Serum iron Profile of Patients with Sickle Cell Disease and its Association with Socio-demographic Characteristics and Duration of Diagnosis

BACKGROUND

Sickle cell anemia is the most common hemoglobinopathy in the world. The study aimed to evaluate the iron profile and its association with socio-demographic characteristics in patients with sickle cell disease.

METHODS

A hospital-based descriptive cross-sectional study was conducted to know the iron profile and its socio-demographic association in patients with sickle cell disease.

RESULTS

The average serum iron, TIBC, and transferrin saturation were 16.75 ± 6.40 mcgMole/L, 69.46 ± 16.94 mcg/dl and 25.15 ± 12.51% respectively. The serum ferritin ranged from 10.00 to 3000.00 ng/ml. The proportion of participants with normal serum iron, TIBC, serum ferritin, and transferrin saturation were 86.10%, 0.00%, 33.90% and 36.40% respectively. All of the participants of this study had low TIBC (1005), and more than half of the participants had elevated serum ferritin (56.40%).

CONCLUSIONS

Iron overload is a common complication of sickle cell disease. There was no association of age and sex with iron profile. The TIBC variation between the Chaudhary ethnic group compared to other ethnic groups signifies the ethnic role in the iron profile.

Antibiotic Prophylaxis in Patients On Extracorporeal Membrane Oxygenation: A Systematic Review

Despite the frequent use of prophylactic antibiotics in hospitals for extracorporeal membrane oxygenation (ECMO) patients, the Extracorporeal Life Support Organization (ELSO) Infectious Disease Task Force does not recommend routine antibiotic prophylaxis due to a lack of compelling evidence. We assessed the effectiveness of prophylactic antibiotics in ECMO patients. We conducted a comprehensive search of multiple databases from their inception up to September 6, 2023, on various databases using keywords like "antibiotics," "prophylaxis," "extracorporeal membrane oxygenation," and "ECMO." Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included research. We collected data using Microsoft Excel version 2016, mean and standard deviations were calculated for continuous data, while frequencies and percentages were calculated for binomial data. A total of three studies was included in the review with a total of 8,954 participants, of which 4,483 (50.06%) received antibiotic prophylaxis, and 1,131 (25.22%) were female. The administration of antibiotics prophylactically was associated with reduction in rate of mortality, the risk of infections, and complications like acute kidney injury and diarrhea. Although there have been some benefits on antibiotic prophylaxis, prospective research, and possibly the creation of tailored, ECMO-specific bundles will be needed to identify efficient ways to prevent ECMO infection.

Herpes zoster vaccination and the risk of dementia: A systematic review and meta-analysis

INTRODUCTION

Previous studies have reported a decreased risk of dementia with herpes zoster vaccination. Given this background, this systematic review and meta-analysis aimed to investigate the association between herpes zoster vaccination and the risk of dementia.

METHODS

We searched five databases until November 2023 for case-control, cross-sectional, or cohort studies investigating the association of herpes zoster vaccination and dementia. Odds ratios and 95% confidence intervals (95% CIs) were pooled in the meta-analysis. Meta-regression, subgroup, and sensitivity analysis were also conducted.

RESULTS

We evaluated a total of five studies (one cross-sectional, one case-control, and four cohort studies) that included a total number of 103,615 patients who were vaccinated with herpes zoster vaccine. All the studies were of high quality, ranging from 7 to 9. Due to the high heterogeneity (I2 = 100%, p < .00001) observed in our study, a random effect model was used for the analysis. The pooled odds ratio was 0.84 (95% CI: 0.50, 1.43), p (overall effect) = .53), indicating that herpes zoster vaccination reduces the risk of dementia.

CONCLUSION

Herpes zoster vaccination is associated with a reduction of the risk of dementia. More epidemiological studies are needed to confirm the association.

