Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal

Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.

Chest CT Scan Findings in Symptomatic Patients Infected with COVID-19 in Norvic International Hospital, Nepal

Background Coronavirus disease (COVID-19) is the recent global health emergency making it crucial for rapid diagnosis and intervention. Computed tomography (CT) is important for screening, diagnosis and evaluating severity and disease progress. Objective To assess the CT changes in COVID patients and study its relationship with various factors. Method A retrospective study was conducted at Norvic International hospital from August 2020 to November 2020 among RT-PCR positive symptomatic COVID cases who had positive CT changes. CT imaging data were analyzed by radiology expertise. Statistical analysis was carried out with the help of SPSS 16. Result Out of 120 patients, 75% were males and mean age was 54.70±15.56 years. The mean CT severity score was 18.35±6.87. Pure ground glass opacities was seen in 74(61.7%), reticulations 89(74.2%) and crazy-paving pattern 28(23.3%). CT scans with bilateral 118(98.3%) and peripheral involvement 109(90.8%) in all five lobes. CT- severity score was positively correlated with oxygen and mechanical ventilation requirement (P-value < 0.05 and 0.011 respectively). Conclusion CT findings including pure ground glass opacities, reticulations, bilateral and peripheral involvement involving all five lobes were more frequent. Our data suggest that CT-severity score significantly correlates with oxygen and mechanical ventilation requirements.

Awareness Regarding Diabetes Mellitus among General Population of Banepa Municipality

Background Diabetes is a silent disease and many people with diabetes may become aware of it only after life-threatening complications. The presence of knowledge of diabetes could contribute in early diagnosis and minimize the occurrence of complications. Hence, healthcare and public policy makers are putting extensive efforts to aware them on diabetes. Objective To assess the level of diabetes knowledge and its risk among the general public of Banepa municipality. Method A Cross sectional study was conducted to assess the awareness about diabetes among the general public of Banepa municipality. During the period of November 2019 to January 2020, 273 respondents of Banepa municipality were included with informed consent. Data was collected using a pre-tested structured questionnaire through one-to-one interviews. Indian Diabetes risk score (IDRS) was used to identify the risk of diabetes among them that consists of four elements i.e. age, abdominal obesity, physical activity, and family history. Data entry and analysis was done using SPSS version 20. Result It was found that 61.9% had a higher level of knowledge of diabetes. IDRS score shows more than half percent (53.5%) of respondents were in high risk, 39.2% were in medium risk and 7.3% were in low risk. Conclusion This study implies that there was good knowledge about diabetes among people. However, the majority of them are at risk for developing diabetes in future which may be due to lack of practical implication of knowledge. It reflects the necessity to educate and reinforce the public regarding prevention of diabetes which further postpones its complications.

Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study

Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson's correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors.

Bacteriological Evaluation of Tonsillar Surface and Tonsillar Core Micro Flora in Patients Undergoing Tonsillectomy

Background: Acute tonsillitis is the most common disease for the ENT surgeons. Effective treatment of the tonsillitis depends on knowledge of the infecting organism but there is always a dilemma whether the antibiotics prescribed for the tonsillitis is sufficient for the different organisms in the surface and core of the tonsils.Objective: To study the microorganism on the surface and in the core of the tonsil among the patients undergoing tonsillectomy and to correlate clinical profile of the patients with various microorganisms isolated.Methods: This was a cross sectional study conducted on fifty patients’ age ranging from 3 years to 45 years. The swabs obtained from the surface of the tonsil prior to tonsillectomy and core of the tonsil post tonsillectomy were sent for isolation of micro organism and microbial susceptibility technique by standard microbial method.Results: The common age group for tonsillitis was below 15 years (n= 26) and having male predominance and more common in patients from hilly region. The commonest indication for tonsillectomy was recurrent tonsillitis (n=47). There was 82% similarity in microorganisms isolated from the surface and core of the culture. Conclusion: This study highlights that the culture from the surface of the tonsil reflects the organism in the core. Staphylococcus aureus was the commonest isolated organism in the surface and core of the tonsil.Health Renaissance 2014;12(3): 149-153

Dermatophytic Infections among the Patients Attending Di Skin Hospital and Research Center at Maharajgunj Kathmandu

BACKGROUND

Dermatophytosis is the common and most significant superficial fungal infections because of their widespread involvement among the people all over the world. The clinical presentation, though very typical of ringworm infection, is often confused with other skin disorders, making laboratory diagnosis and confirmation necessary. The aim of this research is to study different clinical variants of dermatophytosis and its associated risk factor among the patients attending Di Skin Hospital and Research Center.

