https://www.nepjol.info/index.php/AJMS/issue/feed Asian Journal of Medical Sciences 2019-03-01T10:26:43+00:00 Dr Arun Kumar ajmscience@gmail.com Open Journal Systems <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.</p> https://www.nepjol.info/index.php/AJMS/article/view/21977 Immunoglobulin free light chains and interleukin-6 levels in prediction of kidney injury in patients with multiple myeloma 2019-03-01T10:26:22+00:00 Izeta Aganovic-Musinovic zizanax@gmail.com Nesina Avdagic avdagicn@yahoo.com Nermina Babic nermina.babic@mf.unsa.ba Asja Zaciragic zarias@lol.ba Orhan Lepara orhan.lepara@gmail.com Jasminko Huskic huskicj@icloud.com Maida Todic-Rakanovic maida.todic@mf.unsa.ba <p><strong>Background:</strong> Multiple myeloma (MM) is a disease of B cell population with excessive secretion of immunoglobulins and presence of free light chains (FLCs) that are by products of immunoglobulin synthesis. Free light chains play crucial role in causing renal damage. Interleukine-6 (IL-6) supports the survival and/or expansion of MM cells by stimulating cells as well as by preventing programmed cell death.</p> <p><strong>Aims and Objectives:</strong> The aim of this study was to evaluate serum and urine free light chains (FLC)measurement and compare with IL-6 levels in patients with different stages of Multiple Myeloma (MM) and control group of subjects and to determine their relevance in acute kidney injury occurrence.</p> <p><strong>Materials and Methods:</strong> Recruitment of patients with MM (n=62) made the hematologist that followed clinical Solomon-Durie MM classification. Control group consisted of 20 healthy individuals. Results: Patients with MM and renal function injury had significantly higher concentration of urine κ chains compared to control group and group of MM without renal function injury (p&lt;0.005), whereas this difference was not observed when the patients were divided into disease stages groups. Concentration of IL-6 was significantly higher in patients at MM steady stage compared to control group (p&lt;0.001) and significant difference was also detected in patients with MM at relapse stage and control group (p&lt;0.0005). Concentration of IL-6 in MM patients without renal function and with renal function injury was significantly higher compared to control group (p&lt; 0.001; p&lt;0.0005 respectively). Statistically significant correlation was determined between sera κ and urine κ chains (rho=0.437; p&lt;0.01) as well as between urine λ and sera λ chains (rho=0.505; p&lt;0.01) and between urine κ and urine λ chains (rho=0.364; p&lt;0.01).</p> <p><strong>Conclusion:</strong> Results showed that urine κ chains, sera κ chains and IL-6 are constructing a fine tuned net and point to conclusion that FLC and IL-6 are important for an early treatment response detection for patients with potentially reversible renal failure.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/21774 A Comparative Evaluation of Ischemic Mitral Regurgitation in AMI Patients Managed by Revascularization Vs Optimal Medical Therapy 2019-03-01T10:26:24+00:00 Jayanta Saha drjsaha2010@gmail.com Sudhakar Singh sudhakar.harsh@gmail.com Arnab Roy royarnabdumdum@gmail.com Manoj Bhargawa drmanojbhargawa.mp@gmail.com <p><strong>Objectives:</strong> Ischemic mitral regurgitation (IMR) is one of the frequent complications associated with coronary artery disease (CAD); but the optimal management of IMR is controversial. Our aim was to evaluate and compare the impact of medical therapy versus revascularization on the degree of MR.</p><p><strong>Methods:</strong> We performed observational follow up study on 114 patients admitted to our hospital with AMI and mild to moderate degree of MR. Multiple parameters were used to assess the severity of MR at baseline and after 1 year of follow up to assess the change in MR severity after medial therapy and revascularization.</p><p><strong>Results: </strong>In the medically managed group, MR grade improved in 28.57% of patients while 53.57% patients remained in the same grade as before. The grade of MR deteriorated from moderate to severe in 17.86% patients during follow up. In revascularization group; improvement in MR grade was observed in 60.71% of patients while 32.14% patients remained in the previous grade. Deterioration from moderate to severe occurred in 7.14% of patients. PCI and CABG subgroup analysis showed almost similar impact on degree of MR during follow up.