Danazol for the Treatment of Myelodysplastic Syndromes: A Systematic Review

Purpose To study the potential utility of danazol for treating patients with myelodysplastic syndromes, with a focus on efficacy and adverse effects (AEs). Methods MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched for relevant publications from inception June 1, 1950, until June 28, 2022. The studies were screened by title and abstract, followed by full-text screening. The quality of the included studies was assessed via a prespecified set of questionnaires. Data on the efficacy measures and adverse outcomes were extracted and included in a descriptive summary. Results Nine studies consisting of 246 participants were included in our review. The overall quality of the included studies was fair. The age of the participants ranged from 61 to 78 years. In all 9 studies, more male patients had been enrolled than female patients. Overall, a proportion of patients in all the studies reported a desired major response to a danazol dose of 400 to 800 mg/day. Few studies did not observe any improvement in the platelet count. Elevated liver enzyme levels, weight gain, headache, dermatitis, and weakness were the most common AEs observed. One study reported a fatal intracerebral hemorrhage in 1 participant. Conclusions Danazol has been effective in increasing platelet count and hemoglobin level. Despite a few AEs, danazol is a safe drug for the treatment of patients with myelodysplastic syndromes.

The association of multiple sclerosis with thyroid disease: A meta-analysis

BACKGROUND

Multiple Sclerosis (MS) is an autoimmune disease with T-cell-mediated inflammation showing different clinical and pathological phenotypes. The relationship between MS and thyroid diseases has been debated, with varying research outcomes. This meta-analysis aims to clarify the association between different thyroid diseases and MS.

METHODS

Databases PubMed, Google Scholar, ScienceDirect, and Web of Science were searched electronically for the studies investigating the association of thyroid disorders in MS. Studies were selected based on the eligibility criteria and meta-analysis was performed on Review Manager Version 5.4 using a random-effects model. Subgroup analyses were performed based on the clinical subtypes of thyroid disorders and forest plots were generated to interpret the findings. Publication bias was assessed using Egger's and Begg's tests and interpreted into funnel plots. Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled odds ratio.

RESULTS

Inclusive of thirteen studies comprising 13,012 MS cases and 56,850 controls, our analysis unveiled notable findings. pwMS displayed a significantly elevated prevalence of both hypothyroidism (Odds Ratio [OR]: 2.29, 95 % Confidence Interval [CI]: 1.16-4.49, pvalue: 0.02, I2 = 27 %) and autoimmune thyroid disorder (OR: 1.70, 95 % CI: 1.02-2.85, pvalue: 0.04, I2 = 79 %). The collective prevalence of all thyroid diseases among pwMS was markedly higher (OR: 1.60, 95 % CI: 1.20-2.11, p-value: 0.001, I2 = 61 %). Furthermore, gender-specific analyses revealed that females with MS experienced a significantly increased prevalence of thyroid disorders compared to their male counterparts. (pooled odds ratio 2.38,95 % CI 1.11-5.10, p-value: 0.03, I2 = 28 %) CONCLUSION: This comprehensive meta-analysis establishes a significant association between thyroid diseases and MS, substantiating the increased risk of thyroid disorders in pwMS. Moreover, the gender-based analysis implicates a potentially significant interaction between gender and the observed association. These findings collectively contribute to a better understanding of the complex interplay between MS and thyroid diseases, offering crucial insights for both clinical management and future research endeavors.

Association of urinary albumin-to-creatinine ratio with lipid abnormalities and glycemic control in patients with type 2 diabetes mellitus

Introduction

While proteinuria aggravates dyslipidemia in diabetic patients, dyslipidemia further worsens proteinuria via inflammatory cytokines-mediated glomerular damage. Urinary albumin creatinine ratio (ACR) is an easy and reliable method of detecting proteinuria. This study aims to determine the association of ACR with lipid abnormalities and glycemic control in the Nepalese population.

Methods

This was a cross-sectional study conducted among 201 diabetes patients visiting the outpatient department of internal medicine. Based on ACR values, patients were categorized as nonalbuminuric (less than 300 μg/mg) or albuminuric (more than 300 μg/mg). An unpaired t-test was used to compare the mean of various lipoproteins in these two categories. Binary logistic regression was used to check the association of ACR with sociodemographic factors (age, sex, and education), hypertension, and glycated hemoglobin.

