Asian Journal of Medical Sciences 2019-11-01T07:45:04+00:00 Dr Arun Kumar Open Journal Systems <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.</p> Risk Factors for Mortality in Elderly Patients who Live in Nursing Homes: 8-year Follow-up Period 2019-10-31T16:36:32+00:00 Yasar Kucukardali Arzu Yalcin Murat Hakan Terekeci Mehmet Akif Ozturk Betul Kucukardali Elif Cigdem Altunok <p><strong>Background:</strong> In developed countries and our country, the ratio of the elderly to the total population is increasing due to the rise in worldwide medical care spendings and the medical workforce allocated for the treatment of the acute and chronic problems of the elderly.</p> <p><strong>Aims and Objectives:</strong> The number of studies based on long-term observations of the risk factors that affect the survival and mortality rates of the elderly in nursing homes is quite rare. Currently, there are no studies concerning this issue in the country. The authors carried out an eight years prospective study to determine the risk factors for mortality in a private nursing home with a capacity of 150 beds located in Istanbul.</p> <p><strong>Materials and Methods:</strong> From January 2007 to March 2015, we scanned the number of medications, comorbidities, nutritional status, age, mental score, number of falls and fractures, levels of hemoglobin, albumin, creatinine, and glucose parameters related with mortality in 612 patients admitted to the nursing home.</p> <p><strong>Results:</strong> The median overall survival time was 34 months. A total of 240 (39%) residents died within eight years, 44% within two years and 55% within three years. The evaluation results&nbsp;shothat 360 (51%) of the 612 residents, were females and the mean age was 76.49 (± 11.36) years. Hazard ratios of the related parameters that related to mortality were respectively 1,3 for age, 1,5 for BMI less than 20kg/m2, 4,2 for more than six comorbidities, 7,01 for six to nine number of medications, 5 for dependency, 0,7 for one to three episodes of infection, 0,5<br>for falls, 1,3 for fracture, 3,1 for mental score of less than 18, 1,9 for hemoglobin less than 12gr/dl, 4,03 for creatinine higher than 1.5 mg/dl, 2,43 for glucose greater than 126 mg/dl, 4,8 for albumin less than 3 g/dl (95% CI).</p> <p><strong>Conclusion:</strong> The risk factors causing mortality are; old&nbsp;age, BMI less than 20, more than six comorbidities, more than six medications, dependency, one to three episodes of infection, impaired mental score less than 18, anemia, hyperglycemia, kidney failure, hypoalbuminemia at the patients who admitted to nursing homes. Early optimal monitoring of these parameters can provide a positive contribution to the survival of elderly<br>residents in nursing homes.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Human skin bacterial flora differ with altitudes in different ethnic groups of Nepal 2019-11-01T07:45:04+00:00 Dipendra Shrestha Raju Shrestha Rene S. Hendriksen Luna Bhatta Sharma Dwij Raj Bhatta <p><strong>Background: </strong>Largest organ of human body, the skin, is colonized by millions of microorganisms, most of which are not only harmless but also beneficial to the host. Human skin microbes depend upon geographical variations, ethnicity and various host factors. Despite several studies on human skin microbiota in various parts of the globe, it has not been studied in Nepalese population.</p> <p><strong>Aims and Objective: </strong>To identify skin bacterial normal flora in different ethnic groups residing in different altitude of Nepal.</p> <p><strong>Materials and Methods: </strong>We cultured skin swabs of 166 randomly selected volunteers belonging to 10 major ethnic groups from 3 distinct geographical altitudes of Nepal, viz. Bharatpur (415 m from sea level), Kathmandu (1,400 m from sea level) and Lukla (2,860 m from sea level). The isolated organisms were characterized and tested for their susceptibility against different antibiotics.