</p><p><strong>Conclusion:</strong> From our study we concluded that<strong> </strong>revascularization; either in form of PCI or CABG, is associated with improvement in degree of MR when compared to optimal medical therapy alone.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/21098 Burden of multidrug resistant respiratory pathogens in intensive care units of tertiary care hospital 2019-03-01T10:26:26+00:00 Dharm Raj Bhatta ddharma2039@gmail.com Deependra Hamal hmldipendra@yahoo.com Rajani Shrestha rajani_sth7@hotmail.com Supram HS supram.gowda@gmail.com Pushpanjali Joshi joshipushpanjali1990@gmail.com Niranjan Nayak niruni2000@yahoo.com Shishir Gokhale shishirmanju@gmail.com <p><strong>Background:</strong> Lower respiratory tract infections are one of the most common infections among the patients in Intensive Care Units (ICUs). Admission in ICUs and use of life supporting devices increase the risk of infection with multidrug resistant pathogens.</p> <p><strong>Aims and Objectives: </strong>This study was aimed to determine the prevalence and antibiograms ofthe bacterial pathogens causing lower respiratory tract infectionsamong patients of ICUs.</p> <p><strong>Materials and Methods:</strong> A total of 184 specimens from patients admitted in ICUswith lower respiratory tract infections were included in this study. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques. Carbapenamase detection was performed by modified Hodge test method.Detection of metallo beta lactamase (MBL) was tested by imipenem and imipenem/EDTA disc. Detection of <em>Klebsiellapneumoniae</em>carbapenamase (KPC) was performed by imipenem and imipenem/phenyl boronic acid.</p> <p><strong>Results:</strong> Out of 184 samples, 131 showed significant growth of bacterial pathogens. <em>Acinetobacter</em> species (42.6%), <em>Staphylococcus aureus</em> (16.9%) and <em>Pseudomonasaeruginosa</em>(13.9%)were the three most common isolates. Out of 22 imipenem resistant isolates of <em>Acientobacter</em> species, 9 were KPC producer, 4 were MBL producers and 3 isolates were positive for MBL and KPC both. Among the <em>Acinetobacter</em> species, 5.1% isolates were resistant to tigecycline and colistin. One isolate of <em>Pseudomonas aeruginosa</em> was positive for MBL.</p> <p><strong>Conclusions:</strong>High prevalence of multidrug resistant bacteria in ICUs was recorded. Gram negative bacilli were predominantly associated with LRTI among ICU patients;<em>Acinetobacter</em>species being most common isolate. Detection of carbapenamase among the <em>Acinetobacter</em>and emergence of tigecycline resistancelimits the therapeutic options.Regular monitoring of such resistant isolates would be important for managing infection control in critical units.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/21799 Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosis 2019-03-01T10:26:27+00:00 Asim Awan drasim@baariz.com Aftab Saeed drasim@baariz.com Khan Usmanghani drasim@baariz.com Muhammad Rafiq drasim@baariz.com <p><strong>Background:</strong> Cirrhosis is the late, symptomatic stage of chronic liver disease which occurs when scar tissue (fibrosis) largely replaces healthy liver tissue, compromising the function of the organ and predisposing to liver failure and hepatocellular carcinoma. It is mainly caused by hepatitis B and C virus infections or prolonged excessive consumption of alcohol.</p> <p><strong>Aims and Objective:</strong> To study the therapeutic effects of Silybum marianum on liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection with Child Pugh Stage A&amp; B.</p> <p><strong>Materials and Methods:</strong> In this study 119 patients were treated for 6 months with Silybum marianum, their Liver stiffness measurements were carried out through Fibroscan, which is a non-invasive technique to assess liver fibrosis. Liver Fibrosis Scores viz; Aspartate aminotransferase/platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4) were also employed at baseline and end of treatment.