Nutritional Status of Adolescents in Semi-urban Community in Dukuchhap Village of Lalitpur, Nepal

IntroductionMany Nepali adolescents (10-19 years) are undernourished, which increases the risk of morbidity and mortality. Inadequate nutrition during adolescence can retard physical growth and sexual maturation and increases the risk of adult lifestyle diseases. There is a dearth of research on the socio-demographic factors associated with the nutritional status of adolescents in Nepal.ObjectiveTo assess the nutritional status of adolescents (10-19 years) in Dukuchhap Viillage of Lalitpur, NepalMethodologyA community based descriptive cross-sectional study was carried out by medical students during their field placement for and community diagnosis in Dukuchhap Village of Lalitpur from 22th November- 19 December 2017. All 10-19 years adolescent population was included in the study. Among the total population (2545) study, 474 were adolescent. The data were collected using semi-structured questionnaire. Physical and anthropometric measurement were done. Data were analyzed using of WHO Z-scores criteria and cut offs points. All the findings were compared with Nepal Demographic and Health Survey, 2011 and other researches published in different journals on related topic. Excel version 2010 and SPSS version 13.0 were used to enter and analyze data.  ResultsThe prevalence of stunting was found out to be 36.28%.More males (16.51%) than females (12.60%) were severely stunted and 21.70% of male and 22.14% of female were moderately stunted. Among total respondents, 14.4% were severely stunted and 21.9% were moderately stunted. More numbers of male (38.2%) were stunted than female (34.7%).ConclusionPrevalence of malnutrition among adolescent was more in 10- 12 years age group. The prevalence of moderate stunting was slightly high in females than males. Adolescents with extended family type, increasing number of family members & agriculture, labourer and local business as main family occupation are more prone to suffer from malnutrition.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 110-116

Disease Profile and Hospital Outcome of Newborn Admitted to Neonatal Intermediate Care Unit at Tertiary Care Center in Nepal

Background Neonatal mortality rate (NMR) is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, Care of sick children can be done better so as to aid in reducing neonatal mortality rate. Objective The objective was to identify pattern of diseases and outcome admitted to Neonatal Intermediate care Unit (NIMCU). Method A retrospective study was conducted at Neonatal Intermediate care Unit of Kanti Children's hospital from Bhadra 2071 to Shravan 2073 (August 2014 to July 2016). Result Total 1286 neonates were admitted in Neonatal Intermediate care Unit with the highest admission in the months of Bhadra (August-September) 12.52% and the lowest in Push (December-January) 4.82%. Among the admitted cases, 1,028 (80.0%) were full term while 256 (20.0%) were preterm. Among the total admission, 43.6% were less than 7 days old which is the most vulnerable period during the newborn phase. Admission due to neonatal sepsis was 892 (69.36%). Among them, 628 (70.40%) were late onset neonatal sepsis while 264 (29.60%) were early onset. Neonatal jaundice accounted for 12.36% (159) of the cases while Hypoxic Ischemic Encephalopathy accounted for 4.80% (62) of cases. Congenital Heart Disease were 53 (4.12%) and neonatal pustulosis were 27 (2.20%). Meningitis accounted for 45 (3.49%) of cases and UTI 29 (2.22). Death during treatment were 18 (1.39%). 7% of cases deteriorated and referred to NICU while, 3.2 % of cases were referred to other centers and 5.1% of cases were either discharged on request or left against medical advice. Conclusion Neonatal sepsis including both early and late onset, Congenital Heart disease, birth asphyxia and neonatal Jaundice accounted for majority of admission in NICU. Three of four these etiologies are preventable up to some extent.

A comparative study between extracorporeal shock wave lithotripsy and ureterorenoscopic lithotripsy in the management of upper ureteric calculus

Introduction and Objective: A stone in the ureter usually comes from the kidney. Urolithiasis is the third most common disease of the urinary tract which is surpassed only by urinary tract infections and pathologic conditions of prostate. There are some controversies on the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) in ureteral stones. We aim to compare the efficacy of ESWL and URSL in the management of upper ureteric stones in terms of stone clearance.Materials and Methods: This prospective hospital based study included patients with upper ureteric calculus managed with URSL with DJ stenting or ESWL at Dhulikhel Hospital-Kathmandu University Hospital from August 2014 to December 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded.Results: Total number of patients undergone ESWL was 49 and URSL was 48. There was no difference in male/ female ratio, age and stone diameter between two groups (P>0.05). Total stone-free ratio was 85.71%(42/49) for ESWL and 81.25%(39/48) for URSL, partial fragmentation requiring shift of modality of treatment was 12.24%(6/49) for ESWL and 12.5%(6/48) for URSL, failed procedure was 2.04%(1/49) for ESWL and 6.25%(3/48%) for URSL(P= 0.577).Conclusion: ESWL is as effective as URSL in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio

Comparative Study of Prevalence of Cataract at High Altitude and Kathmandu Valley

BACKGROUND

Cataract is the leading cause of avoidable blindness in the world. Many etiological and risk factors for age related cataract has been documented. The present study is conducted to compare the prevalence of cataract at high altitude and Kathmandu valley.Many etiological and risk factors for age related cataract has been documented.