</p> <p><strong>Results: </strong>Altogether 231 bacterial isolates were characterized from 166 skin samples. Among them, 140 isolates (60.60 %) were Gram positive and 91 isolates (39.40 %) were Gram negative bacteria. <em>Staphylococcus aureus </em>(35.49%) was the most dominant skin bacterial flora followed by <em>Escherichia coli </em>(22.51%) and <em>Streptococcus </em>spp. (17.75%). Medium altitude Kathmandu exhibited the highest growth (120 isolates) followed by low land Bharatpur (66 isolates) and high land Lukla (51 isolates) which is statistically significant (p value =0.0124). The antibiotic susceptibility testing against 14 antibiotics exhibited the Gram positive isolates were the most sensitive to Imipenem (94.93 %) whereas the least sensitive to Cephalexin (31.36 %) and the Gram negative isolates were the most sensitive to Amikacin (100%) whereas the least sensitive to Amoxycillin (28.57 %).</p> <p><strong>Conclusion: </strong>Our data indicates that the skin bacterial normal flora; which is directly exposed to external environment; has significant relationship with altitudes where individuals live. The result desires further study for the adaptability of normal flora found in different altitudes. Some bacterial commensals were found resistant even against new generations of antibiotics as well, and hence can cause life-threatening infections if they happen to cross the skin physical barrier.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Pilot epidemiological study of basal cell carcinoma in Melaka 2019-10-31T16:36:36+00:00 Samuel D Abishegam Azira Mat Yasir Ilyasak Hussin Izety Shezlinda Noran <p><strong>Background:</strong> This study was conceptualized to be a stepping stone for analysis of BCC in Melaka.</p> <p><strong>Aims and Objective:</strong> To analyse the incidence of BCC in Melaka and analyse the distribution of age, gender, ethnicity, localization of lesion and treatment done.</p> <p><strong>Materials and Methods:</strong> A retrospective analysis on patients who were diagnosed and treated for BCC was conducted in the Department of Plastic and Reconstructive Surgery, Hospital Melaka from January 2013 until March 2019.</p> <p><strong>Result:</strong> There were 152 patients diagnosed with BCCs (N=152) involving 80 women (52.6%) and 72 men (47.4%) over the study period. The patients were aged between 18–92 years with average age for women were 66.2 years and 66.1 tears for men. The majority of cases, 134 (88.2%) were located on the head and neck region. The most common ethnic group to be affected by BCC is the Chinese with 78 (51.3%) followed by Malays at 72 (47.4%) and 1 (0.7%) for Indians and 1 (0.7%) for other minor ethnic group. There were 89 (58.6%) patients underwent excision only whilst 63 (41.4%) patients underwent excision with reconstruction either with skin grafting or local flap.</p> <p><strong>Conclusion:</strong> Basal cell carcinoma is a common cutaneous malignancy. The local demographics of patients with BCC in Melaka are similar to that in the literature. We hope with the data provided, it will facilitate better outcome treatment of BCC not just in our local setting but elsewhere worldwide.</p> 2019-10-17T00:00:00+00:00 ##submission.copyrightStatement## Breast cancer survivorship in an Asian specialist centre from Malaysia: A retrospective analysis 2019-10-31T16:36:37+00:00 Azura Rozila Ahmad Jia Shin Jessica Tan Arkonam Balasubramaniam Manivannan Mohamed Ibrahim Abdul Wahid <p><strong>Background:&nbsp;</strong>Real world data (RWD) is increasingly relevant in breast cancer (BCa) as it is the most frequently diagnosed cancer. Developed world has seen improved breast cancer survival, however, RWDon BCa survival in Malaysia is still lacking.</p> <p><strong>Aims and Objectives:&nbsp;</strong>This study aims to determine characteristics and survival of BCa patients from a single institute.</p> <p><strong>Materials and Methods:&nbsp;</strong>Retrospective analysis of 168 BCa patients who were treated with at least one treatment modality in Beacon International Specialist Centre (BISC) from 2008-2012 was conducted. Patient characteristicsand treatments received were analysed descriptively to survival outcome.Vital status was obtained from the National Registry of Birth and Death (NRD) records. Observed survival rates wereestimated by Kaplan-Meier method and difference between groups by log-rank.</p> <p><strong>Results:&nbsp;</strong>Of 143 eligible BCa patients,28 (19.6%) died during the study period. Five-year BCa specific survival rates were 100% for Stage I and II, 79.31% for stage III and 38.89% for Stage IV disease. In the multivariate analysis, higher stage at diagnosis, triple negative breast cancer with metastases and higher grade were associated with worse survival outcomes. The overall 5-year survival rate of BCa patients in BISC from 2008-2012 compares favourably to the survival data of developed countries.