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Background: Acute heart failure (AHF) is a clinical syndrome defined as the new onset or acutely decompensated heart failure (ADHF) leading to signs and symptoms of heart failure (HF). The critical cut-off values for these biomarkers that suggest high mortality are not clearly defined in previous studies. More studies are required to better understand the correlation of Pro- BNP and its association with HF. The primary objective is to study the role of Pro-BNP and critical factors in predicting outcomes in AHF patients presenting to a medical emergency. Materials and Methods: The data from the patients presented with symptoms of HF in the Department of Medical Emergency at our hospital were recorded and analysed. AHF is a clinical syndrome defined as the new onset or ADHF leading to signs and symptoms of HF, as based on the European Society of Cardiology. Results: The present study highlights the various risk factors of AHF in patients and their association with mortality. In the present study, mortality in patients with very high Pro-BNP levels ≥2000 pg/ml was significantly higher than in patients with moderately elevated Pro-BNP. The patients who survived after 5 days of hospitalization had Pro-BNP levels ≤2000 pg/ml, suggesting that very high Pro-BNP levels ≥2000 pg/ml are associated with fatal outcomes. Conclusion: To conclude, diabetes and sepsis are critical factors for the hospitalization and mortality of patients with AHF in northern India. Very high Pro-BNP levels ≥2000 pg/ml in patients with AHF requiring hospitalization and associated with fatal outcomes.

ABSTRACT: This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups. Method: This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded. Results: This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal.

ABSTRACT Introduction: Obstructive Sleep Apnea (OSA), characterised by repetitive episodes of breathing cessation due to upper airway collapse is associated with significant morbidity and mortality. Type 2 Diabetes Mellitus (T2DM) and OSA are two common, chronic conditions that are associated with each other, in a bidirectional relationship and both share common risk factor obesity. Aim: To study the prevalence of OSA in obese patients with T2DM. Materials and Methods: Unattended polysomnography was performed in 50 obese (BMI >30 Kg/m2) and T2DM patients (symptoms of diabetes plus random blood glucose concentration ≥200 mg/dL and/or fasting plasma glucose ≥126 mg/dL, and/or Haemoglobin A1c (HbA1c) ≥6.5%, and/or 2-hour plasma glucose ≥200 mg/dL). Descriptive statistical methods were used such as computing percentage, mean, standard deviation and correlations. Results: Over 88% (N=44) of participants i.e., 64% male (N=32) and 24% female (N=12) with obesity and T2DM (Mean HbA1c 8.87±1.88) had OSA with an Apnea-Hypopnea Index (AHI) ≥5 events/h. The mean AHI was 33.57±24.88 events/h in males and 24.33±18.75 events/h in females. A total of 32% (N=16) of the participants had mild OSA (AHI 5-14), 26% (N=13) had moderate OSA (AHI 15-30), and 30% had severe OSA (AHI ≥30) (N=15). 28 out of 34 class I obese (BMI- 30-34.99 kg/m2) with T2DM, 12 out of 12 class II obese (BMI- 35-39.99 kg/m2) with T2DM and 4 out of 4 class III obese (BMI≥40 kg/m2) and T2DM patients had OSA (p-value=0.001). Conclusion: There was an exceedingly high prevalence of undiagnosed OSA in obese patients with T2DM.

Aims and objectives: Psychiatric co-morbidity in patients with diabetes mellitus (DM) is associated with higher level of functional impairment and poor self-care. This study was carried out with the aim to find out existing psychiatric morbidity in newly detected diabetic patients who were not yet started on anti-diabetic medication so that proper evaluation of mental health and comprehensive management of both the conditions can be planned. Methodology: Hundred newly detected and diagnosed type 2 DM patients attending endocrinology and psychiatry outpatient departments of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi were screened and selected for the study. Psychiatric evaluation was done on the basis of structured proforma containing socio-demographic details, physical and mental status examination, and relevant investigations pertaining to diagnosis of DM. Psychiatric diagnosis was made on the basis of the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria. Relevant rating scales (Hamilton Anxiety Rating Scale for anxiety disorder, Hamilton Depression Rating Scale for depression, Yale-Brown Obsessive Compulsive Scale [Y-BOCS] for obsessive compulsive disorder, and Brief Psychiatric Rating Scale [BPRS] for psychosis) were used for assessing severity of the conditions. Result: Majority of the patients were males (65%). Psychiatric morbidity was detected in 34% of patients – most common was major depressive disorder (21%) followed by anxiety disorder (eight per cent), dysthymic disorder (four per cent), and substance abuse (one per cent). In major depressive disorder group, moderate (ten per cent) to severe (four per cent) level of depression was detected and in anxiety disorder group, five per cent patients had moderate level of anxiety. Conclusion: Evaluation of psychiatric status at the very beginning when DM is detected ; may help in proper management of both the conditions resulting in better outcome, self-care, and maintenance therapy in follow-up.

