Prevalence of Nonalcoholic Fatty Liver Disease in a Tertiary Care Teaching Hospital: A Cross Sectional Study in Province 4 of Nepal

Background Nonalcoholic fatty liver disease (NAFLD) is collection of lipids in hepatic tissues excluding other hepatic diseases and chronic alcohol intake. It may advance to nonalcoholic steatohepatitis or cirrhosis. Ultrasonography has high sensitivity and specificity for detecting nonalcoholic fatty liver disease. Objective Lack of sufficient information in this region on sonological prevalence of nonalcoholic fatty liver disease, lead us to design the survey and may also serve as reference for further researches. Method This is a cross sectional study with 600 participants, conducted at Gandaki Medical College Teaching Hospital, Province 4 of Nepal, from September to October 2017. Ethical approval is taken from the Institutional review board. The study group includes the participants referred for abdominal sonography from outpatient department. Result In present survey, 367 (61.2%) are female and 233 (38.8%) are male participants. The mean age is 41.6 years and median age is 38 years. The prevalence of nonalcoholic fatty liver in our observation is 229 cases (38.2%) of which, 102 cases (44.5%) are male and 127 cases (55.4%) are female participants. Normal liver was seen in 61.8%, Grade one fatty liver was discovered in 24.8%, Grade one in 12.6% and Grade three in 0.6%. The mean liver size in those with fatty liver was 14.1 cm. Conclusion Province 4 of Nepal is not exempt from the growing epidemic of nonalcoholic fatty liver disease with prevalence of 38.2%. The study shows that with higher grades of fatty liver, the size of liver is also increased and the mean age of the participants involved is also in the higher side of the spectrum.

Future climate and land uses effects on flow and nutrient loads of a Mediterranean catchment in South Australia

Mediterranean catchments experience already high seasonal variability alternating between dry and wet periods, and are more vulnerable to future climate and land use changes. Quantification of catchment response under future changes is particularly crucial for better water resources management. This study assessed the combined effects of future climate and land use changes on water yield, total nitrogen (TN) and total phosphorus (TP) loads of the Mediterranean Onkaparinga catchment in South Australia by means of the eco-hydrological model SWAT. Six different global climate models (GCMs) under two representative concentration pathways (RCPs) and a hypothetical land use change were used for future simulations. The climate models suggested a high degree of uncertainty, varying seasonally, in both flow and nutrient loads; however, a decreasing trend was observed. Average monthly TN and TP load decreased up to -55% and -56% respectively and were found to be dependent on flow magnitude. The annual and seasonal water yield and nutrient loads may only slightly be affected by envisaged land uses, but significantly altered by intermediate and high emission scenarios, predominantly during the spring season. The combined scenarios indicated the possibility of declining flow in future but nutrient enrichment in summer months, originating mainly from the land use scenario, that may elevate the risk of algal blooms in downstream drinking water reservoir. Hence, careful planning of future water resources in a Mediterranean catchment requires the assessment of combined effects of multiple climate models and land use scenarios on both water quantity and quality.

Orbital lymphoma in an elderly patient

Lymphomas of the orbit and orbital adnexae are rare tumors, comprising only 1% of all non-Hodgkin’s lymphoma. Lymphomas are the most common primary orbital tumor in adults of age 60 years and older. Here we present a case of 49 year male with left upper lid swelling since 1 year who was diagnosed histopathologically as non-Hodgkin’s lymphoma of orbital region. 

Primary nasal meningioma- a case report

Extracranial meningiomas may be subdivided into primary and secondary types based on absence or presence of intracranial attachments respectively. Primary sinonasal tract meningiomas are rare with unknown etiopathology and non-specific clinical presentation. Of these PEMs only 11.5% are in the nasal cavity and nasal septum. To our knowledge less than 50 cases of PEM of nasal cavity have been reported in the literature. We report a case of a 22 years old male who presented with epistaxis and increasing nasal stuffiness for the last one year.

Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease

On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor.Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD.Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure.Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required.Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.DOI: http://dx.doi.org/10.3126/jnps.v34i3.11617  J Nepal Paediatr Soc 2014;34(3):188-194

Visual Axis Opacification in Children Following Paediatric Cataract Surgery

Visual axis opacification (VAO) occurs in up to 40% of pediatric patients after cataract surgery withintraocular lens implantation(IOL) even with a primary posterior capsulotomy (PPC). In both children and adult group, opacification does obscure the visual axis. However, in children after PPC, there is no capsule. Hence, the terminology VAO is used in children rather than posterior capsular opacification. This opacification is caused by a proliferation of epithelial cells on the posterior capsule or anterior vitreous face and can hinder the optical image quality needed for normal visual development. The rate of epithelial mitotic activity is higher in children compared to adult. It can be managed by Yag laser or surgical membranectomy, the latter is preferable. International and national published articles were systematically reviewed on aetio-pathogenesis, surgical techniques and equipment, type and material of IOL, and management of VAO in children operated for cataract. Author's experience was also included to write manuscript. VAO is frequent complication following cataract surgery in pediatric patients. Age of cataract patients, surgical technique and type and materials of IOL are most common influencing factor for VAO. Immediate management with advance equipment of VAO reduces the incidence for development of irreversible stimulation deprivation amblyopia.

Significance of Quadruple assessment of breast lump–A hospital based study

Background: Approximately 10% of breast masses are breast cancer. It is important for women with a breast lump to receive appropriate evaluation. Mammography has been the “gold standard” in breast cancer detection for >40 years. Ultrasonography is non-invasive easily available, cheaper and accurate tool while Fine needle aspiration cytology has a high diagnostic accuracy rate in hands of experienced cytopathologist. Materials and methods: This was a retrospective and prospective study of 173 women attending radiology department in Manipal Teaching Hospital, Pokhara for mammography during a period of 18 months from January 2011 to June 2012.The age ranged from 20yrs to 75yrs. BIRADS score was given for both mammography and sonomammography. All malignant and suspicious cases had undergone fine needle aspiration cytology. Cytology reports were correlated with imaging study. Results: The most common age group for the breast lump was 40-49 years showing 65(37.57%) cases. Most lumps were seen on the left side 54.3% (94/ 173) cases and were seen in upper outer quadrant of the breast (74 cases). 11 cases each were given the BIRADS score of 4 in both mammography and sonomammography. Sensitivity and specificity of mammography and sonomammography were compared to cytologyreports. The sensitivity for mammogram was 73.7% while specificity was 96.3%. The sensitivity and specificity for sonomammogram was 78.9% and 95% respectively. Conclusion: Quadruple assessment i.e. clinical assessment, mammography, sonomammography and cytological study are the new “gold standard” in the investigation of breast disease. DOI: http://dx.doi.org/10.3126/jpn.v4i8.11499 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 630-634

Computed tomogram guided fine-needle aspiration cytology of lung and mediastinal masses with cytological correlation: a study of 257 cases in Western region of Nepal

Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. To evaluate the lung and mediastinal masses and to analyze and compare the results with cytological findings, 257 patients were retrospectively studied who underwent CT guided FNAC over a period of 2007 to 2013. The study was done in patients who presented with respiratory symptoms with a localized lung lesion which was confirmed radiologically. 252 cases of lung masses and 5 cases of mediastinal cases were included. Patients' age ranged from 24 to 84 year and the male to female ration was 1.2:1. Radiologically, out of 257 cases, 225 cases were given as malignant, 8 cases as benign and 24 cases as inflammatory lesions. Cytologically, 212 cases were malignant, 12 cases were benign and 21 cases were inflammatory. Most common lung malignancy was adenocarcinoma (87 cases) followed by squamous cell carcinoma (56 cases). 8 cases of lung metastasis were seen. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

Accessory hepatic lobe in right lumbar region - an incidental finding

An accessory lobe of liver is a rare congenital anomaly which can be detected incidentally or can even present as acute surgical emergency due to torsion. We report a case of accessory hepatic lobe in right lumbar region in a 21years old female who came for a ultrasound abdomen for lower abdominal pain. We report the importance of ultrasonography and Computed Tomogram (CT) scan for the diagnosis of accessory hepatic lobe.