METHODS

A descriptive cross-sectional study design was used. Total of 110 samples collected from suspected cases of dermatophytosis were studied among the patients attending DI Skin Hospital and Research Center at Maharajgunj, Kathmandu, Nepal. Skin, hair and nail specimens taken from the patients were processed by direct microscopy and culture using a standard protocol. Macroscopic appearance and microscopic morphology of micro and macroconidia were studied for proper identification of dermatophytes. Data were analyzed using the statistical package for the social sciences (SPSS) version 20 for windows.

RESULTS

Dermatophytosis was more common in the age group of 21-30 (29.1%) years and was more predominant among male population with male to female ratio being 1.39:1. Among the total number of dermatophytosis cases only 52.72% showed fungal elements in KOH preparation and only 43.63% were culture positive. Most common clinical type was tinea corporis (29.1%) followed by tinea cruris (18.2%). Among the total isolates T. rubrum was most common (58.33%) followed by T. mentagrophytes (20.83%), other Trichophyton spp (12.5%) and Microsporum gypseum (8.33%). Most of the positive cases used to take bath, change their dresses and innerwear only once a week. Similarly, Sweating nature could be the possible cause for dermatophytic infection (P=0.006 at CI=95%) and also there was a significant relation between the sharing habit of dress materials and positive cases (P=0.033 at CI=95%). Among the total cases, most of the positive cases did not have any knowledge about fungal infection.Study concluded that more the knowledge of fungal infection less the chance of fungal infection (P=0.003 at CI=95%).

CONCLUSIONS

Tinea corporis was the commonest clinical pattern and overall predominance in the study was male with 21-30 being most affected age group. T. rubrum forms the commonest aetiological agent of dermatophytosis. Possible cause of dermatophytic infection was due to poor hygienic status and lack of knowledge on fungal infection and its preventive measures.

Microbiology of lower respiratory tract infection in workers of garment industry of Kathmandu

By mistake the wrong PDF was loaded for this article. The correct PDF was loaded on 19th September 2016. OBJECTIVES This study was designed with the objectives of describing the distribution pattern of microorganisms responsible for causing LRTI in the workers of garment industries.MATERIALS AND METHODS A total of 198 cases of suspected person of Lower Respiratory Tract infection (LRTI) LRTI were included in this study. This study was conducted between November 2009 to April 2010. Specimen for the study was expectorated sputum. Gram-stain, Ziehl-Neelsen stains and culture were performed.RESULTS On direct microscopic examination, 20.51% were Gram positive bacteria, 79.48% were Gram negative bacteria and 4% were smear positive AFB. On culture sensitivity examination, 22% percent showed growth of different bacteria in different culture media. The bacteria isolated from the samples included Klebsiella pneumoniae (15.38%), Proteus mirabilis (15.38%) and Citrobacterfruendii (15.38%). Gram Negative bacteria were found most susceptible to Ciprofloxacin (92.30%, 24/26) and Amikacin (92.30%, 24/26). Similarly, Gram Positive bacteria were found most susceptible to Ciprofloxacin (100%, 8/8) followed by Cloxacillin and Cephalexin (87.5%, 7/8). Smear positive AFB was significantly associated with not using the protective measures (mask) by workers and presence of symptoms (cough for more than two weeks, night sweat, hemoptysis and anorexia) (p=0.031). Culture positivity was significantly associated with symptoms like production of purulent sputum (p=0.045).CONCLUSION There was insignificant association between LRTI and risk factors present in working room of garment industries. Most of the isolates were sensitive to Ciprofloxacin and resistance to Ampicillin and Cephalexin.Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 14-22

Acceptance of family planning amongst patients attending Dhulikhel hospital obstetrics and gynecology department

BACKGROUND

Knowledge of contraceptive methods is an important factor for an individual to use or not use of family planning methods. In Nepal, at least one modern method of family planning is universal amongst both men and women.

OBJECTIVES

To assess the knowledge, attitude regarding various family planning methods and practice of contraceptives amongst couples attending Dhulikhel Hospital Obstetrics and Gynecology Department.