METHODS

A cross sectional comparative study was conducted at Jomsom, Kagbeni, Jharkot and Muktinath of Mustang district and Balaju and Jawalakhel of Kathmandu valley of Nepal in 2009 to 2011 . There were 222 participants at Mustang and186 participants at Kathmandu. The prevalence of cataract was studied among the Tibetans and Thakali population at Mustang and Tibetans at Jawalakhel and Thakali population at Balaju of Kathmandu valley.

RESULTS

Prevalence of cataract at high altitude was 31.5% and 10.2% at Kathmandu valley. The prevalence of cataract is 4.05 times more at high altitude as compared to Kathmandu valley (p value < 0.001).

CONCLUSIONS

The prevalence of cataract was significantly high at high altitude as compared to lower altitude.

Contraceptives Knowledge and Use among Reproductive Aged Women from Squatters of Kathmandu, Nepal

Aims: This study aims to assess the knowledge and use of contraceptives and the associated factors among the married reproductive aged women residing in squatters of Kathmandu, Nepal.Methods: This descriptive cross sectional study was conducted in six squatter settlements of Kathmandu in February 2015. A total of 156 married reproductive aged women were included through convenient sampling. Descriptive statistics were summarized and bivariate logistic regression was performed.Results: A total of 80.7% had knowledge and 66.6% of women were currently using at least one modern contraceptives method. Injectable was most commonly used (58%) whereas condom was the least (3%). The women who were less than 35 years of age, having a child less than five years of age and women who were literate were more likely to have knowledge on contraceptives with (OR=2.609, p=0.011), (OR=5.579, p=0.025) and (OR=3.6, p=0.007) respectively. Similarly, women less than 35 years of age and women having last child less than five years of age were less likely to be using contraceptives currently with (OR=0.344, p=0.033) and (OR=0.397, p=0.01) respectively.Conclusions: This study showed the actual use was lower than the knowledge. Among the contraceptives used, condom usage was very low. Younger women and mothers with last child less than five years of age were less likely to use contraceptives. These results highlight the risk related to sexual and reproductive health in this vulnerable population.

Ventricular Tachyarrhythmia after Aortic Cross Clamp Release in Cardiac Surgeries

BACKGROUND

Ventricular tachyarrhythmia (VT/VF) after aortic artery cross clamp release in cardiac surgery is common and the occurrence has been described but the incidence and risk factors are not well defined. This study was designed with the aim to evaluate the prevalence of VT/VF after aortic cross clamp release and to identify risk factors of patients developing such arrhythmias.

METHODS

A retrospective observational study 1052 patients over a period of 12 months from March 2011 to February 2012 undergoing various cardiac surgeries with aortic cross clamp were monitored for new-onset ventricular tachyarrhythmia intraoperatively.

RESULTS

The prevalence of ventricular tachyarrhythmia was 24.4%. We found age above 30 years, increasing body mass index (BMI), valvular surgeries and male gender as risk factors for VT/VF after cross clamp release in cardiac surgeries.

CONCLUSIONS

Ventricular tachyarrhythmia is common following all cardiac surgeries, especially valvular heart diseases. There is a strong relationship between ventricular arrhythmias and age above 30 years, coronary artery bypass surgery (CABG), high (BMI) and male gender. It is essential for intense monitoring of these patients.

Comparative study of prevalence of pterygium at high altitude and Kathmandu Valley

BACKGROUND

Pterygium is a fleshy fibrovascular growth of conjunctiva encroaching upon the superficial cornea towards the visual axis in the interpalpebral fissure. The study aims to compare the prevalence of pterygium at high altitude and Kathmandu.

METHODS

A cross sectional quantitative study organized by Professional Support Service Nepal was conducted at Mustang and Kathmandu Valley in the Tibetan and Thakali population. The sample size at Mustang is 222 and Kathmandu Valley is 186.

RESULTS

At Mustang, pterygium was present in 40 males (38.5%) and 48 females (40.7%) while at Kathmandu, pterygium was present in 6 males (8.8%) and 17 females (14.4%). Pterygium was present in 20.7% (n=12) at the altitude of 2710 meters, 28.8% (n=21) at an altitude of 2900 meters, 56.6% (n=30) at 3500 meters and 65.8% (n=25) at 3800 meters. The prevalence of Pterygium was significantly high with the rise in altitude (p value=0.000). Pterygium was present in 12.4% (n=23) at Kathmandu.The prevalence of pterygium at high altitude as compared with Kathmandu was also statistically significant (p value = 0.000).Pterygium was present in <40years in 40% and =/>40years in 39.5% at high altitude. At Kathmandu,pterygium was present in <40years in 8.2% and=/> 40years in 13.9%.At Mustang, among participants with the duration of stay at high altitude up to 20 years, pterygium was present in 36.1% (n=13) and those with >20years, pterygium was present in 40.3%(n=75).

CONCLUSIONS

Pterygium has significantly higher prevalence at high altitude as compared to lower altitude.

