Serum uric acid level in newly diagnosed essential hypertension in a Nepalese population:A hospital based cross sectional study

Objective:To develop the missing link between hyperuricemia and hypertension.Methods:The study was conducted in Department of Biochemistry in collaboration with Nephrology Unit of Internal Medicine Department.Hypertension was defined according to blood pressure readings by definitions of the Seventh Report of the Joint National Committee.Totally 205newly diagnosed and untreated essential hypertensive cases and age-sex matched nonnotensive controls were enrolled in the study.The potential confounding factors of hyperuricemia and hypertension in both cases and controls were controlled.Uric acid levels in all participants were analyzed.Results:Renal function between newly diagnosed hypertensive cases and nonnotensive healthy controls were adjusted.The mean serum uric acid observed in newly diagnosed hypertensive cases and in nonnotensive healthy controls were(290.05±87.03)μmol/L and(245.24±09.38)μmol/L respectively.A total of 59(28.8%)participants of cases and 28(13.7%)participants of controls had hyperuricemia(odds ratio 2.555(95%CI:1.549-4.213),P<0.00l).Conclusions:The mean serum uric acid leveb and number of hyperuricemic subjects were found to be significantly higher in cases when compared to controls.

Therapeutic Approach for Hair Growth and Regeneration Using Bioactive Formulation Containing Mesenchymal Stromal Cell-Derived Conditioned Medium

Background and Aims: Androgenetic alopecia (AGA) is a common form of hair loss in both men and women. Despite its high prevalence and associated patient morbidity, the approved therapeutic options are limited to finasteride and minoxidil. The present study is aimed at assessing the efficacy of hair serum formulation, Trichosera®containing Bone marrow-derived mesenchymal stromal cells conditioned media as an active ingredient, for hair fall control and hair regrowth in healthy Indian human volunteers. Methods: The product was made using a 20% concentration of 10X Conditioned Media along with excipients. The final product was tested for physicochemical parameters, biomarkers, total protein content and microbial limits as per our in-house specifications. Results: The primary irritation patch test showed that the product is non-irritant and dermatologically safe. A clinical study on 40 subjects was conducted to evaluate the effectiveness of the bioactive formulation in hair fall control and hair regrowth in healthy volunteers. Phototrichogram measurement showed hair density and hair growth rate increased significantly by 11.54% and 18.66% at week 24. Hair tensile strength also increased significantly by 41.10% at 12 weeks follow-up. Hair pull test, to see a reduction in pulled hair and comb’s test to show a decrease in hair fall significantly improved from week 4 onwards. There were no significant adverse events in response to the product application. Conclusion: It is concluded that the hair serum product is completely safe on direct application to the scalp and showed significant improvement in the hair growth rate, hair density, scalp condition and reduction in hair fall. .

左心室室壁瘤的外科治疗

目的 探讨左心室室壁瘤 (left ventricular aneurysm,L VA)的外科治疗效果。 方法 33例 L VA患者行闭式折叠术 1例 ,L VA切除后行标准线性修补术 14例 ,心内膜荷包环缩法 10例 ,心内室壁瘤缝合法 8例。其中 2 0例在心脏不停跳下完成手术。所有患者均同期行冠状动脉旁路移植术 (CABG) ,每例移植血管 3.2± 1.1支。应用主动脉内球囊反搏 (IABP) 6例。 结果 32例手术成功 ,手术死亡 1例 ;术后发生并发症 9例 ,其中低心排血量 6例、室性心律失常 2例、脑并发症 1例。术后早期随访 1～ 3个月 ,超声心动图示患者心功能均获改善 ,心绞痛缓解或消失。结论 L VA的外科治疗中 ,应用左心室几何重建技术和心脏不停跳及同期行 CABG能获得较好的临床治疗效果 。

A review on assessment and treatment of the trunk in stroke A need or luxury

Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary contribution of the trunk muscles is to allow the body to remain upright, adjust weight shifts, and control movements against constant pull of gravity and is considered central key point of the body. Proximal stability of the trunk is a pre-requisite for distal limb mobility, balance, gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross- sectional study. Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors, extensors and rotator muscles in both acute and chronic hemiplegic patients. This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke. Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk, and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients. However, trunk exercises given early after stroke could produce enhanced balance performance post- stroke. This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.

