Search

Background: The epidemiological spectrum of endocrine disorders in hospitalized patients is not much explored in developing countries. Therefore, the spectrum to visualize a complete picture of the endocrine-related disease is still missing. The study aims to find the spectrum of endocrine-related-disorders in a hospitalized patient, characterize demographic variables, and the duration of hospital stay of patients. Methods: This was a retrospective study of medical records of admitted cases between January 2014 to December 2018 in the Medicine Ward of BPKIHS. Records were retrieved from the Medical office and were entered into Excel and then transferred to SPSS and were analysed. Result: Out of 26,590 admitted cases,1141 (4.3%) had endocrine-related-disease. This includes 565 males and 576 females (1.02: 1 ratio) with an overall mean age of 52.81 ± 16.21 years and median (IQR) age 53 (42-64) years. Among which 904 (79.2%) had Diabetes mellitus, 118 (10.3%) had Metabolic Disorders, 38 (3.3%) had Disorders of Thyroid gland, 38 (3.3%) had Other Nutritional Deficiencies, 29 (2.5%) had Disorders of other endocrine glands, 7 (0.6%) had other disorders of glucose regulation and pancreatic internal secretion, 5 (0.4%) had Overweight, obesity and other hyperalimentation, 2 (0.2%) had Malnutrition. Conclusion: Diabetes and Metabolic disorders are the main components of the spectrum of endocrine disorders in admitted cases. Emphasizing the resources essential for further investigation will help both in dealing with and managing the cases of endocrine disorders.

Background Type 2 diabetes constitutes about 85-95% of all diabetes in developed countries, and accounts for an even higher percentage in developing countries. Diabetic retinopathy is probable the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss. Objective To study P100 latencies and inter ocular latency difference in diabetic group and compared it with a control group and study the correlation between P100 and inter ocular latency difference with the duration of disease in diabetic group. Method A comparative, cross sectional study was done from September 2016 to January 2018 in Neurophysiology Lab, Basic and Clinical Physiology, BP Koirala Institute of Health Sciences. The sample size was 64 and random sampling technique was used. Subjects were divided into three groups according to the duration of disease. Anthropometric and visual evoked potentials were recorded. Descriptive analysis, analysis of covariance and Post Hoc multiple comparison analyses were done using SPSS 11.5. Pearson’s correlation was applied between P100 latency and inter ocular latency difference with the duration of disease. Result On using analysis of covariance, P100 latencies were significantly prolonged in diabetic as compared to healthy controls (p < 0.001). Post Hoc multiple comparison showed significant differences in both left and right P100 latencies within diabetic groups and between diabetic groups and healthy controls. Left inter ocular latency difference showed positive correlation with the duration of disease. Conclusion P100 latencies are significantly prolonged in diabetes patients and is positively correlated with duration of disease. Visual evoked potential test can be useful for detecting retinal dysfunction before the appearance of symptoms of retinopathy.

In the recent world, more than 450 million people have diabetes. There are several types of diabetes and among them common are Type 1 DM in which the body cannot produce Insulin, Type 2 DM in which body cannot properly use insulin and Gestational Pregnancy related Diabetes. For diabetic patients, failure to treat or manage it can lead a serious complications like blindness, renal failure, heart attack and lower limb amputation. The burden of diabetes in patients are more acute in low middle income countries where nearly 80 % people lived with diabetes.

