Journal Issue: Volume: 35, No. 2 (2013) August
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2013
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Chlorhexidine cleansing of the umbilical cord in Nepal: leading by example and saving lives
(Institute of Medicine, 2013) Luke, C. Mullany
NA.
Molecular epidemiology of Rotavirus diarrhea among children in Nepal: Emergence of G12 and G9 strains
(Institute of Medicine, 2013) Sherchand, JB; Tandukar, S; Sherchan, JB; Gurung, S; Dhakwa, JR; Bichha, RP; Mahaseth, C
Abstract
Introduction: Rotavirus is the leading cause of diarrhea and dehydration among infants in both developed and developing countries. The primary objective of this study was to find the magnitude of rotavirus disease burden and genotypic variations of rotavirus.
Methodology: Questionnaires and stool samples were collected from 1003 enrolled children under 5 years of age attending tertiary care Children’s Hospital with acute watery diarrhea during January to December 2012. Rotavirus in stool samples was detected by Enzyme Immuno Assay (EIA) and strains detected from rotavirus positive samples were genotyped by Reverse-Transcription Polymerase Chain reaction (RT-PCR).
Results: Among these, 356 (35.4%) cases were positive for rotavirus by EIA, among the positive cases, 344 samples underwent genotyping by RT-PCR. Rotavirus positive cases were predominant in children who were admitted to the hospital which was 37.8% (115 out of 336). Overall G12 was the most prevalent genotype (52.3%), followed by G1 (17.7%), G2 (10.17%) and G9 (8.1%). The P types identified were P[6] (55.23%), P[8] (20%), and P[4] (12.5%).
Conclusion: The study reveals that rotavirus gastroenteritis accounted for more than one-third of all cases of acute diarrhea. Use of rotavirus vaccines may reduce of high burden of rotavirus diarrhea in children. Emergence of G12 and G9 strains proves the immediate need of vaccine in Nepal.
Keywords: Molecular epidemiology, rotavirus, Nepal
Safe Zones for Miniscrew Insertion among Nepalese Population: A cadaveric study
(Institute of Medicine, 2013) Shrestha, BK
Abstract
Introduction: Anchorage plays very important role in executing orthodontic treatment planning and achieving ideal goal. With the use of mini-implant, the job of orthodontists to control anchorage has been easier. Several radiographic, cone beam CT and histopathological studies have been performed to assess the safe locations in the interradicular spaces for miniscrew placement, the so-called ‘‘safe zones.’ The aim of the study is to determine safe zones for miniscrew placement among Nepalese population.
Methods: Cross sections of adult cadaver jaws were analyzed in 16 mandibles and 16 maxillae after decalcification. Direct measurements were done both in mesio-distal and bucco-lingual directions with the use of digital vernier caliper at 2 mm, 5 mm, 8 mm and 11 mm cut levels from the cervical line in posterior regions of the jaws.
Results: Generally interradicular distance measured greater than 3mm at all levels except at 2mm where the measurement varied considerably in both jaws. All the bucco-lingual measurements in maxilla were above 7 mm except at 2 mm level where the measurements varied. The average bucco-lingual distance measured between 6.52 mm to 9.63 mm in mandible. Generally, all the dimensions measured increased upon moving apically and distally except at 11 mm level between first and second premolar region.
Conclusion: At the buccal aspect of the posterior region of both jaws, the optimal sites are between the second premolar and the first molar and between the first and second in agreement with most of the studies done earlier.
Keywords: anchorage, miniscrews, minimplant screws, orthodontics
PAIR for Hepatic Hydatid Cyst: A study in tertiary care hospital in Nepal
(Institute of Medicine, 2013) Lohani, B; Gurung, G; paudel, S
Abstract
Introduction: The purpose of this study was to assess the outcome of PAIR in patients with hepatic hydatid cysts.
Methods: A total of 17 hepatic hydatid cysts were treated by PAIR in a tertiary care teaching hospital in Nepal from June 2007- May 2009. In all cases, local anesthesia was applied. All the patients were kept in supine except 1 where the patient was kept in left lateral position due to location of the cyst. A spinal needle of 18G was used to puncture the cyst. A connecting tube was attached at the hub of the needle to facilitate the aspiration & to prevent the accidental dislodgement of the needle. 95% alcohol was used as scolecidal agent in 12 cysts & 20% hypertonic saline in 5 cysts. The process was repeated in when the aspirated fluid was > 100 ml.
Results: A total of 17 hydatid cysts of liver were treated with PAIR under ultrasound guidance. The age of the patient ranged from 10-76 years. All patients had signs & symptoms of a hepatic mass caused by the cysts. All the cysts had prominent fluid component which was anechoic or hypoechoic with marked enhancement of back wall echoes on USG. A few patients had CT scans owing to the location of the cysts. Majority of the cysts were in right lobe (12) & rest were in the left lobe (5, one patient had two cysts). The maximum amount of fluid aspirated was 1000 ml. The volume of alcohol / hypertonic saline was 1/3rd of the aspirated fluid. No major complication was found in any of the patients. Following aspiration all the patients were relieved of their symptoms. Follow up ultrasonogram showed decrease in diameter of the cyst.
Conclusion: Among the treatment modalities of hydatid disease though surgery is the first choice treatment, it is associated with considerable morbidity. Chemotherapy with benzimidazoles carbamates is palliative as it is poorly absorbed by the intestine & is unable to diffuse across the cyst wall. PAIR has the benefits of minimal invasiveness, less morbidity & hospital stay as compared to surgery along with confirmation of diagnosis (parasitological examination of the fluid) and cost-effectiveness among others.
Keywords: echinococcus, hydatid cyst, liver, PAIR
Development of Skin Disease Disability Index to Assess the Dermatologic Burden in Nepal
(Institute of Medicine, 2013) Shrestha, DP; Shrestha, R; Gurung, D; Lama, L; Rosdahl, I
Abstract
Introduction: Skin disease is one of the leading cause of morbidity worldwide. Most instruments measuring the impact of skin disease on quality of life are developed in the west and not applicable measuring the impact of skin disease on quality of life are developed in the west and not applicable to the socio-cultural situation in Nepal. The aim of the study was to develop and validate a questionnaire to measure quality of life impairment due to skin disease in Nepal.
Methods: Different aspects of quality of life impairment were identified from 35 in-depth. Different aspects of quality of life impairment were identified from 35 in-depth interviews and two focus group discussions, with villagers with various skin diseases. Based interviews and two focus group discussions, with villagers with various skin diseases. Based on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in 212 villagers with skin disease and in 100 healthy villagers.
Results: The maximum total Skin Disease Disability Index score was 36. There was a wideThe maximum total Skin Disease Disability Index score was 36. There was a wide variation in total Skin Disease Disability Index score between individuals with skin disease variation in total Skin Disease Disability Index score between individuals with skin disease (range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001).(range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001). Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The difference in mean score for single questions between patients and controls was also highly significant (p<0.001).
Conclusions: The questionnaire clearly covered all aspects of quality of life related to skin disease and was, simple, robust, easy to use and well accepted by the selected population. The Skin Disease Disability Index was reliable in the overall score as well as in individual questions.