body mass index (BMI) and food consumption. Result Males had a three-fold higher odds of prehypertension than females (OR:3.17, 95% CI:1.91-5.26). The odds of prehypertension increased with being overweight (OR:2.29, 95% CI:1.42-3.70) and with being obese (OR:5.00, 95% CI:1.81-13.79) compared to normal BMI. Education reduced the odds of developing prehypertension (OR:0.51, 95% CI:0.29-0.91). Those who met the recommended level of physical activity (OR:0.61, 95% CI:0.40-0.95) also were associated with lower prehypertension prevalence. Conclusion Obese/overweight and being male increased the odds of prehypertension whereas formal education and recommended level of physical activities were associated with lower prehypertension prevalence. Primordial prevention against cardiovascular risk factors at the community level, especially targeting the young adult male, is imperative.