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Study of Inter-arm Variation of Blood Pressure in Normal and Diabetic In-dividual in Out Patient Department of Nepal Medical College

Introduction: Growing incidence of hypertension and its significant association with diabetes mellitus are being observed in both developing and developed countries around globe. Scanty literature is available about the comparative study of inter-arm variation of blood pressure in normal individuals and diabetic among Nepalese population. This research was performed to determine extent of inter-arm variation in normal individuals and diabetics. Methods: A descriptive observational study was carried out from 2013 January to 2014 January in a tertiary level teaching hospital of Nepal. After taking the consent and giving necessary instructions, blood pressures were measured in both the arms one after another in sitting posture using mercurial sphygmomanometer and Littman cardiosonic stethoscope. Arterial blood pressure was measured by palpatory method followed by auscultatory method The cuff pressure at which the tap sound were first perceived was noted as systolic blood pressure (SBP). Similarly, diastolic blood pressure (DBP) was noted at the point where the sound disappeared. Results: A total of 120 volunteers between ages of 40-80 years were studied. Highly significant inter-arm variation of both SBP and DBP was found in diabetics as compared to normal (p<0.01). Highly significant inter-arm variation was found in diabetic male and female as compared to their normal counter parts (p<0.01). Conclusion: This study showed that there was significant inter-arm variation of SBP and DBP in diabetic and normal individual. So, this study encourages to measure blood pressure (BP) in both arms for proper treatment planning of an individuals.

Demographics and Pharmacotherapy in Neurocysticercosis: A hospital Based Study

Introduction: Neurocysticercosis (NCC) is one of the commonest preventable cause of seizure. It is due to development of the larval form of Taenia solium. This disease is endemic in south east Asia including Nepal and has been considered as one of the neglected tropical disease. Methods: All the patients who came to Neurosurgical outpatient department (OPD) of Annapurna Neurological Institute and Allied Sciences (ANIAS) with the diagnosis of NCC with seizure during the study time frame were included in the study. The time frame of the study was January 1st 2017 till December 31st 2018. Results: There were 167 total cases of which 108 (64.7%) were male and 59 (35.3%) were female. Mean age was 27.9 years (SD 13.1 years, range 1 year to 66 years). Frequency of patients were in the age group 20-30 years followed by 10-20 years. In terms of number of lesions, 86% of the patients had single lesion while 14% had multiple lesionsMaximum number of cases had focal seizure with secondary generalization (46%). This was followed by focal seizure (28%). Most common antiepileptics was carbamazepine (51.5%).Mean duration of antiepileptics was 2.5 years (SD 1.47, Range 9 months to 6 years) and recurrence was noted in 7.78% of cases. Conclusion: NCC affects the productive age group with higher proportion being male patient. Single lesion is more prevalent. Proper measures for treatment and prevention of neurocysticercosis is essential and can lead to better control of this condition.

Bilateral Striopallidodentate Calcinosis in Female: A case report

Bilateral striopallidodentate calcinosis (BSPDC) is associated with many neurological and psychiatric abnormalities and most commonly present with extra pyramidal symptoms and can be idiopathic or associated with endocrinopathy, frequently with parathyroid disorders. Here we describe a case who presented with generalized seizure. During workup, the cause of seizure was found to be bilateral and symmetric, extensive, irregular, intraparenchymal calcifications involving the basal ganglia, thalamus and dentate nucleus, white matter in the frontal, parietal, and occipital lobes and dentate nuclei of cerebellum. On the basis of clinical features, investigations, and exclusion of other causes of intracranial calcification a clinical diagnosis of BSPDC was made. BSPDC should be considered in the differential diagnosis of endocrinopathy particularly parathyroid disorders, when associated with neurological and psychiatric abnormalities.

Overcoming the Challenges of Epilepsy in Nepal- From Grassroots to Advanced level

Epilepsy is considered to be one of the common neurological disease with a high public health concern in recent years. The burden of epilepsy is also high affecting the patients and their care givers physically, mentally as well as socio economically. This burden seems very high in low- and middle –income countries with high rate of treatment gap resulting in higher number of morbidity and mortality. There are various challenges in low-middle income countries to overcome the treatment gap. Sustained and coordinated action prioritizing epilepsy from the rural setting to the advance setting can help in tackling the challenges. This article focuses on the challenges of epilepsy treatment in low-middle income country like Nepal and discusses the ways forward to overcome it.