Background: Diabetic Retinopathy (DR) is a common, potentially blinding and visually disabling complication of diabetes. Early detection of retinopathy and its progression to severity with routine referral for screening by Ophthalmologist can save vision by timely management. Methods: This was a hospital based cross-sectional study done to study the association of glycated hemoglobin (HbA1c), fasting and postprandial blood sugar, serum lipid profile, serum creatinine and urine albumin in diabetic patient with and without DR. A total of 50 patients with Diabetic retinopathy and 50 patients without diabetic retinopathy were enrolled in this study. All patients included were Type 2 DM aged 35 years and above. Results: The mean HbA1c was 8.62±1.5 and 5.54±1.2, total cholesterol was 228.9±63 and 184.9±39.8 mg/dl, serum triglyceride was 226.6±80.7 and 160.8±45.1 mg/dl, LDL-C was 152.3±49 and 127.2±37 mg/dl and serum creatinine was 1.15±0.45 and 0.66±0.27 mg/dl in diabetic retinopathy group and no diabetic retinopathy group respectively. There was significant association of elevated HbA1c, serum triglyceride, LDL- C and total cholesterol with diabetic retinopathy in patients with type 2 DM. The mean values of serum lipoproteins were higher in the diabetic retinopathy group. Conclusion: Elevated fasting and postprandial blood sugar, glycated hemoglobin, total cholesterol, serum triglyceride, LDL-C, serum creatinine and urine albumin were significantly associated with DR in our study. So, all patients with diabetes mellitus should be screened routinely for serum lipoproteins along with blood sugar profile, as it would help in early detection of diabetic retinopathy.

Background: Diabetics are more prone to periodontal diseases leading to poor oral function affecting their quality of life. The objective of the study was to assess the impact of periodontal health on the quality of life among diabetics using the short version of the Oral Health Impact Profile (OHIP -14). Methods: It was a descriptive cross-sectional study. Data was collected using translated and validated Nepalese version of OHIP-14 questionnaire and clinical examination for periodontal status (Community Periodontal Index and Loss of Attachment index) was done using mouth mirror and World Health Organization probe under natural light. Data was entered and analyzed using SPSS version 11.5. Mann- Whitney U test and Kruskal-Wallis tests were used to compare OHIP-14 scores between genders and periodontal status respectively. Statistical significance was established at p

Eosinophilic Esophagitis (EoE) is a chronic condition characterized by eosinophilic inflammation of the esophagus which leads to esophageal dysfunction with common symptoms including vomiting, feeding difficulty, dysphagia, abdominal pain. Current main treatment options of EoE include dietary elimination and swallowed steroids. Diet elimination approach could lead to identifying the trigger food(s), but it often requires repeated upper endoscopy with general anesthesia and potentially could negatively affect nutrition intake and growth of the child and individuals' quality of life. Although the swallowed steroid treatment of effective, the EoE will universally recur after discontinuation of the treatment. Digestive Tea formula (DTF) has been used by the Traditional Chinese Medicine (TCM) practice to improve GI symptoms in EoE patients, including abdominal pain, GE reflux, and abnormal bowel movement. Previously, a flavonoid small molecule compound 7, 4 dihydroxy flavone (DHF) fromThis study comprehensively evaluates the potential therapeutic and immunological mechanisms underlying DHF improvement of symptoms related to EoE using computational modeling, including target mining, gene ontology enrichment, pathway analyses, protein-protein interaction analyses, in silico molecular docking and dynamic simulation followed by ex-vivo target validation by qRT-PCR using cultured human esophagus biopsy specimen with or without DHF from patients with EoE.Computational analyses defined 29 common targets of DHF on EoE, among which TNF-α, IL-6, IL1β, MAPK1, MAPK3 and AKT1 were most important. Docking analysis and dynamic simulation revealed that DHF directly binds TNF-α with a free binding energy of -7.7 kcal/mol with greater stability and flexibility. Subsequently, in the human esophagus biopsy culture system, significant reduction in levels of TNF-α, IL-6, IL-8 and IL1-β was found in the supernatant of biopsy sample cultured with DHF. Furthermore, the gene expression profile showed significant reduction in levels of TNF-α, IL1-β, IL-6, CCND and MAPK1 in the esophagus biopsy sample cultured with DHF.Taken together, the current study provides us an insight into the molecular mechanisms underlying multi-targeted benefits of DHF in the treatment of EoE and paves the way for facilitating more effective EoE therapies.

No abstract available.

Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide. Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days. Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.