Bilateral Synchronous Testicular Seminoma in a Patient with Bilateral Cryptorchidism

Cryptorchidism is a known cause of testicular tumor. The incidence of testicular tumor is 11 times more in inguinal testes and 50 times more in intra-abdominal testes. The position of the undescended testis is related to the likelihood of carcinogenesis with the intra-abdominal location having the highest risk for malignancy. Bilateral testicular tumors are rare and 80% of bilateral tumors are metachronous. Synchronous bilateral testicular tumors are rare and bilateral synchronous testicular seminoma in a patient with bilateral cryptorchidism is very rare.

Bleeding Meckel's Diverticulum in an Infant - A Case Report

Meckel’s diverticulum is a congenital diverticulum. Mostly it is asymptomatic. In children the commonest complication is lower GI bleeding. High index of suspicion is required for its diagnosis. Technetium-99m pertechnetate scan is useful to detect ectopic gastric mucosa. Surgical treatment of symptomatic Meckel’s diverticulum is diverticulectomy or ileal resection.DOI: http://dx.doi.org/10.3126/jnps.v34i1.9523J Nepal Paediatr Soc 2014;34(1):54-56

Retinoblastoma: geographic distribution and presentation at a tertiary eye care centre in Kathmandu, Nepal

Introduction: Several aspects of retinoblastoma in Nepal remain enigmatic. Objective: To assess the demographic and geographic distribution, clinical presentation, and treatment methods of retinoblastoma at a tertiary level ophthalmic institution in Kathmandu, Nepal. Materials and methods: A retrospective analysis of all the patients diagnosed with retinoblastoma at Tilganga Institute of Ophthalmology from July 2004 to June 2008 was performed. The main outcome measures included region of residence, treatment options and histopathological findings. The histopathological analysis was performed on enucleated and exenterated specimens. Statistics: The statistical analysis was performed with SPSS Version 11.5. Descriptive statistics are represented as mean ± standard deviation. All tests were two-sided and the P-values of less than 0.05 were considered statistically significant. Results: Thirty patients presented with retinoblastoma during the study period. The mean age at presentation was 2.5 ± 1.6 years (range five months to seven years). Ten of the 12 patients who presented with bilateral retinoblastoma (83 %) were from the Terai region of Nepal. The ratio of unilateral to bilateral cases in the Terai region was 1:2. This differed significantly with the ratio in the hilly region (Fisher’s Exact Test, p = 0.0012). The mean duration of symptoms before presentation was 2.5 3.2 months (range three days to 12 months). Twenty-four patients (80 %) presented with leukocoria. Eleven patients (36.6 %) presented with leukocoria as their only symptom. Ninety-seven percent of the patients underwent either enucleation (90 %) or exenteration (6.7 %) of at least one eye. Conclusion: Bilateral retinoblastoma is more prevalent in the Terai region of Nepal. The majority of the patients present with leucokoria and are treated with enucleation. Nepal J Ophthalmol 2013; 5(10): 169-176 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8708

Bruckner Red Light Reflex Test in a Hospital Setting

Background Childhood blindness is a major problem in developing world including Nepal that needs to be addressed. Objective The objective of study was to measure the effectiveness of the Bruckner red reflex test for screening of posterior segment opacities in children. Methods Patients aged less than five years who came to the Tilganga Institute of Ophthalmology, Kathmandu from March to August, 2009 were recruited in this cross-sectional descriptive study. Children were screened with the Bruckner red light reflex test in a dark room. Patients with abnormal Bruckner tests had their eyes dilated for further investigations. Abnormalities were recorded. The number of patients with an abnormal Bruckner test was recorded and correlated with their potential pathology. Results A total of 172 patients with 97 boys and 75 girls were included. Twenty-three had abnormal Bruckner test results in either one or both eyes. Four of these twenty-three patients had no pathology diagnosed; hence the sensitivity of the Bruckner screen to diagnose significant pathology was calculated at 82.6%. Of the 153 patients with normal results, two patients were found to have pathology detected, which included cataract and strabismus. Hence, the specificity of this test was 98.7%. The screening test had a positive predictive value of 90.5% and a negative predictive value of 97.4%. Conclusion Bruckner test screening is a sensitive and specific marker for detecting the posterior segment opacities in children. We recommend utilizing the test to evaluate these problems where other technologies are rare. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 23-26 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7338

Age-related macular degeneration in Nepal

BACKGROUND

The Age related Macular Degeneration (AMD) is a common cause of visual impairment and blindness worldwide in elderly.