Background: Morphological examination of the marrow requires a combination of a properly prepared bone marrow aspirate smear, a trephine biopsy section and an imprint of core biopsy. Some conditions often result in a dry tap and are best studied by marrow biopsy.The major drawbacks of biopsy sections are their thickness, precludingfine morphologic detail.The objective of this study was to compare the diagnostic accuracy, cellularity and cytomorphology from bone marrow biopsy core imprint smears with bone marrow aspiration smears.Materials and Methods: Imprint smears were prepared from 138 cases subjected to bone marrow examination. The bone marrow aspiration, imprint smears andbone marrow biopsy sections were examined and were categorized into five different groups on cytomorphological basis: Non-malignant alterations and normal marrow, Myeloid neoplasms, Plasma cell myeloma, myelo-infiltrative disease and absence of residual disease and further delineated into specific entities wherever necessary.Results: Out of 138 cases, non-malignant alterations and normal marrow was the largest subgroup (N=87, 63%), followed by myeloid neoplasms (N=26, 18.5%), Plasma cell myeloma (N=13, 9.4%), myelo-infiltrative disease (N=9, 6.5%) and absence of residual disease (N=3, 2.2%). The diagnostic accuracy of imprint smears was highest (92%) followed by biopsy sections (89.9%) and aspiration smears (87%). Kappa analysis showed strong agreement (>0.8) and p-value was statistically significant (Conclusion: Imprint smear technique is a simple, rapid, inexpensive and reliable procedure. The routine use of imprint smear in the bone marrow examination will serve as an invaluable adjunct to bone marrow aspiration and biopsy.Journal of Pathology of Nepal (2015) Vol. 5, 739-746

Introduction: Gall bladder cancer is the most common cancer of the biliary tree and one of the highly malignant tumors with poor prognosis. Although its incidence is low in west, it is common in our part of the world. There are very few studies regarding gall bladder cancer in Nepal. The incidence of gallstones in patients with gall bladder cancer is high. The aim of the study was to evaluate the clinicopathological aspect of the disease in patients with gallbladder cancer and to Asses the incidence of gallstones in patients with gall bladder cancer. Material and Methods: This was a retrospective study carried out in GI Surgery unit of National Academy of Medical Science, Bir Hospital, Kathmandu, Nepal. All patients diagnosed as gallbladder carcinomas during 12 years period from 2002 to 2014 were included in this study. Their clinical characteristics, laboratory data, tumor histopathology reports were obtained and analyzed using SPSS17. Results: Total of 47 patients who met inclusion criteria were included in the study. Male to Female ratio was 1:1.8. Age ranged from 32 to 72 years with mean age of 54. Most common presenting symptom was Pain abdomen (93.6%) followed by weight loss (51.1%) and Jaundice (46.8%). Most common finding on examination was Icterus (42.6%) followed by palpable gall bladder (34%) and Hepatomegaly (29.8%). Gall Stones were seen in 37 (72.3%) patients. Most common histopathology was Adenocarcinoma (93.6%). Conclusion: Most of the patient with gall bladder cancer remained asymptomatic until late. Pain abdomen was most common presenting symptom and icterus was most common findings. There was strong association between gall bladder cancer and gallstones. There should be high index of suspicion if patient with gallstones has constant pain in right hypochondrium and has jaundice.