Arsenic Contamination in the Deep and Shallow Groundwater of Kathmandu Valley, Nepal

Scientific World, Vol. 11, No. 11, July 2013, page 25-31 DOI: http://dx.doi.org/10.3126/sw.v11i11.8548

Use Of Pesticides In Nepal And Impacts On Human Health And Environment

Majority of the farmers are unaware of pesticide types, level of poisoning, safety precautions and potential hazards on health and environment. According to the latest estimate, the annual import of pesticides in Nepal is about 211t a.i. with 29.19% insecticides, 61.38% fungicides, 7.43% herbicides and 2% others. The gross sale value accounts US $ 3.05 million per year. Average pesticides use in Nepal is 142 g a.i./ha, which is very low as compared to other Asian counties. The focus of this paper is to analyze the use and application status of pesticides in Nepal to aware the society about adverse effects of chemical pesticides in the environment . Pesticidal misuse is being a serious concern mainly in the commercial pocket areas of agricultural production, where farmers are suffering from environmental pollution. Incidence of poisoning is also increasing because of intentional, incidental and occupational exposure. Toxic and environmentally persistent chemicals are being used as pesticides. Many studies showed that the chemical pollution of the environment has long-term effects on human life. It is therefore essential that manufacture, use, storage, transport and disposal of chemical pesticides be strictly regulated. The Journal of Agriculture and Environment Vol:13, Jun.2012, Page 67-72 DOI: http://dx.doi.org/10.3126/aej.v13i0.7590

Survival of arteriovenous fistula for dialysis at different centers in the North of England

BACKGROUND

Renal failure patients rely on their vascular access for hemodialysis. Surgery for construction of arteriovenous fistulae is provided by a range of specialists. The aim of this review was to assess the survival of arteriovenous fistulae for hemodialysis patients in different centers of Northern England.

METHODS

Data was collected on 473 hemodialysis patients in the North of England. Risk factors for failure were determined for each patient (age, sex, diabetes), together with their current mode of dialysis and history of surgical access procedures. This was expressed against their duration of dialysis. The dialysis units were then compared for fistula survival using the Kaplan Meier method.

RESULTS

68.3% (323) patients were dialysed through via arteriovenous fistulae and 31.7% (150) via neck line. Overall fistula survival rates were 85.1% at 1 year, 82.5% at 2 years and 72.7% at 3 years. The best 1 year survival was 91.6% and worst 76.1%. These were 74.4% and 53.1% at 5 years and 74.4% and 29.5% at 10 years; these differences were highly statistically significant (p = 0.0033).

CONCLUSION

Though graft survival is affected by many things, surgical training in access surgery is not mandatory and a review of surgical practice is urgently needed.

Pleural effusion in hepatic vena cava disease

Pleural effusion is not uncommon in developing countries. It is usually considered to be due to tuberculosis and treated with anti-tubercular chemotherapy without much diagnostic workup. Hepatic vena cava disease (HVD), a disease caused by obliterative lesion of the hepatic portion of inferior vena cava induced by bacterial infection is common in developing countries. We report here the occurrence of pleural effusion in 10% of the cases of HVD. Four patients, one with acute and three with chronic HVD that presented with pleural effusion are described. Pleural effusion in HVD responded to treatment with antibiotic and diuretic. In developing countries HVD should be considered in the differential diagnosis of pleural effusion. It is postulated that bacterial infection and sodium retention resulting from acute caval obstruction are important in the pathogenesis of pleural effusion in HVD.

Visual outcome of laser treatment in diabetic retinopathy

OBJECTIVE

To determine the visual outcome of laser treatment in diabetic retinopathy.

DESIGN

Prospective, non-comparative case series.

MATERIALS AND METHODS

A total of 80 eyes of 50 patients with diabetic retinopathy in different stages were photocoagulated using diode green laser. Focal laser only was given in 46 eyes and pan retinal photocoagulation only was given in 29 eyes while 3 eyes received focal laser and pan retinal photocoagulation. One eye was given grid laser only and one eye received both grid and focal laser. The best corrected visual acuity was noted and fundus examination was carried out prior to laser therapy and at the last follow-up and results were compared.

RESULTS

Non- proliferative diabetic retinopathy was present in 76%. Following laser treatment, best corrected visual acuity improved in 52.50%, remained static in 35% and deteriorated in 12.5%. Maculopathy improved in 52%, remained static in 6% and deteriorated in 2% in right eyes while there was no maculopathy in 40% in right eyes. Similarly, maculopathy improved in 38% and remained same in 10% while 52% had no maculopathy in left eyes. After laser treatment, NVD (OD) regressed in 6% and remained unchanged in 4%. Similarly, NVE (OD) regressed in 18% and remained unchanged in 4% and NVE (OS) regressed in 18% and remained unchanged in 2% following laser therapy.

CONCLUSION

Timely and adequate laser treatment helps in saving the vision in patients with diabetic retinopathy.

Hepatitis E in Nepal

Hepatitis E is an acute disease caused by hepatitis E virus that usually manifest as acute jaundice. The hallmark of the disease is its high incidence in young adults, and high mortality in pregnant women from acute hepatic failure. It is a waterborne infection and occurs sporadically or as epidemic outbreaks. Kathmandu valley is a hyper-endemic area for hepatitis E, where during last 30 years three large epidemics and many focal outbreaks have occurred. About 50% of the sporadic cases of acute hepatitis in Kathmandu valley are caused by hepatitis E. This paper describes the epidemiology hepatitis E in Nepal, and its clinical features and management.

Power Doppler ultrasound assessment of follicular vascularity in the early follicular phase and its relationship with outcome of in vitro fertilization

OBJECTIVE

To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome.

DESIGN

Retrospective longitudinal cohort study.

SETTING

Tertiary referral centre/university hospital.

PATIENTS

Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers.

INTERVENTIONS

Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles > or =5 mm was subjectively assessed using a modified grading system (grades 0-4).

MAIN OUTCOME MEASURES

Ovarian PFBF and pregnancy.

