Journal Issue: No 3, Issue 15, JULY-SEPT, 2006
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1812-2027
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Oxidative stress and antioxidant status in cardiovascular diseases in population of western Nepal
(Kathmandu University, 2006) S, Risal; D, Adhikari; VM, Alurkar; PP, Singh
Objectives: To observe if there is any connectivity between oxidative stress and cardiovascular diseases (CVDs).
Materials and methods: Patients suffering from different cardiovascular diseases (hypertension, ischemic heart
disease, rheumatic heart disease) attending Manipal Teaching Hospital, Pokhara and strictly matched controls were
selected for this study. Oxidative stress (OS) was measured by plasma thiobarbituric acid reacting substances
(TBARS) where as antioxidant status was measured by estimating vitamin E, vitamin C and total antioxidant
activity (TAA) in plasma.
Results: The mean level of TBARS, TAA, vitamin C and E were 2.20+0.43 nmol/ml, 547+98 μmol/l, 0.88+0.15
mg/dl and 0.75+0.20 mg/dl respectively in patients. The respective values in controls were 1.86+0.43 nmol/ml,
859+139 μmol/l, 0.94+0.15 mg/dl and 1.10+0.30 mg/dl. Although the OS seems to be raised in patients, is
practically insufficient to oxidize biomolecules and induce CVDs. Despite vitamin C and E levels being well within
normal limits, the TAA was significantly and considerably lower in patients. This is a highly interesting observation
suggesting that dietary antioxidants other than these vitamins were preferentially consumed to control OS because
procedure for TAA used in this study practically measures only total dietary antioxidants.
Conclusion: OS does not appear to be an etiological factor for the cardiovascular diseases; rather slightly raised OS
in patients seems to be a consequence. Further the raised OS was not due to lower nutrient antioxidant (vit. C and
vit. E) in the local population studied herein.
Key words: Oxidative stress, cardiovascular diseases, vitamin C, vitamin E, total antioxidant activity.
Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases
(Kathmandu University, 2006) S, Khan
Background: Hyperbilirubinemia is the result of imbalance between production and excretion of bilirubin by the
liver. It may be because of hepatocellular, cholestatic or haemolytic diseases. Liver receives blood mainly through
portal venous system, which receives blood from abdominal organs. Portal blood carries nutrients and other
substances absorbed from gut including bacteria and its product (toxins). In small percentage, even in normal
healthy people, bacteria are found in portal blood. It is commonly cleared by detoxification and immunological
action of reticuloendothelial (RES) system of liver that act as first line defence in clearing toxic substances, bacteria
and it's products. But when bacterial load overwhelms the Kuffer cell function, may cause dysfunction or damage to
the hepatocytes (liver parenchyma). It reflects, rise in serum bilirubin (SB) alone or in combination with liver
enzymes depending upon the type, severity and site of lesion. Recently, another substance known as Cytokines e.g.
IL-6, Tumour necrosis factor (TNF), have also been labelled to be responsible for depressed excretory function of
liver and may lead to increase in SB level without rise in liver enzymes.
Aim: To evaluate hyperbilirubinemia associated in acute inflammation of appendix (acute appendicitis and its
complication).
Material and methods: This is a prospective study conducted at NGMC Teaching hospital Nepalgunj, Nepal during
Oct.2004-Oct.2005. 45 Consecutive cases of acute appendicitis admitted in surgical unit III, were recruited for this
study. Clinically suspected cases were subjected to investigations to confirm the diagnosis. Investigations included
total leucocytes count, differential leucocytes count, urine analysis and ultrasound. These cases were also subjected
to routine liver function tests. Subsequently these cases were operated and clinical diagnosis was confirmed per–
operatively and post operatively by histopathological examination of the specimen. Their clinical and investigative
data were compiled and analyzed and following observations were obtained. Routine liver function test results were
compared with laboratory reference values given in Table- 1, 2 and 3.
Inclusion Criteria: Case with acute appendicitis and its complication with test negative for HBSAg and no past
history of jaundice. Exclusion Criteria: Case with acute appendicitis and its complication with test positive for
HBSAg and /or past history of jaundice.
