bluuebunny/crossref_metadata_2025 huggingface dataset:
Aesthetic & Economical Management of Diastema
Authors: Dixit PB , Dixit S
Published: May 2013

Diastema is a space between the teeth. Presence of diastema may lead to self-consciousness and patient may experience low self-esteem. Before closing the diastema, the cause must be understood and the treatment should be well planned. Diastemas are commonly closed by preparing the tooth & restoring it with composite resin. Restorative method with composite resin is the least invasive, economical and aesthetic treatment which can be done in a single visit in comparison to all the other available treatment options. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8149 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 110-113
Etiology of urinary tract infection and drug resistance cases of uropathogenes
Authors: Bhatt CP , Shrestha B , Khadka S , Swar S , Shah B , Pun K
Published: May 2013

Background: Multidrug resistant bacterial isolates have been frequently reported from different parts of the world as emerging treatment problem. Objectives: The study was conducted to find out etiology of urinary tract infection and drug resistance trend among clinical pathogens in urinary tract. Methods: Mid-stream urine samples from patients suspected of urinary tract infection were collected for routine culture and antibiotic susceptibility testing and were processed according to the standard laboratory methods. Results: In this study 41.7% urine samples showed significant bacterial growth. Gram negative bacteria were the predominant organisms. Among them Escherichia coli was the predominant isolate (85.1%) whereas Enterococcus faecalis (40.6%), was the major Gram positive isolate. Among culture positive cases organisms were isolated in highest frequency (29.5%) in the age group 21 to 30 years. Urinary tract infections were found more common in females (61.1%) than in males (38.9%). Nitrofurantoin (82.2%) and Ofloxacin (57.8%) were found to be the most effective drugs against Gram negative organisms, whereas for Gram positive organisms, Nitrofurantoin (87.5%) and Gentamycin (78.1%) were found to be the most effective drugs. Escherichia coli was found sensitive to Nitrofurantoin (89.3%) followed by Ofl oxacin (63.3%). Enterococcus faecalis was most susceptible to Nitrofurantion (92.3%) followed by Cotrimoxazole (76.9%). Conclusion: In this study, among the participants 41.7% had culture positive urinary tract infection. Drug resistance was found to be high in both Gram negative and Gram positive organisms. The high prevalence of drug resistance among urinary tract infection patients calls for the need of judicious measures for control of this infection and knowledge of patterns of resistance helps in deciding empirical therapy for urinary tract infection. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8150 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 114-120
Knocking the doors of residency
Authors: Gupta P
Published: May 2013

DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8151 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 121-122
The need and purpose of launching of a new journal Building up to Excellence
Authors: Pradhan RL
Published: May 2013

DOI: http://dx.doi.org/10.3126/noaj.v1i1.8124Nepal Orthopaedics Association Journal Vol.1(1) 2010
The First Oration of the Nepal Orthopaedic Association Challenges of an Orthopaedic Surgeon in Nepal
Authors: Banskota Ashok Kumar
Published: May 2013

DOI: http://dx.doi.org/10.3126/noaj.v1i1.8125 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Percutaneous trigger finger release
Authors: Pandey BK , Sharma S , Manandhar RR , Pradhan RL , Lakhey S , Rijal KP
Published: May 2013

BACKGROUND: Trigger finger is caused by formation of nodule or thickening of A1 pulley by its fibrocartilage metaplasia resulting in entrapment of the flexor tendon. Conservative treatment of this condition consists of NSAIDs, splint immobilization and steroid injection into the tendon sheath. Failure of the conservative treatment is the indication of an open release. Percutaneous release of trigger finger is advised by several authors. The purpose of this prospective study is to evaluate the results of percutaneous release of trigger finger with 18 gauge needle. METHODS: Fifty one patients with 58 trigger digits were treated by percutaneous release using 18 gauge needle under local anaesthesia. Patients were followed up for an average of 12 months. RESULTS: Overall, 97% achieved an excellent or good result. Two digits experienced recurrent symptoms and required an open release. There was no clinical evidence of digital nerve injury or tendon bowstringing. CONCLUSIONS: We recommend this technique as a safe and effective outpatient procedure for releasing trigger finger. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8126 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Neural Decompression by Laminectomy with Spinoplasty for Lumbar Spinal Stenosis
Authors: Pokharel RK , Kafle K , Pradhan RL , Shah LL
Published: May 2013

BACKGROUND Lumbar spinal stenosis is one of the common morbid conditions of adult population. Surgical intervention is recommended if conservative treatment is not effective. Aim of the surgery is to decompress neural tissues and it may vary from simple unilateral foraminotomy or laminotomy to multilevel bilateral laminectomy. Conventional laminectomy violates posterior stability and foraminotomy limits access to the neural tissues. Different techniques have been developed for adequate decompression with preservation of posterior stabilizing structures. METHODS Degenerative lumbar spinal stenosis in 22 cases was treated by laminectomy with spinous process osteotomy and re-positioning during October 2007 to August 2009. All cases had back pain with radicular pain and intermittent neurogenic claudication. Average age of the cases was 49.5 years and the average duration of symptom was 7 months. Conservative treatment was tried for 4 months. Average follow up period was 2.5 months. RESULTS Post operatively 82% of the cases were satisfied. There was no radicular pain and intermittent claudication in all cases. Persistence of back pain and numbness in lower limbs was common complaints of majority of the cases. CONCLUSION “Laminectomy with spinous process osteotomy and re-positioning” technique easily decompresses lumbar spinal stenosis with preservation of posterior osteo-ligamentous structure. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8127 Nepal Orthopaedic Association Journal Vol.1(1) 2010
One year outcome of Subacromial Methylprednisolone Injection and Psychotherapy for Subacromial Impingement Syndrome
Authors: Lakhey S , Manandhar RR
Published: May 2013

