Journal Issue: Volume: 11, No 4, Issue 44, OCT-DEC, 2013
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Volume
Number
Issue Date
2013
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Potential of Global Health Education in Low-Income Settings
(Kathmandu University, 2013) Karmacharya, BM
NA
Prevalence and Correlates of Cervico-Vaginal Clinical Syndromes Among Women Attending a Health Camp in Lalitpur District of Nepal
(Kathmandu University, 2013) Johnson, D; Chamot, E; Lhaki, P; Broker, TR; Steben, M; Shrestha, S
ABSTRACT
Background
Sexual and reproductive health of women is a major public health problem in Nepal.
Screening of cervico-vaginal clinical syndromes could potentially provide insights to
the prevalence of sexually transmitted infections (STIs), which is not known.
Objective
To investigate the prevalence and factors associated with cervico-vaginal clinical
syndromes in the socio-behavioral, medical, and public health context of Nepal.
Methods
Married women attending a clinical health camp held by the Nepal Fertility Care
Centerin Khokana of Lalitpur district were recruited to the study. Seventy-three
participants completed face-to-face questionnaires on basic socio-demographic,
behavioral and reproductive health factors and underwent pelvic screening including
clinical diagnosis of cervicitis and vaginitis. An univariate analysis was performed to
determine if any of the self-reported variables were associated with abnormal pelvic
examination (cervicitis and/or vaginitis).
Results
Vaginitis was diagnosed in three (4.4%) participants, while cervicitis was detected in
16 (23.5%) women. None of the participants reported any high risk sexual behavior.
However, 28% of the participants reported having had STI diagnosis in the past and
was associated (P<0.008) with abnormal pelvic results. Additionally, women with
lower education were associated (p<0.02) with abnormal pelvic results.
Conclusions
The high occurrence of cervicitis in our exploratory could indicate the high
prevalence of STIs. However, while there could potentially be an unknown epidemic
of STIs related to the clinical syndromes, point of care testing practice might help to
understand the true prevalence of STIs in Nepali women and also reduce the health
burden and consequences of over treatment based on the current symptomatic
diagnosis.
KEY WORDS
Cervical Cancer, global health, HPV, Nepal, STI
Evaluation of Matrix Metalloproteinases-2 (MMP-2) and Tissue Inhibitors of Metalloproteinases-2 (TIMP-2) in Oral Submucous Fibrosis and Their Correlation With Disease Severity
(Kathmandu University, 2013) Shrestha, A; Carnelio, S
ABSTRACT
Background
Oral submucous fibrosis (OSF), a potentially malignant oral lesion, is a form of
pathological fibrosis affecting the oral mucosa. It results from an imbalance in
equilibrium of the normal process of synthesis and degradation of extra cellular
matrix. Matrix metalloproteinases and its inhibitors play important role in
remodeling of the extra cellular matrix which are important in progression and
pathogenesis of potentially malignant lesions to malignancy.
Objectives
To evaluate the expression and distribution of Matrix metalloproteinases-2 (MMP-
2) and Tissue inhibitor of metalloproteinases-2 (TIMP-2) in different grades of Oral
Submucous Fibrosis(OSF).
Method
Immunohistochemical analysis for MMP-2 and its TIMP-2 was performed in 30
histopathologically confirmed, formalin fixed, paraffin embedded specimens of
OSF. A semi-quantitative analysis was done to assess the expression, distribution
and comparison of these in various stages of this disease.
Result
All moderately advanced cases and 64.2% for MMP-2 and 78.5% for TIMP-2 of early
stage cases showed positivity. Between two stages of OSF, statistically significant
differences were noted in expression of TIMP-2 in lamina propria, deep connective
tissue and supra basal layers (p<0.05) and basal and supra basal layers for MMP-2
(p<0.05).
Conclusion
The simultaneous increase in expression of MMP-2 and TIMP-2 with advancing
stages of OSF can provide a basis for considering the proteases as important
mediators in the pathogenesis and progression of OSF which could aid in
identifying the aggressiveness of the condition and elucidate its role in its malignant
transformation.