RESULTS

Treatment cycles were retrospectively divided into two groups: Group 1 (n=20) had cycles with at least one small (5-10 mm) or medium (11-14 mm) size follicle(s) of high grade (2-4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n=17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1-3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1-35.7) compared to Group 2.

CONCLUSION

High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.

Longitudinal assessment of ovarian perifollicular and endometrial vascularity by power Doppler ultrasound in pregnant and non-pregnant cycles in the IVF setting

PURPOSE

This longitudinal study aimed to compare ovarian perifollicular and endometrial blood flow (PFBF and EBF, respectively) during the follicular phase in pregnant and non-pregnant IVF cycles.

METHODS

Serial transvaginal scans were performed in 15 subjects undergoing IVF treatment. Both PFBF and EBF were subjectively graded (grades 0-4 for PFBF and grades 1-3 for EBF). After confirmation of clinical pregnancy, the treatment cycles were grouped into 'Pregnant' and 'Non-pregnant' cycles. Ovarian PFBF and EBF were retrospectively compared between the two groups.

RESULTS

In pregnant cycles, the proportion of large (> or = 15 mm) follicles with high (24) grade PFBF increased with time throughout the follicular phase, and the proportion of large follicles with poor (0-1) grade PFBF decreased. In non-pregnant cycles these trends were reversed. There was no difference in EBF between the two groups.

CONCLUSION

The pattern of ovarian PFBF but not EBF may be predictive of treatment outcome.

Epidemiology of foliar blights (spot blotch and tan spot) of wheat in the plains bordering the himalayas

ABSTRACT Helminthosporium leaf blight (HLB), a complex of spot blotch caused by Cochliobolus sativus and of tan spot caused by Pyrenophora tritici-repentis, is a major wheat disease in South Asia. This 2-year study elucidated HLB development and its impact on yield. Symptoms caused by C. sativus and P. tritici-repentis were first observed at the seedling and tillering stages, respectively. The number of airborne conidia and leaves infected by the two pathogens remained low for several weeks under lower temperatures, followed by a sharp rise as temperatures increased. The number of airborne conidia of C. sativus and incidence of infection by C. sativus were higher compared with P. tritici-repentis. The disease complex caused an average 30% reduction in yield, with greater losses under delayed seeding. Delayed seeding increased disease severity even in resistant genotypes and caused higher yield losses. 'Milan/Shanghai-7' was the most resistant among six genotypes evaluated. Despite higher disease severity, 'BL 1473' showed relatively lower yield losses, indicating its tolerance to foliar blight. The findings of this study bear implications for integrated foliar blight management in the warmer areas of South Asia by combining optimum seeding date, seed treatment and foliar spray of fungicides, and resistant wheat genotypes.

Journal of The Nepal Medical Association- Editorial

Sixth All Nepal Medical ConferenceEndemic Goitre In Nepal

Regionalization Of The Health Services

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An Epidemic Of Infectious Hepatitis In The Kathmandu Valley

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"Clinical Survey Of Tuberculosis Peritonitis" [An analysis of one hundred and twenty eight cases admitted in Bir Hospital, Kathmandu.]

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Personal View

NA

Journal of The Nepal Medical Association- Editorial

Regional Mobile Team For Nepal (IX)

Disaster Planning

NA

High prevalence of hepatitis B virus infection amongst Tibetans in Nepal

Tibetans have been living in Nepal since 1959. Study of the prevalence of viral hepatitis among them showed that they have a high prevalence of hepatitis B virus (HBV) infection. Prevalence of total HBV infection and Hepatitis B surface antigen (HBsAg) among them was 61% and 16% compared to 10.0% and 0.7% respectively among the Nepalese. The predominant HBsAg subtype among the Tibetans was 'ayw'. Perinatal and childhood transmission was found important in the spread of HBV infection among the Tibetans.

Cavographic study of an early stage of obstruction of the hepatic portion of the inferior vena cava

BACKGROUND

Liver disease caused by a chronic lesion of the hepatic portion of the inferior vena cava (IVC) is clinically characterized by dilated superficial veins in the body trunk with cephalad flow, hepatomegaly and splenomegaly. Cavography shows stenosis or complete obstruction near the cava-atrial junction.

METHODS

Early (acute and subacute) forms of the disease were recognized. The early stage of the disease manifested as jaundice, hepatomegaly or ascites and fever. Patients with acute and subacute onset of the illness with no past history of liver disease were studied with inferior vena cavography. Some of the patients had repeat cavography at 6 months and at 1 year after the initial investigations.

RESULTS

Three types of cavographic lesions were observed in the early stages of the disease: type 1, linear lucent area in the IVC close to cava-atrial junction; type 2, a smooth or irregular narrowing of almost the whole segment of the hepatic portion of the IVC; and type 3, a constriction or narrowing of a segment of the IVC near the cava-atrial junction. The first two types were associated with the acute stage of the disease and type 3 with the subacute stage. Type 2 and 3 lesions were associated with post-stenotic dilatation (PSD) close to the atrium. Lucent areas resulting from thrombosis are common in PSD. The acute and subacute hepatic IVC diseases in Nepal are commonly associated with bacterial infection.

CONCLUSIONS

It is postulated that the early cavographic lesions are consistent with thrombosis and thrombophlebitis of the hepatic portion of the IVC, and that resolution of the lesions leads to the development of stenosis and to complete obstruction.

