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The study aims to explore the inflammatory cytokines and oxidative stress in children with obstructive sleep apnea syndrome (OSAS) triggered by adenoids and/or tonsillar hypertrophy and their changes after adenotonsillectomy (AT) and to investigate the associated behavioral disorders in OSAS, before and after AT. Thirty patients with OSAS and 20 healthy children, aged 3 - 13 years were included in the study. According to apnea-hypopnea index (AHI), OSAS children were classified into 3 groups: mild (n = 19), moderate (n = 5), and severe OSAS (n = 6). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA) and antioxidant enzymes activities were assessed in serum, preoperative and 6 weeks after AT. TNF-α, IL-6 and malondialdehyde levels were also estimated in adenoid and tonsils tissues. A Pediatric Sleep Questionnaire was completed by the parents before and after AT. As a result of the study, we obtained the following results: TNF-α, IL-6 and malondialdehyde evaluated preoperative increased in serum and tissues in OSAS, especially in severe disease compared to mild and moderate forms. Six weeks after AT, AHI diminished significantly in OSAS, as well as the inflammatory markers and malondialdehyde, in parallel with significant improvement of antioxidant enzymes activities. Daytime sleepiness, hyperactivity and attention deficit in OSAS, even in mild disease were present, with significant improvements of obstructive symptoms after AT. We conclude that OSAS caused by adenoids and/or tonsillar hypertrophy led to changes in the blood parameters, with significant improvement after AT. Postoperatively, a significant improvement in sleep quality and behavior in OSAS patients was also observed.

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INTRODUCTION: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms. METHODS: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters. RESULTS: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; P<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate. CONCLUSIONS: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.

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Adolescence is a period of rapid change and opportunities. It is a coming up of age as children grow into young adults. It constitutes 10-19 yrs of age. In Nepal 23% of the population are adolescents. Across-sectional community based study was carried out in 3 schools in Jhaukhel (Bhaktapur) to determine the prevalence of anemia and the effect of IEC in female adolescents. Does IEC effect improve anemia rapidly. Two hundred four female school children were screened for Hemoglobin estimation by Simple Random Sampling method. Physical examination and nutritional assessment was also done. Hemoglobin estimation was done by Cynomethemoglobin method in their respective schools. Anemia was diagnosed according to WHO guidelines. IEC was given to all adolescents girls thrice in 1 month and again the effect of IEC was studied by estimating hemoglobin. Out of 204, 72 (35.3%) had anemia. Forty (34.2%) had anemia in the age group of 13-15 yrs, followed by 19 in age group 10-12 yrs and mild anemia was found in the age group 16-19 yrs. The adolescents girls whose parents were farmers and labourers were more anemic than others. Twelve (44.4%) maximum anemic girls were observed in those whose parental income was between NPRs 12000-16000. Out of 204 girls only 157 attained menarche. All girls 52 (33.1%) who attained menarche upto 13 yrs had more anemia than others of above 13 yrs of age group. The mean age at menarche was 13.05 yrs. The subjects exhibited increase in Hb significantly P value 0.000. Mean Hb before IEC was 12.26 (SD 1.43) and after IEC it was 12.81 (SD +/- 1.05). The Mean increase in percentage after IEC was 4.48 (SD +/- 9.68) in females. The Range was 20 to 41.18%. The Coefficient of relationship (Karl Pearson coefficient of correlation) between two Hb levels before and after giving IEC was 0.719, which is statistically significant with positive correlation (p = .000) and r2 = 0.516. It is represented as scattered diagram.