METHODS

Five hundred and fifteen couples were interviewed. Their knowledge, attitude and practice of contraception were evaluated with the help of pre-evaluated questionnaire. The other variable used were the age of the couple, parity, educational status and economic status having effect on the contraceptive acceptance were taken into consideration. Descriptive analysis was conducted to obtain percentages.

RESULTS

We observed that 74.98% of women were in the age group of 20-29 years and 59.22% of men were within the age group of 20-29 years. Teen age mothers were 17.86% and teen age fathers were 1.35%. In our study, we observed that higher the educational level better was the acceptance for family planning methods. The higher income group had less number of children compared to lesser income group. In our study, we noticed that all the couples knew about different methods of family planning, main sources of information were television, pamphlets and healthworkers. Only 16 males had undergone vasectomy and 32 women had undergone tubectomy. Fewer number of vasectomy was due to the belief that undergoing vasectomy will make the male partner weak physically. 13.20% of women preferred Depot medroxy progesterone as a temporary method of family planning, 13% of males preferred condom as a temporary method of family planning.

CONCLUSION

We conclude that education plays a vital role in the acceptance of family planning. As couples who have higher education level tend to have higher income and they have lesser number of children. They are more receptive towards counseling and agree upon the various methods of family planning. The easy accessibility to the various media like radio, television tend to make people aware of various methods of family planning.

Bacteriological Profile of Neonatal Sepsis in a Tertiary Level Hospital of Nepal

Introduction: Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. This study was done to determine the bacterial profile causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial agents. Materials and Methods: A cross-sectional prospective study was conducted in Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among 340 neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified with Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI). Results: The prevalence rate of neonatal sepsis was 20.3%. Among 340 neonates, 52.17% were males and 47.82% were females. Gram positive cocci were the most predominant isolates (88.40%). Among Gram positive cocci Staphylococcus epidermidis was the most common isolates (72.46%) followed by Staphylococcus aureus (7.24%), Staphylococcus saprophyticus (4.34%) and Enterococcus fecalis (4.34%). Gram negative bacilli were found in 11.60% of the growth positive samples of which E.coli and Klebsiella spp were found in 10.14% and 1.44% respectively. Sensitivity to Amikacin was highest among all types of organisms isolated. Vancomycin and Gentamycin sensitivity was highest for Gram positive and Gram negative organisms respectively. Ampicillin resistance was highest among isolates. Among the 69 isolates 48 were Multiple drug resistant. Conclusion: The predominance of Gram positive cocci particularly Coagulase negative Staphylococci is shown. Empirical antibiotic therapy should be reviewed for Multiple drug resistant strains. DOI: http://dx.doi.org/10.3126/jnps.v34i3.9183 J Nepal Paediatr Soc 2014;34(3):175-180

Impact of lattice mismatch and stoichiometry on the structure and bandgap of (Fe,Cr)2O3 epitaxial thin films

The structural properties of phase-pure epitaxial (Fe1-xCrx)2O3 thin films deposited on α-Al2O3(0 0 0 1) substrates by oxygen-plasma-assisted molecular beam epitaxy are investigated across the composition range using x-ray photoelectron spectroscopy, high-resolution x-ray diffraction, scanning transmission electron microscopy and electron energy loss spectroscopy, and non-Rutherford resonant elastic scattering measurements. The films possess a columnar grain structure with uniform mixing of cations on the nanometer scale. Fe-rich films are relaxed and appear to be slightly oxygen-rich, while Cr-rich films remain partially strained to the Al2O3 substrate and are found to be oxygen deficient. A model is proposed to explain the oxygen stoichiometry results based on the energetics of oxygen defect formation and rate of oxygen diffusion in the corundum lattice, and the dependence on the cation composition. Deliberately introducing residual compressive biaxial strain into (Fe1-xCrx)2O3 thin films (x = 0, 0.41, 0.52) by employing a Cr2O3 buffer layer is shown to narrow the optical bandgap, from 1.80(1) eV for relaxed (Fe0.47Cr0.53)2O3 to 1.77(1) eV for partially strained (Fe0.48Cr0.52)2O3. The relationships which are elucidated between epitaxial film structure and optical properties can be applied to bandgap optimization in the (Fe,Cr)2O3 system.