BACKGROUND: Subacromial impingement syndrome is a common cause of pain in the shoulder region. When analgesics and physiotherapy are not helpful in relieving the patient’s shoulder pain, subacromial methylprednisolone injection is given. The aim of this prospective study was to determine the one year clinical outcome of subacromial injections of methylprednisolone and physiotherapy in patients with subacromial impingement syndrome. METHODS: The pain of thirty shoulders in twenty nine patients characteristic of subacromial impingement syndrome was assessed by Visual Analogue Scale (VAS) scores of 0 to 10, and the overall clinical and functional assessment was done by Constant Murley score. Each shoulder received methylprednisolone injection in the sub-acromial space by the posterior approach. The subacromial injections were repeated at two to three weekly intervals (a maximum of three injections) until the pain subsided to 2 or less in the VAS. This was followed by physiotherapy exercises. Treatment Outcome at final follow-up of one year was measured using VAS and Constant Murley Score. RESULTS: Pain before starting the injections was a mean of 7.87 in the VAS (range: 5-10 ). At the end of follow-up, it was a mean of 1.27 (range: 0 to 5). The Constant Murley Score was a mean of 30.83 (range: 6-49) before the start of injections. At the end of follow-up, it was a mean of 84.87(range: 70-96). CONCLUSION: Subacromial methylprednisolone injections followed by physiotherapy exercises can provide statistically and clinically satisfactory pain relief and improvement of shoulder function at one year follow up in 96.7% patients with subacromial impingement syndrome. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8128 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Outcome of Carpal Tunnel Release: a prospective study
Authors: Pradhan NMS , Khan JA , Acharya BM , Devkota P , Rajbhandari A
Published: May 2013

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy and is manifested by characteristic signs and symptoms resulting from median nerve compression at the carpal tunnel. The diagnosis is essentially clinical, which is further confirmed by nerve conduction studies. Surgical release of the transverse carpal ligament is advised when conservative treatment fails.  METHODS: This prospective study evaluates the outcome of standard open carpal tunnel release performed at our center* from June 2004 to July 2007. Thirty two patients with idiopathic carpal tunnel syndrome, with failed conservative treatments, either with NSAIDs and/or local infiltration with corticosteroid injections plus night splint, or recurrence after conservative treatment were subjected to open carpal tunnel release after getting approval from the local ethical committee and getting a written and informed consent from the patient. Clinical assessment was done preoperatively and at 6 weeks, 3 months and 6 months following the procedure and included the two-point discrimination test at the tip of the index finger and Boston questionnaires as an outcome measurement of symptoms severity. All the patients were followed up for a period of six months. RESULTS: All the patients presented improvement in the postoperative evaluations in all the analyzed parameters. CONCLUSION: Open carpal tunnel release is a safe and effective method for the treatment of CTS and can be carried out when the conservative means fail to relieve the symptoms. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8129 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Management of double hand amputees with Krukenberg procedure: An option in Nepal
Authors: KC BR , Chand P , Thapa BB , Joshi A
Published: May 2013

BACKGROUND : For the last 14 years, Nepal has been struggling with armed conflict in which civilian population have also been the victims- targeted or accidental. Mine blast is the major cause of severe injuries involving multiple systems, bilateral crush injuries of the extremities and severe soft-tissue lacerations. To the victims with bilateral hand amputation or one hand amputation with severely crushed non-functional other hand, rehabilitation and performance regarding activities of daily living (ADL) is a huge problem. Krukenberg procedure, where radius and ulna are separated and a pincer like grasp is created, was considered to restore manual dexterity in this group. METHODS: From August 2001 to April 2007, we carried out the Krukenberg procedure on a group of double hand amputees and single hand amputee with severely crushed or partial amputation of the other hand. The procedure was initially carried out on two double hand amputees to assess the functional result and acceptability by the patient. The procedure was carried out at least 3 months after the amputation in all cases. Post-procedure the patients were rehabilitated by physiotherapist for grip strength and performance of Activities of daily living, ADL (i.e. feeding, personal hygiene, dressing and manual dexterity). RESULTS: Five Krukenberg procedures were performed on three patients: all three were males with mean age of 25 years. Two had double hand amputation and one had single hand amputation with severely crushed other hand with ray amputations. All three patients at three months follow-up could perform ADL by themselves. CONCLUSIONS: The Krukenberg procedure is a surgical option for double hand amputees in a poor country like Nepal. DOI: http://dx.doi.org/10.3126/noaj.v1i1.8130 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Neuroarthropathy of the Foot and Ankle
Authors: Banskota B , Bijukachhe B , Shrestha BK , Banskota AK
Published: May 2013