</p> <p><strong>Conclusion:&nbsp;</strong>In conclusion, the overall 5-year survival rate of BCa patients in BISC compares favourably to the survival data of developed countries, as well as to other institutions.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## The distribution of hepatitis C virus genotypes in patients with hepatocellular carcinoma 2019-10-31T16:36:39+00:00 Ayfer Bakır Nuran Karabulut Sema Alaçam Barış Bakır Ali Ağaçfidan <p><strong>Background:</strong> Hepatic cirrhosis develops within 20-30 years in approximately 20% of individuals chronically infected with hepatitis C virus (HCV).</p> <p><strong>Aims and Objective:</strong> This study aimed to determine the distribution of HCV genotypes in patients with HCV-associated HCC in our region and thus to contribute to the epidemiology of HCV.</p> <p><strong>Materials and Methods:</strong> HCC patients referred to the virology laboratory for HCV genotype identification between January 2013 and April 2018 were included in this study. Genotyping of HCV was performed by a commercial reverse hybridization line probe-based assay.</p> <p><strong>Results:</strong> Seventeen patients who were diagnosed with HCC and whose HCV genotypes were analyzed were included in this study. Genotype 1 was detected in all 17 patients with HCC. When evaluating subtypes of genotype 1, genotype 1b was detected in 16 (94%) of the patients. The HCV subtyping in one patient (6%) could not be performed.</p> <p><strong>Conclusion:</strong> As a result, genotype 1b, one of the major risk factors for HCC, was detected in 94% of the patients included in this study. This study, consistent with the literature, shows a high association between the development of HCC and genotype 1b in patients with chronic HCV.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Association of serum hydrogen sulphide with hypertension and proteinuria in pre-eclampsia 2019-10-31T16:36:40+00:00 Sayani Chaudhuri Utpal Kumar Biswas Arun Kumar <p><strong>Background:</strong> Preeclampsia is a hypertensive disorder of pregnancy affecting multiple systems and characterized chiefly by hypertension and proteinuria in a previously normotensive and non proteinuric women. The main underlying cause for its pathophysiology is an imbalance between the physiological vasoconstrictor and vasodilator molecules in circulation leading to maternal endothelial dysfunction. Hydrogen sulphide (H2S) is a physiological vasodilatory gasotransmitter which plays an important role in the development of hypertension and proteinuria in preeclampsia.</p> <p><strong>Aims and Objectives:</strong> The aim of this study was to determine the serum level of hydrogen sulphide and spot urinary protein levels in preeclampsia cases and compare it with age matched controls which were normal pregnant women and to find any correlation, if exists, between these two parameters.</p> <p><strong>Materials and Methods:</strong> Serum level of H2S and spot urinary protein level were measured in one hundred pregnant women with preeclampsia and the values were compared with age matched controls.</p> <p><strong>Results:</strong> The mean serum H2S level was 32.31 ± 12.62μmol/L in patients which was significantly lower (p&lt;0.001) when compared to controls where mean was 114.50 ±20.35μmol/L. The mean spot urinary protein level was found to be 11.83 ± 5.06 mg/dl in preeclampsia cases which was significantly higher (p&lt;0.001) than in controls where it was 7.18 ± 2.38 mg/dl. A negative correlation was found between the serum level of H2S and both the systolic BP (r=-0.725, p&lt;0.001) and diastolic BP (r= - 0.639, p&lt;0.001) in preeclampsia patients.A negative correlation was also observed between the serum levels of H2S and spot urinary protein in preeclampsia (r=-0.541, p&lt;0.001).</p> <p><strong>Conclusion:</strong> The present study has elucidated that the serum levels of hydrogen sulphide decreases and the spot urinary protein levels increases in preeclampsia when compared to normal pregnant women and hydrogen sulphide shows a negative correlation with both systolic and diastolic BP in preeclampsia. This study also demonstrates that,there exists a negative correlation between the serum H2S level and spot urinary protein level in preeclampsia patients.