Prevalence of gastrointestinal zoonotic helminths in dogs of Kathmandu, Nepal

INTRODUCTION: Considering the close association of dog and human beings and increasing trend of pet rearing, it is important to know the status of zoonotic helminths of pet and stray dogs and awareness of owners about this in Kathmandu, Nepal. This study was carried out to determine the prevalence of gastrointestinal zoonotic helminth parasites in dogs and to assess the awareness about canine helminth zoonoses in pet owners. MATERIALS AND METHODS: This cross-sectional study was conducted from September- 2012 to December- 2013. A total of 210 fecal samples (105 each from pet and stray dogs) were collected perrectally and examined by using Formalin-Ether Concentration method. Questionnaire survey was carried out among dog owners. RESULTS: The prevalence of gastrointestinal helminths was 46.7% (98/210). Out of 98 positive samples five different parasite species observed were Ancylostoma spp. 52.0% (51/98), Toxocara canis 41.8% (41/98), Taenia/Echinococcus spp. 15/98 (15.3%), Dipylidium caninum, 9.2% (9/98), and Trichuris vulpis, 5.1% (5/98). Prevalence was higher in stray dogs (56.2% vs. 37.1%) (p<0.05); in females (51.6% vs. 39.8%) (p>0.05); in younger dogs up to 2 years of age (56.3% vs. 35.7%) (p<0.05); in non-dewormed dogs (72.7% vs. 33.0%) (p<0.05) and in dogs sharing rooms with owner (46.1% vs. 13.8%) (p<0.05). Only 11.4% of the owners surveyed were aware about canine helminth zoonoses. CONCLUSIONS: Due to potential risk of zoonotic helminths to human beings and low level of zoonoses awareness in pet owners, there is need of generating awareness to pet owners regarding periodic anthelminthic treatment of pet dogs and other prevention and control measures. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8211 Int J Infect Microbiol 2013;2(3):91-94

Breech presentation among nullipara at term: an indication for caesarean section

BACKGROUND

Breech is the commonest malpresentation. Vaginal breech delivery in a nulliparous lady carries higher risk than in multiparous ladies. Poor neonatal outcome following vaginal delivery has made the mode of delivery a matter of controversy.

OBJECTIVE

To evaluate the outcome of planned caesarean section among nullipara ladies with breech presentation.

METHOD

This is a prospective, analytical study conducted in Dhulikhel Hospital Kathmandu University Hospital from January 2008 to June 2012 among 102 nullipara ladies at term gestation with breech presentation. All cases underwent caesarean section either elective or emergency. During section cause of breech presentation was searched for. Neonatal condition was evaluated using APGAR Score, need for resuscitation and admission in NICU. Post partum status was also recorded for evaluation of maternal morbidity and mortality.

RESULTS

These Nullipara ladies often had some reason for breech presentation, the most common being cord around the neck. Perinatal outcome was uneventful in 97(95%) neonates, there were two (2%) still birth and three (3%) needed NICU care. APGAR was good in 92 neonates, average in eight and poor in two. Total 16(15.6%) ladies stayed hospital for more than eight days. Among them 11(10.7%) developed wound infection and five stayed in hospital waiting for baby.

CONCLUSION

Nullipara ladies with breech presentation should have elective caesarean section as a preferred route of delivery.

Subsurface synthesis and characterization of Ag nanoparticles embedded in MgO

Metal nanoparticles exhibit a localized surface plasmon resonance (LSPR) which is very sensitive to the size and shape of the nanoparticle and the surrounding dielectric medium. The coupling between the electromagnetic radiation and the localized surface plasmon in metallic nanoparticles results in a sizable enhancement of the incident fields, making them possible candidates for plasmonic applications. In particular, partially exposed metallic nanoparticles distributed in a dielectric matrix can provide prime locations for LSPR spectroscopy and sensing. We report the synthesis and characterization of a plasmonic substrate consisting of Ag nanoparticles partially buried in MgO. Ag nanoparticles of different shapes and size distributions were synthesized below the surface of MgO by implanting 200 keV Ag(+) ions followed by annealing at 1000 °C for 10 and 30 h. A detailed optical and structural characterization was carried out to understand the evolution of the Ag nanoparticle and size distribution inside the MgO matrix. Micro x-ray diffraction (Micro-XRD) was employed to investigate the structural properties and estimate the crystallite size. The nanoparticles evolved from a spherical to a faceted morphology with annealing time, assuming an octahedral shape truncated at the (001) planes, as visualized from aberration-corrected transmission electron microscopy (TEM) images. The nanoparticles embedded in MgO were shown to be pure metallic Ag using atom probe tomography (APT). The nanoparticles were partially exposed to the surface by employing plasma etch techniques to remove the overlaying MgO. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) were employed to study the surface morphology and obtain a height distribution for the partially exposed nanoparticles.