Acute on chronic phenomenon in hepatic IVC obstruction: a case report

Hepatic IVC obstruction though common is usually misdiagnosed because of lack of appreciation of the disease. Patient with chronic disease may develop acute exacerbation, which may be precipitated by surgery or endoscopic procedures. It is a report of a case of chronic IVC disease with acute development of ascites following gallbladder surgery.

ELISA for IgG-class antibody to hepatitis E virus based on a highly conserved, conformational epitope expressed in Escherichia coli

In assays based on most recombinant hepatitis E virus (HEV) antigens, the IgG antibody responses to HEV are observed commonly to wane or disappear after the acute phase of infection. Such IgG assays have therefore been used for the diagnosis of acute HEV infection, but they have limited usefulness in seroepidemiological studies. Using western immunoblotting, it was shown previously that the open reading frame (ORF) 2.1 antigen, representing the carboxy-terminal 267 amino acids (aa) of the capsid protein, exposes a conformational epitope which allows optimal detection of convalescent antibody compared to other proteins expressed in Escherichia coli. This conformational epitope is shown to be highly conserved between divergent human HEV isolates, and the development of a sensitive and highly specific enzyme immunoassay (ELISA) based on this recombinant antigen is described. The ORF2.1 ELISA allows the detection and quantitation of both acute- and convalescent phase HEV-specific IgG, and will help to define better the antibody responses to the virus and the prevalence of HEV infection worldwide.

Proposal of a new nomenclature for Budd-Chiari syndrome: hepatic vein thrombosis versus thrombosis of the inferior vena cava at its hepatic portion

Budd-Chiari syndrome (BCS) was initially defined as a symptomatic occlusion of the hepatic veins, but subsequent reports on various obliterative changes that occur in the hepatic portion of the inferior vena cava (IVC) and hepatic vein orifices have resulted in a broadened and ambiguous definition. Membranous obstruction of the inferior vena cava has been regarded by many as a congenital vascular malformation, but its relation to the classical BCS has remained obscure. With modern imaging and recent histological study of new cases, membranous obstruction of the IVC is now considered to be a sequela to thrombosis. How to classify various forms of occlusion and stenosis of the IVC and hepatic vein ostia is a major challenge. In this review, we emphasize that primary hepatic vein thrombosis (classical Budd-Chiari) and an obliterative disease predominantly affecting the hepatic portion of the IVC, both of which account for most patients with venous outflow block, are clinically quite different. In the West, the former is more common than the latter, which constitutes the vast majority of cases of outflow block in developing countries such as Nepal, South Africa, China, and India. The latter is frequently complicated by hepatocellular carcinoma (HCC), and primary hepatic vein thrombosis is not. The major cause of thrombosis is a hypercoagulable state in hepatic vein thrombosis, but more of the latter cases are idiopathic. The clinical presentation of the latter is milder, and onset is frequently inapparent, whereas the former is more severe, sometimes causing acute hepatic failure. Markedly enlarged subcutaneous veins over the body trunk characterize the latter. We propose that these two disorders be clinically distinguished with a suggested term "obliterative hepato-cavopathy" for the latter against classical BCS.

Epidemiology of hepatitis C virus infection in Nepal

Prevalence of hepatitis C virus (HCV) infection in Nepal was studied by assaying sera from different population groups for anti-HCV by the second generation enzyme immunoassay method and for HCV RNA by polymerase chain reaction. The anti-HCV was positive in 0.6% of 2,860 healthy adults. HCV infection was responsible for 1.3% of acute viral hepatitis. Only drug addicts (DA) are known to have a very high incidence of the infection. The number of intravenous drug abusers (IDA) in Nepal have increased considerably since 1991 when buprenorphine (tidigesic) was introduced in the local market. About 72% of the drug addicts were found to be IDA and 94% of the IDA were anti-HCV positive. It is concluded that though the prevalence of HCV infection in the community is low, and at present it accounts for only a small number of acute and chronic liver diseases, the presence of a large number of DA in the country with high incidence of HCV infection may result in the emergence of HCV as an important cause of chronic liver disease in Nepal in future.

Infection with GB virus C and hepatitis C virus in drug addicts, patients on maintenance hemodialysis, or with chronic liver disease in Nepal

Infection with GB virus C (GBV-C) and hepatitis C virus (HCV) was surveyed in various populations in Kathmandu, Nepal. GBV-C RNA and HCV RNA were detected in four (2%) and none, respectively, of 181 normal controls. Viral RNAs were detected significantly more frequently (P < 0.001) in 32 (44%) and 43 (60%), respectively, of 72 users of illicit intravenous drug, and in three (14%) and one (5%) of 22 patients on maintenance hemodialysis. The three hemodialysis patients with GBV-C RNA had been transfused with more blood units than the 19 without GBV-C RNA (51 +/- 21 vs. 5 +/- 3 units, P < 0.01), and one was co-infected with HCV. Of 145 patients with chronic liver disease, GBV-C RNA was detected in four (3%) and HCV RNA in 12 (8%); only one patient with GBV-C RNA was without markers of HCV or hepatitis B virus infection. In the 32 drug addicts infected with GBV-C, genotypes were G1 in two (6%), G2 in 26 (81%), G3 in three (9%), and the remaining one (3%) was coinfected with G2 and G3. GBV-C genotypes in the 13 individuals in the populations other than drug addicts were G2 in 11 (85%) and G3 in two (15%). HCV genotypes in the 43 drug addicts with viremia were l/1a in 21 (49%), V/3a in 19 (44%) and l/1a plus V/3a in two (5%); these genotypes were not prevalent in normal controls and patients with chronic liver disease in Nepal. These results indicate that GBV-C infection is prevalent in healthy subjects in Nepal at a frequency (2%) comparable with those in the other countries and that GBV-C transmits efficiently by intravenous drug abuse among drug addicts and by transfusion in hemodialysis patients.

