Assay of iodine deficiency status in three ecological regions of Nepal by a microdigestion method

Iodine deficiency disorders (IDD) are a global public health problem. In continuation of the efforts to eliminate the iodine deficiency in different parts of the world, IDD surveys are being conducted to assess the status of iodine nutriture. A survey was conducted in Nepal in 1998 with assistance from UNICEF. We present the status of the iodine nutriture, as assessed from urinary iodine levels of casual samples by a micro-digestion method, in the three ecological regions: Terai (flat region), Hilly region (300-3,000 m altitude) and mountainous regions (>3,000 m altitude) of Nepal. Terai region is more affected, having iodine deficiency in 18.6% of the population. The hilly and mountainous regions were found to have 11.2% and 9% iodine deficient populations respectively. The study shows improvement in iodine deficiency status with respect to previous surveys yet it continued to be prevalent in the country as a major public health problem which requires strengthening of preventive measures.     

Thyroid dysfunction in eastern Nepal

Nepal lies in an area of endemic iodine deficiency. Thyroid dysfunction, along with a higher than average prevalence of goiter, is a major public health problem among the local population. The present study was undertaken to investigate the prevalence of thyroid dysfunction among the hill and terai (low land) castes of eastern Nepal that attended the thyroid clinic at the BP Koirala Institute of Health Sciences (BPKIHS), Dharan. A total of 599 cases were studied during a single year. The distribution of hyperthyroid and hypothyroidism was 13.68% and 17.19% respectively. The majority of the thyroid dysfunction was seen in the 21-40 year age group. The prevalence of hypothyroidism was slightly higher among terai castes (17.66%) when compared with hill castes (15.17%). There was a similar distribution of thyroid dysfunction among the male and female populations of the goitrous subjects (n=157), most were euthyroid (58.59%); hyperthyroidism affected (27.38%). Since, it was a hospital-based study, the prevalence of thyroid dysfunction may not be applicable to the general population. Extensive field-based countrywide epidemiological studies are necessary to provide data about thyroid dysfunction in the community.     

A clinico-epidemiological study of organophosphorus poisoning at a rural-based teaching hospital in eastern Nepal

Thirty-seven patients with severe organophosphorus poisoning (OPP) presented to the emergency ward of BP Koirala Institute of Health Sciences between January 1995 and December 1996.The mean age of patients was 26.9 years.There were 17 (46%) males and 20 (54%) females, with male:female ratio being 1:1.2.Twenty-three (62%) patients were unmarried with 16 (46%) of them students.The most common reason for poisoning was suicide--32 patients (86.5%).The most commonly involved compound was Metacid (methyl-parathion)--23 (62%) patients. Ninety per cent of the patients presented within 2 h of ingestion. All patients were managed with intravenous atropine. Pralidoxime was given to patients with nicotinic symptoms and mechanical ventilation initiated in patients with respiratory distress.The mean dose of atropine used in the first 24 h and during the hospital stay was 30.6 mg and 136.7 mg, respectively.The mean duration of treatment was 5.5 days (range 2-20 days).Two patients developed intermediate syndrome and the overall mortality among hospitalized patients was 8%.     

Right lower quadrant abdominal mass: A case report

Right lower quadrant mass in the abdomen has many causes, but gastric perforation is rare. We discuss a 65‐year‐old lady who presented with a history of pain in her abdomen followed by swelling in her right lower abdomen. During the evaluation, a diagnosis of gastric perforation was made.     

Type IV jejunal atresia with an unusual variation of enteric duplication: report of a case

We report a rare case of type IV jejunal atresia with enteric duplication and multiple diverticuli, found in a 3-day-old baby girl. To our knowledge, this association has never been reported before.     

Progestin-inducible EDD E3 ubiquitin ligase binds to α4 phosphoprotein to regulate ubiquitination and degradation of protein phosphatase PP2Ac