Extended spectrum beta-lactamase producing multidrug resistant urinary isolates from children visiting Kathmandu Model Hospital

A study was conducted to analyze the status of the multidrug resistant (MDR) isolates producing Extended Spectrum of beta-lactamase (ESBL) among the uropathogens infecting children less than 15 years from November 2010 to April 2011 in the Bacteriology laboratory, Kathmandu Model Hospital. Urine samples received in the laboratory were processed for routine culture. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute (CLSI) recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be multidrug resistant was resistance to two or more drugs of different structural classes. Isolates were confirmed for ESBL-production by performing the Inhibitor Potentiated Disk Diffusion (IPDD) Test/ Combined Disk Assay for ESBL confirmation. Out of 252 urine samples received in the laboratory, 59(23.41%) showed significant growth of which 54.23% (32/59) were MDR isolates. Additionally, 25 isolates (21 Escherichia coli and 3 Citrobacter freundii and single Enterobacter aerogenes) among them were ESBL producers. Among the first line drugs used against gram negative isolates, Nitrofurantoin was drug of choice; meanwhile among the second line drugs Cefoperazone/Sulbactum was drug of choice, whereas, Cephotaxime, Ciprofloxacin, Norfloxacin and Gentamicin were the drug of choice for Gram positive isolates. Significant association was found between ESBL production and spectrum of drug resistance (p < 0.05).

Seroprevalence of Japanese encephalitis virus and risk factors associated with seropositivity in pigs in four mountain districts in Nepal

Japanese encephalitis was recently reported from individuals in the mountain districts of Nepal without travel history to Japanese encephalitis virus (JEV) endemic areas. We performed a cross-sectional study to estimate the seroprevalence of JEV in pigs and subsequently conducted a survey of farmers to identify risk factors associated with seropositivity. In July and August, 2010, 454 pig serum samples were collected and tested by competitive ELISA. Data from a 35-question survey of 109 pig owners were analysed using multivariate logistic regression. Seventy-six (16.7, 95% CI 13.6-20.4) pigs tested positive for anti-JEV antibodies, none of which had been vaccinated against JEV or sourced from JEV endemic areas. Risk factors associated with JEV seropositivity were 'summer abortion', 'wells as a water source', 'urban location', 'reported presence of mosquitoes' and 'lower elevation'. Our results suggest that JEV is likely circulating in the mountain districts of Nepal, and that locally acquired JEV should be considered a risk for residents and travellers in these areas.

Molecular screening of major bacterial enteropathogens in human stool samples from diarrhoeal outbreak sites

BACKGROUND

V. cholera types have been implicated often in a number of occasions in diarrhoeal outbreaks in Nepal. The recent outbreak in Far Western Nepal, 2009, was also attributed primarily to V. cholera. Molecular tools were used for the first time on some of the samples from the outbreak to screen for major pathogens present in those samples.

METHODS

A commercial multiplex PCR kit based bacterial enteropathogen screening assessment was carried out on 33 human stool samples from areas of a diarrhoeal outbreak in Nepal. A total of 10 pathogenic bacterial strains at the genus level were targeted using primers provided by the manufacturer.

RESULTS

Bacterial pathogens were detected in 23 samples (69.7%). Vibrio species was detected at an overall frequency of 36.4% followed by Aeromonas spp (33.3%) and Shigella spp (15.2%) along with Verocytotoxin producing E. coli (VTEC) family (15.2%). The frequency of singly occurring pathogen in all samples was 18.2% with most of the bacterial pathogens detected in combination with other pathogens at a frequency of 60.6%. The study also shows that majority 73 (86%) of the research centers didn't start the research yet.