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Stature of a person is one of the most important and useful anthropometric parameter for establishing identification of unknown living or a dead person. A descriptive cross sectional study was done on 165 Nepalese adult Musahar females of Aurahi Village of Mahottari district, Nepal to predict the stature from their hand length. Measurement of stature and the length of both right and left hands taken with a standard standing height measuring instrument and a slide caliper respectively showed significant (p<0.001) positive correlation between the stature and hand lengths. The multiplication factor which was obtained by dividing the height of the subject by the respective hand lengths was found appropriate parameter to calculate the stature of a questioned person. The importance of the hand length alone will be of a great value for anthropologists and forensic experts. As an alternative method, the coefficient of regression and intercept which were obtained from the measured height and hand length were also proved to be equally valuable to estimate the height of a questioned person.

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Birth weight (BW) is an important determinant of infant's well being. Several factors such as mothers' genetic characteristics, socio-cultural, demographic, behavioral factors, prepregnancy body mass index (BMI), gestational weight gain (GWG) etc contribute to birth weight. This study assesses the anthropometric measurement of ethnic Nepalese women belonging to Sherpa/Tamang community and Brahmin/Chhetri community and the neonatal outcome in this population. A retrospective study was done in singleton pregnant women of Sherpa/Tamang and Brahmin/Chhetri community who delivered baby in Nepal Medical College and Teaching Hospital from April 2007 to March 2008 to examine the association between the maternal Body Mass Index (BMI) and the gestational weight gain among the two ethnic communities and the birth weight of newborns. Among 206 Sherpa women who met the eligibility criteria, the mean BMI of Sherpa/Tamang community was 23.53 +/- 2.28 which was statistically higher than the Brahmin/Chhetri community (21.6 +/- 2.32). Among Sherpa/Tamang community, the mean gestational weight gain was 12.8 +/- 3.4 kg and the mean birth weight was 3460 +/- 410 grams. Similarly among Brahmin/Chhetri community, mean gestation weight gain was 10.3 +/- 3.1 kg and the mean birth weight was 2960 +/- 340 gm. Maternal BMI, gestational weight gain and birth weight of the newborn was significantly higher in Sherpa/Tamang community and the Increasing BMI and the gestational weight gain was found to have strong association with the birth weight of the newborns among this ethnic community.

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A cross sectional observation study was carried out in primary school children of slum dwelling area of Kathmandu Valley which included 454 students. The aim of study was to find out morbidity in habit disorders in age group of 6-10 years so that early detection will be helpful to correct them to prevent it from further personality maladjustment. There was no statistical difference in gender wise habit disorders. The morbidity is due to multiple factors of physico- social environment. However severity of disease is not more here in this area.

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Kidney stone analysis is the test done on the stone which cause problems when they block the flow of urine through or out of the kidneys. The stones cause severe pain and are also associated with morbidity and renal damage. There is also no clear understanding on the relative metabolic composition of renal calculi. Hence, the study is aimed to find out the chemical composition of it which can guide treatment and give information that may prevent more stones from forming. The study was carried out on the stones that had been sent to the department of Biochemistry (n = 99; M = 61; F = 38; Mean age: 33.6 +/- 14.4 years) Approximately 98.9% of stones were composed of oxalate, 95.9% of Calcium, 85.8% of phosphate, 62.6% of Urate, 46.4% of Ammonium and very few percentages of Carbonate.

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OBJECTIVE: To evaluate the reliability of salivary levels of theophylline in monitoring therapy of apnoea of prematurity. STUDY DESIGN: Aminophylline was administered intravenously in 13 infants with apnoea, in a loading dose of 5 mg/kg and maintenance dose of 3 mg/kg, every 8 h. The patients were divided into two groups according to their postconceptional age (PCA): group A, of infants with small PCA (32.8+/-2.0 weeks; n=6 cases), and group B, infants with higher PCA (37.1+/-0.8 weeks; n=7 cases). RESULTS: A total of 57 paired samples of serum and saliva were obtained in all 13 infants. The mean serum level of theophylline was 7.8+/-5.8 microg/ml and the ratio between serum and salivary concentration of theophylline was 1.53+/-0.28. A strong correlation between the serum and salivary concentration of theophylline (r=0.973) was found. Infants with small PCA had significant higher serum concentration of theophylline than those with higher PCA (10.6 vs 5.3 microg/ml; P=0.0002). The difference between the mean ratios of serum/salivary theophylline levels in the two groups was low (1.44 vs 1.62; P=0.0155). CONCLUSION: The strong correlation of theophylline in serum and in saliva recommends the salivary levels as a reliable method for monitoring the treatment of apnoea of prematurity.

