Browsing by Author "A, Neopane"
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Publication Publication Effectiveness of nicotinic acid and bezafibrate alone and in combination for reducing serum triglyceride level(Kathmandu University, 2005) B, Pradhan; A, Neopane; S, Karki; DB, KarkiObjective: To study the effectiveness of nicotinic acid and Bezafibrate alone and in combination for reducing triglyceride level. Design: It was a randomised, prospective, longitudinal study. Setting: Patients attending a private clinic, and medical department of Kathmandu Medical College, Sinamangal. Methods: This study included 83 consecutive patients, 19 females and 64 males with hypertriglyceridaemia (defined as serum triglyceride >200mg/dl) attending the department of medicine, Kathmandu Medical College, Sinamangal and private clinic. Main outcome measures: Statistically significant reduction of serum triglyceride level. Result: 51 out of 83 patients completed the study in which Nicotinic acid alone reduced the serum trygleceride level from 320.62 ± 104.23 to 182.55 ± 46.21, which is a reduction of 138.07 ± 85.69 (P. value = 001). Bezafibrate when given alone also reduced triglyceride level significantly from 345.25 ± 181.03 to 203.30±93.59 which is a reduction of 141.95 ± 121.130 (P value= .001). When a combination of both drugs was given the reduction of 472.73±247.53 (P value =.002) was achieved. Conclusions: Nicotinic acid is a very effective drug in reducing serum triglyceride level and its effectiveness is similar to Bezafibrate. There is no added benefit of giving a combination of nicotinic acid and Bezafibrate in reducing serum triglyceride level. Keywords: Hypertriglyceridaemia, Nicotinic acid, Bezafibrate. Abbreviations: TG= Triglyceride, TC = Total cholesterol, HDL= High density lipoprotein, LDL= Low density lipoprotein NCEP-ATP III= National Cholesterol Education Programme-Adult Treatment panel 111Publication Enteric fever: Diagnostic value of clinical features(Kathmandu University, 2006) A, Neopane; M, Poudel; B, Pradhan; R, Dhakal; DB, KarkiObjectives: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. Design: Prospective observational study Setting: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal Materials and methods: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. Results: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. Conclusion: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever. Key words: enteric fever, clinical features, diagnostic criteriaPublication Hypohiderotic ectodermal dysplasia(Kathmandu University, 2006) A, Neopane; SK, Singh; B, ManandharWe report a case of a six years age girl who presented to our out patients department with the history and findings suggestive of recurrent respiratory tract infections. She was also noticed to have; non homogeneous hyper- pigmented patches on the face since three months of age, sparse hair on the scalp and eyebrows, conical peg like teeth and delayed dentition, prominent and low set ears, perpetually flexed third toe bilaterally. Axillary skin biopsy showed adenexal structures and eccrine glands in subcutaneous fat which were reduced in number. The diagnosis made was: Anhydrotic/ Hypohidrotic type of ectodermal dysplasia. Key words: Ectodermal Dysplasia, Anhidreotic, HypohidroticPublication Lipid levels in Nepalese population(Kathmandu University, 2004) DB, Karki; A, Neopane; B, Pradhan; A, MagarObjective: To study the lipid pattern of Nepalese population Design: Retrospective study Setting: Patients attending Temple of Healing for consultation Methods: Fasting lipid profile of 2218 blood samples was analyzed. Results: Abnormal total cholesterol(TC) was found in 7.7%. High LDL cholesterol(LDL-C) was found in 5% of cases. 70% of subjects had triglyceride(TG) level more than the upper level of normal. All abnormal lipid level was found in the age group 49-60years. 23% of the study group had low level of HDL cholesterol. Conclusions: abnormal triglyceride level is the commonest lipid abnormality in our population. High total cholesterol and LDL cholesterol is not very common except in the age group 40-49 where it is significantly high in comparison to other age groups. HDL cholesterol level did not decrease significantly with increasing age. Keywords: Lipids, Nepalese populationPublication Management of Typhoid fever in the Department of Medicine at Kathmandu Medical College(Kathmandu University, 2003) M, Dhakal; A, Neopane; N, Subedi; R, Dhakal; DB, KarkiAim 1. To assess the ongoing management strategy of typhoid fever in department of medicine at Kathmandu Medical College, Sinamangal, Kathmandu. 1. To suggest changes, if required for the benefit of patients and doctors Method Prospective study of clinically suspected enteric fever from 2060/01/29 to 2060/04/25. Assessment and analysis of the rationality of the diagnostic parameters that are being used in the ward for clinically suspected enteric fever in unit one of department of medicine. Treatment outcome of the patients with the commonly used antibiotics. Analysis of the sensitivity pattern of the salmonellae isolated among the study group. Result 1. Only 11 cases (37%) were actually culture proven among the 30 cases suspected to be enteric fever on clinical basis. 