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Assessment of lipid abnormalities and Cardiovascular Risk indices in Type 2 Diabetes Mellitus 2019-10-31T16:36:42+00:00 Sushil Baral Achyut Bikram Hamal Shyam Kumar BK Sandeep Gupta Manoj Sigdel Laxman Prasad Mandal <p><strong>Background:</strong> Incidence of cardiovascular events is increased to two to four times among diabetic patients when compared with non-diabetic. Dyslipidaemia in diabetes is major risk factor for cardiovascular events. Atherogenic indices have been used as major laboratory measures in clinical practice to assess cardiovascular risk. Recent studies, have shown that non-high-density lipoprotein cholesterol and other atherogenic indices is like or better than LDL-C alone in the prediction of CVD incidence and mortality.</p> <p><strong>Aim and Objectives:</strong> The aim of this study is to assess the lipid abnormalities with cardiovascular risk using atherogenic coefficient (Ac), Cardiac Risk Ratio (TC/HDLc and LDLc/HDLc), TG/HDLc and Non- HDL in diabetes patients.</p> <p><strong>Materials and Methods:</strong> A cross-sectional descriptive study conducted at Bir hospital (tertiary care center) Nepal. Patients diagnosed as diabetes with age 30 years or above were selected in this study during a period of 1 yr.</p> <p><strong>Results:</strong> The mean age of the patients enrolled was 55.08±1.11 (34-81) year with male (52 %) to female (48%) ratio is 1.08:1. In this study the mean Non HDLc was 165.24±43.40 mg/dl (65-323) and AC was 4.0±1.09. The finding of AC was slightly higher in female compare to male i.e mean ±S.D 4.07±1.31 and 3.94±1.15. This study show the strong correlation of Non HDLc with total cholesterol (r=.990, p=0.000), LDLc(r=.602,p=0.000),TG (r=.411,p=0.000), LDLc/HDLc (r=.580,p=0.000),TC/HDLc ((r=.866,p=0.000), TG/HDLc (r=.390,p=0.000) and AC (p=0.866).</p> <p><strong>Conclusion:</strong> The association between abnormal lipid levels and cardiovascular risk is evident among patients with diabetes mellitus. In this study there is the correlation with FBS, Non HDL-c cholesterol, Cardio risk ratio, TG/HDLc, Atherogenic coefficient. Hence Non-HDL cholesterol and Atherogenic indices proves to be more sensitive and a better predictor of cardiovascular events in diabetes patients.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Cross-sectional study of pattern of Dyslipidemia and Prevalence of Atherogenic Diabetic Dyslipidemia in newly detected Diabetic patients 2019-10-31T16:36:43+00:00 Vinay Krishnamurthy Akhila Rao Kerekoppa Prabhakar B <p><strong>Background:</strong> India has seen an ever increasing number of diabetic patients and in turn rise in cardiovascular diseases. Many studies have shown diabetic patients to have dyslipidemia, with certain common patterns early in the disease.</p> <p><strong>Aims and Objective:</strong> The current study was done to identify pattern of dyslipidemia and prevalence of ADD in treatment naïve diabetic patients.</p> <p><strong>Material and Methods:</strong> Fasting lipid profile was analysed in treatment naïve diabetic patients at a tertiary care teaching hospital. Various factors influencing the results were analysed statistically. Results: Prevalence of dyslipidemia was 89.2%, whereasatherogenic diabetic dyslipidemia was seen in 34.2% and raised non-HDL cholesterol in 73.3%.</p> <p><strong>Conclusion:</strong> Our study showed a high prevalence of dyslipidemia in newly diagnosed diabetics indicating the importance of screening for dyslipidemia in newly diagnosed cases and implementation of timely lipid lowering therapy to prevent CVD. It also highlights the importance of pattern of dyslipidemia called Atherogenic diabetic dyslipidemia and raised Non-HDL cholesterol in diabetic patients.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## An antioxidant activity of Cinnamonum tamala improves histopathological alterations and biochemical parameters in alloxan induced diabetic rats 2019-10-31T16:36:44+00:00 Mamata Laxmikant Pochhi <p><strong>Background:</strong> Diabetic mellitus is a multifactorial disorder associated with its devastating consequences has assumed epidemic proportion. Diabetes mellitus (DM) is a global health problem and the incidence of DM is increasing at alarming rate all over the world. Many Indian medicinal plants have been reported to possess potential antidiabetic activity and could play important role in the management of diabetes with less adverse effects.