DOI: http://dx.doi.org/10.3126/noaj.v1i1.8131 Nepal Orthopaedic Association Journal Vol.1(1) 2010
Peer Review: The “next step” for a new journal
Authors: Pradhan RL
Published: May 2013

DOI: http://dx.doi.org/10.3126/noaj.v2i1.8132 Nepal Orthopaedic Association Journal Vol.2(1) 2011
Management of Pediatric Displaced Distal Metaphyseal Forearm Fracture: Comparison between Cast Immobilization and Percutaneous Kirschner Wire Fixation
Authors: Shrestha D , Dhoju D , Parajuli N , Dhakal G , Shrestha R
Published: May 2013

Background: Distal metaphyseal forearm fracture is one of the common injuries in children. Closed reduction and above elbow cast is the standard method of treatment but reported to be associated with redisplacement rate of 7-25%. Closed reduction and fixation with percutaneous Kirschner wire is an alternative treatment option to prevent redisplacement. Methods: Thirty five children (group I) of age between 6 to 13 yrs with displaced ( more than 50% of cortical diameter) or angulated (more than 20°) distal metaphyseal forearm fracture managed with closed reduction and above elbow cast were compared with 21 children (group II) managed with closed reduction and percutaneous crossed Kirschner fixation. Clinical outcomes and complications were compared in both groups after 12 weeks of follow up. Results: Preoperative variables in both the groups were comparable. Mean loss of elbow flexion and extension (12° vs. 4°, p =0.08), wrist dorsflexion and palmerflexion (27° vs. 14°, p=0.12) and forearm supination and pronation (27° vs. 15°, p= 0.143) were more in group I but were statistically not significant. Complications rate (28.4% vs. 19.04%, p= 0.04) was higher in group I (such as fracture redisplacement and swelling) than in group II (pin tract infection). Conclusions: Grossly displaced or angulated distal metaphyseal forearm both bone fracture in children treated with either closed reduction and above elbow cast or closed reduction with crossed Kirschner wire fixation have no statistically significant clinical outcomes in terms of loss of movement of elbow, wrist and forearm but complication rate is higher in cast group. Percutaneous Kirschner wire fixation prevents redisplacement. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8133 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 1-6
Serum Lactate –An indicator of morbidity and mortality in polytrauma and multi-trauma patients
Authors: Lamichhane P , Shrestha S , Banskota B , Banskota AK
Published: May 2013

Background: The search for the best marker or set of markers for the diagnosis, prognosis and treatment of ‘at risk’ trauma patients is ongoing. Serial estimation of serum lactate values are thought to help predict morbidity and mortality in trauma victims. There is evidence to support the use of blood lactate levels as an end point of resuscitation. The presence of elevated lactic acid levels in the serum can direct the treating physician to safe and correct timing of any surgical intervention. Early identification and aggressive resuscitation measures aimed at correcting the impaired metabolic dysfunction improves survival and reduces complications in severely injured trauma patients. Methods: A prospective analytical study of 52 patients with polytrauma and multiple trauma admitted within 12 hours of injury to our institution between March 2007 to February 2008 was carried out. All the patients were resuscitated as per the advance trauma life support (ATLS) protocol in the emergency room. Serum lactate level was analyzed on the 1st, 5th and 14th day of injury. Serum lactate levels greater than 2 milimoles/L was considered abnormal and serum lactate level greater than 5 milimoles/L was considered significant. Results: There were 45 males and 7 females with an average age of 32.8 years (18-82). 18 patients out of 52 sustained polytrauma. Of these 18 patients, 8 patients sustained chest injury, 4 had head injury and 2 had abdominal injury. In the polytrauma group (n-18), 5 patients had an elevated lactate above 2 milimoles/Lon admission. 2 patients who had significant rise of lactate (>5 milimoles/L) on admission died on the 5th day. Out of 34 multiple trauma patients, 13 patients had an elevated lactate level at admission. One patient in this group with lactate level 7.2 died of ARDS on 3rd day of admission. Conclusion: Blood lactate appears to be a reliable marker reflecting not only the severity of the shock, but also for predicting survival. The longer the lactate is elevated, the more a patient is likely to develop multiple organ dysfunctions and die. Lactate levels followed over time is more reliable than isolated values. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8134 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 7-13
Displaced Colles fractures: Functional outcome following closed reduction and stabilization with percutaneous K-wires
Authors: Manandhar RR , Lakhey S , Pandey BK , Pradhan RL , Sharma S , Rijal KP
Published: May 2013

Background: Displaced Colles fractures are generally treated by manipulation and below elbow cast application. Malunion is a common complication resulting in pain, mid carpal instability and post-traumatic arthritis. Fracture stabilization by percutaneous pinning is a simple, minimally invasive technique which helps prevent dislodgment of the fracture thereby minimizing complications. The study aims to assess the amount of collapse after closed manipulation and percutaneous pinning with K-wires and its correlation with the functional outcome of the wrist after union. Methods: A prospective study was conducted from October 2006 to November 2009. Fifty adults (27 female, 23 male) with an average age of 40.72 years with type II fractures underwent closed manipulation and percutaneous pinning with crossed K-wires as the primary procedure. Serial radiographs were taken to document the amount of collapse. The functional outcome was assessed using Mayo Wrist Score. Results: At the final follow up of 6 months the collapse in the mean dorsal angle was 1.15 and mean ulnar variance 0.51. Functionally 25 patients (53.19%) had excellent, 17 patients (36.17%) good and 5 patients (10.63%) had satisfactory or fair outcome. Conclusions: Displaced Colles fractures should be reduced and stabilized with percutaneous K-wires to achieve an excellent functional outcome. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8135 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 14-20
Single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spines
Authors: Pandey BK , Sangondimath GM , Chhabra HS
Published: May 2013

