Virological and Immunological Status of the People Living with HIV Undertaking Highly Active Antiretroviral Therapy

Background The major goal of antiretroviral therapy (ART) is immunological recovery and virological suppression. Immunological and virological response in People Living with HIV (PLHIV) undertaking ART has to be monitored to assess the treatment response, diagnosing treatment failure and switching antiretroviral therapy. Objective To assess the immunological and virological response to antiretroviral therapy among Human Immunodeficiency Virus (HIV) infected individuals. Method This is a cross-sectional study including people living with HIV (PLHIV) taking antiretroviral therapy for at least 6 months and was conducted in Dhulikhel Hospital in 2017. The socio-demographic profile, clinical characteristics, CD4 count and viral load were analyzed. Descriptive analysis of socio-demographic and other characteristics was done. Result Fifty-two patients undertaking antiretroviral therapy were included in the study with the mean age of 29.69±9.59 years at diagnosis. The majority of the patients were male (51.9%). Sexual transmission was the dominant mode of transmission (78.9%). The mean CD4 count at baseline was 244.08±214.32 cells/µL. Four patients (7.7%) had a virological failure. There was a discordance between immunological and virological response in patients taking antiretroviral therapy for more than 2 years' duration with four patients with a recent CD4 count of ≤250 cells/µL had virological suppression. The mean CD4 count at treatment increased from 229.65 cells/µL to 453.33 cells/µL after 1 year of commencement of antiretroviral therapy (p<0.001). Conclusion There are optimal CD4 recovery and virological suppression as expected with antiretroviral therapy use.

Endoscopic Septoplasty without Nasal Packing: An Experience in a Tertiary Hospital

Background: Deviated nasal septum (DNS) is easily caused by trauma and septal surgeries have evolved from forceful fractures to endoscopic surgery being the leading trend now. Endoscopic surgery has lots of advantage over the conventional headlight method in alleviating symptoms and reducing complications. Endoscopic septoplasty without the nasal packing significantly shorten the surgery time and hospital stay thus reducing the financial burden. Hence this prospective study done in Nobel Hospital and Teaching Center was an Endeavour to see the indications, technique and outcome of the new surgical procedure. Materials and Methods: Sixty-five patients irrespective of sex in the age group of 18-60 years were enrolled in the study from December 2017 to December 2018. All symptomatic DNS confirmed by 00 and 300 rigid endoscope were enrolled. Informed consent from patients and ethical clearance was taken. Results: The maximum patients were in the age group of 18-30 years. The commonest symptoms of the patient was nasal obstruction in 51(78.46%), followed by post-nasal drip in 20(30.76%), hyposmia in 17(26.15%), headache in 15(23.07%) and epitasis in 10(15.38%). According to Mladina classification, the commonest deviated septum was type V in 29(45%), followed by type VI in12(18%), type II and IV in 7(11%) each, type VII in 6(9%) and least being type III in 4(6%) patients. There were no patients with Mladina type I DNS in this study. The improvement in symptoms were 90% in nasal obstruction, 88% in hyposmia, 85% in post nasal drip, 90% inepistaxis and 100% in headache. The complications were haemorrhage in 1(1.5%), synechia2(3.07%), mucosal tear 5(7.69%), haematoma 1(1.5%) and persistant DNS 5(7.69%). The average hospital stay was 48 hours. Conclusion: Endoscopic septoplasty without post-operative packing is very convenient to the patient. Endoscopic septoplasty with trans- septal suture is safe, cost effective and a better alternative.

Intra-Articular Synovial Fibroma of the Knee in a Young Boy

Synovial fibroma, a benign fibro collagenous soft tissue tumour, arising in the knee joint is a rare entity. It is even rarer in the paediatric age group. The clinical symptoms, investigations, diagnosis, and treatment with the literature reviews are presented for this uncommon occurrence in an 11 year old boy.

A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance

Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication.