Hepatitis B and C infection among drug abusers in Nepal

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.

Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at the Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 1992 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 patients with chronic liver disease and for nearly one quarter of 267 biopsies performed on this patient group during the same period. Obstructive lesions of the inferior vena cava seem to be more common among poor people with malnutrition. Clinically, our patient group could be divided into acute (n = 27), subacute (n = 43) and chronic (n = 80) cases. The important clinical features are hepatomegaly and/or ascites and, in chronic cases, prominent dilated superficial veins over the body trunk with cephalad flow. Ultrasound is the most helpful diagnostic procedure, especially in subacute and chronic cases, as it frequently demonstrates caval obstruction, thrombosis, dilated hepatic veins and intrahepatic collaterals. Diagnosis is confirmed by cavography, which shows a caval obstruction of varying lengths at the cavo-atrial junction or a marked narrowing of the hepatic portion of the vena cava. In subacute and chronic cases cavography also demonstrates collateral veins, such as the ascending lumbar, hemiazygos and azygos that drain into the superior vena cava. Chronic cases had periods of exacerbation often associated with bacterial infection. The aetiology of inferior vena cava obstruction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.

Hepatic venous outflow obstruction in Nepal

Intra hepatic inferior venacaval (IVC) obstruction at the site or just above hepatic vein opening in the IVC, is a common hepatic problem in Nepal. These patients either present as a chronic IVC obstruction with insidious onset or may present with rapid onset disease (acute/subacute disease). The former type may be asymptomatic (20%) or may have features of chronic liver dysfunction. The latter presents with rapid onset ascites. Presence of hepatomegaly with flank/back veins are characteristic clinical features of the disease. The disease is invariably encountered amongst rural poor, alcoholic and in the peripartum period. Ultrasonography, IVC graphy hepatogram and liver biopsies are the usual diagnostic modalities. Twenty four percent of the 126 chronic hepatic IVC disease had associated liver cell cancer at our centre. The aetiology of the disease is unclear. Presently it is believed that local thrombophlebitis in IVC causes such obstruction. Despite, surgical and radiological intervention, the ideal management in such patients is yet to be established. We believe conservative therapy, particularly prevention and early therapy of sepsis in such patients prolongs survival.

Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at the Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 1992 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 patients with chronic liver disease and for nearly one quarter of 267 biopsies performed on this patient group during the same period. Obstructive lesions of the inferior vena cava seem to be more common among poor people with malnutrition. Clinically, our patient group could be divided into acute (n = 27), subacute (n = 43) and chronic (n = 80) cases. The important clinical features are hepatomegaly and/or ascites and, in chronic cases, prominent dilated superficial veins over the body trunk with cephalad flow. Ultrasound is the most helpful diagnostic procedure, especially in subacute and chronic cases, as it frequently demonstrates caval obstruction, thrombosis, dilated hepatic veins and intrahepatic collaterals. Diagnosis is confirmed by cavography, which shows a caval obstruction of varying lengths at the cavo-atrial junction or a marked narrowing of the hepatic portion of the vena cava. In subacute and chronic cases cavography also demonstrates collateral veins, such as the ascending lumbar, hemiazygos and azygos that drain into the superior vena cava. Chronic cases had periods of exacerbation often associated with bacterial infection. The aetiology of inferior vena cava obstruction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.

Membranous obstruction of the hepatic portion of the inferior vena cava: is this an underdiagnosed entity in developing countries?

Chronic liver disease due to obstructive lesion of the hepatic inferior vena cava (IVC) is common in Nepal. This study presents 10 patients with cavographically documented membranous obstruction of the hepatic IVC with minimal symptoms and a benign course. One patient with an incomplete membrane had balloon dilation of the lesion. The duration of the disease among these patients varied from 5 months to 23 yr; eight patients have been followed for periods varying from 1 to 15 yr, with an average of 6 yr. In developing countries, the possibility of hepatic IVC obstruction should be considered in the differential diagnosis of hepatomegaly or hepatosplenomegaly, even in the absence of ascites and external cava-caval collateral. Routine liver and hematology tests in these patients usually are normal, and liver biopsy findings may not always be specific. Ultrasound, however, has proved to be the best diagnostic procedure for the condition. The lesion can be demonstrated easily by cavography. The disease runs a chronic course, and, in the absence of resistant ascites or repeated variceal bleeding, surgical procedures such as cavoatrial bypass, which are a significant cause of death in developing countries, may be contra-indicated.