</p> <p><strong>Results:</strong> Pre-treatment Liver Stiffness Measurement (LSM) score was 22.54 kilopascals(kPa) and post treatment was 17.30 kPa, a statistically significant change of 5.24 kPa (P ˂ 0.01) was observed, the mean percent change was 23.24%, its impact was observed in all METAVIR stages. Of the 72 (60.5%) patients with LSM ≥ 12.5 kPa (cirrhosis) at baseline 23 (32%) proved to have no cirrhosis (≥ 1 decrease in fibrosis stage) at post treatment. Similarly, 19 patients moved to stage F0-F1, 28 patients in F2 and 23 in F3. Overall fibrosis stage was improved (≥ 1 decrease in fibrosis stage) in 46 (38.7%) of 119 patients after 6 months of treatment. Serum fibrosis scores APRI and FIB-4 significantly decreased in comparison to baseline values. APRI values drooped from 1.24 to 0.83. FIB-4 score changed from 3.90 to 2.10.</p> <p><strong>Conclusion:</strong> Our result suggests significant improvement with Silybum marianum in the patients status of liver fibrosis and cirrhosis associated with hepatitis C related chronic liver disease. Silybum marianum shows therapeutic effect in real life setting on the entire aspect of disease, as evaluated with the fibroscan and serum fibrosis score.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22578 Screening of Hemoglobin A1c in Gestational Diabetes among women attending metabolic clinic at a tertiary care hospital in Uttar Pradesh 2019-03-01T10:26:29+00:00 Vivek Sinha drviveksinha13@gmail.com Poonam Kachhawa poonamkac@yahoo.com <p><strong>Background:&nbsp;</strong>Gestational diabetes mellitus (GDM) is a common medical condition that complicates pregnancies..Gestational diabetes mellitus (GDM) is a diabetic metabolic disorder that occurs in 4% of all pregnant women and 14% of ethnic groups with more prevalence of type II diabetes.&nbsp;It can be defined as increased or abnormal insulin resistance, decreased insulin sensitivity or glucose intolerance with first diagnosis during pregnancy.</p> <p><strong>Aims and Objectives:&nbsp;</strong>The purpose of this study was to evaluate the diagnostic screening value of the HbA1c, prevalence of GDM and associated risk factors.</p> <p><strong>Materials and Methods:&nbsp;</strong>The study was conducted at the metabolic clinic; in the department of Biochemistry located at SIMS, Hapur. A semi-structured pretested questionnaire was used for data collection. Following the DIPSI guidelines, patients with plasma glucose values &gt;140 mg/dl were labeled as GDM. Statistical methods used were OR (CI95%), percentage, Chi square.</p> <p><strong>Results:</strong></p> <p>Out of 500, 6.72% had GDM. Among all GDM patients, 64.71% had age more than 30 years, 70.59% had BMI more than 25, 41.18% had gravida more than 3 and p- value was significant with regard to age and BMI. P value was found to be significant for risk factors namely positive family history of Diabetes Mellitus, history of big baby and presence of more than one risk factor.</p> <p><strong>Conclusion:&nbsp;</strong>GDM is associated with high BMI, early pregnancy loss, family history of DM and previous history of big baby and there could be more than one risk factor. Thus universal screening followed by close monitoring of the pregnant women for early detection of GDM may help improving maternal and fetal outcomes.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22240 Retrospectively analysis of Pathological features of 1047 cases of Thyroid Nodules 2019-03-01T10:26:31+00:00 Zhao Xing 435444923@qq.com Zhang Gang 86781938@qq.com <p><strong>Background:</strong> In recent years, the incidence of thyroid cancer is on the rise, almost become one of the fastest-growing malignant tumor, especially in women. The reasons of the incidence of thyroid, is not only the use of detection means. The relationship between clinical pathological characteristics and prognosis of thyroid is controversial.</p> <p><strong>Aims and Objective:</strong> One thousand forty seven cases of thyroid nodule (thyroid nodules, TN) were retrospectively analyzed, to study the distribution of TN and its clinical pathological features.</p> <p><strong>Materials and Methods:</strong> Clinicopathological data of 1047 cases TN were retrospectively studied, from Chengde Medical College Affiliated Hospital and (10.2017 to 08.2018) Chengde County Hospital (01. 2016 to 08.2018), χ2 test is used to analyze the relationship between clinical pathologic factors and lymph node.</p> <p><strong>Results:</strong> In 1047 cases of TN, nodular goiter 50.62%, Hashimo-to’s thyroiditis 3.34%, thyroid carcinomas 32.28%,thyroid adenoma 10.12%, toxic nodular goiter 0.29%. The lymph node metastasis positive rate was<br>higher in &lt;45 years of age and tumor diameter &gt;1 cm of the thyroid carcinoma patients. Gender, whether single had no relation with occurrence of neck lymph node metastasis.