Diabetes mellitus is a metabolic abnormality leading to an increase in the plasma concentration of glucose and is a major cause of stroke and peripheral circulatory disorders. Momordica charantia (MC), commonly known as bitter gourd/Karela, and Trigonella foenum-graecum (TFG) (fenugreek/Methi) have several medicinal values like anti-diabetic, lipid-lowering property, anti-oxidant activity, anti-inflammatory, and anti-mutagenic activity. This is an open-label, four-parallel-group, prospective interventional clinical trial with a total number of 48 patients enrolled in the study and divided into four equal groups (12 in each group) viz; Group I (allopathic drug), Group II (allopathic drug and Karela (MC), Group III (allopathic drug and Methi (TFG) and Group IV (allopathic drug, methi, and karela). Blood sugar and lipid profile were measured at day 0 and day 90. One way ANOVA test was applied to find the significant difference between the groups and Tukey HSD post hoc test was applied for multiple comparisons among the four groups with probability p-value 0.05%. Multiple comparisons by post-hoc analysis between groups on day 90 showed a significant reduction of fasting blood sugar by 19.0% (p = 0.021), postprandial blood sugar by 35.0% (p= 0.001), total serum cholesterol by 14.0% (p= 0.000), serum triglyceride by 21.0% (p=0.000), and serum LDL cholesterol by 17.0% (p= 0.000)ingroup receiving Karela and fenugreek seeds supplementation. Whereas serum HDL cholesterol on the 90th day was higher in the group by 10.0% (p=0.015) receiving only fenugreek seeds as a supplementation. Fenugreek and karela, when given as a supplement, have a beneficial effect on blood sugar and lipid profile.

This study focuses on the effectiveness of vehicle-free zone in terms of air quality. Particulate matter (PM10, PM2.5) and carbon monoxide (CO) were measured at V1, a core area of vehicle-free zone for three seasons (post-monsoon, winter, and pre-monsoon), seven days each for 12-h time period. PM and CO concentrations were higher in the morning hours, considerably lower during the afternoon and increased during the evening. PM2.5, PM10, and CO were found to be 28.49 ± 15.10 µg/m3, 83.78 ± 46.24 µg/m3, 4.53 ± 3.08 mg/m3 in post-monsoon; 62.49 ± 34.37 µg/m3, 89.28 ± 34.91 µg/m3, and 7.9 ± 4.76 mg/m3 in winter; 27.41 ± 11.16 µg/m3, 42.12 ± 15.35 µg/m3, and 5.27 ± 0.56 mg/m3 in pre-monsoon, respectively. PM was found to be lower in the vehicle-free zone than the reference stations (R1 and R2) as well as before the vehicle-free intervention. However, there were occasional mornings and evenings with higher emissions as compared to the National Ambient Air Quality Standards (NAAQS) and the World Health Organization (WHO) air quality standards guidelines. This means that background pollution and atmospheric conditions might have a greater impact on the degradation of the ambient air quality to which the population is exposed chronically. Despite these results, the decrease in particulate matter concentration also suggests that these regulations could be one of the effective measures to control air pollution.

Background: Chronic Kidney Disease is one of the major complications of Diabetic patients. Cardiovascular mortality increases in patient with diabetes and more so with diabetic CKD. Clinician treating diabetic CKD finds option limited as metformin is considered contraindicated when serum creatinine is greater than 1.5 mg/dl in males and greater than 1.4 mg/dl in females. The primary aim of the study is to evaluate the efficacy of metformin in terms of glycemic control in patient with diabetic stage 3 and 4 CKD. Methods: This is Randomised open labelled clinical trial done in the Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Primary end point were glycemic status at 6 months as defined by with fasting, post prandial blood sugar, glycosylated hemoglobin in comparison to baseline. Results: Altogether 73 diabetic patients with diabetic CKD stage 3 and 4 were included in the study. 41 patients were included in insulin group and 32 patients in metformin group. In metformin group, the fasting and past prandial blood sugar declined progressively compared to insulin group, where fasting and post prandial blood sugar declined more rapidly. Conclusions: Metformin is found to be efficacious in diabetic CKD as it had already proved to be effective in diabetes without CKD. In this study metformin was not associated with lactic acidosis and the level of lactate with metformin treatment was similar to that of treatment with insulin. The vast majority of case reports relating metformin to lactic acidosis report at least one other disease/illness that could result in lactic acidosis. Despite increasing disregard of contraindications to metformin by physicians, the incidence of lactic acidosis has not increased, as does the result of this study. So metformin may be safe even in patients with diabetic CKD stage 3 and 4.