An Autopsy Study of Atherosclerotic Changes in Coronary Arteries at B.P. Koirala Institute of Health Sciences

Introduction: Atherosclerosis is a giant killer and the incidence of atherosclerosis in coronary arteries is rapidly increasing. The study was designed to assess the atherosclerotic lesions in coronary artery and to correlate the risk factors related to prevalence of atherosclerosis. Methods: Heart from 100 medico legal autopsy cases ranging between ages 15 to 35 years which came to BPKIHS Dharan were taken for this study and processed for coronary arteries using conventional technique. They were then studied,and grading was done based on Modified American Heart Association (AHA) classification of atherosclerosis. Results: Intimal thickening was noted in more than 90% in all three coronary arteries followed by intimal xanthoma whereas intermediate lesion for atherosclerosis was not found. Age, gender, smoking and alcohol in relation to atherosclerosis were found to be of no significance. Conclusion: The study highlights the impact of atherosclerotic lesions in the Eastern region of Nepal. Meticulous postmortem examination along with histopathological study is the best possible way to study atherosclerotic disease in humans and risk factors associated with it.

Biomedical Engineering in Nepal: Opportunities and Challenges

Biomedical engineering is the blend of engineering and medical science, professional with a combination of knowledge of various engineering discipline to improve health care and quality of life. While biomedical engineering formally came up as major course in 1950s, the course started in Nepal just a decade back with its importance being acknowledged and biomedical engineers have been recruited by various institutes. Accounting for artificial intelligence, robotic surgery, 3-d printing, which are believed to be the future of medical science, it is necessary to strengthen the biomedical engineering. This article aims to highlight the overview as well as opportunities and challenges of biomedical engineering in Nepal.

A Notorious Mimicker Nasal Melanoma: A Case Report

Melanomas arising in the nasal cavity or paranasal sinus are rare and have a poor prognosis and is more aggressive than cutaneous counter part. The incidence rate reaches its peak when the patients are in the 5th to 8th decades of life, and the disease is slightly more common in males than females; age and sex do not affect the prognosis. We present a case with histologically deceiving features which was proven Malignant Melanoma by application of Immunohistochemistry. On sinoscopic examination, a mass noted of which incisional biopsy was obtained. Histologically, poorly differentiated Sinonasal carcinoma and Malignant Vascular Neoplasm was differential diagnosis. On immunohistochemistry, strong expression of SOX-10, Melan-A, HMB-45 was observed and p63, CK-7, CK20, Synaptophysin, CD56, CD138, CD45, S100, Desmin, Myogenin were all non-immunoreactive. Thus Malignant Melanoma was final diagnosis.Awareness of melanoma mimickers is very important for clinicians in general, and

A Case Report of Angioplasty and Stenting Experience for Peripheral Arte-rial Disease of the Lower Limbs at Annapurna Neurological Institute

Atherosclerosis leading to stenosis or blockage in the major vessels of lower extremities causes peripheral arterial disease(PAD). PAD may be asymptomatic in early stage. But in late stage PAD present in the form of intermittent claudication (IC) or critical limb ischaemia (CLI) . The Fontaine classification is commonly used to measure the severity of disease which is staged from l-asymtomatic to lV-gangrene. PAD can be treated by medical , endovascular and surgical management The purpose of this case report is to consider the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities.

Analysis/Spectrum of admitted cases of lower extremity arterial disease (LEAD) in University Hospital of Nepal

Introduction: Peripheral arterial disease is a condition due to partial or complete occlusion of arteries excluding that of heart and brain. Lower extremity arterial disease is specific to lower limbs. Some of the patients are asymptomatic while a majority present with claudication, rest pain, ulceration or even gangrene. Methods: We took all admitted cases of lower extremity arterial disease from January, 2015 to December 2018. ABI was used as the first clinical tool for the diagnosis of PAD in patients with history or physical examination findings suggestive of PAD as per AHA guidelines. Outpatient arterial Doppler ultrasonography complemented by lower limb CT angiogram was used as a confirmatory tool for the diagnosis and also to assess anatomical location and severity of stenosis. Results: Total of 54 cases of lower extremity arterial diseases were identified with a mean age of 59.2 years (S.D. 11.4). Right lower limb was involved in 35(50%). Mean age was 58 years(SD 13.1). Mean duration of symptom was 3.4 years (SD 3.3). Claudication was present in all the patients. 32(45.7%) had ulcers. Toe(44.3%) was most commonly involved. Decreased local temperature(91.4%) and color change(87.1%) were major symptoms. 35(50%) of the patients had gangrene. Mean peak systolic velocity was lowest in the peroneal artery. 16.6% patients got additional peripheral bypass surgery. Conclusion: Claudication, decreased local temperature and color change were very common findings of lower extremity arterial disease. Gangrene was present in half of the patients.