Night Time Gadget Use and Quality of Sleep among Health Science Students in Bangalore, India

INTRODUCTION: Electronic gadgets have become a necessity for modern life, and unstructured use of these devices can result in sleep disturbances among youth in the digital era. This study correlated patterns of nighttime electronic gadget use and quality of sleep among health science students.METHODS: Cross-sectional research study was conducted among 243 health science students of selected colleges in Bangalore. The subjects comprised students from pharmacy 79 (32.6%), physiotherapy 79 (32.6%) and nursing 84 (34.7%). A self-administered questionnaire was used to collect demographic information on nighttime electronic gadget use. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). RESULTS: Watching movies (43.6%), communicating (36.1%) and academic use (20.3%) were the most reported purposes of nighttime gadget use among the students. 22.8 % of the participants were using the gadgets for 2-4 hours and 7.5 % of the students used them for more than 5 hours at night. Linear regression analysis revealed that the habit of checking one’s phone at night and staying up late at night had an impact on the daytime activity of students. Subjective sleep quality, sleep latency, sleep duration and sleep efficiency were significantly affected by nighttime gadget use.CONCLUSION: Unrestricted gadget use during nighttime can result in sleep-deprived individuals who may not be able to perform as efficiently. Effective measures should be initiated to structure the use of technologies.

A survey of final year pharmacy undergraduates’ mentorship experience

Introduction

The General Pharmaceutical Council (GPhC) Standard 7.3 for the initial education and training of pharmacists1 states student pharmacists and trainee pharmacists must have access to pharmacy professionals to provide professional support and guidance by acting as role models and mentors. Four mentoring programmes exist for Brighton University undergraduates, available virtually in addition to external mentoring programmes, such as Royal Pharmaceutical Society (RPS) mentoring programme. Chang et al2 studied RPS mentoring participants and found previous positive experiences inspired participants to participate in their programme. This work investigates 2021/2022 final year Brighton University pharmacy undergraduate mentoring experience.

Aim

To survey final year pharmacy undergraduates’ mentorship experience.

Methods

An online survey consisting of 5-point Likert-scale statements and closed-ended questions, was designed, piloted, and distributed using the JISC online survey platform to final year Brighton University pharmacy undergraduates. Data collected included awareness of mentorship programmes, whether undergraduates had previous mentorship experience, and attitudes towards mentoring using 12 Likert-scale statements each for respondents who were mentors, mentees, and those with no mentoring experience. The data were quantitively analysed using Microsoft Excel version 16.58 and the JISC online survey platform. The 5-point Likert Scale questions were analysed by calculating a weighted average. Ethics approval was received from the Brighton University School of Applied Sciences Research Ethics Committee.

Results

48 undergraduates completed the survey. 13 (27%) had previous experience mentoring. This sample was comprised of 8 undergraduates with mentor experience and 10 undergraduates with mentee experience. Four undergraduates had both mentor and mentee experience. In total, 63% (n=39) respondents were aware of the University’s mentoring programmes, 32 (60%) were aware of external mentoring programmes available with 45% (n=24) citing the RPS mentoring programme. A total of 75% (n=6) mentors and 70% (n=7) mentees reported that mentoring aided their professional development. All (n=8) undergraduates who were mentors and 80% (n=8) mentees reported that this was a beneficial experience. Three quarters (n=6) of those who were a mentor and 60% (n=6) who were mentees reported that this improved their employability skills. The main challenge found by mentors and mentees was the amount of time needed to undertake these roles. 16 (46%) undergraduates with no mentoring experience agreed that participating in a mentoring programme would be too much time and effort, 28 (80%) would prefer if their mentor/mentee was from or following the same professional background as them and 20 (57%) agreed they would consider signing up for a mentorship programme if offered to them.

Discussion/Conclusion

Limitations included a low response, but results obtained were sufficient to highlight issues. Although most undergraduates were found to be aware of benefits of a mentorship programme, these should be promoted further, with realism around time mentoring takes, and opportunities scoped to incorporate time for mentoring in undergraduates’ timetables. Many undergraduates still lack mentoring experience and are not aware of mentoring programmes. Establishing mentoring arrangements within the final year with trainee pharmacists could be a mechanism to address the undergraduate’s preference of mentoring arrangements with the same professional background.