Introduction: Around 90% of patients with OHS have coexistent obstructive sleep apnea (OSA) defined by an apnea–hypopnea index (AHI) >5 events/h, with nearly 70% having severe OSA (AHI > 30 events/h). Prevalence of OHS is between 8% and 20% in obese patients referred to sleep centers for evaluation of SDB. As prevalence of OHS in OSA patients data from Nepal is not available we planned to carry out the study and to address gaps in diagnosis and management. Methodology: This is a cross sectional observational study done in OM hospital and research centre from 2018 January to 2019 June. Awake daytime Arterial blood gas ( ABG) was obtained and patients having PaCO2 more than 45 mmHg were diagnosed as obesity hypoventilation syndrome in a recently diagnosed patients with OSA. Results: 32 patients diagnosed to have OSA and whose BMI is more than 30 were included in the study. Among 32 patients 26 (81.25%) were male and 6 (18.75) were female. Among all patients who underwent level A polysomnography 3 (12.5%) had mild OSA,4(16.66%) had moderate and 17 (53.12%) had severe OSA. 8 (25%) patients had normal diagnostic polysomnography. Among these patients 3(12.5%) who had mild OSA has BMI between 30-35,16 (66.66%) patients who had BMI between 30-35, 2 had mild 3 had moderate and 11 had severe OSA. Patients with BMI more than 40,5 (28.3%) had OSA among which 21 had moderate and 4 had severe OSA. Conclusions: As OHS is often misdiagnosed even in patients with severe obesity, we strongly recommended screening in obese patients with OSA for OHS as early recognition and effective treatment are important in improving morbidity and mortality in this group of patients.

Background Momordica charantia is evoloving as supplementary therapy in type 2 diabetes mellitus. Animal studies reveal its anti-diabetic and lipid lowering property. However, clinical studies with human subjects are very few. Objective To find out the effects of Momordica charantia supplements on glycemic and lipid profile among type 2 diabetes mellitus patients taking allopathic drugs. Method A comparative study was conducted in internal medicine department of B P Koirala Institute of Health Sciences, Dharan from July 2015 to May 2016 after ethical clearance. Twenty two uncomplicated type-2 diabetes mellitus patients were enrolled. Group A patients were supplemented with allopathic drug (oral anti-diabetic agents) only and Group B with add on treatment of 200 ml juice of Momordica charantia along with allopathic drug daily for ninety days. Fasting, post prandial blood sugar and lipid profile levels were compared between baseline and ninety days post supplementation. Data was collected and entry was done in Statistical Packages for Social Services version 20.0, using independent t test with p0.05. Result Add on treatment with 200 ml of Momordica charantia along with anti-diabetic drug daily significantly reduced fasting (p=0.0001) and post prandial blood sugar (p0.0001). Treatment with anti-diabetic drugs only reduced fasting (p = 0.0008) and post-prandial blood sugar but the reduction was not significant ((p =0.0001). There was improvement in lipid profile by both anti-diabetic drugs alone and Momordica charantia along with anti-diabetic drug, but it was not significant. Conclusion Add on treatment with 200 ml/day juice of Momordica charantia is effective in glycaemic control in type-2 diabetes mellitus patients as compared to the allopathic treatment alone.

No abstract available.

The aim of this paper is to empirically examine a comprehensive list of factors that are anticipated to affect information sharing (IS) in supply chains (SC) in the context of a landlocked developi...

No abstract available.