OBJECTIVE

This study aimed to explore the demographic characteristics, pattern and risk factors for AMD at a tertiary referral eye centre in Nepal.

METHODS

This is a hospital-based prospective study, conducted at Tilganga Institute of Ophthalmology, Nepal from September 2008 to May 2009. All the consecutive cases of AMD diagnosed at the institute were included.

RESULTS

A total of 141 patients (266 eyes) with AMD recruited for the study. The mean age was 69.5 years (9.1SD) with three fifth males (58.9%). Housewives and occupations like agriculture comprised of 38.3% and 42.5% respectively. Three fourth (75.6%) of the patients were illiterate. The proportion of dry and wet AMD were found in 62.4% and 37.6% respectively. Bilateral involvement was seen in 88.7% of the subjects. Three fourth (71.4%) of the AMD eyes had presenting visual acuity less than 6/18. History of smoking was found in 69.9% of patients. Hypertension was the predominant systemic problem (45.4%) followed by diabetes mellitus (12.8%).

CONCLUSION

AMD is correlated with ageing in our study as well. Dry AMD is more in age groups 45-64 years and wet AMD at 65 years and older. Bilateral involvement with one eye dry and fellow eye wet AMD is more predominant (44%). Smoking and occupations like agriculture and housewife are significant risk factors for AMD. Likewise male sex, illiteracy and hypertension are other risk factors for AMD in hospital settings.

Gender equity in eye health of Nepal: a hospital-based study

INTRODUCTION

There is a lack of literature examining the impact of gender on access to eye care in developing countries.

OBJECTIVE

To assess the differences in access to eye care between females and males, in the urban hospital setting and in rural outreach clinics.

MATERIALS AND METHODS

A retrospective study was designed to review the patients who sought eye care at a tertiary level eye care institute and its rural outreach clinics from 2006 to 2009 in Nepal. Data were retrieved from clinical records.

RESULTS

In the hospital, females accounted for 50.8% of patients receiving outpatient care and 48.3% of patients receiving surgical care. In rural outreach clinics, females accounted for 56.1% of clinic patients and 51.5% of patients undergoing surgery. Fewer girls than boys aged 0-14 years (44.3%) sought clinical care at the hospital.

CONCLUSION

Females account for approximately half of the hospital eye care services in Nepal. More females seek care at rural outreach clinics than at the urban hospital. However, given the female burden of disease in Nepal, there is still much improvement to be made in this area of care.

Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre, Nepal

Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years. Materials and Methods: This was a descriptive study in a hospital setting. A review of pediatric cataract cases operated between November 2007 and June 2009 in Tilganga Institute of Ophthalmology (TIO), a tertiary eye care centre in Nepal was carried out. The personal profile, preoperative and intra-operative details were noted. In the statistical analysis p value less than 0.05 is considered as significant. Results: A total of 175 eyes of 132 children had presented during study. The sex ratio was 1.6 male per female with mean age of 6.7 years (SD ±4.3). About one-third (32%) presented within the age of three years where as more than two-fifths (46%) presented at the age eight years and above. Seventy two cases were collected through door to door enumeration and screening clinics for children. The proportion of cataract was higher in males than in females (P>0.05). Visual acuity ranged from 6/18 to follows light. Conclusion: Nearly half of the paediatric cataract had presented after the age of eight years mainly from hilly region through the screening program. Most of the pediatric cataract cases presented with the whitish pupillary reflex with more than two-thirds of visual acuity of less than 3/60. The most common type of the cataract surgery performed was lens aspiration with anterior vitrectomy with lens implantation. The earlier the surgery better is the visual prognoses. Hence, community screening through as door to door screening and one day screening clinics will help for early referral and earlier surgery to reduce visual disabilities due to paediatric cataract. Key words: Cataract; Cataract surgery; Childhood blindness; Nepal DOI: http://dx.doi.org/10.3126/jnps.v32i1.5378    J. Nepal Paediatr. Soc. Vol.32(1) 2012 14-18  