Results: Total number cases were 45. Of 45, 25 were males and 20 were females. Their age ranged from 11years to
60 years. The average was 27.2 years. Duration of symptoms ranged from 5 hours to maximum 9 days. Among 45
cases diagnosed as acute appendicitis clinically (preoperatively), per operatively, 36 cases had inflamed appendix, 3
cases had gangrene, 5 cases had perforation with peritonitis (4 localized and 1 generalized peritonitis) and only a
single case was noted to be of normal appendix (Table 4). Liver function tests (LFT) analysis revealed following
results, Among 45 cases, SB was raised in 39cases where as 6 cases had normal SB level. The raised SB ranged
from 1.2 mg/dL to 8.4 mg/dL. The average level of SB was 2.38 mg/dL. All the cases had indirect fraction of SB
above 15%. (Table 4). The rise in SB was without concomitant much rise in liver enzymes.
Conclusion: Following conclusion can be drawn from the present study. Firstly, There was Hyperbilirubinemia in
86.6% of the patients of acute inflammation of appendix (i.e. acute appendicitis and its complications). Secondly,
Raised SB ranged from 1.2mg/dL - 8.4 mg/dL. Thirdly, The rise in SB was mixed in type (both indirect and direct).
Finally, The hyperbiliubinemia was intra hepatic cholestatic in type due either to abnormality in permeability of
hepatocyte or ductular membrane enzyme inhibition as the liver enzymes were not much elevated.
Key words: Acute Inflammation of Appendix, Acute appendicitis, Hyperbilirubinemia, Serum bilirubin
Characterization of candida species isolated from cases of lower respiratory tract infection
(Kathmandu University, 2006) BK, Jha; S, Dey; MD, Tamang; ME, Joshy; PG, Shivananda; KN, Brahmadatan
Objectives: (1) To identify and characterize the Candida species isolates from lower respiratory tract infection.
(2) to determine the rate of isolation of Candida species from sputum samples.
Methods: This study was carried out in the Department of Microbiology, Manipal Teaching Hospital, Pokhara,
Nepal from June 2002 to January 2003. A total of 462 sputum samples were collected from patients suspected lower
respiratory tract infection. The samples were processed as Gram staining to find out the suitability of the specimen,
cultured on Sabouraud’s Dextrose Agar (SDA) and also on blood agar and chocolate agar to identify the potential
lower respiratory tract pathogens. For the identification of Candida, sputum samples were processed for Gram stain,
culture, germ tube test, production of chlamydospore, sugar fermentation and assimilation test. For the identification
of bacteria, Gram stain, culture, and biochemical tests were performed by standardized procedure.
Result: Out of 462 samples, 246 (53.24%) samples grew potential pathogens of lower respiratory tract. Among
them Haemophilus influenzae 61(24.79%) and Streptococcus pneumoniae 57 (23.17%) were the predominant
bacterial pathogens. Candida species were isolated from 30 samples (12.2%). The majority of Candida species
amongst the Candida isolates were Candida albicans 21(70%) followed by Candida tropicalis 4(13.33%). Candida
krusei 3(10%), Candida parapsilosis 1(3.33%) and Candida stellatoidea 1(3.33%). The highest rate of isolation of
Candida was between the age of 71 and 80.
Conclusion: Candida isolation from sputum samples is important as found in the present study in which Candida
species were the third most common pathogen isolated from patients with lower respiratory tract infection.
Key words: Candida albicans, Pulmonary candidiasis, Nepal
Common pathogens isolated in diabetic foot infection in Bir Hospital
(Kathmandu University, 2006) VK, Sharma; PB, Khadka; A, Joshi; R, Sharma
Aim: Foot ulcers are a frequent complication of patients suffering with diabetes mellitus, accounting for up to 20%
of diabetes-related hospital admission6. Secondary infection of these ulcers is by far the leading cause of amputation
of feet and legs and the polymicrobial nature of diabetic foot infection has been well documented in the literature.
The present study sought to reveal the bacterial etiology of diabetic foot ulcer in patients presenting to Bir Hospital.
Method: A 1 year retrospective study was carried out to analyse the bacterial isolates of all patients admitted with
diabetic foot infection presented with Wagner grade 2 -5 ulcers. Bacteriological diagnosis and antibiotic sensitivity
profiles were carried out and analysed using standard procedures.
Results: Diabetic polyneuropathy was found to be common in (51.1%) and gram positive bacteria were isolated
more often than gram-negative ones in the patients screened. The most frequent bacterial isolate were
Staphylococcus aureus (38.4%), Pseudomonas aeruginosa (17.5%), and Proteus (14%). Imipenem was the most
effective agent against gram-negative organisms. Vancomycine was found to be most effective against gram-
positive organisms. 13
Conclusion: Staph aureus and Pseodomonas aeruginosa were the most common causes of diabetic foot infections in
Bir Hospital. Theses wounds require use of combined antimicrobial therapy for initial management, repeated
dressing and wound debridements were done.