</p> <p><strong>Aims and Objectives:</strong> The main objective of this study was to focus on the anti-diabetic activity of Cinnamomum tamala, with special reference to its curative and protective role in alloxan induced diabetic rats. Attempts were further made to study the antioxidant properties of C. tamala leaves.</p> <p><strong>Materials and Methods:</strong> The diabetic rats were administered orally with the aqueous leaves extracts of Cinnamonum tamala (250 mg/kg) for 30 days. The results were compared with standard drug Tolbutamide.</p> <p><strong>Result:</strong> The alloxan treated diabetic control rats showed a significant increase in the plasma glucose, glycosylated hemoglobin (HbA1C), glucose-6-phosphatase, aldolase, LDH, ALT, AST, ALP and GGT activity, free<br>radicals formation with a concomitant decrease in glycogen content in the liver and serum insulin level and phosphoglucoisomerase and hexokinase activity in tissues as compared to normal control rats. Oral administration of C. tamala extract for 30 days showed significant result as compared to Tolbutamide and diabetic control rats.</p> <p><strong>Conclusion:</strong> On the basis of above findings it can be concluded that extracts of C. tamala to alloxan induced diabetic rats showed significant positive changes in the biochemical and histopathological parameters<br>related to carbohydrate and protein metabolism.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Oxidative stress biomarkers in pulmonary tuberculosis patients in Gombe, North-eastern Nigeria 2019-10-31T16:36:46+00:00 Mohammed Haruna Yeldu Yakubu Ibrahim Shehu Abubakar Akuyam Isah Muhammad Danasabe Buhari Shehu Mohammed Danjuma Miftahu Bello Usman Yahaya <p><strong>Background:</strong> Oxidative stress may play an important role in the pathogenesis of pulmonary tuberculosis (PTB). To our knowledge there is paucity of data on the status of oxidative stress biomarkers among PTB patients in Gombe, North-eastern Nigeria. Our study was designed to evaluate the oxidative stress biomarkers in pulmonary tuberculosis patients in Gombe, North-eastern Nigeria.</p> <p><strong>Aims and Objectives: </strong>To determine the serum levels of oxidative stress biomarkers among patients with pulmonary tuberculosis in Gombe metropolis, North-eastern Nigeria and to assess the correlation between the oxidative stress biomarkers in pulmonary tuberculosis patients.</p> <p><strong> Materials and Methods:</strong> A cross sectional comparative study was conducted in a tertiary health care facility with 40 pulmonary tuberculosis (PTB) patients on anti-TB drugs treatment (ATT), 40 newly diagnosed PTB patients not yet on anti-TB drugs treatment (ATT-naïve) and 40 age- and sex-marched apparently healthy subjects (controls). Serum total antioxidant status (TAS), total oxidant status (TOS), malondialdehyde (MDA), nitric oxide (NO) and oxidative stress index (OSI) determined using standard techniques. Data was analysed using INSTAT® (Graph Pad Software Inc., La Jolla, CA, USA).</p> <p><strong>Results: </strong>Serum levels of TOS, OSI, MDA and NO were significantly (p ˂ 0.001) increased in PTB patients (ATT and ATT-naïve) when compared with healthy individuals. Serum TAS and body mass index (BMI) were significantly (p ˂ 0.001) decreased in PTB patients when compared with healthy individuals. Serum TOS significantly correlated with serum OSI, MDA and NO in ATT-naïve PTB patients.</p> <p><strong>Conclusion:</strong> This study observed an increased oxidative stress biomarkers and decreased total antioxidant status in newly diagnosed pulmonary tuberculosis patients and those on treatment. Our findings suggest that antioxidants supplementation and improved nutrition in the management of pulmonary tuberculosis patients may go a long way in preventing the oxidative onslaught and further complications in PTB patients.