Background: Spine is the most common site for osseous involvement of tuberculosis, accounting around 50% cases of musculoskeletal tuberculosis. The most frequent sites of the involvement are the thoracic and lumbar spine. The anterior column is primarily affected resulting in progressive or residual kyphotic deformity even after the eradication of the disease by chemotherapy. Various surgical techniques like anterior fusion, posterior or combined fusion have been described. In this study we evaluated the clinical outcome and radiological results of single stage posterior instrumentation and anterior interbody fusion for tuberculosis of dorsal and lumbar spine. Methods: Details of the patients of tuberculosis of dorsal and lumbar spine operated with single stage posterior instrumentation and anterior interbody fusion from December 2004 to June 2008 were retrieved from the hospital database. There were 55 cases operated with this technique. Thirty patients, whose final details were available, were involved in this study. Pre-operative, post-operative and final follow up clinical and radiological assessments were performed. The follow up ranged from 18 to 60 months. Results: Average operation time was 5 hours 45 minutes and blood loss was 1100 ml. Anterior body fusion was achieved in all the patients. 93.3% of the patients had neurological improvement. Satisfactory post-operative kyphotic angle correction was achieved. There was minimal final loss of kyphotic correction. One patient had post-operative wound infection. Post operative paralytic ileus, chest infection, urinary tract infection, jaundice were the complications found in the patients. No graft related complication was seen. There was no recurrence of the disease in any of the cases. Conclusion: Single stage anterior debridement and interbody fusion with posterior instrumentation can be performed safely to achieve satisfactory clinical and radiographic outcomes in patients of thoracic and lumbar tuberculosis. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8136 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 21-26
Osteosynthesis of Unstable Fractures of Distal Radius with Volar Locking Plate
Authors: Pradhan RL , Sharma S , Pandey BK , Manandhar RR , Lakhey S , Rijal KP
Published: May 2013

Background: Various surgical treatment methods are available for unstable distal radius fractures. Clinical and radiological outcome with volar locking plate has been very satisfactory. The purpose of this prospective study is to evaluate the results of the treatment of unstable fractures with the volar locking plate with regard to loss of reduction, functional outcome and complications. Methods: Unstable distal radius fractures were enrolled for the study from May 2008 until July 2010. All patients were treated with 3.5 mm distal radius volar locking plate and assessed by clinical and radiological examination. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: Eighteen male and 12 female patients with the average age of 42.53 (range 30- 64years) were followed up for a period of 9 to 34 months (average.23 months). There were fourteen A3 fractures, nine C1 fractures, six C2 fractures, and one C3 fracture, whereas one had a Gustilo grade I open wound on the volar aspect. Seven of the fractures had associate fracture of the ulnar styloid. The functional outcome was excellent in 23 (76%), good in 6 (20%), fair in 1 (4%) and none had poor outcome. There were very few complications in our series. Conclusion: Unstable fractures of distal radius treated by open reduction with volar locking plate provides adequate fixation with no collapse in reduction and also have satisfactory functional outcome with minimal complications. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8137 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 27-34
Free hand insertion of pedicle screws in Dorsal / Lumbar / Sacral spine – Our experience
Authors: Bijukachhe B , Shrestha BK , Pandey JR , Banskota AK
Published: May 2013

Background: Fluoroscopic guidance to put pedicle screws helps to confirm the accuracy of the screw in place; however, it is always not mandatory Methods: In 79 patients, 531 pedicle screws were inserted during a period between July 2006 and November 2009. There were 218 pedicle screws in trauma, 138 in TB spine, 107 in Scoliosis, 26 in Scheuermann’s kyphosis, 18 in Spondylolysis / spondylolisthesis and 24 in tumors. In lumbar / sacral region total of 140 screws and in Dorsal region 391 screws were introduced. All screws were inserted free hand without fluoroscopic guidance. Accuracy of the placement was checked per operatively with pedicle probe by sounding technique. Before wound closure and whenever in doubt position of screws was checked under fluoroscope. Post operatively patients were subjected for CT scan to confirm the position of the screws. Seventeen patients with 107 screws were excluded from the study since they were not subjected for post-operative CT scan. The study consisted of 424 pedicle screws in 62 patients. Results: Out of 424 pedicle screws four screws (0.9%) were misplaced. Three patients complained of dysesthesia. Eleven screws (2.5%) were broken at last follow up of 12.6 months. The average surgical time for insertion of the screw without image intensifier is four minutes whereas with image intensifier was 7.5 minutes. Conclusion: Free hand insertion of pedicle screws is safe and time saving. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8138 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 35-42
Stroke and the Orthopaedic Surgeon
Authors: Banskota AK
Published: May 2013