Results

Albuminuric patients had higher mean cholesterol (192.8±53.5 vs. 184.2± 37.6; P=0.209), triglyceride (194.9±97.8 vs. 164.4±73.7; P=0.017) and low-density lipoprotein (99.9±38.4 vs. 90.0±27.4; P=0.034) but lower high-density lipoprotein (53.9±18.5 vs. 61.3±19.9; P=0.008) compared to nonalbuminuric patients. There was a significant difference in mean HbA1c values across albuminuria and nonalbuminuria groups (7.1±1.1 vs. 6.7±0.8; OR: 1.4, 95% CI=1.1-1.9, P=0.030).

Conclusions

Urine ACR of more than 30 mg/gram was associated with higher triglyceride and low-density lipoprotein levels and lower high-density lipoprotein levels. The HbA1c level strongly correlates with the development of albuminuria.

A case report on agenesis of dorsal pancreas with insulin-dependent diabetes mellitus: a rare entity

Agenesis of the dorsal pancreas (ADP) is a clinically rare entity that occasionally presents with abdominal pain. It is also association with various disorders of glucose metabolism.

Case presentation

A 23-year-old male presented with continuous epigastric pain for 4 h and intermittent vomiting. He has a history of experiencing recurrent abdominal pain and diarrhoea for the past 5 years. Additionally, he has been diagnosed with type 1 diabetes mellitus for 15 years. Contrast-enhanced computed tomography of the abdomen showed the absence of body and tail of the pancreas.

Discussion

ADP is caused by unknown factors, but may be linked to genetic mutations or changes in signalling pathways related to retinoic acid and hedgehog. Symptoms can be absent, but may include abdominal pain, pancreatitis, and hyperglycaemia due to beta-cell dysfunction and insulin deficiency. Imaging modalities, such as contrast tomography or magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, are crucial in the diagnosis of ADP.

Conclusion

It is important to consider ADP as a differential diagnosis in patients with glucose metabolism disorders and associated symptoms such as abdominal pain, pancreatitis, or steatorrhea. It requires the combined use of imaging modalities such as ultrasound, contrast tomography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography, as ultrasound alone may not provide a complete diagnosis.

Traumatic retroclival hematoma complicated with hyponatremia and delayed traumatic intracranial hematoma in an adult: A case report

Intracranial hematoma is a common variety of brain insults in trauma. However, posterior fossa hematoma in the retroclival location is quite unusual. There are limited numbers of case reports regarding traumatic retroclival hematoma. Some are managed with surgery in this condition. We present a traumatic retroclival hematoma in a 34-year-old gentleman who sustained brain trauma in a motor vehicle accident. His condition was further complicated by hyponatremia and delayed traumatic intracerebral hematoma in a distant location. The only symptom he had later was severe headache which could be attributed to delayed traumatic intracerebral hematoma and hyponatremia. He was managed conservatively and discharged on the 12th day from the hospital.

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%.

Case presentation

A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm³, 36% in peripheral blood smear).

Discussion

Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement.

Conclusion

Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.

Prevalence and risk factors of chronic kidney disease among patients with type 2 diabetes mellitus at a tertiary care hospital in Nepal: a cross-sectional study

OBJECTIVE

To estimate the prevalence of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus (T2DM) and determine the sociodemographic and clinical risk factors associated with CKD.

DESIGN AND SETTINGS

Cross-sectional study among diabetic outpatients of a tertiary hospital in Nepal.

PARTICIPANTS

201 patients with T2DM above 18 years of age.

INTERVENTION

Participants completed a questionnaire regarding their socioeconomic information and underwent pertinent physical and haematological examinations.

PRIMARY AND SECONDARY OUTCOMES MEASURE

The prevalence and risk factors of CKD among patients with T2DM.

