The implications of these amendments in the clinical research are highlighted. Keywords Consent; Declaration of Helsinki; ethics; experimental medicine; research; seventh revision.BACKGROUND Rheumatoid arthritis and Periodontitis both are chronic destructive inflammatory disorders characterized by dysregulation of the host inflammatory response and increase in localized and systemically circulating pro-inflammatory cytokines. The objective of this study was to determine prevalence of periodontitis among Rheumatoid Arthritis patients in our setup. METHODS A crossectional study was done in 43 cases of diagnosed Rheumatoid Arthritis patients visiting to department of Orthopedics of Bir Hospital during the period of July 2016 to January 2017 were examined for presence of periodontitis and its severity. A descriptive questionnaire was also prepared concerning age, sex, personal history. Parameters to be measured were Plaque Index, Gingival Index, Pocket Depth and Clinical Attachment Level. RESULTS Prevalence of periodontitis among Rheumatoid Arthritis patients was found to be 86.04% (37) with Mild periodontitis in 9%(4), Moderate periodontitis 56% (24)and severe periodontitis in 21% (9). The commonest age group was 50.41±9. with male to female ratio of 13 Conclusions Periodontitis was common in Rheumatoid Arthritis in our set up. Moderate periodontitis was more frequent. Periodic oral examination of patients with Rheumatoid Arthritis is required to improve periodontal health.BACKGROUND The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver. Selleckchem EN4 METHODS This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test. RESULTS A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries. CONCLUSIONS Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.BACKGROUND Anterior cruciate ligament is one of the commonly injured ligaments in knee. The shape and dimension of the femoral notch has been linked with the risk of anterior cruciate ligament injury. The aim of this study was to study the risk of Anterior cruciate ligament injury with notch morphology in the Nepalese population. METHODS This study is a case control study. Cases undergoing arthroscopic surgery at 2 tertiary level centers were enrolled. Patients with arthroscopic confirmation of Anterior cruciate ligament tear were taken as case and those without tear were taken as control. Axial Magnetic resonance Imaging sequence was used to study notch. Sections at the level of popliteal groove was taken for study and shapes were identified as A, U and W type, and notch width index was calculated. These variables were correlated with presence or absence of Anterior cruciate ligament tear. RESULTS Out of 118 cases, 59 had tear, and 59 had no tear. Tear was found in 74% of Type A notch compared to 30.15% in Type U notch. The femoral notch width index was low in 42.59% of A type notch patients compared to 20.63% with U type notch. Analysis of notch width index among patients with Anterior cruciate ligament tears, showed that 40.67% of Anterior cruciate ligament torn knee had narrow notch compared to 22% in non- injured group, which was statistically significant. CONCLUSIONS Type A notch and narrow notch both are risk factors for Anterior cruciate ligament tear.BACKGROUND Disturbances of the autonomic nervous system play a crucial role in the pathogenesis and clinical course of many diseases. Sympathetic response is an exaggerated response to stress. Studies have shown that enhanced sympathetic response to stress is an indication of prehypertensive states. Young offspring of hypertensive parents are a good model for assessing sympathetic reactivity prior to clinical hypertension. The aim of this study is to compare the sympathetic response in normotensive offspring of both hypertensive and normotensive parents. METHODS 100 young normotensives, non-smoking and healthy students (male and female) of Manipal College of medical science with a family history of hypertension and 100 young normotensives students, non-smoking and healthy with a negative family history of hypertension were enrolled in the study. Blood pressures at rest and after Isometric hand grip test and cold pressor test were measured. Statistical analysis was done to compare the blood pressure at rest and after isometric hand grip exercise and cold pressor test using independent t test. RESULTS A statistically significant increase in systolic and diastolic blood pressures were observed in normotensive offspring of hypertensive parents, compared to the normotensive offspring of normotensive parents indicating sympathetic overactivity after isometric hand grip exercise and cold pressor test (P less then 0.001). CONCLUSIONS Normotensive offspring of hypertensive parents showed increase sympathetic reactivity after stress was given in the form of isometric hand grip exercise and cold pressor test. Thus, normotensive offspring of hypertensive parents are more likely to develop future hypertension and the risk is greater when both the parents were hypertensive.BACKGROUND Drug therapy and adherence to the medication is critical to prevent complications of hypertension and more importantly in countries like Nepal where more than one quarter adults suffer from it. Primary aim was to measure adherence to anti-hypertensive medication and factors associated with low adherence. METHODS Morisky Medication Adherence Scale was used for measuring medication adherence and a structured questionnaire for measuring background and illness related factors in a cross-sectional