KEY WORDS
Immunohistochemistry, matrix metalloproteinases, oral submucous fibrosis, tissue
inhibitors of metalloproteinases
Nuchal Translucency in Normal Fetus and Its Variation With Increasing Crown Rump Length (Crl) and Gestational Age
(Kathmandu University, 2013) Karki, S; Joshi, KS; Tamrakar, SR; Regmi, S; Khanal, K
ABSTRACT
Background
Nuchal translucency (NT) is the fluid collection behind the fetal neck which can
be measured by ultrasound at 11-14 weeks of gestation. Increase in the nuchal
translucency thickness is associated with various congenital anomalies.
Objective
To study the relationship between nuchal translucency thickness, crown rump length
and gestational age in normal fetus.
Methods
Prospective analytical study conducted on 211 pregnant women from March 2011 to
August 2012. Measurement of Nuchal translucency thickness and crown rump length
was performed by ultrasound at 11-14 weeks of gestation. The relationship between
nuchal translucency thickness, crown rump length and gestational age was studied by
using linear regression analysis.
Results
The mean CRL was 63.67+13.48mm (range 41.2-88mm) and mean NT thickness was
1.55+0.35mm (range 0.8-2.7mm), respectively. The median gestational age was 12.9
weeks. The regression equation which shows relation between median NT thickness
and CRL was described as follows: expected NT thickness = 0.013CRL+0.725, (R2 =
0.258, p <0.001). There was increase in the incidence of NT thickness more than or
equal to 2.5mm; 1.7% in fetus between 12-12.9 weeks of gestation to 15.1% in fetus
between 14.0-14.9 weeks.
Conclusion
Our study offers normative data of NT thickness in normal fetus, which can be used as
reference to screen various chromosomal and congenital abnormalities between 11-
14 weeks of gestation. NT thickness increased with increasing CRL and a false positive
rate increases with increasing gestational age.
KEY WORDS
Crown Rump length, gestational age, nuchal translucency
Comparative Study of Hyperbaric Bupivacaine Plus Ketamine Vs Bupivacaine Plus Fentanyl for Spinal Anaesthesia during Caeserean Section
(Kathmandu University, 2013) Shrestha, SK; Bhattarai, B; Shah, R
ABSTRACT
Background
Spinal anesthesia is widely used for caesarean section due to its rapid onset, low
failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to
local anaesthetics seems to improve the quality of block and prolong the duration
of analgesia.
Objectives
The purpose of this study was to compare the effect of intrathecal ketamine
mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric
bupivacaine.
Methods
One hundred parturients ASA Grade I scheduled for elective or semiurgent
caesarean section under spinal anaesthesia were randomly divided into two
groups. Group A received 2ml (10 mg) hyperbaric bupivacaine 0.5% plus 25 mg
preservative free ketamine. Group B received 2ml (10mg) hyperbaric bupivacaine
0.5% plus 25μg fentanyl. The patients were observed intraoperatively for the onset
of sensory block, degree of motor block and total duration of analgesia.
Results
The time to achieve Bromage scale 3 motor blockade was shorter in Group A than
in Group B.(p= 0.445) whereas time to achieve highest dermatomal level of sensory
block was shorter in Group A than in Group B (p= 0.143). The duration of spinal
analgesia was longer in Group B than in Group A (p= 0.730). The frequency of side
effect such as sedation score was higher in Group A compared to Group B (p=
0.048). The incidence of pruritus was significantly higher in Group B compared to
Group A (p = 0.000).
Conclusion
Addition of preservative free ketamine lead to faster onset of sensory and motor
blockade, although it did not prolong the duration of spinal analgesia compared
to addition of fentanyl in parturients undergoing caesarean section with spinal
anaesthesia.
KEY WORDS
Bupivacaine, caesarean section, fentanyl, ketamine, spinal anaesthesia