References

1. GPhC. Standards for the initial education and training of pharmacists2021 [cited 2021 10/11/2021]:[16-32 pp.]. Available from: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-initial-education-and-training-of-pharmacists-january-2021_0.pdf

2. Chang H, Desselle S, Canedo J, Mantzourani E. Reflections of mentors and mentees on a national mentoring programme for pharmacists in the United Kingdom: An examination into organisational culture and systems. Research in Social and Administrative Pharmacy. 2021.

Disease Pattern and Outcome of Neonates at Special Newborn Care Unit (SNCU) of Pokhara Academy of Health Science (PAHS), Nepal

Aims: This study was conducted to identify the causes and the outcome of neonates admitted to SNCU of Western Regional Hospital.Methods: A retrospective study was conducted at SNCU of western Regional Hospital, a referral tertiary centre of  Western Region of Nepal from March 2016 to March 2017.Results: Total of 1144 neonates were admitted in NICU comprised of 562 (49.12.%) neonatal sepsis, 164 (14.33%) neonatal hyperbilirubinemia, 120 (10.48%) birth asphyxia, 109 (9.52%) premature, 92 (8.04%) Meconium Aspiration Syndrome, 96 (8.39%) Congenital anomalies and 14 (1.22%) necrotizing enterocolitis. Out of neonatal sepsis, 20.62% were early onset and 28.49% late onset conditions. Among Birth asphyxia, 102 (85.00%) were of HIE I& II and 18 (15%) of  HIE III. Overall mortality observed was 3.32%. Those who required mechanical ventilation had higher mortality (87.50%) than the cases that were kept for CPAP (14.81%).Conclusions: Neonatal Sepsis, birth asphyxia, prematurity and Neonatal hyperbilirubinemia were major causes for admission in SNCU.

Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy

Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion.

The impact of ocular trauma during the Nepal earthquake in 2015

Background

Nepal was struck by a massive earthquake on the 25th April 2015 and major aftershock on the 12th of May 2015, resulting in widespread devastation with a death toll in the thousands. The burden of ocular trauma resulting from the recent earthquakes in Nepal has not been described thus far. The aim of this study was to determine the types of ocular injuries sustained in the earthquake in Nepal and its management in Tilganga Institute of Ophthalmology (TIO) in Gaushala, Kathmandu.

Methods

This is a hospital-based retrospective study of patients presenting to TIO following repeated earthquake. Variables that were recorded included patients’ presenting symptoms and time to presentation, visual acuities at presentation and at follow-up, diagnosis of ocular injury and surgery performed.

Results

There were 59 cases of earthquake victims visiting TIO, Gaushala, Kathmandu from April 2015 to July 2015, with 64 affected eyes due to 5 cases of bilateral involvement. The majority of patients were from the district Sindhupalchowk (14 cases, 23.7%), which was the epicenter of the main earthquake. The average duration between the earthquake and presentation was 13 · 9 days (range 1–120 days). Closed globe injury was most frequent (23 cases), followed by open globe injuries (8 cases). While 24 patients (38%) initially presented with a visual acuity <3/60 in their affected eye, 15 patients (23%) had a visual acuity of <3/60 on follow-up. A variety of surgical treatments were required including anterior and posterior segment repair.

Conclusions

Immediate management of ocular trauma is critical in order to prevent blindness. Characterizing the burden of earthquake-related ocular trauma will facilitate planning for service provision in the event of a future earthquake in Nepal, or in countries, which are similarly at risk of having natural disasters.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-017-0429-z) contains supplementary material, which is available to authorized users.