Hepatitis C virus variants from Nepal with novel genotypes and their classification into the third major group

Five isolates of hepatitis C virus (HCV) RNA from patients with chronic liver disease in Nepal were not classifiable into the known genotypes I/1a, II/1b, III/2a, IV/2b or V/3a using PCR with type-specific primers deduced from the HCV core gene. Their nucleotide sequences were determined for the 5'-terminal 1.5 kilobases and 3'-terminal 1.2 kilobases, covering 30% of the entire genome, and compared with each other and with reported sequences of HCV isolates of various genotypes. They were more similar to a reported HCV isolate (NZL1) of genotype V/3a (in 81.6 to 84.1% of their nucleotides and 85.7 to 88.7% of the deduced amino acid sequence) compared with the genotypes I/1a to IV/2b (in 69.3 to 74.7% and 72.3 to 77.4%, respectively). Hence they were considered to be variants of the third major group (group 3). The five HCV isolates shared 81.3 to 85.2% of nucleotide sequence and 85.4 to 89.3% of deduced amino acid sequence. Thus they were substantially different from each other. One of them was classified as genotype VI/3b due to an 88.2% similarity in nucleotide sequence to that of the reported HCV isolates of this genotype, whereas the remaining four were classified into provisional genotypes 3c, 3d, 3e and 3f. These HCV variants have evolved and remained in Nepal, and have not been observed in the other areas of the world.

Hepatitis B virus subtypes and hepatitis C virus genotypes in patients with chronic liver disease in Nepal

A total of 145 patients with chronic liver disease, including 20 with chronic hepatitis, 63 with cirrhosis and 62 with primary hepatocellular carcinoma from Nepal were tested for markers of hepatitis B virus or hepatitis C virus infection. HBsAg was detected in 57 (39%) and hepatitis C virus RNA in 12 (8%); the cause of liver disease was not known in the remaining 76 (52%). HBsAg was found in 5 (1.3%) of 379 normal controls, whereas hepatitis C virus-associated antibodies were detected in 13 (3.4%), none of whom was positive for serum hepatitis C virus RNA. Subtypes of 102 HBsAg samples, from patients and asymptomatic carriers, were adw in 35 (34%), adr in 4 (4%) and ayw in 48 (47%); the remaining 15 (15%) were of atypical subtypes such as ad, ay and a. Of 12 hepatitis C virus RNA samples, genotype I was detected in 1, genotype II in 5 and genotype V in 1; the remaining five samples were not to be classified by polymerase chain reaction with primers specific for genotypes I to V deduced from hepatitis C virus core sequences, despite high hepatitis C virus RNA titers in all of them. Sequences of 192 amino acids in the entire E1 region of unclassifiable hepatitis C virus isolates from five patients differed from each other in 17% to 23%, and varied from reported isolates of defined genotypes in 13% to 44%. These results indicate that atypical subtypes of hepatitis B virus and novel genotypes of hepatitis C virus would prevail in Nepal.

Field studies of aflatoxin exposure, metabolism and induction of genetic alterations in relation to HBV infection and hepatocellular carcinoma in The Gambia and Thailand

The relative contribution of aflatoxins (AF) and hepatitis B virus (HBV) to the aetiology of liver cancer remains to be determined, as does the mechanism of any interaction between these two factors. Methods to measure individual exposure to AF permit the assessment of this possible interaction in field studies. The measurement of AF covalently bound to albumin in peripheral blood has been particularly useful in this respect. In east and west African countries the majority (75-100%) of individuals has been found positive (> 5 pg AFB1-lysine eq./mg albumin) for the AF-albumin adduct with levels ranging up to 720 pg/mg. Levels of adduct to date have been age- and sex-independent, although marked seasonal variations were seen in The Gambia. Exposure also occurs in utero, with the AF-adduct being found in umbilical cord blood. In a study in The Gambia involving 323 children (age 3-8 years) the AF-albumin adduct levels were examined with respect to HBV infection and ethnic group. Over 95% of all sera contained detectable adduct but children positive for HBV surface antigen (HBsAG) had significantly higher adduct levels than children with markers of past infection or who had never been infected (mean (log) AF-albumin adduct levels 4.41 +/- 0.95, 4.04 +/- 0.99, and 4.05 +/- 1.03 respectively, p = 0.04). In addition, there were highly significant differences in adduct levels between the three major ethnic groups (Wollof 4.41 +/- 0.69: Fula 4.05 +/- 1.1; Mandinka 3.7 +/- 1.14). Wollof children were also more likely to be HBsAg positive than the other two groups. These data suggest that ethnic group and HBV infection can influence AF metabolism and this is being examined in this population with respect to genetic polymorphisms in cytochrome P450 and glutathione-S-transferase enzymes. In addition, these biomarkers are being compared to the nature and frequency of mutations in somatic and tumour cells.

Epidemiology of HIV and hepatitis B virus (HBV) in selected African and Asian populations

401 sera from patients of a rural hospital in Zimbabwe (1987), 211 South African sera (1982/83), as well as 460 sera from four Katmandu hospitals (1985) were tested for HIV-1 antibodies. The sera from Zimbabwe and Nepal were additionally tested for anti-HIV-2 using a panel of different tests, for hepatitis B markers, and partially for antibodies against other viral, bacterial, and protozoal antigens. Detailed clinical and sociodemographic data were taken from the Zimbabwe and Katmandu patients. The prevalence of HIV-1 antibodies in the Zimbabwe study population was 3.2%. All infections were found in the age group 17 to 30 years (n = 254). The epidemiological situation was entirely different from that of HBV (hepatitis B virus). No serum could be confirmed to be anti-HIV-2-positive, but a definite diagnosis is still difficult to establish. Regular town contacts may be considered a possible risk factor. Antibodies against HIV-1 could not be detected in the South African and Asian sera. The seropositivity for anti-HBc in Katmandu (14%) and the prevalence of HBsAg (1.1%) was much lower than reported from other Asian countries.