Impact of Community Diagnosis Programme on Undergraduate Students at BP Koirala Institute of Health Sciences

Background Community Diagnosis Programme (CDP) aims to demonstrate the importance of teamwork in health care to understand the comprehensive health needs of the rural people and conceive about the research. Objective To assess the impact of community diagnosis program on undergraduate students of BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method A cross sectional study with mixed design (quantitative and qualitative) was conducted among the undergraduate students of batch 2017 participating in community diagnosis programme of BP Koirala Institute of Health Sciences, Dharan, Nepal. Eight questions assessed the students' perceptions regarding their abilities about community diagnosis program using six point Likert Scale and four open ended questions were used to know the students' experience and perception of community diagnosis programme. Result Overall mean ± SD score for pre-exposure response was 30.47 ± 6.18 and for the post-exposure response was 40.49 ± 5.16. The overall mean ± SD score of the students categorized according to streams showed similar results in both pre-exposure response and post-exposure responses. Qualitative analysis revealed the themes like "Research, a reflection of community and new method of learning to medical students"; "method of developing confidence and good communication skills", "learning to work as a team" and "exposure to rural area"; "Research an adjunct to medical profession". Conclusion Community diagnosis programme had a positive impact on the students about basic survey process, learnt to communicate with rural people, understood the type of data and were willing to participate in similar projects in future. Qualitative analysis showed most of the students had positive experience with some negative experience of community diagnosis programme.

Inflammatory potential of monospecies biofilm matrix components

AIM

To assess the inflammatory potential of biofilm matrix constituents of Enterococcus faecalis and Pseudomonas aeruginosa monospecies biofilms on macrophages.

METHODOLOGY

In vitro biofilms of E. faecalis and P. aeruginosa were grown (7 days) in aerobic and anaerobic conditions. The biofilm matrix components: exopolysaccharides (EPS) and extracellular DNA (eDNA) were extracted and quantified. The inflammatory potential of EPS and eDNA was assessed on macrophage cell lines (RAW 267.4) using nitric oxide (NO), and enzyme-linked immunosorbent assay for tumour necrosis factor (TNF-α) and interleukin-6 (IL-6) expressions. LPS from P. aeruginosa and planktonic bacteria were positive controls. One-way analysis of variance and the Tukey post hoc test were used for statistical analysis.

RESULTS

Extracted EPS from both biofilm strains was associated with higher levels than eDNA in both growth conditions (P < 0.05). The biofilm components had less inflammatory potential compared to planktonic bacteria and LPS. EPS produced higher levels of inflammatory response compared to eDNA for both strains (P < 0.05). IL-6 and TNF-α, and NO expression showed no difference for E. faecalis EPS (P ≥ 0.05). In contrast, P. aeruginosa EPS and eDNA had significant levels of IL-6 compared to TNF-α and NO (P < 0.05).

CONCLUSIONS

Monospecies biofilm matrix EPS and eDNA from the bacterial strains tested had the ability to induce a low-grade inflammatory response when compared to planktonic bacteria and LPS. This study highlights the potential of biofilm matrix/components, devoid of bacteria to induce low-grade chronic inflammation.

Abstract P2-14-06: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Athanasiou I, Reed MW, Shrestha A, Cheung K-L, Audisio R, Collins K, Wyld L. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-06.

Pregnancy Outcomes in Patients with Hypothyroidism

Background Pregnancy is an important event in reproductive years of women life. It has a reversible effect on the thyroid gland and its functions. The role of thyroid gland function and conception has been known for a long time. The most common thyroid gland dysfunction in pregnancy is hypothyroidism. It is estimated that the prevalence is 1.5-4.4% of pregnant women. It is known to cause complications during pregnancy leading to adverse pregnancy outcomes. Objective To observe the pregnancy outcomes in patients with hypothyroidism. Method This is a retrospective study conducted from January 2015 to December 2018. Two hundred and thirty nine patients with hypothyroidism were included. They were investigated for thyroid stimulating hormone (TSH), free tri iodothyronin (FT ), free thyroxine (FT ) levels and for auto-antibodies against thyroperoxidase (anti TPO). All these patients after the detection of hypothyroidism were under thyroxine hormone replacement. Result Amongst 239 ladies with hypothyroidism 97.5% came from hilly region. Seventy seven (32%)of them had history of abortions. Twenty three (9.8%) of them had antepartum hemorrhage. Eleven (4.6%) had preeclampsia during this pregnancy. Seven (2.9%) had fetuses with intrauterine growth restriction (IUGR). Seven (2.9%) had fetuses with preterm delivery. Twenty seven (11.3%) of fetuses had APGAR Score of < 6. Conclusion Of 239 women with hypothyroidism, many had history of recurrent abortions and also complications during antenatal period like preeclampsia, abruption placenta, IUGR and preterm delivery. After thyroxine replacement, risk is much lowered and it has a positive outcome.