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Age related variations in the morphometric parameters of the mitral valve complex- A cadaveric based study from Kolkata 2019-10-31T16:36:48+00:00 Rajasri Chunder Sayantani Majumdar Arijit Dey <p><strong>Background:</strong> Mitral valve diseases are quite common in Indian Population across the age groups and the latest trend in the valvular surgery for better outcome is “Respect rather than Resect”. So, reconstructive surgeries being a preferred modality of treatment in Mitral Valvular Disorders, morphometric parameters of mitral valve are of immense importance.</p> <p><strong>Aims and Objective:</strong> This study deals with the age wise variation of the morphometric parameters of the mitral valve.</p> <p><strong>Material and Method:</strong> In this study, fifty formalin hardened cadaveric hearts were studied which were dissected and measurements of the morphometric parameters were recorded and analysed.</p> <p><strong>Results:</strong> While analyzing the data on the weight of the heart,mean annular circumference (MAC), antero-posterior (APD) and transverse diameter (TD) of the mitral valve annulus, it was observed that all the parameters significantly increases with age.</p> <p><strong>Conclusion:</strong> This data will be immensely helpful in planning the reconstructive surgeries of mitral valve age-wise.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of blood groups in patients with anti TPO positive 2019-10-31T16:36:49+00:00 Eşref Araç İhsan Solmaz <p><strong>Background:</strong> In studies, ABO blood group system has been shown to be associated with type 2 diabetes mellitus, chronic renal failure, gestational diabetes mellitus, postpartum depression, coronary artery disease, Crohn’s disease as well as various cancer types such as stomach, breast, skin cancers and rheumatologic diseases.</p> <p><strong>Aims and Objective:</strong> The relationship between anti TPO positivity and ABO blood group system is aimed to be investigated by using blood groups which are the product of genetic structure and easy to identify by considering the relationship between anti TPO positivity and blood group.</p> <p><strong>Materials and Methods:</strong> 4312 patients with determined blood groups were included among the patients, who were admitted to the internal medicine outpatient clinics of our hospital between January 2, 2017 and May 28, 2019 and were screeened for thyroid antibodies with thyroiditis susceptibility.</p> <p><strong>Results:</strong> The most common blood group was A in both anti TPO positive and anti TPO negative patient groups.<br>The rate of those with O blood group was 2.65% higher in anti TPO positive group than anti TPO negative group. B blood group was found to be 4.87% higher in anti TPO negative group than anti TPO positive group (p:0.148).</p> <p><strong>Conclusion:</strong> In conclusion, it was found that O blood group may be a risk factor for anti TPO positivity and B blood group is much lower in anti TPO positive ones. However, it is obvious that more comprehensive prospective multicentered clinical and experimental studies are needed to establish the relationship between blood groups and autoimmune diseases, especially autoimmune thyroiditis.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Morphometric and morphologic study of Foramen Ovale in In Indian population 2019-10-31T16:36:50+00:00 Mumal Nagwani Mishra Kaveri Dande Dewanshi Mishra Archana Rani Madhuresh Kumar <p><strong>Background:</strong>The floor of middle cranial fossa shows several foramina through which vital neural and vascular structures pass. Thus, the knowledge of normal and variant anatomy of these foramina is important. One such foramen is Foramen ovale which allows the passage of certain important structures.</p> <p><strong>Aims and Objective:</strong>This study also aimed to provide a base line data to neurosurgeons for easy and safe approach to middle cranial fossa. Thus, to fulfill the above, the morphometric and morphologic characteristics of the foramenovalewere studied and the observed metric and non-metric parameters were compared with those of previous studies.</p> <p><strong>Materials and Methods:</strong>The study has been conducted on 160 adult non-pathological dry human skulls of unknown age and sex. Those parts of broken skulls were included in the study in which the area of Foramen ovale was intact. All the parameters were obtained by one observer only to avoid inter-observer error. The foramen ovale was identified and different metric and non-metric parameters were observed and measured.