Journal Issue: Volume: 9, No 3, Issue 35, JUL-SEP, 2011
Loading...
Volume
Number
Issue Date
2011
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Peripheral Airway Responsiveness to Sub-maximal Exercise in Asymptomatic Cigarette Smokers
(Kathmandu University, 2011) Pokhrel, BR; Chatopadhyaya, S; Paudel, BH
ABSTRACT
Background
Cigarette smoking is one of the cardinal causes for the development of bronchial
hyperresponsiveness among the smokers.
Objectives
This study was perspectively designed to determine the peripheral bronchial
responsiveness to sub-maximal exercise challenge in the asymptomatic smokers.
Methods
The subjects were between age of 18-25 years without any findings of cardio-
respiratory diseases. We performed the 5 min step test exercise at intensity of 80 to
90% of maximum predicted heart rate in 42 young adult male asymptomatic smokers
to examine the effect of cigarette smoking on airway responsiveness. Forced expiratory
spirogram was recorded before and at 0, 5, 10, 15 min after the completion of exercise.
Pre- to post exercise drop in Forced Expiratory Volume in first second ≥ 15% was
considered hyperresponsive to the challenge.
Result
The analysis of data (mean± SE) indicated the bronchial hyper-responsiveness in
22 (52%) smokers. The post exercise recovery time pattern showed drop in forced
expiratory spirogram from the resting baseline in the responsive smokers and the
maximum percentage fall in the parameters or increase in airway resistance which
reflect the peripheral airway integrity such as Forced Expiratory Flow 25% (20.30
±2.18 Vs 7.88 ±3.23, p<0.01), Forced Expiratory Flow 50% (18.46 ±4.40 Vs 1.93 ±2.78,
p<0.01), Forced Expiratory Flow 75% (23.94 ±3.68 Vs 0.80 ±4.72, p<0.001) and Forced
Expiratory Flow 25-75% (32.50 ±4.79 Vs 3.64 ±3.32, p<0.001) was significantly higher in
the responsive than non-responsive subgroup of the smokers.
Conclusion
The occurrence of peripheral airway resistance is more in the responsive than non-
responsive subset of smokers to the exercise challenge and hence more prone to
develop obstructive airway disease in the long run.
KEY WORDS
airway hyper-responsiveness, cigarette smokers, forced expiratory flow
Age-Related Macular Degeneration in Nepal
(Kathmandu university, 2011) Thapa, R; Paudyal, G; Shrestha, MK; Gurung, R; Ruit, S
ABSTRACT
Background
The Age–related Macular Degeneration (AMD) is a common cause of visual impairment
and blindness worldwide in elderly.
Objective
This study aimed to explore the demographic characteristics, pattern and risk factors
for AMD at a tertiary referral eye centre in Nepal.
Methods
This is a hospital-based prospective study, conducted at Tilganga Institute of
Ophthalmology, Nepal from September 2008 to May 2009. All the consecutive cases of
AMD diagnosed at the institute were included.
Results
A total of 141 patients (266 eyes) with AMD recruited for the study. The mean age
was 69.5 years (9.1SD) with three fifth males (58.9%). Housewives and occupations
like agriculture comprised of 38.3% and 42.5% respectively. Three fourth (75.6%) of
the patients were illiterate. The proportion of dry and wet AMD were found in 62.4%
and 37.6% respectively. Bilateral involvement was seen in 88.7% of the subjects. Three
fourth (71.4%) of the AMD eyes had presenting visual acuity less than 6/18. History of
smoking was found in 69.9% of patients. Hypertension was the predominant systemic
problem (45.4%) followed by diabetes mellitus (12.8%).
Conclusion
AMD is correlated with ageing in our study as well. Dry AMD is more in age groups
45-64 years and wet AMD at 65 years and older. Bilateral involvement with one eye
dry and fellow eye wet AMD is more predominant (44%). Smoking and occupations
like agriculture and housewife are significant risk factors for AMD. Likewise male sex,
illiteracy and hypertension are other risk factors for AMD in hospital settings.
KEYWORDS
agriculture, dry macular degeneration, hypertension, illiterate, smoking, wet macular
degeneration
Propofol Sedation During Spinal Anaesthesia - A Dose Finding Study
(Kathmandu University, 2011) Ghimire, A; Bhattarai, B; Rahman, TR; Singh, SN; Koirala, S; Tripathi, M
ABSTRACT
Background
It is important to be able to measure and maintain a specific sedation level to
compare outcomes of different levels of sedation during anesthesia and the aims
include general patient comfort, freedom from specific discomfort, and some
amnesia for both the block procedure and the surgical operation, in order to meet
the patient’s preference and safety. In this prospective randomized clinical study,
we compared the three different infusion doses of propofol.
Objective
To find out the appropriate infusion dose of propofol for optimal sedation without
causing undue side effects in patients undergoing spinal anaesthesia.
Method
One hundred twenty patients ASA PS I-II were randomly allocated to three groups
1, 2 and 3 receiving propofol infusion at the rate of 25, 50 and 75 microgram/kg/
min with concentration of (0.5%), (1%) and (1.5%) respectively. They were observed
for sedation score, hemodynamic parameters and satisfaction level. The adverse
effects like respiratory depression, nausea and vomiting score were assessed.
Result
Median sedation score increased in a dose dependent manner, with significantly
higher scores in group 2 and 3 compared with group 1. Hemodynamic parameters
were better in group 1 and 2 as judged by mephentermine requirement. The
awakening time after stoppage of infusion was significantly delayed in group 3 (p
< 0.001). Respiratory depression, nausea and vomiting were comparable clinically.
Almost three fourth of the patients were satisfied with the techniques used.
Conclusion
Propofol infusion at the rate of 50mcg/kg/min for sedation in spinal anaesthesia
provides optimal sedation, early awakening and excellent satisfaction level in the
postoperative period
KEYWORDS
propofol, sedation, spinal anaesthesia.
Clinical, MRI and Arthroscopic Correlation in Internal Derangement of Knee
(Kathmandu University, 2011) Sharma, UK; Shrestha, BK; Rijal, S; Bijukachhe, B; Barakoti, R; Banskota, B; Pradhan, I; Banskota, AK
ABSTRACT
Background
The traumatic or degenerative internal derangement of the knee requires certain
investigations for the establishment of diagnosis, in addition to clinical history and a
thorough physical examination. The use of arthrography and arthroscopy improves
the accuracy of the diagnosis. MRI scanning of the knee joint has often been
regarded as the noninvasive alternative to diagnostic arthroscopy.
Objective
The purpose of the study was to correlate clinical and low field MRI findings with
arthroscopy in internal derangement of the knee.
Methods
Forty one patients with suspected internal derangement of the knee were subjected
to MR examination followed by arthroscopy. Clinical criteria used were history,
mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury.
Drawer test was considered to be essential for clinical diagnosis of cruciate ligament
injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom
C, Seimens). Arthroscopy was done within two months of MR examination and was
considered gold standard for the internal derangement of the knee.
Results
The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%,
33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1%
respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy
of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and
92.6% respectively for lateral meniscal tear.
Conclusion
Clinical examination showed higher sensitivity for medial meniscal tear compared
to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed
high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament
injury, in addition to associated derangement like articular cartilage damage,
synovial thickening.
KEY WORDS
arthroscospy, knee, MRI.