The role that can be effectively played by the orthopaedic surgeon in the long-term management of the stroke victim is often overlooked. Post-stroke patients rely heavily on the orthopaedist, amongst other members of the multidisciplinary team, to regain the maximum possible functional status following the stroke event. A great need to understand and implement the principles of post-stroke orthopaedic treatment and rehabilitation exists in our own community and practice.DOI: http://dx.doi.org/10.3126/noaj.v2i1.8139 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 43-46
Pathology - The Science Behind Cure
Authors: Ali Syed Mukarram
Published: May 2013

DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14967 Delta Med Col J. Jan 2013;1(1): 1-2
Insulin Resistance and Hypogonadism
Authors: Amin Md Ruhul , Pathan Md Faruque , Aktaruzzaman AHM , Qureshi Nazmul Kabir , Akter Fahmida , Rahman Sabura , Huq Md Ehsanul , Shermin Shahana , Rahman Md Rezwanur
Published: May 2013

Backgound: The number of hypogonads is increasing day by day. It may be due to sedentary life style with increased obesity, increased tension or stressed lifestyle among all groups of populations. Visceral obesity is associated with insulin resistance, diabetes mellitus and also with hypogonadism. Objective: This study was carried out to determine the proportion of insulin resistance among male subjects with hypogonadism in different age groups along with status of erectile quality among diabetics and non diabetics. Materials and method: This cross sectional study among 161 adult male subjects aged ? 20 to ? 60 years were purposively selected from Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh between May 2009 to September 2010. Glycemic status and insulin resistance (by HOMA-R) were done and relevant history were documented. Results: The highest proportion (38.9%) of hypogonadism was in ? 50 years age group whereas highest proportion (39.6%) of the eugonads was in the age group of 40 to 49 years. More than half of the hypogonad subjects had weak erectile quality (54.0%) which were followed by absent erectile quality in 32.7% and 13.3% subjects had normal erectile quality. Among the eugonad subjects 41.7% had normal erectile quality, 41.6% subjects had weak erectile quality and 16.7% subjects had no erectile quality. More than ninety percent of the hypogonad subjects and about 60% of the eugonad subjects had insulin resistance. The average HOMA-R was more in the subjects with hypogonadism with diabetes which was highly significant (p-value < 0.001). Conclusion: Hypogonadism is associated with insulin resistance.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14968 Delta Med Col J. Jan 2013;1(1):3-7
Histodemography of Lymphadenopathy
Authors: Majid Nadira , Talukder MA Samad , Ali Syed Mukarram
Published: May 2013

Background: Lymph node enlargement presents a clinical problem whose significance can range from trivial to critical, depending on the cause of lymphadenopathy. Diseases involving the lymph node fall primarily into three categories, which include lymphadenitis, metastatic malignancies, malignant lymphoma. It is not feasible to excise every enlarge lymph node. So clinical selection of patients must take place and diagnosis of definite causes of lymphadenopathy by histological examination is essential for appropriate treatment. Objective: The aim was to find the relation and association of proportion of different types of lymphadenopathy with age and gender. Materials and method: This cross sectional study was done in Delta Hospital Limited, Dhaka, Bangladesh during the period of May 2010 to December 2010. A total 88 cases were studied irrespective of age, sex along with clinical diagnosis. Results: Among the study subjects 55.7% was being benign lesions and remaining were with malignant lesions. Among the benign lesions majority (31.8%) were tuberculosis with female predominance which commonly occurs below the age of 20 years, where as non-Hodgkins lymphoma (33.3%) was the commoner form among malignant cases with male predominance occurs in older age group. Mean (±) age of benign and malignant cases was 22.1 (±12.73) years and 44.1 (±17.37) years respectively. Conclusion: The present study revealed that lymphadenopathy occurs more commonly in the middle age group with predominance of benign lesions. Among the benign lesions tuberculosis is the most common one and non-Hodgkins lymphoma is the commonest malignant lesion.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14969 Delta Med Col J. Jan 2013;1(1):8-12
Morphometrical and Topographical Anatomy of Position of Nutrient Foramen on Fully Ossified Left Femur
Authors: Chowdhury Md Shahajahan , Naushaba Humaira , Begum Jahanara , Ahmed Shameem , Khan Laila Farjana , Parash Tanvir Hossain , Qashem Rubina
Published: May 2013

Background: The femur is the typical long bone of lower limb which extends from the pelvis to the knee. It forms the skeleton of the thigh, bears body weight, supports movement of legs; provide attachment to muscles, form blood cells and acts as a store house for calcium and phosphate. The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves. The majority blood supply for femur originates from the nutrient arteries, mainly during the growing period and during the early phase of ossification. In bone grafts the nutrient blood supply is crucial and it should be preserved in order to promote the fracture healing. Objective: The anatomy of nutrient foramen of femur is very essential for orthopedic & vascular surgeons as well as to radiologists for planning of treatment. Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012. The study comprised 199 fully ossified left sided dry femur of both sex (n=89 male, n=110 female). Sampling technique was purposive. Morphometric and topographic study was carried out on all samples by direct physical and photographic methods. Results: The most common position of nutrient foramen on the shaft of femur was found on the middle 1/5th in both male and female femur (50.78% in male and 56.86% in female respectively). Conclusion: The anatomical knowledge about this study might be useful in certain surgical procedures as well as micro vascular bone transfer to preserve the circulation.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14970 Delta Med Col J. Jan 2013;1(1):13-15
Nd:YAG Laser Posterior Capsulotomy and Visual Outcome
Authors: Bari Khaleda Nazneen
Published: May 2013