Tamsulosin versus Alfuzosin as medical therapy for ureteric stones

Objectives: To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones.Patients and Methods: A total of 87 patients with ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group I patients (n-30) received 0.4 mg of tamsulosin daily, group II patients (n-29) received 10 mg of alfuzosin daily and group III patients (n-28) received no alpha blockers. All patients were given analgesia when needed. Follow up was done in weekly basis for 4 weeks.Results: The mean stone size (5.33±1.58, 5.79±1.84, 5.67±1.64) and age (29.1±6.3, 30.31±7.22, 29.4±7.63) were comparable in each groups. The stone expulsion rate was 83.3%, 79.3% and 50% in group I, II and III respectively. The drugs related side effects reported by patients were mild and transient.Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other

Risk Factors and Outcome of Neonates Born through Meconium Stained Amniotic Fluid in a Tertiary Hospital of Nepal

Introduction: The incidence of meconium aspiration syndrome is still high in the developing world contributing significantly to the neonatal mortality. The study was aimed to know the risk factors contributing to meconium aspiration syndrome and neonatal outcome in a tertiary government hospital of the country.Materials and Methods: It was a hospital based cross sectional study done over a period of three months. All live newborns born through meconium stained liquor were enrolled and all the details regarding mother, neonate were recorded. Odd’s ratio and bivariate analysis was done to assess the risk factors for meconium aspiration syndrome.Result: Out of all the deliveries 14.6% were meconium stained amniotic fluid and meconium aspiration syndrome developed in 6.6% of the neonates. Low Apgar score and premature rupture of membranes was significantly associated with the risk of occurrence of meconium aspiration syndrome. Neonates who developed meconium aspiration syndrome had mortality of 11.3%.Conclusion: Perinatal asphyxia and premature rupture of membranes were significantly associated with the development of meconium aspiration syndrome and neonates who developed meconium aspiration syndrome had high mortality.J Nepal Paediatr Soc 2015;35(1):44-48

What is the impact of genome-wide supported risk variants for schizophrenia and bipolar disorder on brain structure and function? A systematic review

The powerful genome-wide association studies (GWAS) revealed common mutations that increase susceptibility for schizophrenia (SZ) and bipolar disorder (BD), but the vast majority were not known to be functional or associated with these illnesses. To help fill this gap, their impact on human brain structure and function has been examined. We systematically discuss this output to facilitate its timely integration in the psychosis research field; and encourage reflection for future research. Irrespective of imaging modality, studies addressing the effect of SZ/BD GWAS risk genes (ANK3, CACNA1C, MHC, TCF4, NRGN, DGKH, PBRM1, NCAN and ZNF804A) were included. Most GWAS risk variations were reported to affect neuroimaging phenotypes implicated in SZ/BD: white-matter integrity (ANK3 and ZNF804A), volume (CACNA1C and ZNF804A) and density (ZNF804A); grey-matter (CACNA1C, NRGN, TCF4 and ZNF804A) and ventricular (TCF4) volume; cortical folding (NCAN) and thickness (ZNF804A); regional activation during executive tasks (ANK3, CACNA1C, DGKH, NRGN and ZNF804A) and functional connectivity during executive tasks (CACNA1C and ZNF804A), facial affect recognition (CACNA1C and ZNF804A) and theory-of-mind (ZNF804A); but inconsistencies and non-replications also exist. Further efforts such as standardizing reporting and exploring complementary designs, are warranted to test the reproducibility of these early findings.

Indications for keratoplasty in Nepal: 2005 - 2010

Introduction: Corneal disease, especially infective keratitis, is one of the major causes of visual impairment and blindness in developing countries. Objective: To find out the current indications for keratoplasty, how these indications have changed over time as well as how they are different from those in other parts of the world. Materials and methods: A retrospective study of a case series of 645 keratoplasty surgeries (589 patients) was conducted at the Tilganga Institute of Ophthalmology from January 2005 to December 2010. Outcome measures: The cases were evaluated in terms of demographic parameters, preoperative diagnosis and the type of surgery performed. Results: The most common indication for surgery was active infectious keratitis (264 eyes, 40.9 %), followed by corneal opacity (173 eyes, 26.8 %), regraft (73 eyes, 11.2 %), bullous keratopathy (58 eyes, 9.0 %), keratoconus (45 eyes, 7.0 %) and corneal dystrophy (11 eyes, 1.7 %). The mean recipient age was 41.7 ± 19.9 years with over a half of the patients between 15 to 49 years of age. More men (64.1 %) underwent keratoplasty than women (35.8 %). 59.8 % of the eyes with infectious keratitis had a perforated corneal ulcer. 49.7 % of corneal opacities were due to previous infectious keratitis. 72 % of regrafts were for endothelial failure of various causes. In older patients (> 50 years), bullous keratopathy was an important indication, after infectious keratitis. Keratoconus and corneal scar were major causes of keratoplasty in children of 14 years or less. Four percent of the patients had keratoplasty in both the eyes. 17.1 % of the patients who had one eye operated on had a blind fellow eye with a vision of less than 3/60. Conclusion: Currently, keratitis, either active or healed, is the major indication for keratoplasty, suggesting that improved primary eye health care is necessary to decrease the prevalence of corneal blindness. Nepal J Ophthalmol 2013; 5(10): 207-214 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8730