Outcomes of Endoscopic Sphincteroplasty Using Large Balloon Dilatation for Difficult Common Bile Duct Stone Removal at Dhulikhel Hospital

Background Endoscopic sphincteroplasty (ESPT) using a large Controlled Radial Expansion (CRE) Wire guided balloon dilatation has gained acceptance in removing a difficult common bile duct (CBD) stones. Objective To evaluate effectiveness and complications of removing large and difficult bile duct stones with sphincterotomy combined with large balloon dilatation. Method A total of 132 patients, from February 2014 to June 2017, who had biliary ductal calculus which was either greater than 15 mm or difficult to remove with standard technique, underwent Endoscopic Retrograde Cholangiopancreaticography (ERCP) with Endoscopic sphincteroplasty using a large Controlled radial expansion wire guided balloon dilatation. The success rate of complete stone clearance and post Endoscopic Retrograde Cholangiopancreaticography complications were analyzed. Result There were 48 (36.4 %) male and 84 (63.6%) female patients with mean age of 55.48 ± 16.36 years. Stones were removed with sphincteroplasty in first attempt in 90 out of 132 (68.2%) patients, 26 out of 37 (70.27%) patients in second session and in all 7(100%) patients in third attempt. Five (11.90%) patients were lost to follow up and 4 were advised for surgery because of failure to remove stones by sphincteroplasty. Overall success of endoscopic sphincterotomy and large balloon dilatation in our study was 93.18%. Complications were seen in 17 (13.6%) patients; bleeding seen in 9 (6.8%) patients and mild pancreatitis in 8 (6.1%) patients. None of the patients had severe pancreatitis or perforation secondary to the procedure. Conclusion Endoscopic sphincteroplasty after sphincterotomy is an effective and safe technique for a difficult common bile duct stone removal.

Microinvasion: A Clinical Dilemma

Microinvasive oral squamous cell carcinoma (MIOSCC) is an early stage malignant tumour,showing invasion of the epithelial cells confined to the superficial lamina propria. This is matter of debate in respect to the clinical presentation, metastasis, therapeutic intervention and prognosis. A 32-year female reported to the department with chief complaint of wound and burning sensation in her left back region of lower gums. Clinical diagnosis of erosive oral lichen planus was made and topical steroid was started. The lesion clinically healed with the use of topical medicine. After stopping the medication the lesion recurred, following which, excisional biopsy was done. On histopathological evaluation diagnosis of microinvasive oral squamous cell carcinoma was made. Recurrence of similar symptom in the same site was seen 10 weeks later, which now showed features of moderate dysplasia. Clinical features of microinvasive oral squamous cell carcinoma resembles premalignant lesion, leading to difficulty in diagnosis, treatment and prognostic assessment. Thus, adequate representation of this entity is necessary.

Awareness of Undergraduate Dental and Medical Students Toward Oral Cancer

Background: Oral cancer is a common malignancy in Nepal and many other southeast Asian countries, which is predisposed by a variety of potentially malignant oral diseases. Considering the importance of knowledge of health professionals and their role in early diagnosis and reduction of cancer statistics. Aim: This study aims to evaluate the awareness of undergraduate dental and medical students toward oral cancer. Methods: The study involved undergraduate dental and medical students of BP Koirala Institute of Health Sciences, Dharan, Nepal. A self-administered questionnaire adapted from Carter and Ogden was distributed among undergraduate medical and dental students. Results: 143 dental and 311 medical students responded to the questionnaire. Significantly more dental (80.4%) than medical students (36.0%) were found to routinely examine the oral mucosa. Tobacco smoking and chewing were the most commonly recognized risk factors by both medical and dental students. Most of the students found ulcer as the most common change associated with oral cancer. Only 30 out of the total students felt very well informed about oral cancer. Conclusion: This study has demonstrated a lack of awareness in some aspects of oral cancer among medical and dental students which highlights the need to frame new teaching methodologies. Similar studies from other health institutions would provide an insight regarding the same and could be a base for formulating a uniform curriculum in the implementation of knowledge regarding oral cancer.