RESULTS

The prevalence of CKD in T2DM was 86.6%. In univariable analysis, the variables like age (p=0.026), hypertension status (p=0.002), duration of diabetes (p=0.009) and haemoglobin levels (p=0.027) were significantly associated with CKD among the participants with T2DM. Kruskal-Wallis H test showed that age was significantly different between various CKD stages. Multivariate analysis demonstrated a significant relationship between CKD with age (Adjusted odds ratio (AOR) 3, 95% CI 1.1 to 8.8) and literacy status (AOR 5.8, 95% CI 1.4 to 24.6) CONCLUSION: Advancing age, concomitant hypertension, increasing duration of T2DM and presence of anaemia were found to be important risk factors of CKD. Age is the most important predictor of CKD showing increasing prevalence in the elderly population. Periodic screening tests are essential at an early age to identify kidney diseases at incipient stages, thereby preventing progression to end-stage renal disease.

Emergency Caesarean Section in a COVID-19 Infected Mother in a Primary Health Care Centre: A Case Report

People from rural areas of Nepal struggle to have access to adequate medical care on time. Most of the tertiary centres are overburdened by patients, while the peripheral health facilities have been unable to function efficiently due to a lack of infrastructures and skilled manpower needed to run hospitals smoothly. We present a case of a 21-year-old primigravida at 41 weeks and 3 days of gestation with mild COVID-19 symptoms who underwent a Caesarean section for non-progression of labour and foetal distress at a primary health care centre in Nepal; however, both maternal and foetal outcomes were favourable. Therefore, upgrading the quality of care in peripheral health facilities can help in the achievement of accessibility, equity, and quality in health care service in Nepal.

Association of Anthropometric Indices with Menstrual Abnormality among Nursing Students of Nepal: A Cross-Sectional Study

INTRODUCTION

Obesity has been reported to be linked with menstrual abnormalities including abnormality in cycle length, duration, and period blood loss. However, which anthropometric parameter is a better marker of menstrual abnormality is yet unknown. This study aims to explore the association of BMI, waist-hip ratio (WHR), and waist-height ratio (WHtR) with menstrual abnormalities.

METHODS

This was a cross-sectional study conducted among 240 nursing students on two nursing campuses of Nepal. Demographic and menstrual characteristics related data were collected from the participants via the face-to-face interview technique followed by anthropometric measurements. Binary logistic regression was used to study the association of BMI, WHR, and WHtR with menstrual characteristics. Univariable and multivariable regression models were calculated at 95% confidence interval and a P value of 0.05 using a Statistical Package for Social Sciences, IBM SPSS® v21 (IBM, Armonk, New York).

RESULTS

Out of 240 participants, 52 participants (21.67%) were underweight (<18.5 kg/m²), and 47 participants (19.58%) were either overweight (≥23 kg/m²) or obese (≥25 kg/m²). Overweight and obese BMI was associated with abnormality in menstrual cycle length (AOR = 4.24; 95% CI = 1.77-10.17), duration of the menstrual period (AOR = 2.52; 95% CI = 1.09-5.81), and periodic menstrual blood loss (AOR = 9.04; 95% CI = 3.55-23.01). Increase in WHtR (>0.5) was associated with abnormal cycle length (AOR = 3.09; 95% CI = 1.09-8.80) and abnormal period duration (AOR = 3.05; 95% CI = 1.10-8.44). An increase in WHR (>0.8) was associated with abnormal cyclical menstrual blood loss (AOR = 4.93; 95% CI = 1.55-15.71).

CONCLUSIONS

Obesity predisposes to menstrual irregularities. BMI is a better predictor of menstrual irregularity as the increase in BMI is associated with abnormality in menstrual cycle length, period duration, and blood loss. Increased WHR was associated with periodic blood loss only. Increased WHtR was associated with abnormal cycle length and period duration, but not menstrual blood loss.