A Review of Epilepsy Diagnosis Using PET Parameters

Epilepsy is caused by abnormal excessive electric discharges from the neurons in the brain. Epileptic seizures are non- specific responses of the brain to many types of insults. The structural abnormalities causing epilepsy can be identified using various state of art imaging methods. Through a combination of brain activity monitoring, imaging and mapping techniques, physicians can locate the specific area in the brain causing epileptic discharges and identify its location in relation to those areas in the brain controlling vital functions. Positron Emission Tomography (PET) has emerged as a useful tool to identify abnormal metabolic activity of the epileptogenic foci. Parameters like asymmetric index, stan- dard uptake value (SUV) etc obtained by PET are processed and analyzed for identifying the origin of epileptic sei- zures. This paper discuss the techniques used to diagnose in general and to localize the epileptogenic regions using post-processing other features on PET imaging.

Osteoporosis: Epidemiology, Pathogenesis, Evaluation and Treatment

Purpose: Osteoporosis is a global health disease. Increasing life span will add to the burden of osteoporosis, especially in postmenopausal women. The lifetime risk of osteoporotic fractures is 30% to 40%. Fractures pose an extensive burden on healthcare resources. Therefore, early diagnosis of osteoporosis is necessary. Methods: In this review, we provide a comprehensive approach to the current epidemiology, diagnosis aspects, treatments and fracture management in relation to the osteoporosis. Results: In assessing osteoporotic patients, good medical history with identification of clinical risk factors should be done. Along with basic blood investigations, bone mineral density, vertebral imaging, and bone turnover markers can aid the accurate diagnosis of bone loss. Modification of risk factors and dietary interventions are the first step in managing osteoporosis. Multiple options can be tailored to the individual needs in the treatment of osteoporosis. The frequency and duration for which the treatment is continued depend on the individual response to treatment. For fractures, surgical management is necessary whereas pharmacological interventions are needed to prevent further fractures. As osteoporosis often goes unrecognized until one or more fractures occur, it is important to understand the impact of osteoporosis. Conclusion: Osteoporosis remains a significant health problem globally that needs immediate attention to improve bone quality and prevent fractures associated with it optimally.

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical problems.Metabolic surgery has evolved as a promising therapeutic option for both conditions.It is recommended that patients,particularly those of Asian origin,maintain a lower body mass index threshold in the presence of uncontrolled DM.However,several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome.Laparoscopic Roux-en-Y gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used bariatric procedures worldwide.The bariatric benefits of RYGB and LSG are similar,but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission.Several scoring systems have been formulated that are utilized to predict the chances of remission.A glycemic target of glycated hemoglobin<7%is a reasonable goal before surgery.Cardiovascular,pulmonary,gastrointestinal,hepatic,renal,endocrine,nutritional,and psychological optimization of surgical candidates improves perioperative and long-term outcomes.Various guidelines for preoperative care of individuals with obesity have been formulated,but very few specifically focus on the concerns arising from the presence of concomitant DM.It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

Anthropometric studies on medical students of Nepal and Sri Lanka:height and weight

Nutritional status of a population or an individual could be assessed by clinical,biochemical and anthropometric means.It is widely used in the monitoring of growth and assessment of the nutritional status of children and adults.Even though a large number of anthropometric studies is done in Nepal and Sri Lanka,on various projects related to the nutritional aspects,but only few have been done on anthropometry and due to lack of information on anthropometric data of Nepalese and Sri Lankan medical students,the present study was initiated at Nepal Medical college and Faculty of Medicine,University of Peradeniya,Sri Lanka.The aim of the study was to measure height and weight of medical students of Nepal Medical College and Faculty of Medicine,University of Peradeniya.A total of 1228(males 681;females 547)medical students participated in the study.The ratio of male to female was 1.24:1.The height was measured,to the nearest 0.1 cm without shoes,using a measuring tape affixed to the wall.The weight was recorded using weighing scale,with minimum clothes and without shoes to the nearest 0.1kg.Two tail unpaired t’test was performed to compare mean values.The percentile values were obtained using Microsoft excel for Windows 98.The age of the students varied from 18-26 years with a mean±SD of 20.77±1.17 and 20.90±1.10 in males and females respectively.The heights of the male and female medical students werel.65±0.08 and 1.61±0.08 and the weight was 59.70±9.26 and 55.54±9.16 respectively.The percentile values obtained for height and weight were compared with National Centre for Health statistics(NCHS) standards.The 50th percentile value of males height and weight corresponded to the 20th percentile and below the 20th percentile values respectively of the NCHS standard.The 50th percentile value of female’s height and weight corresponded to less than 10th and 15th percentiles respectively.The height and weight of only 9 males and 8 females were above the 50th percentile value of NCHS standards.The study reveals that the Nepalese medical students and Sri Lankan medical students are underweight and shorter compared to western standards.