</p> <p><strong>Conclusion:</strong> The lymph node metastasis positive rate is higher in &lt;45 years of age and tumor diameter greater than 1 cm of the thyroid carcinoma patients.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/21980 Biochemical assessment of risk factors in coronary artery disease patients: An observational study in suburban hospital of Hapur, Uttar Pradesh 2019-03-01T10:26:32+00:00 Vivek Sinha drviveksinha13@gmail.com Poonam Kachhawa poonamkac@yahoo.com <p><strong>Background:</strong> Coronary risk factors such as hypertension, diabetes and coronary artery disease (CAD) have become major health problem in Indian subcontinent, despite low fat intake and low rates of obesity. It is a paradox that the increased risk of people of Indian origin to diabetes and CAD is not explained by conventional risk factors. It is possible that the presence of new risk factors may explain this paradox.</p> <p><strong>Aims and Objective:</strong> The present study was undertaken to estimate the prevalence of coronary artery disease and identify &amp; compare some socio-demographic and lifestyle risk factors associated with coronary artery disease in urban and rural populations of Hapur.</p> <p><strong>Materials and Methods:</strong> It’s a community based study in which 350 adults each were randomly selected from urban and rural populations of Hapur using modified cluster sampling method. Selected individuals were examined. Data entry and analysis was done using SPSSversion16 for windows version 8.1. Several published epidemiological and case-controlled studies are reviewed. The prevalence of hypertension (3.2%), diabetes (2.6%) and CAD (3.2%) is very low in the rural population of India. However, in urban and immigrant populations, the prevalence of hypertension (≥160/95, 12–20%), diabetes (6–8%) and CAD (7–14%) is significantly higher than in the developed countries.</p> <p><strong>Result:</strong> Out of 350 patients of CAD included in study, 133(38%) were females and 217(62%) were males. Among those 54(15.4%) were below 45 years of age and 296(84.6%) were equal to and above 45 years of age. Risk factors like gender prevalence, family history of IHD, lifestyle, triglycerides level, HDL level, BMI and smoking<br>were not significantly associated with different age groups(p-value &gt;0.05). While HTN, DM, stress, LDL level and cholesterol were found to be significantly associated with age ≥45 years.</p> <p><strong>Conclusions:</strong> These studies support the consensus that people of urban origin wherever they are settled should have lower desirable limits of serum cholesterol, body mass index and dietary fat intake and should also decrease new risk factors for prevention<br>of CAD. This finding may require modification of the existing guidelines of the International Task Force for Prevention of CAD.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22050 Comparative analysis of indices of the metabolic syndrome in patients with and without non-alcoholic fatty liver disease at a teaching hospital in Nnewi, South-East, Nigeria 2019-03-01T10:26:34+00:00 Nneka S. Chukwurah nasfic2@yahoo.com Uchenna C. Okonkwo ucsuizes@yahoo.co.uk Anele E. Ihekwaba anele.ihekwaba@uniport.edu.ng <p><strong>Background:</strong> Non-Alcoholic fatty liver disease (NAFLD) has become a worldwide health concern with increase in the global incidence of obesity and it is now considered the hepatic component of the metabolic syndrome.</p> <p><strong>Aims and Objective:</strong> The study’s aim was to compare the indices of the metabolic syndrome in compensated chronic liver disease patients with and without NAFLD at NAUTH, Nnewi.</p> <p><strong>Materials and Methods:</strong> A total of 136 consecutive patients with compensated chronic liver disease were recruited into the study. A structured questionnaire was administered to obtain relevant socio-demographic data. NAFLD was diagnosed based on clinical, biochemical, ultrasonographic and in a few histological features. The Adult Treatment Panel III criteria were used to identify patients with the metabolic syndrome.