Epidemic non-A, non-B hepatitis in Nepal. Recovery of a possible etiologic agent and transmission studies in marmosets

An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981-1982, with approximately 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15- to 34-year-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains, and multiple opportunities for enteric transmission existed. One of eight patient stools examined by immune electron microscopy revealed aggregated, antibody-coated, 27-nm viruslike particles when convalescent serum samples were used as sources of antibody. Inoculation of two chimpanzees and four marmosets with a suspension of this stool resulted in elevated liver enzyme activity in three marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in one marmoset, which also developed convalescent antibody against the particles in the original inoculum.

Coagulation studies of viral hepatitis occurring during pregnancy

A study of coagulation disorders due to hepatitis A infection occurring during pregnancy was undertaken to determine if the unique coagulation status produced by pregnancy (elevated clotting factors and decreased fibrinolytic activity) was responsible for the increased severity of hepatitis A infections reported for pregnant women from various parts of the world. Of 49 patients studied, 12 (24%) developed hepatic failure and 9 (18%) died. A prolonged prothrombin time and low fibrinogen level were found to be as frequent as previously reported for nonpregnant patients with and without hepatic failure. Thrombocytopenia was less common and a long thrombin time was more common. Although intravascular coagulation was suggested by a lower mean fibrinogen level than expected in late pregnancy, mean platelet counts were similar to controls. The frequency of a positive protamine sulfate paracoagulation test for intravascular coagulation (DIC) was similar to that reported for uncomplicated pregnancy, and was of no prognostic value when performed on admission. We conclude that the severe clinical course of hepatitis during pregnancy in this epidemic was not attributable to a predisposition for DIC. However, once fulminant hepatitis occurred, DIC may have been a clinically significant factor.

Clinical Profile and Outcome of Childhood Tuberculosis at Dhulikhel Hospital

The corrected PDF for this article was loaded on 07/02/2011.Background: Children contribute a significant proportion of the tuberculosis (TB) burden in Nepal and suffer severe TB related morbidity and mortality, particularly in endemic areas. Diagnosis and management of pediatric TB especially Extra pulmonary TB (EPTB) is challenging.Objectives: The present study was designed to study clinical, laboratory characteristics and outcome of childhood tuberculosis. Methods: A prospective analysis of 60 cases of TB children within three years period was conducted at Pediatric Department, Dhulikhel Hospital and followed up till child completely recovered.Results: In the present study 60 children had clinical and lab evidence of tuberculosis and received anti tubercular therapy. Extra pulmonary tuberculosis was common (78.3%) than pulmonary tuberculosis (21.6%). BCG scar was absent in eight (13.33%) and absent BCG vaccination was significantly associated with disseminated TB (p<0.05). The most frequently seen symptoms were fever (65 %), cough (46.67 %) and abdominal distension (36.67%). Hepatomegaly (45%), ascites (33.33%), lymphadenopathy (23.33 %) and splenomegaly (11.67 %), and are common signs. Malnutrition seen in (33.3%) with more malnourished children with disseminated TB than in other diagnosis (p<0.001). Mantoux test was positive in (48.3%). Isolation of AFB was possible only in (8.33%). Among 60 cases (60%) were recovered completely with the primary regimen, (5%) recovered with extending the duration of primary regimen to three more months. (25%) failed to follow up, while (6.67%) died.Conclusion: EPTB is common than pulmonary TB. Among 60 cases 36 (60%) recovered completely with the primary regimen, three cases (5%) recovered with extending the duration with primary regimen. Fifteen cases (25%) failed to follow up, while four cases (6.67%) died.Key words: Children; Tuberculosis; Diagnosis; Outcome DOI: 10.3126/jnps.v31i1.4160J Nep Paedtr Soc 2010;31(1):11-16

Pattern of Ophthalmological Diseases in the Patients of Shree Birendra Hospital

Introduction: Blindness is one of the most tragic yet often avoidable disabilities in the developing world. The pattern of ocular diseases varies in different parts of Nepal due to differences in socioeconomic and geographic factors. This retrospective study likely reflects the pattern of ocular diseases in Kathmandu Valley. Aim: To assess the patterns of ocular disease in the patients attending the outpatient department of Ophthalmology from 14th April 2009 to 13th April 2010 at the Army Hospital. Methods: This is a retrospective study and all the new cases which attended the department of Ophthalmology of Shree Birendra Hospital in the year 2066 were included. The diseases were divided into 11 groups i.e. lid & adenexal disorder, disease of conjunctiva & sclera, corneal diseases, lens associated disorders, diseases of uveal tract, refractive error, glaucoma & its associations, posterior segment diseases, ocular & systemic neoplastic disorders, Nekebadi (annual medical check up) and others. Result: The total number of patients recorded in the department of Ophthalmology is 16709. Among them 4473 were regular serving army personnel and 12236 were ex-army and army families. Conclusion: The pattern of eye disease varies in different age groups. In younger age group conjunctival, scleral disease and refractive error were commonly seen whereas in elder age group lens disorder was frequently seen. The number of blind patients was more in females than in male patients. Key words: Conjunctivitis; Cataract; Blindness. DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5023 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 30-37

Incidence Of Urolithiasis In Bir Hospital

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