The internal thoracic artery (ITA) is the largest artery of the thoracic wall. ITA has become a conduit of choice for coronary artery bypass graft surgery because of its predictable intrathoracic course, anatomical proximity to the heart and excellent long-term patency. The rare and unexpected occurrence of anomalies of the internal thoracic artery such as the one reported here may complicate the entire procedure of revascularization of the myocardium. We conclude that knowledge of variation of internal thoracic artery is necessary during surgical procedures that involve thoracic region.

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It is the era of developments and technologies in Southeast Asian countries including Nepal. Medical practice is growing to its supreme level. There is several funded and clinically relevant research works from this region. But it is questionable whether the data is collected scientifically and the inferred evidence is useful to the medical sciences. Improper sampling methods will result with biased evidence, which will make the researcher misleading. This article will discuss the basic sampling techniques required for a good research.

Congenital missing or absence of 6 or less teeth is known as Hypodontia which is a usual part of more complex set of developmental problems. Most cases of tooth agenesis involve hypodontia. In reference to second premolar, agenesis of a single second premolar is the most common form and occurrence of agenesis of four second premolars in both maxilla and mandible is not a very common condition.The purpose of this report is to describe a case of agenesis of a four second premolars in all the four quadrants in a 17 year old boy.Patient referred to the pediatric dentistry department as a chief complaint of pain in the left lower back tooth region since one week. Clinical examination revealed the retained four primary second molars in both the arches of right and left sides and orthopantamograph confirmed the diagnosis. Pulpectomy was performed in maxillary left as well as mandibular left and right pimary molars and maxillary right second molar was grossly decayed which was extracted. In addition to case report, this article discusses possible etiological factors along with various treatment modalities.

In human beings the most common branching pattern of the aortic arch was its division into three great vessels ie the brachiocephalic trunk, left common carotid artery and the subclavian artery. The vertebral arteries arise from the superior aspect of the first part of the subclavian artery. In present case, a left vertebral artery arose from the aortic arch as fourth branch was found. The diameter of left vertebral artery at its origin was 6 mm as compared to the right vertebral artery, which has diameter of 3.5 mm at its origin. In this case left sixth dorsal intersegmental artery might have persisted as first part of vertebral artery hence left vertebral artery arising from arch of aorta. Knowledge of the variations in branching pattern of the aortic arch is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.

Background This study was designed to determine the role of aqueous extract of water lily (Nymphaea lotus) for potential antibacterial activity against some gram-negative fish pathogenic bacteria. Material and methods Aqueous extracts of the dried whole plant Nymphaea lotus was tested by the agar disc diffusion method against four bacteria strains, namely, Escherichia coli, Vibrio anguillarum, Pseudomonas fluorescens, Aeromonas hydrophila and Salmonella typhi. Inhibitory growth values were determined in colony forming unit per gram (cfu/g) for each pathogen while examination of phytochemical constituents of the crude extricate of the plant was also carried out qualitatively. Results Phytochemical screening of the crude aqueous extract revealed the high presence of saponins, alkaloids and carbohydrate, moderate presence of cardiac glycosides, tannins, phenolics, anthroquinones, terpenoid, quinones, catechins and trace of flavonoids. Conclusion The antibacterial analysis of crude aqueous extracts showed moderate varying degrees of resistance against the microbes especially Escherichia coli and Vibrio anguillarum where complete growth inhibition was observed. Hence, this plant aqueous extract can help in the treatment of fish bacterial infections.

Intrauterine Growth Restriction (IUGR) is defined as the inability of a fetus to gain the normal growth potential due to maternal-placental-fetal factors. These factors mainly involve metabolic disorders, infections, substance abuse and exposure to harmful substances. Incidence of IUGR is higher in developing countries. Proper diagnosis at suitable time is necessary for proper treatment and management. Although, the mechanism is not clear but oxidative stress, immunological factors, aryl hydrocarbon receptor and adduct formation are some pathways which are involved in IUGR. The aftermaths of IUGR involves post-birth complications, perinatal mortality and morbidity. Therefore, management and treatment involves use of both pharmacological (Tocolytics, Corticosteroids, antibiotics) and non-pharmacological methods (bed rest, cerclage). This review highlights the possible risk factors, mechanisms, other biochemical pathways involved, as well as pharmacological and non-pharmacological management of IUGR.

Background Co-existence of one sexually transmitted infection (STI) with another viral or bacterial agent may change the classical behavior of the genital infection and may provide the stimulus for reactivation. The objectives of this study were to document and appraise the relevance and importance of co-infection in STIs in their prevailing permutation and combination. Material and methods This cross-sectional study included 200 consecutive patients, attended the STI clinic of a tertiary care hospital in East Delhi with one or more complaints related to STI. Samples were collected, stained, cultured and antibody detection was done. Results A number of STIs patients had significant association with multiple co-infecting agents. Dual coinfection was seen in 53.1%, while = 3 STIs pathogens were seen in18% cases. Importance of serology in detecting subclinical cases is also highlighted in the study. Conclusion Present study highlights the requirement for periodic need based surveillance of STIs for clinical intervention with challenge to clinicians for diagnosing multiple co-infections. The number of subclinical STIs in the present study underscores the importance of serology for detection of common STIs in all patients presenting to the STI clinic.

Background Carbapenems are considered as drugs of choice for the treatment of the infections caused by drug resistant bacteria. However, in the recent years the prevalence of carbapenem resistant gram negative bacteria has increased significantly. The main objective of this study was to determine the prevalence of carbapenemase producing gram negative bacteria among all the clinical isolates. Material and methods A total of 3246 non-repeated, different clinical specimens from patients attending Kathmandu Model Hospital, from July 2013 to January 2014 were cultured and the gram negative bacterial isolates obtained were subjected to identification with the help of colony morphology, Gram’s stain and conventional biochemical tests. Kirby-Bauer disk diffusion technique was used to perform antimicrobial susceptibility testing. Phenotypic confirmation of carbapenemase and AmpC beta-lactamase production was done by combined disc method. Results 890 samples showed the growth of bacterial pathogens. Out of total 769 gram negative bacteria, 57 were found to be carbapenem resistant. Of which, highest number (47) of the isolates were found to be metallo-ß lactamase (MBL) producers. Six bacterial isolates produced both (Klebsiella pneumoniae carbapenemase) KPC and MBL, whereas only one isolate was found to be positive for both MBL and AmpC. Three bacterial strains showed carbapenem resistance due to over production of AmpC ß-lactamase. Conclusion Among carbapenem resistant gram negative bacteria, MBL was present as the major enzyme responsible for resisting carbapenem antibiotics.

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Obesity is a state of “positive” energy balance when energy intake in is much greater than energy expenditure. The familial aggregation of body size was first published by Sir Francis Galton in 1889, which become a well-established risk factor for childhood obesity. Obesity is often allied with insulin resistance, dyslipidemia and cardiovascular disease. Monogenic obesity includes the involvements of Leptin (LEP) gene, leptin receptor(LEPR), Proopiomelanocortin (POMC), Melanocortin-4 receptor (MC4R), single-minded gene 1 (SIM 1), Proprotein convertase subtilisin/ kexin type 1 (PCSK1), Neuropeptide Y (NPY). Polygenic obesity is due to Adrenoceptor beta 1 (ADRB1), ADRB2, ADRB3, Uncoupling protein 1(UCP1), UCP2, UCP3. Monogenic and polygenic obesity; pleiotropic syndromes, chromosomal rearrangement are different types of obesity with genetic cause. Surprisingly all “obesity genes” carriers do not become overweight, and exercise, maintaining healthy routine is a significant contributing factor to nullify genetic prediposition.

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