Tobacco and alcohol: the relation to pulmonary tuberculosis in household contacts

Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Lowered immunity may be associated with cigarette smoking, tobacco chewing and alcohol consumption. The co-relationship between these all factors to TB should be explored. This study aims to detect the hidden household contacts (HC) cases early and to examine the relative contribution of tobacco and alcohol use to the risk of TB. Across-sectional study was in Dharan among HCs. From June 2009 to May 2010, 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. AFB were detected in sputum of 13 (1.6%) HCs. The association between habits (alcohol user and smoking) and TB was found except with chewing tobacco user (P > 0.05). The risk of contact TB was 4 and 8 times greater in smoker (OR = 3.94 95% CI = 1.26-12.26, P < 0.05) and alcoholic (OR = 8.23 95% CI = 2.71-24.98, P < 0.05) HCs respectively. This study has revealed smoking and alcohols as the risk factors for tuberculosis. Effective campaign to discourage use of alcohol and tobacco, and awareness programme about the mode of transmission of TB are needed in community.

A case of nocardia keratitis treated successfully with topical amikacin

BACKGROUND

Keratitis caused by the nocardia species is rare in clinical practice and can cause confusion during treatment because it often mimics fungal keratitis.

CASE

This is a case of nocardia keratitis occurring in a forty-year-old lady without any predisposing factors. It was initially treated as fungal keratitis, then as herpes simplex viral keratitis, but once the organism was known, it was successfully treated with topical fortified amikacin 14 mg/ml (1.4 %).

CONCLUSION

Delay in diagnosis can occur in nocardia keratitis due to its rarity in occurrence. It responds well if proper therapy is instituted on time.

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.

Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors

Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerable place for transmission of this disease to its contacts. Risk factors associated with this contact transmission may differ according to locality. This study aims to determine the prevalence of household contact (HC) PTB and examine the risk factors contributing to it. A cross-sectional study was conducted to determine the prevalence of HC TB among HCs aged > 5 years in Dharan. During the study period (June 2009 - May 2010), 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. The prevalence of HC TB was found to be 1.6%. The result was statistically associated (P < 0.05) with illiterate HCs (OR= 5.77, 95%CI =1.52-21.81), close proximity with ICs (OR=3.07, 95%CI = 1.02-9.25), primary relatives to ICs (OR= 4.85, 95%CI = 1.07-22.05) and slum dweller (OR = 4.56, 95%CI = 1.25-16.71). Similarly, AFB positivity was associated (P<0.05) with household crowding (OR = 7.46, 95%CI = 2.36-23.49), room size < or = 10 x 10 feet (OR=4.05, 95%CI = 1.23-13.25), firewood user while cooking (OR = 5.96, 95%CI = 1.92-18.45). The prevalence of HCs tuberculosis is found to be 1.6%. Poverty, illiteracy, overcrowding, close proximity, close relation with ICs, firewood while cooking, slum dweller, are major factors highlighted by this study as risk factors of contact TB. Our results recommend a much better contact tracing and treatment program.

Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis.

Spectrum of diseases in a medical ward of a teaching hospital in a developing country