Background: Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a relatively noninvasive procedure that is used in the treatment of posterior capsular opacification (PCO). PCO is caused by proliferation of lens epithelial cells which causes fibrotic changes and wrinkling of the posterior capsule and results in decreased vision, glare, and other symptoms similar to that of the original cataract. Objective: To find out the visual outcome after performing Nd:YAG laser capsulotomy for PCO. Materials and method: A prospective clinical trial was carried out in National Institute of Ophthalmology (NIO), Dhaka, Bangladesh from January 2010 to June 2011 on purposively selected 70 adult subjects of both sexes who developed PCO within 2 months to more than 2 years after extracapsular cataract extraction with posterior chamber intra ocular lens implant. After thorough pre laser assessment Nd:YAG laser capsulotomy was carried out with Zeis VISULAS YAG II through Zeiss slit lamp under topical anesthesia. Data were recorded and expressed as proportion. Results: Out of the 70 subjects 40 were male and 30 were female. The average time interval of cataract surgery and Nd: YAG laser capsulotomy was 23 months. Capsular fibrosis (57.04%) was the predominant type of PCO. The pre laser visual acuity (VA) of more than 61.06% of eyes was 6/36 or below while 41.12% had VA hand movements to finger count. After Nd:YAG laser capsulotomy VA of 6/18 or better was achieved in 63.9% of eyes while 9.94% recovered to 6/9 and 11.36% achieved 6/6. None of these eyes showed further deterioration in VA. Conclusion: Nd:YAG laser capsulotomy for PCO is safe, effective and a rewarding procedure for improvement of vision.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14971 Delta Med Col J. Jan 2013;1(1):16-19
Bifidogenic Effect and the Immunity Power of Human Breast Milk
Authors: Islam Md Rafiqul
Published: May 2013

Bifidobacteria finds optimal living conditions for growth and overgrowth in the colonized part of the bowel when the chyme is rich in malabsorbed carbohydrate and poor in protein. Such condition is fulfilled with breastfeeding. Though the bifidogenic principle of human milk is attributed to the protein free fraction, the quality and quantity of its protein play an important role in the origination and maintenance of microflora .The low concentration of protein in human milk, the properties of this protein and the presence of specific proteins that inhibit competing microbes in the intestinal microflora are essential components of the bifidogenic principle of human milk. Due to the presence of immunological factors in breast milk like antimicrobial agents, anti-inflammatory agents, and immunomodulatory agents, human milk plays vital protective and defensive role when the infants immune apparatus is immature. It also contributes early childhood growth and development when the infant is absolutely dependent on his/her caregivers for provision of nutrition.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14972 Delta Med Col J. Jan 2013;1(1):20-24
Verrucous Carcinoma in External Auditory Canal  A Rare Case
Authors: Rahman Md Zillur , Bhowmik Bithi , Islam Robiul , Hossain Rakib
Published: May 2013

Verrucous carcinoma is a variant of squamous cell carcinoma. It is of low grade malignancy and rarely present with distant metastasis. Oral cavity is the commonest site of this tumour, other sites are larynx, oesophagus and genitalia. Verrucous carcinoma in external auditory canal is extremely rare. This is the presentation of a 45 years old woman who came to the ENT & Head Neck Surgery department of Delta medical college, Dhaka, Bangladesh with discharging left ear and impairment of hearing on the same side for 7 years. Otoscopic examination showed a mass occupying almost whole of the external auditory canal and the overlying skin was thickened, papillary and blackish. Cytology from external auditory canal scrap showed hyperkeratosis and parakeratosis. External auditory canal bone was found eroded at some parts. Excision of the mass was done under microscope. Split thickness skin grafting was done in external auditory canal. The mass was diagnosed as verrucous carcinoma on histopathological examination. Afterwards she was given radiotherapy. Six months follow up showed no recurrence and healthy epithelialization of external auditory canal.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14973 Delta Med Col J. Jan 2013;1(1):25-27
Reviewers in this issue Vol.1(1)
Authors: Editor The
Published: May 2013

DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14974 Delta Med Col J. Jan 2013;1(1):28
Effect Of Sodium Dodecyl Sulfate On Viscometric Properties Of Methanol, Ethanol, n-Propanol And iso-Propanol At Different Temperatures
Authors: Motin MA , Mia MA Hafiz , Islam AKM Nasimul , Reza KM Salim , Yousuf MA
Published: May 2013