</p> <p><strong>Results:</strong>The most common shape on both sides was noted to be transversely oval. Out of 160 skulls, 2 skulls (1.25%) showed accessory FO bilaterally. 4 skulls showed divided FO on left side. Out of 4, 2 skulls( 1.25%) were noted to have bony bar and in 2 skulls (1.25%) the main FO were divided by bony plate.</p> <p><strong>Conclusion:</strong> The morphologic variations of Foramen Ovale in the form of accessory foramen and presence of bony bar / bony plate are common. This study will provide a baseline data as well as frequency of related variations in our population for a safer approach by the surgeons.&nbsp;</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children 2019-10-31T16:36:51+00:00 Pabin Thapa Krishna Sapkota Krishna Wahegaonkar Niraj Ranjeet Pratyenta Raj Onta Upendra Jung Thapa <p><strong>Background:</strong> Lateral condyle fracture of the distal humerus is the second most common injury around the elbow.</p> <p><strong>Aims and Objective:</strong> The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children.</p> <p><strong>Materials and Methods:</strong> Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al.</p> <p><strong>Results:</strong> There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022).</p> <p><strong>Conclusion:</strong> Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Study of adverse drug reactions and clinical profile of elderly in relation to polypharmacy 2019-10-31T16:36:53+00:00 Nagaraja BS Keerthana Sharma <p><strong>Background:</strong> Polypharmacy is a becoming more prevalent in older adults and adverse risk increases with age-related change. Adverse drug reactions (ADRs) are common in older adults and worrisome aspect of treatment in elderly.</p> <p><strong>Aims and Objective:</strong> The study aimed to identify the common clinical conditions leading to polypharmacy and to compare the adverse drug profiles of the 2 groups.</p> <p><strong>Materials and Methods:</strong> This case-control study was conducted in Hospitals attached to BMCRI, where 200 patients aged 65 or more were interviewed. 100 elderly patients using 5 or more drugs were identified as cases and assessed against a control group of 100 patients.</p> <p><strong>Results:</strong> Our study found that ADRs were found to be three times higher in individuals on polypharmacy compared to the control group (OR 3.4675 95% CI 1.6241 to 7.4035). The most commonly occurring ADRs were dyspepsia (OR 1.9259), drowsiness (OR 3.5926) and fatigue (OR 1.5319) with increased incidence in the case group. The most common conditions associated with polypharmacy were found to be hypertension (53%), diabetes mellitus(46%), COPD(14%) and IHD(14%). 66% of the study group had two or more of the above diseases, whereas in the control group only 32% had multiple illnesses. The most commonly prescribed medications were antihypertensives (61%), hypolipidemics (44%), antiplatelets (41%) and antibiotics(40%).</p> <p><strong>Conclusion:</strong> Polypharmacy in the elderly comes with a significant increase in adverse effects. The reduced pill burden will not only decrease ADRs and improve compliance, but will also result in greater patient satisfaction and mental health, thereby improving the quality of geriatric care.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Demographic profile, pattern, practice of energy drink and substance use among undergraduate students in BPKIHS 2019-10-31T16:36:54+00:00 Ramayan Prasad Kushwaha Namita Kumari Mandal Bhawesh Koirala Gajendra Prasad Rauniar <p><strong>Background:</strong> The consumption of caffeinated energy drinks is a common practice among college students. Energy drinks are believed to increase energy, stamina, wakefulness, and reduce hangover symptoms.</p> <p><strong>Aims and Objective:</strong> This study aims to find out the profile, pattern, practice of energy drink and substance use among undergraduate students in BP Koirala Institute of Health Sciences.