Knowledge, Attitude and Practice Regarding Environmental Tobacco Smoke among Pregnant Women of Sunsari

Background Second hand tobacco smoke or Environmental Tobacco Smoke (ETS), contains toxic substances and carcinogens that cause serious health effects in humans. Studies show that ETS exposure during pregnancy is injurious to the mother-infant pair with long term consequences. Limited studies are found in context of ETS in pregnancy in Nepal. Objective To explore the knowledge about harmful effect of ETS exposure in pregnant women and to know the behavior of avoidance from exposure to ETS during pregnancy. Method A cross sectional study was conducted among 303 pregnant women attending antenatal clinics at the District Hospital Inaruwa and BPKIHS Dharan. A pre-tested semi-structured questionnaire was used to collect data regarding socio-demographic characteristics, knowledge, attitude and practice regarding Environmental tobacco smoke. Data was entered in Excel and analyzed in SPSS 11.5. Result The mean age of the respondents was 23.86±4.68 years. The proportion of primigravida was 53.5% and multi-gravida was 46.5%. Among the respondents, 14% were illiterate and 91% were unemployed. A similar proportion of the husbands (12%) were illiterate. Three-fourth (75%) of the respondents lived in joint family. It was found that 86% of their husbands were smokers. There were 61% of pregnant women who had heard about ETS, mainly through television (35%) and radio (30%). There was 86% of the households who had initiated some measures to prevent smoking inside the house. Conclusion The pregnant women in this study are aware about ETS. However a significant number of them believe that ETS is not harmful compared to active smoking. There is a need for further studies to identify interventions to avoid ETS exposure among the pregnant women.

Risk Factors Associated with Childhood Asthma - A Case Control Study

Background Asthma is one of the most common chronic childhood illnesses with rapidly increasing prevalence in low income countries. For planning effective intervention to reverse this condition we need a better understanding of the risk factors for asthma in early life. Objective To identify the risk factors associated with childhood asthma and its morbidity patterns. Method The case control study was conducted in the pediatric department of Dhulikhel hospital, Kathmandu University hospital, Dhulikhel from March 2016 to March 2017. The control group was composed of 175 age matched children attending the outpatient clinic with non pulmonary health problem. Data was collected through Performa and analyzed using SPSS version 23. The association of asthma with genetic and environmental risk factors was evaluated by univariant (chi-square or Fisher's exact test) and binomial logistic regression. Result Childhood asthma was more common in male children between 1-5 years. Majority of children 77(44%) were graded as mild persistent asthma. Risk factor associated with asthma include family history of asthma (OR0.06; 95%CI .005-0.94, p=0.04), nonexclusive breast feeding (OR18.42; 95% CI 2.56-132.3, p=0.004), allergic disorder in children (OR0.003; 95%CI 0.000-0.037, p=0.0001). Conclusion Family history of asthma, allergic history in the patient and nonexclusive breast feeding were significantly associated with asthma. There is no significant association of asthma with exposure to allergic food, exposure to smoke and domestic animals.

Approaches and Strategies for Habit Intervention in Smokeless Tobacco/Arecanut/ Betel Quid and Non-Starting