A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

Pregnancy-related acute myocardial infarction is rare, but a serious event. We report a case of acute myocardial infarction in a 33-year-old female with 5 months of pregnancy. Angiography, under abdominal shield, revealed 100% thrombotic occlusion in the left anterior descending artery, which was treated successfully with a stent implantation. The patient was found to have hyperhomocysteinemia within the first week of primary percutaneous coronary intervention (PCI). Rest of the follow-up was uneventful with delivery of a healthy baby by elective caesarean section at about 36 weeks of gestation. Within 7 days of post-partum period, the patient displayed signs of cerebrovascular infarction and was managed successfully. To the best of our knowledge, the association between primary PCI during pregnancy and cerebrovascular event in the postpartum period has not been reported previously.

A Single Arm, Monocentric, Prospective, Open Label Study to Evaluate Anti-Ageing Efficacy of Human Growth Factors and Cytokines Containing Cosmetic Skin Serum in Indian Female Population

Introduction: The use of growth factors and cytokines in skin rejuvenation and reversal of photo ageing is a novel anti-ageing treatment. These factors provide a microenvironment that seems to favor tissue repair and regeneration. Methods: An open label, monocentric, single arm study to evaluate anti-ageing efficacy of conditioned medium obtained from adult human bone-marrow derived allogenic mesenchymal stromal cells (BMMSC) along with excipients formulated into a cosmetic serum, was conducted in 40 Indian female population aged 35 to 60 years, belonging to skin type IV - VI of Norwood Scale for a duration of 90 days. Parameters—fine lines, wrinkles, crow’s feet, evenness of skin tone, skin firmness/laxity, hydration of skin, homogeneity of age spots, and visible pores were used to evaluate the anti-ageing and rejuvenating properties of the test product. Results and Discussion: Improvement was seen in majority of parameters starting from 15 - 30 days. Product was safe and well tolerated as per the dermatologist and subjects’ self-assessment.

Complete Coronary Revascularization with on Pump Beating Heart

Background Off-pump coronary artery bypass grafting (CABG) is becoming increasingly popular world - wide. But it is not always feasible. Current cardioplegic techniques do not consistently avoid myocardial ischemic damage. So we use on pump beating heart technique to supplement off-pump CABG. Methods Based on 860 off-pump CABG cases between Aug 1998 to Aug 2000. From Aug 1999 to Aug 2000, 46 CABG cases were performed with on pump beating heart technique at Mani-pal Hospital Heart Foundation, Bangalore, India. All surgeries were performed through a median sternotomy. Exposure techniques were tailored to individual vessels and cardiac regions and local immobilization was performed with octopus. Vascular control was achieved with occluders and shunts. Total cardiopulmonary bypass (CPB) was established before or during CABG and normolthemia was used. Results Among 46 on -pump beating heart CABG patients, 26 patients used CPB before or during OP - CABG because of unstable hemodynamics and electric instability , 7 had very deep intramyocardial left anterior descending arteries, 5 patients had poor LV function (LVEF < 30 % ), 8 patients had cardiomegaly. The average number of grafts was 3.5. No operative mortality. Three patients had postoperative myocardial infarction. Anesthetic time 4. 5±1. 2 hours, extubation time 10±2. 5 hours, blood lost 680±230 mL, blood requirement 540±150 mL, preoperative LVEF 50. 3±13 % , postoperative LVEF 64. 1±14 %, ICU stay 1. 5±0. 5 days, hospi- tal stay 9.2±1.8 days. Conclusion Complete coronary revascularization with on pump beating heart is a supplement for off - pump CABG when it is not feasible. It eliminates intraoperative globe myocardial ischemia and avoids transient myocardial injury during cardioplegic arrest and myocardial reperfusion.