The critical micelle concentration (CMC) of Sodium Dodecyl Sulfate (SDS) in water was determined from the conductance and viscosity measurement. The estimated value of CMC was found to be 0.0085 mol.L-1 at 29°C. The concentration of SDS in pre-micellar and post-micellar region of 0.005M and 0.01M, respectively were used for the viscometric measurements of Methanol, Ethanol, n-Propanol, iso-Propanol at different temperatures. Viscosities of ternary mixtures of Methanol, Ethanol, n- Propanol and iso-Propanol in 0.005M and 0.01M aqueous SDS have been studied over the entire range of composition at 298.15- 323.15K with an interval of 5K except Methanol. Methanol system was studied at 298.15-308.15K owing to its low boiling point. Viscosities increase rapidly with alcohol concentration and show maxima in aqueous SDS rich region at 0.2  0.3 mole fraction of alcohols. The position of maxima virtually does not change remarkably with the variation of temperature. The excess viscosities, ?E values are found to be positive and large in magnitude, indicating that aqueous SDS solutions of alcohols are highly non ideal. The heights of the maxima are in the order:iso-Propanol + aqueous SDS > n-Propanol + aqueous SDS > Ethanol + aqueous SDS > Methanol + aqueous SDS.The excess viscosities, ?E data have been fitted by the least square method to the four parameter Redlich-Kister equation and the values of the parameter aj have been reported. Journal of Bangladesh Chemical Society, Vol. 25(2), 110-123, 2012 DOI: http://dx.doi.org/10.3329/jbcs.v25i2.15046
Preparation Of Carboxymethyl Cellulose/Acrylamide Copoly-Mer Hydrogel Using Gamma Radiation And Investigation Of Its Swelling Behavior
Authors: Sultana S , Islam MR , Dafader NC , Haque ME
Published: May 2013

Acrylamide (AAm)/carboxymethyl cellulose (CMC) blend hydrogels have been prepared by the application of gamma radiation from C0-60 source at room temperature (27°C). The preparation conditions such as effect of CMC concentration and radiation dose on gel fraction and swelling behaviors were investigated. The maximum value of gel fraction is obtained at 25 kGy radiation dose. The swelling properties were investigated in distilled water, saline solution (NaCl) and buffer medium. The maximum swelling value of hydrogel was obtained at 48 hours in water. The swelling ratio of hydrogel decreased with increase in concentration of NaCl in swelling medium. In buffer, it was found that swelling ratio increased with increase in pH of medium. Journal of Bangladesh Chemical Society, Vol. 25(2), 132-138, 2012 DOI: http://dx.doi.org/10.3329/jbcs.v25i2.15065
Influence Of Caffeine On The Redox Characteristics Of Iron In Aqueous Solution
Authors: Jabbar Md. Abdul , Kabir Md. Humayun , Chowdhury Reaz Ahmed
Published: May 2013

Electrochemical investigation of the influence of caffeine on the redox behaviour of iron (Fe) was studied by using cyclic voltammetry (CV) and chronocoulometry (CC) in aqueous solution. It was found that caffeine retards the heterogeneous charge transfer of Fe due to the formation of Fe-caffeine complex. Qualitative information for the formation of Fe-caffeine complex was obtained from CV and CC data. Jobs plot suggested that a 1:1 complex of Fe-caffeine was formed in aqueous media. The active center of caffeine for the formation of Fe-caffeine complex was found between O(33) and O(34) position, revealed from MOPAC (Semi-empirical computation, molecular orbital packagePM3) computation. Journal of Bangladesh Chemical Society, Vol. 25(2), 166-179, 2012 DOI: http://dx.doi.org/10.3329/jbcs.v25i2.15083
High Blood Pressure can be Controlled by Reducing Extra Table Salt Intake
Authors: Alamgir AKM , Ali Shah Mohammad Keramat , Haque KMHS Sirajul , Ali Md. Zulfikar
Published: May 2013

Background: This quasi-experimental community trial was done through door-to-door health education to find out effect of reducing extra table salt intake on patients with high blood pressure.Material and Method: This study was conducted among 4,930 respondents out of 7,474 population (response rate was 65.96%). Respondents had age 18 years or above living in Mohammadpur area of Dhaka city in Bangladesh. Study period was from August 2005 to February 2009. Intervention was for 18 months on 282 (male 69.5% and female 30.5%) respondents with stage-I hypertension. Respondents on trial had no co-morbidity and they were neither aware about their hypertension nor were ever treated for it. The intervention was given person-to-person to quit extra table salt after signing the informed consent form. Follow-up for selected parameters were done after 6, 12 and 18 month of intervention. Data analysis and interpretation were done through SPSS.Result: Mean Blood Pressure of the respondents was found to be 121/78 mmHg. Overall prevalence of hypertension is 20.1% (JNC-7 criteria). After 18m intervention percent reduction of SBP is -7.0% and DBP is -9.9%. Blood pressure of 14.9% (n=42) went up in spite of behavioural risk reduction. Normal blood pressure was found among 7.8% respondents having stage-I hypertension while 17.7% remained at stage-I but their blood pressure is reduced. Multinominal regression analysis showed chi-square value of 25.8 df 13 p=0.018 between use of extra table salt and systolic blood pressure while the value was 28.684 df 11 p= 0.003 for diastolic blood pressure in a -2 Log Likelihood reduced model. At beginning 44% respondents used extra salt while eating. After 6m, 12m and 18m of intervention, extra salt intake was found among 20.6%, 5.0% and 1.8% respondents respectively. Quantitatively extra salt intake reduced from 63±6.5g per week at beginning to 29±4.6g per week after 18m intervention. Change of salt intake was significantly related to change of both SBP (F= 9.688; p=0.000) and DBP (F=6.544; p=0.002). Quality of life was evaluated for both subjective and objective indices.Conclusion: Reversal of hypertension was 56.7% by lifestyle modification and behavioural changes including salt intake reduction. This study confirmed relation of salt with hypertension and also confirmed reduction of blood pressure after reducing salt intake. This study recommended no extra salt intake for patients at risk or with high blood pressure.DOI: http://dx.doi.org/10.3329/kyamcj.v1i2.13314KYAMC Journal Vol.1(2) January 2011, 48-53
Prospect of Destandau microendoscopic lumbar discectomy in Bangladesh
Authors: Asaduzzaman Khan , Anwer Masud
Published: May 2013