Background: Although adequate research has been conducted regarding smoking and smokeless tobacco, there is a dearth of research exploring reasons for chewing areca nut and betel-quid. Global epidemiology of areca nut and betel-quid shows distinct ethnic and cultural preferences. Areca nut is chewed for its psychological stimulating effects and perhaps, a medicinal value. To develop empirically supported treatments and to promote nonstarting, healthcare workers and researchers must first understand the reasons people engage in the behavior. Aim: To discuss evidence based approaches and strategies for habit intervention in smokeless tobacco/arecanut/betel-quid and nonstarting. Methods: Data were collected from published national and international research, conference reports, WHO reports, tobacco control guides, Clinical Best Practice Guidelines and Cochrane database systematic reviews. Results: Individual behaviors are largely determined by complex range of factors beyond the control of the most individuals. Behavior change is complex and most people are well-informed about the basic health messages. Most people will have extensive experience of attempting to change their health career including quitting tobacco products. It is therefore essential to know a detailed history of a person's previous experiences of change and learn from this. Interventions need to match individuals' desire and ability to change. Encouragement, understanding, support, and empathy are all essential to enable clients achieve their goals. The most effective preventive intervention that a clinician can provide for tobacco-using patients against is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete cessation. Reduction provides no direct health benefits to the individual. Oral examination by a dental professional who points out tissue damage from smokeless tobacco use in a user´s own mouth, advice to quit, and brief problem solving and supportive counseling are effective in promoting smokeless tobacco cessation. There is also a need to develop culturally tailored areca nut and betel-quid cessation and risk reduction programs, the first step in reducing the public health burden associated with betel-quid chewing worldwide. Interventions are available, but underutilized, in part due to lack of clinician training and organizational support. Conclusion: Although the deleterious effects of smokeless tobacco/areca nut/betel-quid are well known by both users and healthcare workers, the knowledge has not translated effectively into cessation. Proven, brief, repetitive, directed interventions tailored to the needs of the patients can increase successful cessation. Controlling sociodemographic, environmental and personal factors may promote nonstarting.

Quit Intentions and Attempts among Smokers in Sub-urban Nepal: Findings from the Dhulikhel Heart Study

Background The most effective way for smokers to avoid or minimize the harmful effects is to quit smoking. Smoking cessation has been attributed to multiple factors operating at physiological, psychological, environmental and social level. There is common consensus that smoking cessation programs should be tailored for specific populations. However, there has been lack of data regarding factors that influence smoking cessation in Nepal, which has hindered the development of effective smoking-cessation interventions. Objective To assess the prevalence of quit attempts, successful quitting and the factors associated with them in a randomly selected, population-based adult participants in sub-urban Nepal. Method This cross-sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained using the questions based on the WHO STEPS survey questionnaire and questions on past quit attempts. Result Out of 1073 participants, 248 (23.1%) were current smokers and 99 (9.2%) were former smokers. Only 58% of the current smokers mentioned that they had attempted to quit smoking. When asked if they were interested in quitting if helped, almost 90.5% mentioned they were willing. Brahmins were less likely to have quit smoking (former smoker) compared to Newars (OR: 0.41, 95% CI: 0.18-0.90). We also observed that those who had high alcohol consumption were less likely to have quit smoking (OR: 0.36, 95% CI: 0.17-0.76). We didn't find any meaningful significant association between socio-demographic factors or other CVD risk factors and the quit attempts. Conclusion As the country braces to address the burden of non-communicable diseases in Nepal, it is crucial to incorporate tobacco cessation programs in the national health system to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to get a broader understanding of quit effort and factors associated with thereby supporting the development of evidence-based strategies to address tobacco cessation.

Associated Factors and Outcome of Babies Born Through Meconium Stained Amniotic Fluid