Effectiveness of craniosacral therapy,Bowen therapy,static touch and standard exercise program on sleep quality in fibromyalgia syndrome:A randomized controlled trial

Background:Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS);however,high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.Objective:Craniosacral therapy (CST),Bowen therapy and exercises have been found to influence the autonomic nervous system,which plays a crucial role in sleep physiology.Given the paucity of evidence concerning these effects in individuals with FMS,our study tests the effectiveness of CST,Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.Design,setting,participants and intervention:A placebo-controlled randomized trial was conducted on132 FMS participants with poor sleep at a hospital in Bangalore.The participants were randomly allocated to one of the four study groups,including CST,Bowen therapy,standard exercise program,and a manual placebo control group that received static touch.CST,Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks;the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks.After 12 weeks,all study participants performed the standard exercises at home for another 12 weeks.Main outcome measures:Sleep quality,pressure pain threshold (PPT),quality of life and fibromyalgia impact,physical function,fatigue,pain catastrophizing,kinesiophobia,and positive–negative affect were recorded at baseline,and at weeks 12 and 24 of the intervention.Results:At the end of 12 weeks,the sleep quality improved significantly in the CST group (P=0.037) and Bowen therapy group (P=0.023),and the PPT improved significantly in the Bowen therapy group(P=0.002) and the standard exercise group (P<0.001),compared to the static touch group.These improvements were maintained at 24 weeks.No between-group differences were observed for other secondary outcomes.Conclusion:CST and Bowen therapy improved sleep quality,and Bowen therapy and standard exercises improved pain threshold in the short term.These improvements were retained within the groups in the long term by adding exercises.CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.

Transphyseal separation of the distal humerus in newborns

Obstetric traumatic separation of the distal humeral epiphysis is a very uncommon injury, which pre- sents a diagnostic challenge. These case serials reviewed the functional outcomes of 5 patients who had sustained a fracture-separation of the distal humeral epiphysis at birth. The diagnosis was made at a mean time of 40.8 h after delivery. All the patients were treated with gentle close manipulation, reduction under fluoroscopy and above-elbow cast application. After discharge, the patients were fol- lowed up for a mean of 30 months. Clinico-radiological results were excellent in four patients. One case necessitated closed reduction and percutaneous K-wire fixation at one week follow-up due to failed reduction. Cubitusvarus deformity was the only complication noted in I case. Good functional outcome can be expected in newborns with fracture-separation of the distal humeral epiphysis wherein the physis is anatomically reduced.

Effects of lifestyle modification on liver enzyme and Fibroscan in Indian patients with non-alcoholic fatty liver disease

Background and aims:Non-alcoholic fatty liver disease(NAFLD)is remarkably increasing in developing countries like India,in parallel with the increasing incidence of obesity.Lifestyle modification is a recommended treatment for NAFLD.In most of the previous studies,improvement after lifestyle modification was assessed by liver fibrosis through liver biopsy,but we cannot do a serial liver biopsy in every NAFLD patient.Liver fibrosis can also be assessed by fibroscan non-invasively in NAFLD.This study was designed to evaluate the effect of lifestyle modification on liver enzymes and Fibroscan values in a population with NAFLD.Methods:Initially,50 NAFLD patients were included in this prospective follow-up study;however,after 6 months of lifestyle modification,only 39 participants were studied.During both the first and second consultations,Fibroscan was carried out.All participants underwent a careful interview,anthropometry measurements and radiological and biochemical tests during every consultation.Results:After 6 months of lifestyle modification,Fibroscan values improved significantly(8.3160.11kPa vs 7.8760.12kPa,p¼0.009).Alanine aminotransferase(ALT)values also showed improvement during the second consultation(97.2562.62 U/L vs 66.6963.95 U/L,p<0.001).Conclusion:Measured by Fibroscan and liver enzymes,it has been found that lifestyle modification is an effective therapy to downgrade hepatic injury in NAFLD patients.Serial Fibroscan can be used to assess the treatment response in NAFLD patients due to its non-invasive nature.

My biggest mistake A lesson from a death

Neurocysticercosis is a major public health problem in many developing countries in Asia and has a profound impact on productivity, health, economy, and quality of life. It is endemic in Nepal and is the commonest parasitic infestation of the central nervous system, caused by larvae of the tapeworm Taenia solium. Neurological manifestations vary from a simple chronic headache to life threatening meningoencephalitis depending on the location and number of the parasites in the brain.