Evaluation of nurse providers of comprehensive abortion care using MVA in Nepal

BACKGROUND

Although Nepal's maternal mortality ratio has fallen over the past decade, unsafe abortion remains a leading cause of maternal morbidity and mortality. A key strategy for improving access to safe abortion services is to train mid-level providers such as nurses in comprehensive abortion care (CAC). The Family Health Division of the Nepal Ministry of Health trained an initial cohort of 96 nurses to provide first trimester CAC services using manual vacuum aspiration (MVA) between September 2006 and July 2009. This study evaluates the acceptability and quality of CAC services provided by trained nurses in Nepal.

METHODS

Five assessments were used to evaluate post-training service provision on CAC: facility logbooks registry, nurse provider interviews, facility assessments, facility manager interviews and procedure observation checklists. Ninety-two nurses from 50 facilities participated in the evaluation. Descriptive statistics are reported.

RESULTS

Overall, 5,600 women received CAC services from 42 facilities where nurses were providing services between June 2009 and April 2010. Complications were experienced by 68 surgical abortion clients (1.6%) and 12 medical abortion clients (1.2%). All nurses reported that clients were happy to receive care from them, and 67% of facility managers reported that clients preferred nurse providers over physicians or had no preference. Facility managers and nurses reported a need for additional support, including further training and improved drug and equipment supply.

CONCLUSIONS

Trained nurses provide high quality CAC services in Nepal. Additional support in the form of facilitative supervision and training should be considered to strengthen CAC service provision.

Diagnostic Accuracy of Computed Tomogram in the Evaluation of a Neck Mass

Introduction: The concept of dividing extracranial head and neck into different spaces is a notion that dates back to the 1800s. Various studies have led to detailed description of the soft tissue spaces that are contained within the fascial layers. This study was carried out to determine the accuracy of computed tomogram (CT) in differentiating malignant from benign lesions in the neck, to study the spatial distribution of different types of histological groups in the neck and the prevalence of malignant versus benign diseases involving the neck. Methods: This was a hospital-based, prospective study conducted in the department of Radiodiagnosis, Kasturba Medical college, Mangalore, from 2005-2008. A hundred consecutive patients referred for CT scan examination presenting with complaints related to involvement of neck spaces or presence of palpable neck masses were enrolled in this study. The details of all the cases regarding their radiological fi ndings and histopathology were reviewed. Results: Of the 100 patients studied, 53 % had malignant lesions, out of which 43 % were squamous cell carcinoma and 4 % were metastatic lymph nodal involvement. Twenty percent of the lesions were of an infective origin while 23 % were benign and congenital cystic lesions. Conclusions: CT scan as an imaging modality has the ability to evaluate the malignant and benign tumors of the neck. Considering histopathology as the gold standard, the sensitivity of CT in detecting malignant/benign lesions was 96.5 % with a specifi city of 100 %. The positive predictive value was 100 % and the negative predictive value 95.2 %. Keywords: CT scan, neck mass, neck spaces.

Diagnostic accuracy of computed tomogram in the evaluation of a neck mass

OBJECTIVE

The concept of dividing extracranial head and neck into different spaces is a notion that dates back to the 1800s. Various studies have led to detailed description of the soft tissue spaces that are contained within the fascial layers. This study was carried out to determine the accuracy of computed tomogram (CT) in differentiating malignant from benign lesions in the neck, to study the spatial distribution of different types of histological groups in the neck and the prevalence of malignant versus benign diseases involving the neck.

METHODS

This was a hospital-based, prospective study conducted in the department of Radiodiagnosis, Kasturba Medical college, Mangalore, from 2005-2008. A hundred consecutive patients referred for CT scan examination presenting with complaints related to involvement of neck spaces or presence of palpable neck masses were enrolled in this study. The details of all the cases regarding their radiological findings and histopathology were reviewed.

RESULTS

Of the 100 patients studied, 53 % had malignant lesions, out of which 43 % were squamous cell carcinoma and 4 % were metastatic lymph nodal involvement. Twenty percent of the lesions were of an infective origin while 23 % were benign and congenital cystic lesions.