</p> <p><strong>Materials and Methods:</strong> It was a self-reported questionnaire based descriptive cross-sectional study. The questionnaire included demographic details, patterns of energy drink used, mixing practice of alcohol with energy drinks or other beverages, substance use behavior, and the knowledge about the main constituents of energy drinks. Alcohol mixing practice was further categorized into a) Alcohol + Energy drink mixing group, b) Alcohol + Other beverages mixing group, c) Only Alcohol group.</p> <p><strong>Results: </strong>Out of 319 students, 188 (58.9%) were male. The prevalence of energy drink use was 186 (58.3%). Red Bull (176, 94.6%) was the most preferred energy drink. The use of alcohol (29, 87.9%), tobacco (20, 60.6%), and marijuana (13, 39.4%) was more prevalent in students using energy drinks on a daily basis. Thirty percent (57) alcohol user students were mixed alcohol with energy drink among them 42 (73.7%) used tobacco and 24 (42.1%) used marijuana.</p> <p><strong>Conclusion: </strong>The overall energy drinks use among the students was high. The occurrence of various substance misuse was more among those students who consumed energy drink more frequently or consumed it with alcohol. Frequent consumption of energy drinks alone or mix with alcohol is not recommended.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Enterobius vermicularis in anterior chamber of eye 2019-10-31T16:36:56+00:00 Kabindra Bajracharya Arjun Malla Bhari Salma KC Rai Saraswati Pandey <p><em>Enterobius vermiculari which is </em>often referred as pinworm, is an intestinal nematode which is transmitted through fecal-oral route. The extraintestinal presentation of the worm is rare<em>. </em>&nbsp;A live worm, <em>Enterobius vermicularis</em> in anterior chamber is a very rare case. To present an unusual case of <em>Enterobius vermicularis</em> in anterior chamber of right eye in a 3 years old girl. Visual acuity assessment, slit lamp examination and ultrasonography of the eye were performed. The worm was found in anterior chamber of right eye at 8-9 o' clock hour position, coiling at the presentation. The living, white worm was freely moving and changing position frequently. There was hypopyon with exudates inferiorly. The pupil was irregular, posterior synechiae was present with cataractous lens. The living worm was removed surgically under general anesthesia and sent for microbiological examination. Synecholysis with lens aspiration and Posterior chamber intraocular lens implantation was done in second surgery. An adult worm in anterior chamber is rare. Treatment is surgical removal. The visual prognosis is not good when the case present with severe form of anterior uveitis and complicated cataract.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement## Reliability assessment of pre -post test questionnaire on the impact of a daylong clinical pharmacology workshop among medical professionals 2019-10-31T16:36:57+00:00 Arunava Biswas Sukanta Sen Krishnangshu Ray <p><strong>Background:</strong> Pretest-posttest questionnaire are often used during workshop to assess the impact of a program on the participants. However, the reliability of such data collection ‘tool’ is not often judged. There is lack of evidence supporting the authentication of such research instrument.</p> <p><strong>Aims and Objective:</strong> This study was conducted to assess the reliability of prepost test questionnaire comprising MCQs, on participants attending a one-day workshop on clinical pharmacology at a teaching hospital in eastern India.</p> <p><strong>Materials and Methods:</strong> Pre and post test questionnaire comprising 15 MCQs covering different aspects of ‘Good Clinical Practices’ on which several presentations were later delivered by experts were distributed to (n=42) participants in a one-day oriented workshop within stipulated time period and their feedback were collected and statistically analyzed after the workshop was over.</p> <p><strong>Results:</strong> The average number of MCQs attempted in the pretest questionnaire was 12.42 and in posttest were 14.44 by the participants. The workshop participants increased their percentage of correct answer score from an average of 48.4 in pretest to a statistically significant 88.73 in posttest (p&lt;0.0001).</p> <p><strong>Conclusion:</strong> Pre/post questionnaire could be effective and reliable tools in meeting stipulated learning objectives and help in assessing the aftermath of an educational program.</p> 2019-10-30T00:00:00+00:00 ##submission.copyrightStatement##