Communicable and respiratory tract diseases especially chronic obstructive pulmonary diseases are the main reasons of admission in medical ward of low and middle income countries. This is different from the developed countries where non communicable diseases are the main reasons of hospital admission. In developing countries the data of hospital admission are still lacking. Therefore this study will help us to assess the common patterns of diseases admitted in a medical ward, the average length of hospital stay etc. The record of 1040 hospitalized patients in medical ward was analyzed for the period of six months from Jan 2010 to Jun 2010. Patient’s medical records were retrieved and data analysis was done to obtain age, sex, common diagnosis, the affected system and the duration of the hospital stay. The data was analyzed by using SPSSV 16. After reviewing the data the most common age of patients being admitted were between 46-65 years (31.5%) followed by more than 65 years (25%) between 26-45 years (21.28%) and less than 25 years (21.28%). Among the admitted patients females were more than the males except in neurolog ward. The most effected system was respiratory (31.73 %),and the most common diagnosis was Chronic obstructive pulmonary diseases (23.17%). The next common system involved was gastroenterology including liver (18.64%) ,genitourinary (12.01%), cardiovascular ( 11.34%), neurology (9.23%), endocrine (4.80%) hematology (2.30%). The cause for hospital admission by infection in different system was (30.08%) The average duration of hospital stay of the patients was less than 7 days. The respiratory diseases and the infectious disease are the most common disease in Nepal. The communicable diseases still hold a greater position, while non communicable diseases are main reasons for admission to the medical wards in developed countries. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 7-11 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6831

Etiological agents of corneal ulcer: five years prospective study in eastern Nepal

To identify the most common isolates from the corneal ulcers with antimicrobial pattern of bacterial isolates. All patients with suspected corneal ulceration presenting to BP Koirala Institute of Health Sciences from Jan 2004 - Dec 2008 were evaluated. Corneal scraping was performed and processed for direct microscopy, bacteriological and fungal culture. Bacterial isolates were subjected to antimicrobial susceptibility testing. Of 351 specimens examined, growth of etiological agents were obtained in 278 (79.20%). Of these, 113 (40.65%) had pure fungal growth, 108 (38.85%) had pure bacterial growth and 57 (20.50%) had mixed fungal and bacterial infection. The commonest fungal pathogen was Aspergillus spp 50 (33.33%) followed by Fusarium spp 19 (12.66%). Staphylococcal aureus 57 (44.53%) was isolated as commonest bacterial agent. Coagulase Negative Staphylococci 20 (15.6%) was second in the list. Pseudomonas spp 12 (9.40%) was the most common gram negative bacilli isolated. Most of the bacterial isolates were sensitive to commonly used antibiotics. Corneal Ulcer is a common problem in eastern Nepal. Knowledge of both fungal and bacterial agents associated with this condition is of value for the prevention and management of corneal ulcers and their complications.

Study of clinical profile of megaloblastic anemia: An experience of six year at Kathmandu University Hospital, Dhulikhel

Megaloblastic anemia is not uncommon, however varied of presentation makes difficult to come to conclusion. It’s more difficult when resources are limited. In this back ground clinical features of megaloblastic anemia are very important for diagnosis and treatment. It is a retrospective analysis of data from December 2003 to September 2009. During the period, bone marrow aspiration was done for analysis of cause and type of anemia.A total of 14 cases bone marrow findings was consistent with megaloblastic anemia. These reports were taken into consideration after pathologist impression. Serum Vitamin B12 and RBC folate were not done in view of limited resources and financial constrain. In the analysis 14 (11.96%) bone marrow findings were consistent with megaloblastic anemia. Regarding clinical presentation; pallor was 13 (92.85%) followed by glossitis 5 (35.71%) and Jaundice 5 (35.71%), paresthesia 3 (21.42%), and pigmentation, ataxia, confusion each case (7.14 %). Mostly the patients were between the 21- 40 years of age. Megloblastic anemia is common clinical problem with pallor and glossitis as major presentation. However some had neurological features. This disease can be diagnosed and treated on the basis of bone marrow aspiration when resources are limited.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 41-44DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6679

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.

Intrauterine growth curves for singleton live babies in Paropakar Maternity and Women's Hospital in Nepal

BACKGROUND

To construct birth weight, crown heel length and head circumference centile chart referenced to gestational age for Nepalese infants.

METHODS

The study was conducted over a period of six months. It included consecutive live births from 28 to 42 weeks of gestation. Their birth weight, crown-heel length and head circumference were recorded. Smoothed percentile values along with curves were created using the Lambda Mu Sigma (LMS) method. The curves were compared with one of the Indian study.

RESULTS

A total of 9710 newborns were measured. The mean birth weight, crown-heel length, head circumference at 40 weeks were 3023g, 49.22cm and 33.61cm respectively. Smoothed percentile values calculated gave the cutoffs for defining small and large gestational age for Nepalese newborns. Comparison with Indian study showed significant difference (p<0.01) in weight. The Indian babies weighed less than Nepalese babies.