Visual Evoked Potentials (VEPs) in Patients with Type 2 Diabetes Mellitus

Background Type 2 diabetes constitutes about 85-95% of all diabetes in developed countries, and accounts for an even higher percentage in developing countries. Diabetic retinopathy is probable the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss. Objective To study P100 latencies and inter ocular latency difference in diabetic group and compared it with a control group and study the correlation between P100 and inter ocular latency difference with the duration of disease in diabetic group. Method A comparative, cross sectional study was done from September 2016 to January 2018 in Neurophysiology Lab, Basic and Clinical Physiology, BP Koirala Institute of Health Sciences. The sample size was 64 and random sampling technique was used. Subjects were divided into three groups according to the duration of disease. Anthropometric and visual evoked potentials were recorded. Descriptive analysis, analysis of covariance and Post Hoc multiple comparison analyses were done using SPSS 11.5. Pearson's correlation was applied between P100 latency and inter ocular latency difference with the duration of disease. Result On using analysis of covariance, P100 latencies were significantly prolonged in diabetic as compared to healthy controls (p < 0.001). Post Hoc multiple comparison showed significant differences in both left and right P100 latencies within diabetic groups and between diabetic groups and healthy controls. Left inter ocular latency difference showed positive correlation with the duration of disease. Conclusion P100 latencies are significantly prolonged in diabetes patients and is positively correlated with duration of disease. Visual evoked potential test can be useful for detecting retinal dysfunction before the appearance of symptoms of retinopathy.

Adverse events following the first dose of Covishield (ChAdOx1 nCoV-19) vaccination among health workers in selected districts of central and western Nepal: A cross-sectional study

INTRODUCTION

The study aimed at exploring the adverse events following immunization (AEFI) and their incidences among health workers in three different districts of central and western Nepal following the first dose of Covishield vaccine,. It also aimed at studying the association of AEFI with demographic and clinical characteristics of vaccinees, pre-vaccination anxiety level and prior history of COVID-19 infection (RT- PCR confirmed) status.

MATERIALS AND METHODS

This was a cross-sectional study carried out via face-to-face or telephonic interview among 1006 health workers one week after receiving their first dose of the Covishield vaccine. Incidence of adverse events was calculated in percentage while Chi-square Test was used to check the association of AEFI with independent variables. Logistic regression was used to find out the adjusted odd's ratio at 95% CI.

RESULTS

Incidence of AEFI was 79.8% with local and systemic AEFI being 68.0% and 59.7% respectively. Injection site tenderness was the commonest manifestation. Local and systemic symptoms resolved in less than one week among 96.8% and 98.7% vaccinees respectively. Females were more likely to develop AEFI than males (AOR = 1.7, 95% CI = 1.2-2.4). Vaccinees aged 45-59 years were 50% less likely to develop AEFI as compared to those aged less than 30 years (AOR 0.5, 95% CI = 0.3-0.8). Most of the vaccinees had not undergone RT-PCR testing for COVID-19 (59.8%). Those who were not tested for COVID-19 prior were 1.5 odds more likely to develop AEFI compared to those who were negative (AOR = 1.5, 95% CI = 1.1-2.1).

CONCLUSION

More than two-third of the vaccinees developed one or more forms of adverse events, but most events were self-limiting. Females and young adults were more prone to develop AEFI.

A Study of F Wave Latencies, Chronodispersion and Persistence in Healthy Medical Undergraduates at BPKIHS

Background The F wave is a CMAP (compound muscle action potential) evoked by a supramaximal stimulation of a motor nerve. F waves are particularly useful for the diagnoses of polyneuropathies at a very early stage and proximal nerve lesions. F waves have a very high diagnostic role in neurophysiology; we would like to study different F wave parameters and effect of anthropometric variables on F wave parameters in normal healthy individuals. Objective To study the effect of anthropometric variables on F wave latencies, chronodispersion and persistence Method Healthy males (n=64) and females (n=26) medical students of BPKIHS with age 21.64±1.19 years were enrolled in the study. Anthropometric parameters and maximum and minimum F wave latencies, F persistence and chronodispersion of bilateral median, ulnar and tibial nerves were recorded in Neurophysiology Lab II of BPKIHS. Descriptive analysis was done for anthropometric and F wave parameters. Unpaired t test was applied for comparing anthropometric and F wave variables between males and females. Pearson correlation was applied between anthropometric variables and F wave parameters. Result Age, height and weight of the subjects were 21.64±1.19 years, 165.61±5.4 cms and 64.07±5.5 kg respectively. Minimum F wave latencies (ms) of right median, ulnar and tibial nerves were 24.09±1.95, 24.02±1.76 and 44.34±3.02 while on the left side were 23.92±1.96, 24.11±1.92 and 44.07±2.83 respectively. Anthropometric variables of male and females were statistically significant. Also, F wave latencies between groups were different which were statistically significant. F persistence was above 80% for all tested peripheral nerves. Height and weight showed a significant effect on F wave latencies (p<0.001). However, age did not show any significant effect on F wave parameters. Conclusion Males have prolonged latencies as compared to females. Height and weight showed a significant relationship with the F wave latencies of the tested peripheral nerves.

Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Change in storage symptoms after transurethral resection of prostate: a prospective observational study

Introduction: Patients with enlarged prostate generally rate their storage symptoms (frequency, urgency and nocturia) as the most bothersome as these symptoms interfere more with daily activities and have huge impact on quality of life. Effect of transurethral resection of prostate (TURP) on storage symptoms is unknown. Objective of the study is to assess the change in storage symptoms in patients undergoing TURP.Methods: A prospective observational study was conducted at the author’s institute from August 2011 to July 2012. Patients undergoing TURP for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate were included. Patients were evaluated by International prostate symptom score (IPSS) questionnaires. The question number 2, 4 and 7 of the IPSS questionnaire gave the storage symptom subscore (0-15). After initial evaluations, the patients underwent TURP. After 3 months, the IPSS was reevaluated and the change in storage symptom was analyzed.Results: A total of 57 patients who had undergone TURP were eligible for final data analysis. Majority of the patients had severe bothersome LUTS with mean IPSS score of 24.6±6. The baseline storage symptom subscore was 11.1±3. After 3 months of follow-up, there was significant decrease in total IPSS score and both of its subscores. On comparing the mean change in storage and voiding subscore, there was less decrement in storage subscore which was statistically significant (p=0.001). Conclusions: This study showed that after TURP change in voiding subscore occurs more than storage subscore and storage symptoms may not revert to normal.

The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal

Background The worldwide prevalence of diabetic retinopathy (DR) was found to be 34.6%. WHO estimates that DR is responsible for 4.8% of the 37 million cases of blindness throughout the world. In a study undertaken in urban population in Nepal, M.D. Bhattarai found the prevalence of diabetes among people aged 20 years and above to be 14.6% and the prevalence among people aged 40 years and above to be 19%. Studies on DR, to our knowledge, have mostly been hospital based in Nepal. Little information is available about prevalence of DR at the community level in Nepal. Objective To investigate the prevalence of diabetic retinopathy and associated risk factors among known diabetic population of Nepal. Method A descriptive cross sectional study was conducted among individuals aged 30 and more using cluster sampling method. The study sites were Kathmandu metropolitan city and Birgunj sub-metropolitan city. A sample size of 5400 was calculated assuming 5% prevalence rate with 95% confidence level, 5% worst acceptable level and 1.5 cluster sampling design effect. Study participants were interviewed, anthropometric measurements and fundus photograph was taken from participants with diabetes. Fundus photographs were used to grade retinopathy. Result Around 12% of the respondents were diabetic, mean age 55.43±11.86 years, of which slightly more than half were females (50.2%). Among these diabetic respondents 9.9% had some forms of diabetic retinopathy, mean age 54.08±10.34 years, 56.7% were male. When severe grade of retinopathy in any eye was considered as overall grade of retinopathy for the individual, prevalence of Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy and complete vision loss was found to be 9.1%, 0.5% and 0.3%. Prevalence of Diabetic Macular Edema was 5.5%. Duration of diabetes, family history of diabetes and blood pressure at the day of survey was found to be associated with having any retinopathy. Conclusion Diabetic retinopathy is emerging as a public health threat in Nepal. With increasing diabetes, DR can be expected to increase more. Existing eye care services may require upgrading to provide quality and affordable retinopathy services to address this emerging problem.