study among 216 hypertensive patients in a tertiary care hospital selected through sequential sampling. Data was analysed using descriptive and inferential statistics and results presented with proportion or odds ratio with 95% CI. RESULTS It was found that 72% of the patients had low adherence to anti-hypertensive medication, with sub-group differences notably higher among females (77%); among those with co-morbidity (80%); and among those getting medicines free of cost (76%). Post multivariate logistic regression, it was found that patients with co-morbidity had higher odds of having low adherence (Adjusted Odds Ratio - AOR 2.50; 95%CI1.28-4.89) than those without; and those who get medicine free of cost had higher odds of having low adherence (AOR 3.01; 95%CI1.32-6.86) than those who pay for medicine. CONCLUSIONS A substantial proportion of hypertensive patients had low adherence to medication. Presence of co-morbidity, getting medicine free of cost, and not having regular follow up were the major factors associated with low adherence to anti-hypertensive medication. Targeted interventions in hospitals and health care centers in Nepal would improve medication adherence.BACKGROUND The screening tests used for pre-operative evaluation of airway to predict difficult laryngoscopy and intubation have variable diagnostic accuracy. The unanticipated poor laryngeal view is gold standard for defining difficult intubation. We aimed to find out the prevalence of difficult laryngoscopy and intubation, which airway parameter better predicts difficult intubation and whether difficult laryngoscopy is associated with difficult intubation or not. METHODS This analytic cross sectional study was conducted in 665 ASA I/II adult patients, aged 18-65, without obvious airway pathology undergoing elective surgery under general anesthesia. The pre-operative screening tests included mouth opening, modified mallampatti, ratio of height to thyromental distance, sternomentaldistance and upper lip bite test. Cormack-Lehane grade III/ IV was defined as difficult laryngoscopy and potentially difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under curve at 95% confidence interval was calculated for all five screening tests. RESULTS The prevalence of difficult laryngoscopy and intubation was 6.6% (44 cases). The upper lip bite test because of its highest specificity, positive predictive value, negative predictive value, accuracy and area under curve (99.7%; 93.9%; 99.7%; 95.2%; 85.1% respectively) with moderate level of sensitivity (70.5%) was better predictor of difficult intubation than other tests. The difficult laryngoscopy was associated with difficult intubation (p=0.00). CONCLUSIONS The prevalence of difficult laryngoscopy and intubation was 6.6%.The upper lip bite test was a better predictor of difficult intubation and there was a significant association of difficult laryngoscopy with difficult intubation.BACKGROUND Fibreoptic bronchoscopy is one of the most vital procedures performed in health care setting. Globally, several studies have reported findings of fibreoptic bronchoscopy while only few studies have been reported in Nepal. The aim of this study was to perform two year retrospective analysis of diagnostic fibreoptic bronchoscopy at tertiary referral centre. METHODS A hospital based retrospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Consecutive bronchoscopy reports from June 2017 to May 2019 were included. Data entry and analysis was done in Microsoft Office Excel 2010. Descriptive statistics was performed to obtain clinico-demographic profile of patients, indications and findings of bronchoscopy. RESULTS A total of 238 bronchoscopy procedures were analyzed. Mean age of patients was 55.02 years with range from 15 to 84 years. Majority of bronchoscopy were performed in male patients (58%). One hundred and twelve patients (47.05%) had no endobronchial lesion. Endoscopically visible tumor was the most common abnormality seen in 57 (23.9%) patients with highest prevalence in 55-65 years followed by extrinsic compression of bronchial tree seen in 13 (5.5%) patients. Bronchioalveolar lavage for routine examination (n=207) was the most commonly performed procedure during bronchoscopy followed by bronchial biopsy (n=55). CONCLUSIONS Fibreoptic bronchoscopy is an extremely useful tool for evaluation of tracheobronchial pathology. Baseline bronchoscopic findings from tertiary referral centre in Nepal was obtained in this study.BACKGROUND Geriatric depression is a significant problem in both the developed and the developing world. To identify this condition, Geriatric Depression Scale has been used in different languages and cultural settings; it has proved to be a reliable and valid instrument. However, the Geriatric Depression Scale-15 version in Nepali has so far not been validated. METHODS The original 15-item version of the Geriatric Depression Scale-15 was translated into Nepali and administered by trained nurses to a target sample aged ?60 years at Dhulikhel Hospital (n=106). Subsequently, the participants were blindly interviewed by a consultant psychiatrist for possible geriatric depression according to the ICD-10 criteria. Cronbach's alpha checked the reliability. Validity was assessed for three different cut-off points (4/5, 5/6, and 6/7); the related sensitivity, specificity, positive predictive value, and the negative predictive value of the scale were estimated. RESULTS The mean participant age was 68.1 (±7.2); males and females, 50.Selleckchem EN4