Background: The term chronic headache is commonly taken as headache lasting for more than three months. It is common in general practice with minimal research on the topic in Nepal. Objective: To sort out the common diagnoses of chronic headache and to study the clinical features and demographic profile of patients presenting with chronic headache. Method: A descriptive cross sectional study was conducted (2012 August to 2013 August) at General Practice outpatients in BP Koirala Institute of Health Sciences, a medical university in eastern Nepal. Approval and ethical clearance was taken from Research Committee and Institutional Ethical Review Board. Descriptive statistical analysis was done. Result: 168 patients constituting 1% of outpatient visits presented due to chronic headache. Mean age was 29.57 years (SD 10.53) and female to male ratio was 3.67. Mean number of days of headache was 19.46 days (SD 4.62). Numerical pain score was reported at 7.1/10 (SD 1.85). The mean duration of presentation was 22 months (SD 11). 40% reported impaired activity of more than one week. Headache was classified as chronic migraine in 20.2%, chronic tension type headache in 16.7%, and chronic daily persistent headache in 11.9%. The diagnosis did not fit into any diagnostic criteria in 51.2% cases. Conclusion: Chronic headache is common in females and young age group. Patients present late despite significant pain scores. Significant proportion is still unclassified. Health Renaissance 2015;13(2): 22-29

Background: Diabetes mellitus (DM) is one of the risk factors for Primary open angle glaucoma (POAG). Inclusion of DM as a risk factor for POAG is controversial. The objectives of the study were to investigate whether Type II (T2) DM is a risk factor for POAG and to determine central corneal thickness (CCT) in the subjects with T2DM and to examine the relationship between T2DM and intraocular pressure (IOP). Materials and methods: A comparative cross sectional study was conducted including 189 subjects of age > 40 years. In Group I, 113 patients diagnosed with T2DM and Group II, age and sex matched 76 subjects with POAG without DM was included. Detailed ocular examination, IOP, CCT and funduscopy evaluation was done. Results: Most of the patients were more than 60 years of age with mean age 58 ± 11 years. Male: female ratio was 1:1. POAG was seen in 27.4% of patients with T2DM. Mean IOP in T2DM was 14.67± 2.63mmHg and in non diabetic, 17.25±4.47 mmHg (p

Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multiorgan failure. Depending on the global region, 20–50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes.

No Abstract available.Jour of Diab and Endo Assoc of Nepal 2017; 1(1): 1-2

Diabetes mellitus is reported to be common in cases with acromegaly. However, diabetic ketoacidosis (DKA) is rarely reported in this disease. Here is a 17 year old female case with acromegaly who presented to our hospital with the first presentation was DKA. DOI: http://dx.doi.org/10.3126/stcj.v1i1.8662 Sunsari Technical College Journal Vol.1(1) 2012 57-60

Background: The view point of the students, the main stakeholder, regarding ragging bears a great significance on this tradition. Objective: To explore how medical students of a health science institute in eastern Nepal view ragging. Methodology: This is a semi-qualitative attitudinal study conducted in 2009/10 among medical students. An intensive questionnaire was prepared to assess different aspects of ragging. The questionnaire mainly focused on their view about ragging: positive and negative sides, their favour and some local issues, e.g. personal experience, common modes of ragging in the institute and their suggestions for the change. Some questions were open ended. Every 5th students of the frame of all medical students of B. P. Koirala Institute of health sciences (BPKIHS) were approached personally or through mail for response to the questionnaire. Hence, 200 were approached and we could collect 60 responses for analysis. Results: Among 60 participating medical students of different academic programs, 28.3% were female and 66.8% were male. Average student age was 23 years. Thirty two percents of the respondents were in favour of some sort of ragging though a great majority expressed that there was a need of some modification in its current pattern in the institute. Many felt that it might facilitate socialization and some better form of interactive program was a need. Sixty eight percent respondents found ragging to be stressful. Conclusion: Ragging exists in BPKIHS though a majority of medical students were against it. They opined for the modification in the current tradition of ragging. DOI: http://dx.doi.org/10.3126/stcj.v1i1.8658 Sunsari Technical College Journal Vol.1(1) 2012 27-32