Nephron sparing surgery in a tertiary care center in Nepal--an initial experience

BACKGROUND

Malignant renal mass accounts for 2 to 3% of all malignant diseases in adults. Radical surgery used to be the treatment of choice with high propensity to develop chronic kidney disease in the compromised contralateral kidney. Currently, nephron sparing surgery is considered to be the standard of care with equivalent oncological outcome.

METHODS

This was a retrospective chart review of patients with renal mass less than seven cm in size who had open nephron sparing surgery from July 2012 to Sep 2013 at Tribhuvan university teaching hospital, Nepal. Latest follow up either from record or over telephone was documented.

RESULTS

Eight patients (mean age 45 years, male: female ratio1:1.6) underwent nephron sparing surgery over the specified period. Mean size of tumor was 4.75 cm. Mean ischemia time was 16.37 min. Histopathological diagnosis was benign in two and renal cell carcinoma in six patients.

CONCLUSIONS

Nephron sparing surgery is safe in low stage renal tumors. It also prevents unnecessary nephrectomy in benign lesions and prevents negative sequelae of long term chronic renal impairment in remaining contralateral kidney.

Onset of a propagating self-sustained spin reversal front in a magnetic system

The energy released in a magnetic material by reversing spins as they relax toward equilibrium can lead to a dynamical instability that ignites self-sustained rapid relaxation along a deflagration front that propagates at a constant subsonic speed. Using a trigger heat pulse and transverse and longitudinal magnetic fields, we investigate and control the crossover between thermally driven magnetic relaxation and magnetic deflagration in single crystals of Mn(12)-acetate.

Does earlier headache response equate to earlier return to functioning in patients suffering from migraine?

This study explored the association between headache response and return to functioning, and identified migraine-associated symptoms related to functional status and acceptability of migraine treatment as reported by patients. Data from migraineurs enrolled in the active arms of a randomized, double-blind, parallel group, placebo-controlled, clinical trial were analysed. The relationships between headache response and functional response, and clinical factors and treatment acceptability were assessed using chi(2) tests of proportions and logistic regressions. A greater proportion of patients with headache response at 0.5 h were functioning at 0.5, 1 and 2 h compared with patients who did not attain a headache response at 0.5 h (P < 0.0001). These patients also were more likely to find their treatment acceptable (P < 0.05). The results suggest a direct temporal relationship among the key determinants of migraine resolution. Rapid headache response is associated with faster return to functioning; rapid headache and functional responses are significant attributes of treatment acceptability.

Selection of clinical, patient-reported, and economic end points in acute exacerbation of chronic bronchitis

BACKGROUND

Acute exacerbation of chronic bronchitis (AECB) places tremendous burden on patients, providers, employers, and health care systems.

OBJECTIVE

The purpose of this paper is to (1) review the clinical, patient-reported, and economic measures used to evaluate disease burden and treatment effectiveness in AECB in clinical trials and (2) propose a guide for selecting study end points in AECB that will help capture all the relevant disease outcomes.

METHODS

Two literature searches of the PubMed database were conducted to identify studies of clinical trials in bronchitis and evaluate the clinical, patient-reported, and economic end points used in these studies.

RESULTS

Previous studies have focused primarily on clinician-assessed outcomes, which do not capture the full impact of AECB on patients' lives. Reporting mechanisms for most end points have been inconsistent, limiting the ability to compare information or interpret differences. Previous studies have given limited attention to patient-reported outcomes and the economic implications of AECB. Patient-reported outcomes such as speed of symptom relief and work productivity are important parameters for assessing treatment effectiveness and provide practical information for treatment evaluation.

CONCLUSIONS

Additional research is needed to develop, examine, and validate patient-reported outcomes and the indirect costs of AECB. Measuring the relevant clinical, economic, and patient-reported outcomes in AECB patients using standardized methods may lead to a clearer understanding of the disease burden and the role, effectiveness, and cost-effectiveness of antibiotic treatment.