CONCLUSION

CT scan as an imaging modality has the ability to evaluate the malignant and benign tumors of the neck. Considering histopathology as the gold standard, the sensitivity of CT in detecting malignant/benign lesions was 96.5 % with a specificity of 100 %. The positive predictive value was 100 % and the negative predictive value 95.2 %.

Axial length in eyes with bilateral pediatric cataract at tertiary eye care center in Nepal: a preliminary report

The aim of the study was to determine the average axial length reading of the bilateral pediatric cataract undergoing cataract surgery. Pre-operative axial length measurement was done in 80 children below 15 years who had bilateral pediatric cataract. Axial length measurement was done in 56 fellow eyes. The axial length was measured under general anesthesia with the Accutome A-scan. The mean age was 69.7 months (SD=52.6), range from one month to 168 months. The mean axial length reading was 21.3 mm in operated eyes and 21.1 mm in fellow eyes. The range of axial length reading was 16.2 -31.5 mm in operated eyes and it was 16.5 -31.5 mm in fellow eyes. This short observation found that in bilateral pediatric cataract, the axial length value is similar in both operated and fellow eyes. Based on the axial length value of the operated eye, the patients with bilateral congenital cataract can undergo surgery in those eye hospitals where facilities of measurement of axial length is not available.

Adrenal gland teratoma in a 40-year-old woman

Teratoma is a germ-cell tumor that commonly affects the gonads. Extragondal teratoma is a rare entity. Teratoma in the region of adrenal gland is a rare and uncommon retroperitoneal tumor; only few cases have been reported. This case report describes such a tumor in a 40-year-old-woman who presented with multiple vague complaints. Ultrasonography of the abdomen showed a mixed echogenic mass with areas of calcification in right suprarenal region and a lymph nodal mass in the right renal hilar region. Computed tomography showed a mass containing fat, calcification and soft tissue component in right supra-renal region indenting the superior pole of kidney. Intraoperatively a supra-renal tumor was found within in a pseudocapsule that covered most of the tumor with a part of duodenum fixed to the mass.

Substance use among third year medical students of Nepal

BACKGROUND

Substance use is very rampant in a developing country like Nepal. Unfortunately, medical field is not exempt from it either. Substance use among medical students and doctors not only reduces their efficiency at present but also increases their DALY on long term. The main objectives of the study were to assess the prevalence of substance use among medical student and to find out whether substance use started before or after joining the medical school.

METHODS

The study design employed for the research was descriptive cross sectional. A structured questionnaire about current use of tobacco, alcohol and marijuana was used to collect the data from third year students from eight medical and one dental college from across the country having 2006 batch.

RESULTS

The overall response rate was 74.12% (N=510). Among those who responded, prevalence of substance use was 49.6%, of which 38.2% were Nepalese nationals and 11.4% were foreign nationals and 39% were male and 10.6% female. Alcohol based product users were 52.3%, tobacco based product users were 55% and marijuana users were 65.7% and all started using them after joining the medical school.

CONCLUSIONS

Almost half of the respondents were involved in some sort of substance use and more than half of those using started after joining medical school. Hence if proper measures are taken to address this then its prevalence can be significantly reduced if not eliminated completely.

Ocular Morbidity among Orphanages

INTRODUCTION: The study assesses the spectrum of ocular morbidity and predictors of morbidity in children living in orphanages in the Kathmandu Valley. METHODS: A descriptive, cross-sectional survey was performed at 12 orphanages over a period of three months. The survey included a questionnaire and a complete eye examination, which included measurement of refraction, ocular deviation, and a fundus exam. Prevalence of ocular morbidity was calculated. Factors associated with ocular morbidity were examined using logistic regression. RESULTS: A total of 660 children were included in the study (median age nine years [range 0.25-15]; 53% male). The prevalence of ocular morbiditywas 17.9% (118). Of those with ocular morbidity, 88.1% (104) had similar ocular problems bilaterally. The most common type of morbidity was refractive error, found in 70.3% (83) of those with ocular morbidity (12.6% overall). CONCLUSIONS: Refractive errors, which are largely correctable, are the greatest source of morbidity. In order to reduce childhood blindness, children living in orphanages are an appropriate group to target for future ocular screening in Nepal. Keywords: children, Nepal, ocular morbidity, ocular screening, orphanage

Ocular morbidity among orphanages

INTRODUCTION

The study assesses the spectrum of ocular morbidity and predictors of morbidity in children living in orphanages in the Kathmandu Valley.