Mammalian α4 phosphoprotein binds to the protein phosphatase 2A catalytic subunit (PP2Ac) to regulate PP2A activity, and to poly(A)-binding protein (PABP) and progestin-inducible EDD E3 ubiquitin ligase. This study showed induction of the EDD protein by progesterone, 17β-estradiol and prolactin in breast cancer cells. Co-immunoprecipitation analyses, using lysates of COS-1 cells transfected with α4-deletion constructs, showed the α4 N-terminus binding to endogenous PP2Ac and PABP, and the C-terminus to EDD. Monoubiquitinated α4 in MCF-7 cells was unaffected by EDD-targeting siRNA (siEDD) nor by non-targetting siNT, thus, EDD does not ubiquitinate α4. PP2Ac is polyubiquitinated, and 36-kDa PP2Ac only was detected in siEDD- or siNT-transfected cells. However, treatment with proteasomal inhibitor MG132 showed polyubiquitinated-PP2Ac molecules (∼65–250 kDa) abundantly in siNT controls but low in siEDD-transfectants, implicating PP2Ac as an EDD substrate. Finally, progesterone induction of EDD in MCF-7 cells correlated with decreased PP2Ac levels, further implicating hormone-inducible EDD in PP2Ac turnover.     

Unusual mode of firearm injury from the recoiled rear end of a gun barrel

Atypical gunshot wounds are caused by a diverse set of parameters relating to weapons and ammunition. We report a previously-unreported and atypical mode of gunshot wound produced by a detached rear end of the barrel of a gun following accidental gun fire, and discuss the difficulties in the management. A 36-year-old man presented to the emergency department with an alleged history of injury on the forehead with the rear end of a gun barrel following accidental gunfire while cleaning the nozzle. Since the time of injury, the patient was in an altered sensorium and had weakness on the right side of the body. There was minimal but continuous bleeding from the wound, with extrusion of brain matter. Skull radiograph showed that the rear end of the barrel had entered the left frontal bone, with associated depressed fracture of the frontal bone. The patient underwent a bicoronal, bifrontal craniotomy with a T-shaped extension towards the barrel to facilitate the reflection of the scalp flap and to avoid any movement of the barrel as it might further injure the brain. Necrotic brain, dura and bone pieces were removed. The patient was doing well at follow-up except for mild residual motor deficits. This case illustrates that while working with limited facilities, particularly in underdeveloped countries, a careful clinical assessment, interpretation of available images and a judicious operative approach can help to save the patient.     

Cyno-EBV (EBV-related herpesvirus from cynomolgus macaques) induces rabbit malignant lymphomas and their tumor cell lines frequently show specific chromosomal abnormalities.

Malignant lymphoma (ML) induction in rabbits by Epstein-Barr virus (EBV)-related herpesvirus of cynomolgus (Cyno-EBV) is reported. Twenty-seven of 30 (90%) rabbits inoculated intravenously with Cyno-EBV-producing simian (cynomolgus) lymphocyte cell line (Ts-B6) cells developed ML between 45 and 115 days after inoculation. The peroral inoculation of Ts-B6 cells induced ML in only 2 of 10 (20%) rabbits (75 to 85 days). Five of 6 (83%) rabbits injected with cell-free pellets from Ts-B6 cultures also developed ML (27 to 122 days). Antibody response to the viral capsid antigen of EBV was also detected in sera from rabbits inoculated with Ts-B6. ML of the large cell or mixed type infiltrated diffusely in many organs, frequently involving the spleen, liver, kidneys, heart, and less frequently the lungs, lymph nodes, brain, eyes, gastrointestinal tract, thymus, and bone marrow. A chromosomal analysis of five lymphoma cell lines established from tumor-bearing rabbits revealed the rabbit karyotype. Three of these cell lines showed the chromosomal abnormalities with 12q- or t (7p+:12q-). EBV-encoded small RNA-1 and EBV-associated nuclear antigen 1 were expressed in Ts-B6 cells, the tumor tissues, and all rabbit cell lines by in situ hybridization and by immunofluorescence tests, respectively. EBV DNA was also detected in Ts-B6 cells and rabbit lymphoma cell lines by polymerase chain reaction and Southern blot analysis. The Southern blots of EBV termini revealed oligoclonal bands in the Cyno-EBV-induced rabbit lymphomas. No lymphoma was induced by the inoculation of B95-8 (EBV-producing cells) or peripheral leukocytes from normal cynomolgus (controls). These data suggest that the high rate of lymphoma induction in rabbits may be caused not by human EBV (B95-8) but by Cyno-EBV from Ts-B6 cells. A sequence analysis of the IR1 (BamHIW) region of Cyno-EBV revealed that this region is quite similar to that of herpesvirus Macaca fascicularis 1, which is a causative agent for a monkey model of AIDS-related lymphomas. The present rabbit model of lymphoma with specific chromosomal abnormalities is very useful to clarify the role of EBV in human EBV-associated lymphoma and provides a means for studying prophylactic and therapeutic regimens.