CONCLUSIONS

This first ever molecular screening study shows that bacterial screening is indeed possible in diarrhoeal samples. The results obtained from this study will enable monitoring of future such outbreaks using similar techniques.

Tetanus

Tetanus is now a rare disease in developed world. However it remains an important cause of death worldwide and is associated with a high case fatality, particularly in the developing world. Tetanus is caused by contamination of wound by spores of Clostridium tetani. Neonatal tetanus results from contamination of the umbilical stump at or following delivery of a child born to a mother who did not possess sufficient circulatory antitoxin to protect the infant passively by transplacental transfer. It produces its clinical effects via a powerful exotoxin, tetanospasmin, which leads to uncontrolled disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, causing intense muscular rigidity and spasm. Shorter incubation and onset times are associated with more severe disease and poorer prognosis. Four clinical forms of tetanus are recognised. They are generalised, localised, cephalic and neonatal tetanus. Tetanus is associated with several complications like respiratory failure, cardiovascular instability, renal failure and autonomic dysfunctions. Recovery from tetanus takes a long time. Diagnosis is established clinically. Symptomatic management, early recognition of complications, careful monitoring for dysautonomia and respiratory assistance are the anchors for successful outcome of patients. Tetanus is preventable through vaccination. Vaccination is highly safe and efficacious. Active immunisation should be instituted in all partially immunised, unimmunised persons and those recovering from tetanus. Passive immunisation is given as treatment of a case as well as prevention following high risk injury. Nepal has achieved neonatal tetanus elimination status on 2005 and is running different programs to sustain the status.

Brain tumours in children

A 10 years old, female patient presented with symptoms of abnormal movement of the body for 5 years, deviation of mouth to left side for 12 days and difficulty in walking for 12 days. We report a very rare case of Brain Stem gliomas. Clinical and imaging findings were suggestive of brain stem gliomas.

DESIGN OF A SURVEILLANCE SYSTEM FOR PREGNANCY AND ITS OUTCOMES IN RURAL NEPAL

IntroductionCommunity trials in low-income countries require monitoring and evaluation systems.The requirements of a community surveillance system include coherent design, training,field supervision and reporting, as well as the need for a robust and flexible database.Materials and methodsThis paper describes a surveillance system for identification of pregnancy and itsoutcomes in a rural area of Nepal. Mother Infant Research Activities (MIRA), incollaboration with the Institute of Child Health, London, are presently conducting astudy on the impact of a community-based participatory intervention to improveessential newborn care (ENC) in rural Nepal. The study is a cluster randomisedcontrolled trial involving 12 pairs of Village Development Committees (VDCs) inMakwanpur District. The surveillance system covers approximately 28 000 householdsand 28 000 married women of reproductive age. It was designed to identify pregnancy,its outcome for mother and infant, and activities such as antenatal care and problem-related health care seeking behaviour.DiscussionThe paper describes the processes of mapping and enumeration, pregnancyidentification, conduct of interviews, quality control and data management.Key Words: data quality, database, rural Nepal.

In Vitro Propagation of Carrot (Daucus Carota) L

In vitro method for rapid propagation of Daucus carota L. was developed. Root, stem, leaf and nodal explants were cultured on MS medium supplemented with different concentration and combinations of hormones. Multiple shoot were induced from the nodal explant of D. carota by culturing them in MS medium supplemented with 0.5 mg/l of 6-benzylaminopurine (BAP). Differentiation of shoot initiated after one week of culture, and after eight weeks of primary culture, an average of six plantlets were developed from a single shoot. The nodal explant also induced same number of multiple shoot in MS medium supplemented with 2 mg/l of BAP and 1 mg/l of α-nephthalene acetic acid (NAA). The shoots when sub-cultured in the medium supplemented with 1 mg/l NAA produced roots after five weeks of sub-culture. Root and leaf explants induced roots and callus when cultured on MS medium with NAA at the rate of 1 mg/l and 2 mg/ l. Similarly, stem explants also induced roots and callus in the same concentration of hormones whereas few multiple shoot were induced when cultured on MS supplemented with 2 mg/l of BAP and 1 mg/l of NAA. This result suggests that this methodology can be applied for the rapid and mass propagation of this species. Key words: In vitro; Propagation; MS medium; Explant; Culture. DOI: 10.3126/sw.v5i5.2656 Scientific World, Vol. 5, No. 5, July 2007 51-53