Background: Despite increasing number of medical schools, there is a limited data about medical students from Nepal. Information about their characteristics and profile will help devise necessary policies and strategies. Objective: To study social, demographic, economic, geographic, educational and psychological attributes of MBBS students. Methodology: From the list of MBBS students of all years/semesters of BPKIHS (2009), every 5th students were enrolled to include 20% of all. After informed written consent, relevant information was collected from the subject by direct interview and recorded in a priory-prepared semi-structured proforma. The investigator MD-psychiatrist clinically assessed their personality traits. Results: A total of 104 MBBS students were enrolled. Majority were male (76, 69%) and single (102, 98%). Average age was 23 years. Most (79, 76%) came from nuclear family, with family’s better education and employment status. Only fewer (18, 17%) were from rural set-ups. Average distance from the institute was 17 hours of road travel. Though many had local supports of relatives and friends, some expressed lack of support. A variety of creative and extracurricular activities were reported. Besides major clinical subjects, other specialties are also the choice for many future Nepali doctors. Among the personality clusters, many had anxious and anancastic (OC) traits. Conclusion: Majority of MBBS students are male, from urban areas, nuclear family with good economic and educational background. They have a range of recreational extracurricular activities and specialties for future career. Many reported anxious and anancastic traits. DOI: http://dx.doi.org/10.3126/hren.v10i3.7134 Health Renaissance; September-December 2012; Vol 10 (No.3);192-197

New onset diabetes mellitus after transplantation (NODAT) is a well known complication following solid organ transplantation and has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, hepatitis C virus (HCV) infection between 40% and 60% and 2% to 53% of all solid organ transplants. This variation in the reported incidence may be because of lack of a universal agreement on the definition of NODAT, the duration of follow-up, and the presence of modifiable and non-modifiable risks factors. Moreover, reduced patient survival and accelerated graft loss have been reported with NODAT. In our country also there is increasing in number of kidney transplants patients and along with that there is chance of development of NODA. It is better to detect the NODATS early. So in this article I tried to presents an overview of the literature on the current diagnostic criteria for NODAT and discuss suggested risk factors for the development of NODAT, its potential pathogenic mechanisms, and its impact on post-transplant outcomes after solid organ transplantation.Kathmandu University Medical Journal Vol.12(4) 2014; 301-305

One hundred and five (72 males; 33 females) consecutive patients who met the inclusion criteria were studied. The mean age of the patients was 49.06 +/- 11.27 years (range 23-73 years). Ninety patients were adult cirrhotics (ageor = 35 yrs) and the remaining 15 patients were young (ageor = 35 yrs). Ninety out of 105 patients were having alcohol related cirrhosis. The commonest presenting symptoms were abdomen distension (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and jaundice (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics). The most common presenting signs were ascites (100% in young cirrhotics vs. 84.4% in adult cirrhotics) and icterus (93.3% in young cirrhotics vs. 84.4% in adult cirrhotics), followed by loss of body hair (73.3% vs. 71.1% in young and adult cirrhotics respectively) and spider naevi (46.7% vs. 61.1% in young and adult cirrhotics respectively). Sixty percent of young cirrhotics and 52% of adult cirrhotics were in Child's grade C at the time of presentation. Most of the deaths were seen in Child's grade C of liver disease. Alcoholic cirrhosis is common in the eastern part of Nepal. Cirrhosis is not uncommon in younger age group. Abdomen distension and jaundice were most common clinical presentations. Most patients were in Child's grade C and most deaths were due to hepatic failure.