DOI: http://dx.doi.org/10.3329/kyamcj.v1i2.13318KYAMC Journal Vol.1(2) January 2011, 70-73
Electrocardiography and Chest X-ray in Prediction of Left Ventricular Systolic Dysfunction
Authors: Siddiqui Md Nure Alom , Sultana Shahnaj , Hossain Abul , Siddiqui Muhammad Afsar
Published: May 2013

Introduction: Echocardiography is the definitive diagnostic tool for left ventricular systolic dysfunction. But it is expensive and requires trained manpower and thus might not be available in the primary care set up. EGG and Chest X ray, the more basic investigations, may help diagnose LVSD or at least streamline those who absolutely require echocardiography in primary care setup. Methods: ECG, Chest X ray and Echocardiography along with clinical assessment were performed on 70 patients with some form of complaints related to heart. The inferences on systolic function obtained from ECG, Chest X ray were compared with Echocardiography findings. Results: Out of 70 participants, 50 had left ventricular ejection fraction less than 45%, 56 had abnormal EGG, 60 had cardiomegaly in chest X-ray. A set of pre-selected ECG abnormalities had a sensitivity of 100% (83.4-100), specificity of 70% (35.4-91.9) and a positive predictive value of 89.3% (70.6-97.2) in diagnosing LVSD. Likewise, the figures were 92% (72.5-98.6), 30% (8.l-64.6) and 76.7% (57.3-89.4) respectively for a cardiothoracic ratio of more than 0.5 in chest X-ray. Conclusions: Although, ECG and Chest X-ray could not replace Echocardiography, they could very well give an idea of the systolic function of an individual and suggest the need or no need for an echo-study in primary care setup.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13515 KYAMC Journal Vol.2(1) 2011 pp.118-122
Lofgren syndrome: Acute Variant of Sarcoidosis, A case report
Authors: Siddiqui M Nure Alom , Siddiqui Muhammad Afsar , Sultana Shahnaj
Published: May 2013

Lofgren's syndrome is an acute form of sarcoidosis that is characterized by erythema nodosum (EN), bilateral hilar lymphadenopathy (BHL) accompanied by arthritis or arthralgia. We are reporting a 32 year old male with Lofgren's syndrome and then the literature is reviewed. Keywords: lofgren's syndrome, sarcoidosis.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13520 KYAMC Journal Vol.2(1) 2011 pp.145-148
A Case report on non-invasive ventilation in the management of acute COPD exacerbation (AECOPD)
Authors: Yousuf Mohammed , Assaduzzaman Khan , Islam Mohammad Saiful , Mowla SM Niaz
Published: May 2013

Recent years have seen the emergence of noninvasive ventilation (NIV) as an important tool for management of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Several well-conducted studies in the recent years have established its role in the initial, as well as later management of these patients. The aim of this case report is to encourage ICU physician to use NIV on selected AECOPD patients, therefore to reduce the need for endotracheal intubation, the length of hospital stay, and the risk of death. In this case report, we selected a case of AECOPD whose symptoms were getting worse in spite of adequate conventional treatment. He was given NIV for 20 hours following a standard protocol. Final result showed significant improvement in patient's symptoms, vital signs and ABG parameters ultimately patient stay time in ICU was reduced and patient was also benefited financially. From this first ever-successful application of NIV in our ICU we learned that we can use it successfully in next cases.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13522 KYAMC Journal Vol.2(1) 2011 pp.152-155
Role of Corticosteroids in the Treatment of Tuberculosis: An Evidence-based Update
Authors: Siddiqui MNA , Sultana Shahnaj , Ekram ARM Saifuddin
Published: May 2013

Corticosteroids are often used as an adjunct in the treatment of various forms of tuberculosis (TB) and for the prevention of complications, such as constrictive pericarditis, hydrocephalus, focal neurological deficits, pleural adhesions, and intestinal strictures. Notwithstanding, they have been proven in clinical trials to improve the following outcomes only death or disability in human immunodeficiency virus (HIV)-seronegative patients with tubercular meningitis and tubercular pericarditis. Despite a lack of specific evidence for efficacy in HIV co-infected patients with tubercular meningitis or pericarditis, corticosteroids are generally recommended in them as well. Corticosteroids significantly decrease the risk of pleural thickening in patients with tubercular pleural effusion; the clinical significance of this finding, however, is unclear. Recently, it has been demonstrated that use of corticosteroids improves the morbidity in HIV co-infected patients with paradoxical TB immune reconstitution inflammatory syndrome (IRIS). However, evidence favouring the use of corticosteroids in other clinical situations is sparse or lacking. Likewise, the biological mechanisms underlying their beneficial effect in TB meningitis and pericarditis remain poorly understood.DOI: http://dx.doi.org/10.3329/kyamcj.v2i2.13265KYAMC Journal Vol.2(2) January 2012, 198-204