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Long-term therapy with slow-release theophylline is compulsory to be monitorized by measuring serum concentration of the drug. This is due to the narrow therapeutically index of theophylline for monitoring the long term therapy with this drug, and to establish the correlation between the serum and saliva concentration of theophylline. The study group was represented by 13 children with asthma, with the age between 2 and 13 years that received theophylline in an average dosage of 15.2 mg/kg/24 hours. In all of them there were obtained two paired simultaneous samples of venous blood and of saliva, at 4 hours and at 8 hours respectively, after the administration of theophylline. For facilitate the saliva sampling, its production was stimulated by applying citric acid on the tongue and aspiration with a sterile syringe. For measuring the serum and saliva levels of the drug it was used mass spectrometry with 15N-theophylline as internal standard. Serum theophylline concentration varied between 6.56 +/- 4.48 micrograms/ml at 8 hours after drug administration and respectively 7.45 +/- 3.94 micrograms/ml at 4 hours after drug administration. Saliva concentrations of theophylline varied between 4.18 +/- 2.40 micrograms/ml at 8 hours after drug administration and respectively 4.66 +/- 2.39 micrograms/ml at 4 hours after drug administration. The average ratio between serum and saliva concentration in the 24 paired samples was 1.62 +/- 0.18. The intraindividual variation of this ratio was 8.64%.

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In the past decade the use of theophylline was less extensive because of its narrow therapeutically index and due to its side effects. The widening of possibilities of monitoring the treatment by serum level determination, the introduction of slow release formula, and the demonstration of antiinflammatory effects made theophylline to become actual again. Theophylline is indicated for the chronic treatment of asthma in association with other medication. The authors study the efficacy and serum level of theophylline in 13 children with asthma who received slow release theophylline in a dosage of 15.2 mg/body weight/24 hours in average, administered 3 times a day. The efficacy was estimated by a clinical score and the serum level was determined by isotopic mass spectrometry with 15N-theophylline as internal standard. After a period of at least 2 months of therapy it was recorded the amelioration of clinical score (with 5.09 points, that represents 36.3% of the maximum initial score) and the reducing of circadian variation of peak expiratory flow from 27% to 15%. The serum level of theophylline was of 8.25 +/- 4.16 micrograms/ml at 4 hours after administration and of 5.69 +/- 2.6 micrograms/ml at 8 hours after administration of the last dose. The individual values less than 5 micrograms/ml was found in 3 of 13 children at 4 hours and in 7 of 13 children at 8 hours after the last dose. There were no patients with toxic serum levels of theophylline (> 20 micrograms/ml). The correlation between serum level of theophylline and the dosage was weak both at 4 hours (r = 0.054) and 8 hours (r = 0.229) after the last dose. At the same dose there were found high interindividual variations. These findings are arguments for the usefulness of determination of serum levels of theophylline, that together with clinical and functional parameters allowed the individualization of the dosage.

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We compared early versus late re-feeding in the management of acute diarrhoea in the first year of life. In the study group (73 groups) breast feeding was resumed or early re-feeding was performed in non-breast-fed infants, so that the feeding regimen used prior to the onset of the disease was reached within 2-3 days. In the control group (49 patients) late re-feeding was performed so that the infants returned to their original feeding pattern after 4-6 days. there were no significant differences between the two groups in the number of stools and stool output per day, or in the duration of the disease. No weight gain or loss during the diet was noted more frequently in the late re-feeding group (67.2% versus 2.3.4%). This study confirms the favourable effect on body weight of early re-feeding in the management of acute diarrhoea.

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