Background Neonates born through meconium stained amniotic fluid (MSAF) are associated with significant morbidity and mortality. Objective To study the incidence, associated factors and outcome of meconium stained amniotic fluid babies born in Dhulikhel hospital. Method Prospective, cross-sectional study conducted in Obstetric ward and Neonatal Intensive Care Unit (NICU) from 15 December 2015 to 15 December 2016. All the babies born through meconium stained amniotic fluid during the period were included. Result Incidence of meconium stained amniotic fluid was 6.5%(167/2581). Meconium aspiration syndrome (MAS) developed in 9(5.4%) among all meconium stained amniotic fluid cases. Primigravidity and postdatism were observed more in Meconium aspiration syndrome group than meconium stained amniotic fluid group (77.8% VS 73.4%; 33.3% VS 26.3%). Babies delivered by caesarian section were more in meconium stained amniotic fluid group than Meconium aspiration syndrome group (47.5% VS 33.3%). All the babies with meconium stained amniotic fluid improved except one baby with Meconium aspiration syndrome who expired. Neonatal sepsis was a significant co-morbidity in Meconium aspiration syndrome group (P value= 0.008). There was increased incidence of operative delivery in thick meconium stained amniotic fluid than thin meconium stained amniotic fluid (52.6% VS 38.9%). Similarly, Neonatal Intensive Care Unit admission and neonatal complications like Meconium aspiration syndrome, perinatal asphyxia and sepsis were more commonly observed in thick meconium stained amniotic fluid group than thin meconium stained amniotic fluid group. Conclusion The progression to meconium aspiration syndrome in babies with meconium stained amniotic fluid is not associated with any maternal and neonatal factors studied. MAS babies are 10 times more likely to require NICU admission and sepsis is a significant co-morbidity. Thick meconium stained amniotic fluid is worrisome. There is increased chance of operative delivery and neonatal complications if associated with thick meconium stained amniotic fluid.

Association between Dental Prosthesis and Periodontal Disease among Patients Visiting a Tertiary Dental Care Centre in Eastern Nepal

Background Dental caries and Periodontal diseases are the most prevalent oral health problems present globally. The distribution and severity of such oral health problems varies in different parts of the world and even in different regions of the same country. Nepal is one of the country with higher prevalence rate of these problems. These problems arise in association with multiple factors. Objective This study was carried out to describe the periodontal status and to analyse the association of periodontal disease with the wearing of fixed or removable partial dentures in a Nepalese population reporting to the College of Dental Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal. Method This study comprised of a sample of 200 adult individuals. All data were collected by performing clinical examinations in accordance with the World Health Organization Oral Health Surveys Basic Methods Criteria. It included the Community Periodontal Index and dental prosthesis examination. Result A descriptive analysis was performed and odds ratio (1.048) and 95% confidence interval (1.001; 1.096) was found out. The mean age of the population participated in the study was 41.82 ± 14.80 years. A total of 93 (46.5%) males and 107 (53.5%) females participated in the study. Among these subjects, 100% presented some periodontal problems. The statistical analysis indicated that the probability of periodontal disease with regards to wearing partial dentures was not significant as suggested by the odds ratio (1.048). Conclusion There is no association of the wearing of dental prosthesis (RPD and/or FPD) with the periodontal disease and suggests a need for populations based oral health education programs, plaque control programs to reduce the incidence of periodontal disease.

Ultrasound evaluation of normal orbital preseptal thickness

INTRODUCTION

Orbital preseptal thickness is an important parameter not only in diagnosis of orbital cellulitis but also in recent classification and management of dark eye circle (DEC).

OBJECTIVE

The aim of this study was to evaluate normal preseptal thickness and collect baseline data in normal skin in a given population with no orbital pathology.

MATERIALS & METHOD

Ultrasound was performed on 42 patients (23 females and 19 males) with clinically normal eyes and orbits for evaluation of normal orbital preseptal thickness. The age ranged between 15 to 35 years with a mean age of 24.9 years.

RESULTS

Our study concluded that normal preseptal thickness ranged from 2.1 mm to 5.5 mm. Mean preseptal thickness for both sides was 3.9 mm.

CONCLUSION

Ultrasound can be used as quick, reliable and cost-effective modality for evaluation of orbital preseptal thickness.

Prevalence and Correlates of Tobacco Use in a Suburban community of Nepal: Findings from the Dhulikhel Heart Study