</p> <p><strong>Results:</strong> Of the 136 participants recruited into the study, 52 (38.2%) fulfilled 2 or more diagnostic criteria for NAFLD with a male: female ratio of 1:1.36. The mean (SD) age of persons with NAFLD was 45.12 (±8.07) years compared to 47.49(±11.79) years for persons without NAFLD. The difference was not statistically significant (p=0.2). Body mass index (BMI), central obesity (waist circumference), fasting blood sugar, blood pressure, total cholesterol and triglycerides were significantly higher in the NAFLD group (p= &lt;0.05) respectively.</p> <p><strong>Conclusion:</strong> Indices of the metabolic syndrome were more prevalent in persons with NAFLD. It is recommended that patients with NAFLD be screened for metabolic syndrome and appropriate therapy instituted to decrease the risk of both hepatic and cardiovascular complications.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22365 The Spectrum of Biopsy-Proved Kidney Disease: A Retrospective Single Center Study in Erbil-Iraq 2019-03-01T10:26:35+00:00 Ahmed Al-Imam tesla1452@gmail.com Mudhafar Abdullah Ali muzaffarabdulla@yahoo.com Safa Ezzaddin Al-Mukhtar ahmed.lutfi@uob.edu.iq <p>BACKGROUND</p> <p>Renal biopsy is crucial to determine the pattern of the different types of renal diseases. It represents the gold standard of diagnostics for renal pathologies, including glomerular diseases, and it has an important value for the prognosis, monitoring disease progression, and planning the management protocol.</p> <p>AIMS AND OBJECTIVE</p> <p>To report the frequency of different pathological lesions affecting the kidney in patients who were admitted to our medical centre.</p> <p>MATERIALS AND METHODS</p> <p>This is a retrospective study of all patients with renal diseases who underwent percutaneous renal biopsy at the Erbil Kidney Centre for eight years &nbsp;(1<sup>st</sup> of January 2010&nbsp; to 31<sup>st</sup> of December 2017). A total of 893 cases were biopsied and subsequently studied via histopathological examination and immunofluorescence microscopy. The study is ethically permitted by the Kurdistan Board for Medical Specialization.</p> <p>RESULTS</p> <p>The average age of the patients was 30.9 years. The most common clinical indication for biopsy included nephrotic syndrome (46.47%), acute renal failure (19.04%), chronic renal failure (15.34%), nephritic syndrome (7.39%), proteinuria alone (7.28%), and hematuria alone (4.48%). In patients with a primary glomerular disease, focal segmental glomerulosclerosis and minimal change disease were the most frequent (27.44% and 16.01%) in the younger patients (18.61±13.47 years), while membranous glomerulonephritis was more common in older patients (38.94±13.69 years). Patients with a secondary glomerular disease were mainly diagnosed with lupus nephritis, amyloidosis, and diabetic nephropathy.</p> <p>CONCLUSION</p> <p>The epitome of our study signifies that the spectrum of glomerular diseases varies based on age, sex, ethnicity, and geographical distribution. The implementation of renal biopsy proved to be a cornerstone in reaching the correct diagnosis. Future studies should implement the use of electron microscopy in conjunction with classical techniques of histopathology and immunofluorescence microscopy to diagnose equivocal cases of interest.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22762 Ear Findings and Hearing analysis in cleft palate patients in Nepal 2019-03-01T10:26:37+00:00 Sanjeev Thakur sanjeevkr055@gmail.com Baleshwar Yadav sanjeevkr055@gmail.com Manish Agrawal sanjeevkr055@gmail.com Kailash Khaki Shrestha sanjeevkr055@gmail.com Raj Kumar Bedajit sanjeevkr055@gmail.com <p><strong>Background: </strong>The orofacial cleft is the most common birth anomaly with a prevalence rate ranging from 1/1000 to 2.69/ 1000. The middle ear diseases are known to be associated with cleft palate, however, the prevalence and the magnitude of the condition is usually underestimated.</p> <p><strong>Aims and Objectives:</strong> The purpose of this study was to find out the various exisiting ear abnormalities, to assess the middle ear function and hearing status&nbsp; in patients with cleft palate and confirm the existence of these manifestations and their significance.</p> <p><strong>Materials and Methods:</strong> All the patients with cleft palate with or without cleft lip over a&nbsp;one-year duration from January to December 2018 at the teaching hospital were include after informed consent. The patients with only cleft lip were excluded. General ENT examination and Otoscopy was performed.