2. 19 cases (63 %) of the clinically suspected enteric fever were diagnosed only on the basis of single widal test (titre more than 1:320), blood culture being negative. 3. Bone marrow was subjected to culture for salmonella only in 4 Cases (13%) despite blood culture being sterile. 4. The laboratory could provide sensitivity pattern of salmonellae only in 5 cases out of 11 culture positive cases (45%). 5. Eighteen cases (60%) had to be given 3rd generation cephalosporin after not responding to 5 days course of fluoroquinolones (ciprofloxacin or ofloxacin). On the other hand all the cases in the study group subjected to 3rd generation cephalosporin (injection ceftriaxone or cefixime orally) responded well to the treatment. Conclusion 1. We shouldn’t be relying too heavily on a single titre of widal test for the diagnosis of enteric fever and should be sending blood for culture for salmonella and even bone marrow culture, if necessary. This can be concluded on the basis of lots of literature against single widal test in the diagnosis of enteric fever. 2. Widal test should be positive with clearly significant rising titre (with paired sample) or modified widal test has to be performed if one wants to give gravity to the test for the diagnosis of enteric fever. 3. Laboratory personnel’s need to be more serious in their works so as to try to see sensitivity pattern in all positive cultures, if rational use of antibiotics is really desired in view of increasing antibiotic resistance. 4. Fluoroquinolones, once thought to be super powerful antibiotic & still taken as the drug of choice almost everywhere, has been found to be resistant in most of the cases in this study. Though the sample size is too small and there are lots of limitations in this study to come to a firm conclusion, it has borne one serious question in the minds of our unit doctors: Correspondence Dr. Mahesh Dhakal Dept. of Medicine, Kathmandu Medical College, Teaching Hospital Kathmandu University Medical Journal (2003) Vol. 1, No. 3, 197-204 198 whether we are over-using fluoroquinolones for trivial infections and leading to the emergence of resistant strains of salmonellae?Publication Publication Study of patients presenting with symptoms of peripheral neuropathy and thickened greater auricular nerve(2003) A, Neopane; B, Upadhyaya; S, Dungana; DB, KarkiObjective: To analyze symptoms and make a clinical diagnosis of leprosy in patients presenting with symptoms of peripheral neuropathy and found to have thickened greater auricular nerve. Design: Cross- sectional study Setting: Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. Patients attending the medical out patient department of this hospital were taken in the study. Materials and methods: 40 patients presenting with symptoms of peripheral neuropathy and are found to have thickened greater auricular nerve were included. Results: Thickened greater auricular nerve and sensory symptoms showed male predominance (97.5%). Mean age of involvement was 28.65 years. The symptom most frequently complained of was chest pain (75%), followed by pins and needle sensation 67.5%, burning of the upper extremities, nape of the neck and chest 57.5%, palpitation 45%, disturbed sleep mostly said to be due to burning 35%, sweating 20%, dizziness17.5%, shortness of breath 7.5%, and numbness of the limbs in 2.5%. None of the patients had somatic neuropathy. Autonomic neuropathy was present in 42.5 %. Conclusions: 1. In endemic areas patients with thickened peripheral nerve and sensory symptoms should be diagnosed clinically as primary neuritic leprosy. 2. In absence of objective loss of somatic sensation autonomic neuropathy may be the only early indicator of neuritis. 3. Close follow up of these patients is necessary. Key words: peripheral neuropathy, primary neuritic leprosy, autonomic neuropathy, follow upPublication Two cases of severe falciparum malaria in KMCTH(Kathmandu University, 2006) SB, Singh; D, Chaudhary; A, Neopane; DB, KarkiMalaria is the most important parasitic disease of man. It is the protozoan infection of RBCs transmitted by bite of blood feeding female anopheline mosquito. Until the 19th century malaria was found throughout Europe, North America and Russia. Since then, it has been eradicated from these areas but in tropics though initial efforts of eradication had been successful, there has been resurgence of disease1 accompanied by increasing resistance of the anopheline vector to insecticide and of the parasite to antimalarial drugs. We report two cases of falciparum malaria in which there was co-existent vivax malarial infection. These two cases were both exposed to highly endemic zone for malaria. Key words: Sequestration, malaria, falciparum.