Objectives: To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones. Patients and Methods: A total of 87 patients with ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group I patients (n-30) received 0.4 mg of tamsulosin daily, group II patients (n-29) received 10 mg of alfuzosin daily and group III patients (n-28) received no alpha blockers. All patients were given analgesia when needed. Follow up was done in weekly basis for 4 weeks. Results: The mean stone size (5.33±1.58, 5.79±1.84, 5.67±1.64) and age (29.1±6.3, 30.31±7.22, 29.4±7.63) were comparable in each groups. The stone expulsion rate was 83.3%, 79.3% and 50% in group I, II and III respectively. The drugs related side effects reported by patients were mild and transient. Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other

Age and tooth loss are expected to have a complex relationship with oral health-related quality of life. So the purpose of this study was to explain the impact of age and tooth loss on oral health-related quality of life using the short form 14-item oral health impact profile (OHIP-14) among two population samples of Gujarat and Rajasthan.A cross-sectional questionnaire-based survey was conducted among 1441 subjects collected from two major cities of Gujarat and Rajasthan. Both questionnaire approaches using OHIP-14 scale and clinical examination were conducted in accordance with WHO criteria using type III procedure on the same day. Chi square test, ANOVA and stepwise multiple regression analysis were applied using SPSS software version 15.0.With the increase of age, OHIP mean score in both states increased, but that among Rajasthan state was higher, depicting poor oral health. Whereas, in the remaining 23-27 number of teeth both states showed higher OHIP mean, however again the score was much higher among Rajasthan subjects showing worse oral hygiene. Hence, overall all mean OHIP score for Gujarat was lower indicating good oral health; whereas, that among Rajasthan was higher indicating poor oral health-related quality of life.Both age and tooth loss are associated with each other, but they have an independent effect on the oral health-related quality of life. Thus, all studied populations with complete natural dentition showed good oral health-related quality of life.

Purpose. Vitamin D deficiency impairs bone mineralisation and can predispose individuals to fractures. This study aimed at testing whether measurement of plasma calcium, alkaline phosphatase, and phosphate levels could detect vitamin D insufficiency. Methods. During a 10-week winter period from December 2000 to February 2001, all elderly patients presenting to a general hospital in Brighton—a British seaside town—with a fracture of the proximal femur and without known bone mineralisation problems were invited to participate in the study. Results. 23 (63.9%) of the 36 eligible patients had insufficient levels of vitamin D, with a plasma concentration of less than 30 nmol/L. The mean parathyroid hormone level was 56 pg/mL (range, 12–193 pg/mL). 11 of the 36 patients had an elevated level of parathyroid hormone and were insufficient in vitamin D. The mean plasma concentration of calcium was 2.30 mmol/L (range, 2.05–2.98 mmol/L). The mean phosphate level was 0.98 mmol/L (range, 0.40–1.79 mmol/L), and the mean alkaline phosphatase level was 91 IU/L (range, 46–127 IU/L). There was poor correlation between vitamin D insufficiency and plasma calcium, alkaline phosphatase, or phosphate levels. Conclusion. Plasma calcium, alkaline phosphatase, and phosphate testing cannot detect vitamin D insufficiency. We recommend that vitamin D and calcium supplementation be considered for patients with low-energy hip fractures.

Ifosfamide associated central nervous system toxicity has been reported in 5% to 30%of patients treated with ifosfamide. Death from irreversible encephalopathy has been reported rarely. A 52-year-old lady with carcinoma of cervix was treated with concurrent chemo-Radiatherapy, and residual disease was given with new adjuvant chemotherapy, containing regimens ifosfamide and cisplatin. Two days after the initiation of ifosfamide, the patient exhibited onset of lethal encephalopathy manifested by subacutely progressive encephlopathy then to a vegetative state and eventually to death. Brain CT-scan showed no metastatic tumor and vascular cause, blood routine examination for infection and metabolic factors was also negative; except Urea and Creatinine was increasing. Ifosfamide is known to be capable of causing acute encephalopathy that can be severe but is generally reversible. This lady showed a very atypical progressive, lethal course of ifosfamide toxicity. The possibility of this complication should be considered when kidney function is within normal limits. Key Words: ifosfamide, encephalopathy.