METHODS

A descriptive, cross-sectional survey was performed at 12 orphanages over a period of three months. The survey included a questionnaire and a complete eye examination, which included measurement of refraction, ocular deviation, and a fundus exam. Prevalence of ocular morbidity was calculated. Factors associated with ocular morbidity were examined using logistic regression.

RESULTS

A total of 660 children were included in the study (median age nine years [range 0.25-15]; 53% male). The prevalence of ocular morbidity was 17.9% (118). Of those with ocular morbidity, 88.1% (104) had similar ocular problems bilaterally. The most common type of morbidity was refractive error, found in 70.3% (83) of those with ocular morbidity (12.6% overall).

CONCLUSIONS

Refractive errors, which are largely correctable, are the greatest source of morbidity. In order to reduce childhood blindness, children living in orphanages are an appropriate group to target for future ocular screening in Nepal.

Keratometry in eyes with bilateral pediatric cataract at tertiary eye care center in Nepal: a preliminary report

Pre-operative keratometry measurement of the subjects was done in 80 children with bilateral congenital cataract below 15 years who had undergone pediatric cataract surgery. The objective of the study was to evaluate the average keratometry reading in Nepalese children with bilateral cataract. The keratometry reading was taken under general anesthesia with the Nidek Auto Keratometer, model KM-500. The mean age was 69.7 months (SD = 52.6), range from one month to 168 months. The mean keratometry reading was 44.8 (SD = 2.7) in operated eyes and 44.7 (SD = 2.6) in fellow eyes. The minimum and the maximum values of keratometry reading in operated eyes were 39.4 and 51.5 respectively where as it was 40.3 and 51.5 in fellow eyes. We concluded that in bilateral pediatric cataract the keratometry value is similar in both operated and fellow eyes. Based on the keratometry value of the operated eye, the patients with bilateral congenital cataract can undergo surgery in those eye hospitals where facilities of the keratometry is not available under general anesthesia. We also recommended that additional study on axial length will be needed to calculate the Intra Ocular Lens power in fellow eye.

Outcome of pneumatic retinopexy at a tertiary eye care centre in Nepal

BACKGROUND

Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment.

AIM

This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility.

STUDY DESIGN

This was a retrospective- prospective, interventional case series.

MATERIALS AND METHODS

All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study.

RESULTS

A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of <6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure.

CONCLUSION

The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce.

Prevalence of diabetic retinopathy following a community screening for diabetes

Diabetic retinopathy is a public health challenge in developing countries including Nepal and is not like other preventable or treatable causes of blindness. The aim of study was to estimate the prevalence of diabetic retinopathy following a community screening for diabetes. A community-based, cross sectional study was designed to screen for diabetes in people age > or =40 years in a semi-urban community of Kathmandu, Nepal. In those individuals with detected diabetes, a comprehensive eye examination was performed by an ophthalmologist and diabetic retinopathy was graded using a standard protocol. 1475 persons were screened for diabetes with a mean age of 54.7 +/- 12 years with sex ratio of 0.69 male per female. Thirty-four subjects were found to have impaired fasting glucose and sixty subjects had diabetes. The prevalence of diabetes mellitus was 4.1% (60) but 6.4% (94) had an abnormal blood sugar level. Fifty-seven diabetic patients visited at-Tilganga Eye Centre for ocular examination. Among examined patients, the prevalence of diabetic retinopathy was 19.3% (11). Only one person had clinically significant macular edema requiring laser therapy. The prevalence of hypertension and cataracts were the same among patients with and without diabetic retinopathy. The prevalence of diabetic retinopathy was low but one of sixteen newly diagnosed diabetics did have evidence of diabetic retinopathy. Eighty-four percent of known diabetics had never had their eyes examined for ocular complications. Community awareness and physician coordination should be emphasized to increase the eye examination rate.