&nbsp; Tympanometry and Pure tone Audiometry was done (in those above 5 years). The degree of hearing loss was categorized using the WHO guidelines.</p> <p><strong>Results:</strong> Out of a total of 56 patients, there were 30(53.6%) male and 26(46.4%) female. The age range was from 2years to 31 years. The mean age was 12.8 years. Maximum number of patients were in the 10-20 years age group 29(51.8%) followed by 22 (39.3%) in the less than 10 years age group. 53 (47.3%) of 112 ears examined&nbsp; had dull tympanic membrane, followed by retraction of tympanic membrane in 42 (37.5%) ears. Other findings were central perforation in 5 (4.5%), bulging tympanic membrane in 2 (1.8%) and atticoantral disease in 1 (0.9%) ear. 8 (7.1%) ears&nbsp; had normal findings. There was one case with right ear atresia (0.9%). In Tympanometry findings, the maximum number of ears, 51 (48.1%) had&nbsp; type B curve, followed by 33 (31.2%) ears with type As curve. 16 (15%) of ears had type C curve. 6 (5.7%) ears had type A curve. B type curve was found more common in less than 10 years age group. A chi Square test was performed and the findings had statistically significant association.&nbsp; (P value: 0.03 for Right ear tympanometry ; P value: 0.043 for left ear tympanometry). In Pure tone audiometry findings of 105 ears, 72 (68.6%) ears had mild conductive hearing loss. 10 (9.5%) ears had moderate conductive hearing loss, while 1 (1%) ear had mixed hearing loss. 22 (20.9%) ears had normal hearing level.</p> <p><strong>Conclusion:</strong> This study assessed the common ear problems prevalent in cleft patients, along with the hearing loss. Since, ear disease were quite common in these patients, these patients should be evaluated regularly by an otolaryngologist to detect, treat and prevent such problems in these patients so that long term morbidity could be avoided.&nbsp;</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22034 Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children. 2019-03-01T10:26:39+00:00 Krishna Sapkota krishapkota@gmail.com Krishna Wahegaonkar krishapkota@gmail.com Niraj Ranjeet ranjitniraj@yahoo.com Pabin Thapa krishapkota@gmail.com Upendra Jung Thapa drupendra1986@gmail.com Pratyenta Raj Onta drpratyenta@gmail.com <p><strong>Background:</strong></p> <p>Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability.</p> <p><strong>Materials and Methods:</strong></p> <p>This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture.</p> <p><strong>Result:</strong></p> <p>Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups.</p> <p><strong>Conclusion:</strong></p> <p>Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22614 Parkinsonism following basal ganglia infarction in Dengue fever 2019-03-01T10:26:41+00:00 Robin George Manappallil drrobingeorgempl@gmail.com Pradeep Kumar V.G. pradeepkumarvg@gmail.com Apurva Rao K.S. apurvarks@gmail.com <p>Dengue fever is an acute febrile viral illness characterized by severe headache, myalgia, arthralgia, rashes, leucopenia and thrombocytopenia. Patients may face haemorrhagic complications like gastrointestinal bleeding, intracranial haemorrhage, menorrhagia, hematomas, hematuria and massive epistaxis. Ischemic stroke in dengue fever is a rare scenario; and Parkinsonism following basal ganglia infarction in dengue fever, to the best of our knowledge, has not been reported yet.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/AJMS/article/view/22323 A reversible hypocalcemic dilated cardiomyopathy caused by primary hypoparathyroidism 2019-03-01T10:26:42+00:00 Zhenli Cheng sk_divakar@hotmail.com Shiv Kumar Yadav sk_divakar@hotmail.com Xiaoyan Liu sk_divakar@hotmail.com Qijian Yi sk_divakar@hotmail.com <p>Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of one or both ventricles. Affected patients have impaired systolic function and may or may not develop overt heart failure (HF). Prognosis is generally poor without heart transplantation. We experienced a case of a 10-year-old child with dilated cardiomyopathy (DCM) accompanied by undiagnosed primary hypoparathyroidism. In our case,aggressive management of hypoparathyroidism significantly improved the manifestations of DCM. The case presentation highlights the importance of considering hypoparathyroidism as a cause of reversible myocardial dysfunction.</p> 2019-03-01T00:00:00+00:00 ##submission.copyrightStatement##