Mushroom poisoning is not new to Nepal. Undocumented and unrecorded mushroom poisoning is more common than the published one. We evaluated the pattern and outcomes following toxic mushroom ingestions.We did a retrospective analysis of patients admitted with mushroom poisoning in BPKIHS, a tertiary care hospital in Nepal, from 2002 to 2006. The diagnosis of mushroom poisoning was based on history and clinical presentation.Twenty seven patients, aged between 7-83 years were studied. Fourteen (51.86%) were male and 13 (48.14%) were female. All (100%) patients had consumed wild mushroom unintentionally. Twelve patients developed symptoms within first hour and 11 patients within one to six hours. The average delay in presenting to our hospital was 23.1 (2-96) hours. In 10 cases, other family members were affected, out of which in two cases the family members had died in other hospitals. Reported symptoms were nausea 27 (100%), vomiting 24 (88.88%), abdominal cramping 8 (29.6%), jaundice 3 (11.1%), diarrhea 17 (62.96%) and altered sensorium in 8 patients (29.65%). All patients were treated conservatively. Three patients with severe hepatitis were admitted in ICU, out of which two recovered without liver transplant. One eight year old boy developed acute liver failure and expired within 24 hours of hospitalization.Most of the mushroom poisoning was acute, unintentional and by consumption of wild mushroom. Community based awareness programs will help prevent the instances of poisoning.

We propose here a one-scan sanitization algorithm to hide informative association rules. For a given predicting item, an informative association rule set by Jiuyong Li et. al, (2001) is the smallest association rule set that makes the same prediction as the entire association rule set by confidence priority. To hide association rules, previously proposed algorithms based on a priori approach require multiple scanning of database to calculate the supports of the large itemsets. In this work, we propose using a pattern-inversion tree to store related information so that only one scan of database is required. Numerical experiments show that the performance is more efficient than previous algorithms with similar side effects

Idiopathic thrombocytopenia (ITP) is an autoimmune disorder characterized by a reduced platelet count with otherwise normal blood cell counts. Autoimmune thyroid disease is not considered a cause of thrombocytopenia. We report a case of autoimmune thrombocytopenic purpura associated with hyperthyroidism in which the patient's thrombocytopenia and thyrotoxicosis resolved concomitantly. We recommend testing for hyperthyroidism in all patients with unexplained thrombocytopenia and that family members of patients be evaluated, screened, and observed for thrombocytopenia and hyperthyroidism. Health Renaissance; September-December 2012; Vol 10 (No.3);254-255DOI: http://dx.doi.org/10.3126/hren.v10i3.7058

Maintaining profitability under conditions of limited water availability is a key issue facing dairy farmers in the Shepparton Irrigation Region. These farmers predominantly use border-check irrigation. Pressurised irrigation methods are seen as one option for increasing productivity from the limited water resources. This study reports on landowners’ perceptions towards the adoption of centre pivot and lateral move irrigators, based on survey and factor analysis. The survey was of 20 landowners using face-to-face interviews. Factor analysis was used to identify broad categories of benefits and barriers that best summarised farmers’ responses to survey questions. Improved farm management, productivity benefits, lifestyle benefits and improved marketability of farms were identified as the key benefits of adopting centre pivot and lateral move irrigators perceived by farmers. Capital cost, operation and maintenance costs, layout of the farm and unreliability of systems were seen as the key barriers. An understanding of these perceived benefits and barriers is the first step towards the development of extension information relating to the adoption of centre pivot and lateral move irrigation systems.

Metronidazole is a little known cause of drug-induced neuropathy.We report a patient who developed paraesthesia of both limbs after one month course of metronidazole. The electrophysiologic test confirmed a bilateral motor-axonal neuropathy. This neuropathy improved dramatically with cessation of the drug. Keywords: metronidazole; peripheral neuropathy; hepatic amebiasis DOI: http://dx.doi.org/10.3126/hren.v9i2.4986 Health Renaissance 2011: Vol.9 (No.2): 119-121

It is expected that between 2000 and 2030 there will be 37% increase in the worldwide prevalence of diabetes.Besides aging of the population, family history of diabetes, genetic predisposition, lack of physical activity and high-energy intake leading to overweight and obesity have been shown to be largely responsible for this epidemic. Among five lifestyle behaviors moderate consumption of alcohol could be attributed to the lack of adherence in 91% of new type 2 diabetics. So I agree with the conclusion made by the author that alcohol has played a significant role in nonadherence. But since there are other factors responsible for non-adherence, I think it should also be mentioned in this study.