Prevalence of and factors associated with diabetic retinopathy among diabetics in Nepal: a hospital based study

Diabetic retinopathy is the one of the leading cause of visual impairment in world including Nepal. The objective of the study is to estimate the prevalence of and factors associated with Diabetic Retinopathy among diabetics in a Tertiary Eye Care Centre, Nepal. A hospital-based, cross sectional study, was conducted at Tilganga Eye Centre, Nepal. 371 consecutive subjects were recruited during a period of study. Ophthalmologist performed comprehensive eye examinations, which were reconfirmed by senior ophthalmologist. Diabetic Retinopathy was graded using the Early Treatment Diabetic Retinopathy Study. Total 371 consecutive diabetics were examined, mean of 57.4 years (SD 12.0) having the sex ratio of 0.72 male per female. The prevalence of Diabetic Retinopathy was 44.7% (166) with non-proliferative Diabetic Retinopathy presented 85.5% (142) and 14.5% (24) were proliferative Diabetic Retinopathy. Clinically significant macular edema was found in 19.2% (32). The age at onset of diabetes, duration of diabetes and hypertension were significantly associated with Diabetic Retinopathy (p = < 0.05) whereas ethnicity, sex and cataract surgery were not associated with it (p = > 0.05). The prevalence of Diabetic Retinopathy was within the range of previous studies with a high rate of proliferative diabetic retinopathy. Factors associated with diabetic retinopathy were similar to other developed countries. To prevent this condition of Diabetic Retinopathy, the coordination between physician and ophthalmologist needs to be strengthened.

Willingness to pay for cataract surgery in Kathmandu valley

AIM

A cross sectional study was carried out on 78 screened cataract patients of two screening camps in Kathmandu valley, Nepal, to assess the willingness to pay for cataract surgery.

METHODS

A non-probability sampling technique with open ended and close ended questionnaires was used.

RESULTS

The average age of patients was 68.8 years. The ratio of men and women was 0.9:1. 42.3% (33) of patients were willing to pay for cataract surgery. Among them 48.5% (16) of people were willing to pay less than dollars 13 and 51.5% (17) were willing to pay more than dollars 13. The mean was dollars 2.3 (SD dollars 15.5) per case. Patients with bilateral cataract were more willing to pay than unilateral cases. Poverty (44.4%, 20) was the main barrier for unwillingness to pay for cataract surgery. Other reasons were the lack of family support (28.9%, 13), lack of knowledge of surgery and belief that it was an unnecessary procedure (15.6%, seven), and waiting for a free surgical service (11.1%, five).

CONCLUSION

This study clearly indicates that although there was awareness of the availability of treatment and services provided within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients' attitudes, a more holistic approach is needed, keeping in view the cultural, social, and economic background of the society.

Utility of fine needle aspiration cytology in metastatic lymph nodes

Background: Fine needle aspiration cytology is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries like Nepal for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor. The aim of the study was to find out the cytological diagnosis of metastatic lymph node lesions. Materials and Methods: A combined prospective and retrospective study was done of all metastatic lymph node lesions (including both superficial and deep nodes) reported in Department of Pathology, Manipal Teaching Hospital, Pokhara from January 2005 to Deceember 2010. Results: A total of 4180 cases of fine needle aspiration cytology were carried out of which 508 cases were of lymph node. Cytology results were unsatisfactory in 58 specimens (12%), “reactive” or “infective” in 347 specimens (68%), positive for metastasis in 93 specimens (18%) and hematolymphoid malignancies include 10 cases (2%). The most common site was anterior and posterior triangles cervical nodes. The most common malignancy was adenocarcinoma, seen in 62 cases (67%), followed by metastatic squamous cells carcinoma (14 cases, 15%). Conclusion: Fine needle aspiration cytology of lymphadenoathy is a useful tool in diagnosing metastatic lesions with good certainty. Keywords: Fine needle aspiration cytology; Lymphadenopathy; Metastasis DOI: http://dx.doi.org/10.3126/jpn.v1i2.5399 JPN 2011; 1(2): 92-95