Background Smoking and oral tobacco use are important risk factors for cancer and other chronic diseases. The distribution of tobacco consumption in Nepal varies across the population subgroups. There is little information on the correlates of tobacco use among suburban population in Nepal. Objective To estimate the prevalence of smoking and oral tobacco use; and determine the socio-demographic and other CVD risk factors associated with them in a suburban population of Dhulikhel, Nepal. Method This cross sectional study utilized data from the first wave of the baseline survey of the Dhulikhel Heart Study (DHS). A total of 2225 households of Dhulikhel city were enumerated and a third of the households (n=735) were randomly selected. Questions on tobacco use were ascertained from 1073 adults age 18 years and older using the questions based on the WHO STEPS survey questionnaire. Result More than a third (36%) of the men were current smokers and 12% reported regular use of oral tobacco. About 14% of the women were current smokers and only 0.5% reported to use oral tobacco regularly.In the multivariate analysis, sex, ethnicity, education, alcohol consumption and body mass index were significantly associated with tobacco use. Males were 2.6 times as likely as females to smoke (95%: 1.53-4.59; p<0.001). Brahmin/Chhetri were 2.8 times more likely to smoke compared to Newars (95% Ci: 1.53-5.18; p=0.001). Education reduced the odds of smoking; compared to those with no formal education, those with up to high school and those with a high school degree or higher were 0.50 (95% CI: 0.27-0.92; p=0.02 ) and 0.38 (95% CI: 0.16-0.91; p=0.03) percent less likely to smoke, respectively. Moderate drinkers were 8 times more likely (95% CI: .54 - 18.40; p<0.001) and high drinkers were 13 times (95% CI: 6.63 - 24.26; p<0.001) compared to non-drinkers. Regarding oral tobacco use males were 15 times as likely as females to use oral tobacco (95% CI: 4.1-58.8; p<0.001). Compared to Newars, Brahmin/Chhetri were 2.7 times as likely to use oral tobacco (95% CI: 1.08 - 6.66; p=0.03). Conclusion Although Nepal has made some progress in passing progressive laws for tobacco control, and national surveys have shown slight reduction on tobacco use, this is far from satisfactory to meet the global target of bringing tobacco consumption to less than 5% by 2040. We recommend future studies to focus on socio-cultural, gender and behavioral aspects of tobacco use in addition to the epidemiological aspects.

Hemiconvulsion-Hemiplegia-Epilepsy Syndrome in a Girl Presented with Complex Partial Seizures

The mechanisms underlying the Hemiconvulsion-Hemiplegia-Epilepsy syndrome remains unclear. The current proposed pathogenic mechanism is a neuronal injury induced by venous thrombosis and/or hypoxia. Children develop hemispheric brain atrophy with contralateral hemiplegia, epilepsy, and a variable degree of cognitive deficit. We report a 33 months old female child a case of hemiconvulsion-hemiplegia-epilepsy syndrome with right hemisphere unilateral brain edema and left sided hemiplegia and aphasia who presented with left upper extremities complex partial seizures with generalization to tonic clonic seizures and developed status epilepticus that posed diagnostic and therapeutic challenges. Progressive atrophy of the right cerebral hemisphere was noted after 3 months of follow up. Hemiconvulsion-Hemiplegia-Epilepsy syndrome should be suspected in a child with unilateral cerebral hemisphere brain edema and hemiplegia with cognitive deficit following status epilepticus to provide patients and families with an accurate prognosis regarding the subsequent development of epilepsy.

A Study on Obstetric Intensive Care in Dhulikhel Hospital, Kathmandu University Hospital

Background Maternal mortality ratio in developing countries is high, depending upon the country and region. Many programmes have been launched in different parts of the world like "Safe motherhood Initiatives" under the WHO guidance. An alternative indicator of obstetric health care is obstetric transfer to an intensive care unit. Very few have been reported from developing countries in South East Asia. Objective To determine the intensive care unit (ICU) utilization by critically ill obstetric patients and to see the spectrum and outcome of disease. Method A prospective study performed on obstetric patients admitted to the intensive care unit of Kathmandu university hospital during a five year period (1st January 2010- 31st December 2015). A total of 56 patients were studied. Result The main cause of admission was hypertensive disorder in pregnancy (22 patients), bleeding disorders in pregnancy (18 patients), sepsis (8 patients), heart disease complicating the pregnancy (4 patients) and 4 others with respiratory problems encountered during delivery. These are the important causes of maternal mortality and morbidity. Conclusion In this study obstetric patients form a small percentage of the total patients admitted to ICU and majority of them were with preventable aetiology. In order to decrease the maternal mortality in developing countries better primary health care and efficient referral system is recommended.