CONCLUSIONS

The referenced growth standards help in clinical assessment, defining and identifying high risk newborns, thus, leading to improved care and management of neonates. It should help public health policy makers to track population difference due to several factors, intervene and find response over time.

Tuberculin reactivity in bacille calmette-guerin vaccinated individuals with sputum positive pulmonary tuberculosis

The study was carried out to assess the value of tuberculin skin test for the diagnosis of Tuberculosis (TB) in BCG vaccinated individuals and to find out the sensitivity rate of tuberculin skin test (TST) in comparison to acid fast bacilli positive pulmonary TB. Similar population with high BCG vaccination coverage having both pulmonary TB patients (n=150) and apparently healthy individuals (n=150) in eastern Nepal were enrolled in this comparative study. Sputum from all the subjects was subjected to Z-N microscopy. TST was performed on these subjects by standard Mantoux method. Among the patients (mean age 36.18±14.15 yrs) and controls (mean age 35.61±13.44 yrs), 55.33 % and 47.33 % respectively have been found to be positive PPD reactors (>10mm) which is statistically not significant (P>0.05). About 23% of the patients & 27% of controls failed to react (anergic) to 5 TU PPD. PPD reactivity rate was high in the patients whose sputum smears were graded as 1+ in Z-N microscopy. The sensitivity of TST was highest for the induration of >5mm (77.3%). Specificity increased with increasing size of induration and was highest (73.3%) with induration of >15 mm. Tuberculin skin test is an all or none phenomenon. In Nepal, tuberculin test has a limited value in the diagnosis of pulmonary TB as both the apparently healthy individuals and patients with sputum smear positive pulmonary TB who had been immunized with BCG, showed almost similar rate of tuberculin reactivity. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5970 JCMSN 2011; 7(1): 28-35

In vitro activity of cefoperazone-sulbactam combination against gram negative bacilli

Cefoperazone is a â-lactam antimicrobial and Sulbactam is an irreversible â-lactamase inhibitor. The objective of this study was to know the susceptibility pattern of gram negative bacilli (GNB) towards cefoperazone-sulbactum. All GNB isolated from different clinical samples during the period of May, 2010 to Aug, 2010 were tested for susceptibility to cefoperazone-sulbactum, meropenem, ceftazidime, cefotaxime, ceftriaxone, chloromphenicol, cotrimoxazole, ampicillin, amikacin, nalidixic acid, ciprofloxacin, carbenicillin and piperacillin using standard Kirby-Bauer disc diffusion antimicrobial susceptibility testing method. The susceptibilities were recorded according to CLSI guidelines. A total of 406 GNB were isolated (urine: 66.7%, pus: 19.2%, and blood: 7.9%). Escherichia coli (54.4%) was most frequently isolated organisms followed by Acinetobacter species (17.7%), Klebsiella pneumoniae (9.1%) and Pseudomonas species (6.1%). Overall, 11.8% of isolates showed resistance to cefoperazone-sulbactam. Frequencies of isolates showing resistance to meropenem and amikacin were 14.7% and 26.25% respectively. Only 3.9% of Escherichia coli isolates showed resistance to cefoperazone-sulbactam. For other organisms, their lowest frequency ranging from 0-20%, exhibited resistance to meropenem. In Pseudomonas spp, in-vitro activity of amikacin was also better as only 11.1% isolates showed resistance to it. This study demonstrated the in-vitro synergistic effect of cefoperazonerazone-sulbactam and meropenem having good activity against GNB compared to the activity of other commonly tested antimicrobials. Cefoperazone-sulbactam can be recommended for the clinical practice against GNB exhibiting resistant to other antimicrobials as it is cheaper alternative to meropenem. Our results also focused on the continuous surveillance of the trends and features of resistance of common antimicrobials.