Abstract

ABSTRACT

The failure of cartilages to fuse, particularly in the case of articular cartilage under conditions of repair is due to morphological and structural constraints of the tissue. Factors that impede integration include, non-vascularisation, low cellularity, and proteoglycan in the surrounding extracellular matrix acting as a natural barrier to cellular migration. We hypothesised that brief activation of a catabolic cascade by cytokines followed by culture under anabolic conditions would promote tissue fusion in a ring-disk model of cartilage integration. Our results show that transient exposure to 10 ng mL-1 interleukin-1β, followed by two weeks post-culture under anabolic conditions, enhanced cartilage-cartilage integration compared to untreated explants. Quantitative PCR analysis of catabolism-related genes ADAMTS4 and MMP13 showed both were transiently upregulated and these findings correlated with evidence of extracellular matrix remodelling. At the level of histology, we observed chondrocytes readily populated the interfacial matrix between fused explants in interleukin-1β treated explants, whereas in control explants this region was relatively acellular in comparison. Catabolic cytokine treated explants exhibited 29-fold greater adhesive strength (0.859 MPa versus 0.028 MPa, P

Articular cartilage is a challenging tissue to reconstruct or replace principally because of its avascular nature; large chondral lesions in the tissue do not spontaneously heal. Where lesions do penetrate the bony subchondral plate, formation of hematomas and the migration of mesenchymal stem cells provide an inferior and transient fibrocartilagenous replacement for hyaline cartilage. To circumvent the poor intrinsic reparative response of articular cartilage several surgical techniques based on tissue transplantation have emerged. One characteristic shared by intrinsic reparative processes and the new surgical therapies is an apparent lack of lateral integration of repair or graft tissue with the host cartilage that can lead to poor prognosis. Many factors have been cited as impeding cartilage:cartilage integration including; chondrocyte cell death, chondrocyte dedifferentiation, the nature of the collagenous and proteoglycan networks that constitute the extracellular matrix, the type of biomaterial scaffold employed in repair and the origin of the cells used to repopulate the defect or lesion. This review addresses the principal intrinsic and extrinsic factors that impede integration and describe how manipulation of these factors using a host of strategies can positively influence cartilage integration.

Articular cartilage is a challenging tissue to reconstruct or replace principally because of its avascular nature; large chondral lesions in the tissue do not spontaneously heal. Where lesions do penetrate the bony subchondral plate, formation of hematomas and the migration of mesenchymal stem cells provide an inferior and transient fibrocartilagenous replacement for hyaline cartilage. To circumvent the poor intrinsic reparative response of articular cartilage several surgical techniques based on tissue transplantation have emerged. One characteristic shared by intrinsic reparative processes and the new surgical therapies is an apparent lack of lateral integration of repair or graft tissue with the host cartilage that can lead to poor prognosis. Many factors have been cited as impeding cartilage:cartilage integration including; chondrocyte cell death, chondrocyte dedifferentiation, the nature of the collagenous and proteoglycan networks that constitute the extracellular matrix, the type of biomaterial scaffold employed in repair and the origin of the cells used to repopulate the defect or lesion. This review addresses the principal intrinsic and extrinsic factors that impede integration and describe how manipulation of these factors using a host of strategies can positively influence cartilage integration.

Introduction: In India there are four distinct dengue viruses (DENVs) serotypes prevalent that can cause a full spectrum of disease from a subclinical infection to a mild self-limiting disease. The present study aimed to detect the dengue NS1 antigen by ELISA to screen the presence of dengue-specific IgM antibodies by IgM antibody capture ELISA (MAC-ELISA), and to detect dengue viral RNA in sero-positive samples and identify serotypes by one step multiplex real time reverse transcriptase-polymerase chain reaction (RT-PCR). Methodology: A hospital based observational, descriptive study was carried out on a total of 260 blood samples of clinically suspected patients with complaints of fever, myalgia, rash, and/or arthralgia. Detection of dengue NS 1 antigen and IgM antibody were done and then dengue viral RNA detection and serotype identification in seropositive samples was done to look for prevalent strain in the study area. All these methodologies were followed as per manufacturer's kit. Results: Out of 260 blood samples, a total of 82 (31.5%) samples tested positive for both sero-markers of dengue infection. Among these 82, 53 (64.6%) samples tested positive for NS1 antigen, 8 (9.8%) for IgM antibody alone, and 21 (25.6%) for both NS1 antigen and IgM antibody. PCR testing was done for these 82 seropositive patients and out of these, 75 (91.5%) tested positive on PCR testing. Of these 75 samples, 84% tested positive for dengue serotype-2 and only 16% tested positive for dengue serotype-1. Conclusion: In the study area, DENV-2 is more prevalent followed by DENV-1. None of the samples tested positive for serotype-3 and serotype-4. There was no coinfection in any sample. The information of predominant serotypes can guide in forecasting dengue outbreaks and improving control measures of vectors and thus may be helpful in the prevention of outbreaks.