Comparison of Acute Physiology, Age, Chronic Health Evaluation III score with initial Sequential Organ Failure Assessment score to predict ICU mortality

Critically ill patients are provided with highest level of monitoring, care and treatment in Intensive Care Unit (ICU), which is very expensive and consumes many hospital resources. Various scoring systems have been developed to predict outcome in ICU patients so as to help physicians to prioritize patient admission and management. The objective of this study was to compare Acute Physiology and Chronic Health Evaluation (APACHE) III score with initial Sequential Organ Failure Assessment (SOFA) score to predict ICU mortality. Hundred seventeen patients admitted consecutively in ICU were enrolled. APACHE III and initial SOFA score of individual patients were calculated based on worst values in first 24 hours of admission. Outcome was recorded as survivors or non survivors in ICU. Both the scores were significantly higher in non survivors (p<0.001). A positive and strong correlation was seen between the scores with Spearman's rho correlation coefficient of 0.866 (p<0.001). Discrimination for APACHE III and initial SOFA score was good with area under ROC curve of 0.895 and 0.879 respectively. Cut off point with best Youden index was e" 61 for APACHE III and e" 8 for initial SOFA score. ICU mortality differed significantly above and below cut off points (p<0.001). Hosmer Lemeshow test showed initial SOFA score to have better calibration than APACHE III score. Initial SOFA score is comparable to APACHE III score for mortality prediction in ICU and so can be helpful for better utilization of limited resources in ICU.

Short-Term Outcome of Mechanical Ventilation in Neonates

Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the Western world and our neighbouring countries, neonatal ventilation in our country is still in its infancy. Objectives: To analyze the common indications and outcome of neonates requiring mechanical ventilation. Methods: This was a prospective observational study conducted on neonates requiring mechanical ventilation within first 24 hours of birth over a period of nine months. Results: Birth asphyxia was the commonest indication for ventilation (59.67%) followed by asphyxia with meconium aspiration syndrome (MAS) (17.74%), hyaline membrane disease (HMD) (8.06%), MAS (6.45%) and intrauterine pneumonia (6.45%). Out of 62 babies, 22 (35.48%) survived. Babies with asphyxia had highest survival rate (51.35%). Neonates with HMD did not survive. Term babies and babies weighing ≥2500g had higher survival rate of 40.47% and 41.46% respectively, while babies less than 32 weeks had survival rate of 16.66% only. Conclusions: Mechanical ventilation reduces the neonatal mortality; hence, facilities for neonatal ventilation should be included in the regional and central hospitals providing level II neonatal care. Key words: neonatal ventilation; hyaline membrane disease; low birth weight DOI: 10.3126/jnps.v31i1.3463J Nep Paedtr Soc 2010;31(1):35-38

Antimicrobial Resistant Streptococcus pneumoniae

Introduction: Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy.  Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against  commonly used antimicrobials with special reference to determination of minimum inhibitory  concentration (MIC) of penicillin in a tertiary care hospital in eastern Nepal. Methods: Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by  disk diffusion method. MIC of penicillin was tested by broth dilution method. Results: Of the total isolates 19 (73%) were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L) was observed in five (17%) isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant. Conclusions: S. pneumoniaeisolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future. Keywords: antimicrobial susceptibility pattern, penicillin, Streptococcus pneumoniae.

Antimicrobial resistant Streptococcus pneumoniae

INTRODUCTION

Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy. Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against commonly used antimicrobials with special reference to determination of minimum inhibitory concentration (MIC) of penicillin in a tertiary care hospital in eastern Nepal.

METHODS

Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by disk diffusion method. MIC of penicillin was tested by broth dilution method.

RESULTS

Of the total isolates 19 (73%) were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L) was observed in five (17%) isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant.

CONCLUSIONS

S. pneumoniae isolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future.

Bacteriology and Antibiotic Susceptibility Pattern of Peitonsillar Abscess

INTRODUCTION: Peritonsillar abscess is a common complication of acute tonsillitis. Its management consists of aspiration or surgical drainage followed by appropriate antibiotics. Appropriate antibiotic treatment depends on the common organisms associated with infection and their antibioticsensitivity pattern in local scenario. METHODS: Pus samples aspirated from diagnosed cases of peritonsillar abscess and submitted for culture and sensitivity in last two years were included in this study. Identification of different microorganisms was made on the basis of the microscopic findings, observation of their colony morphology and standard biochemical reactions. Susceptibility pattern to commonly used antibiotics were determined by Clinical Laboratory Standards Institute (CLSI) guidelines. RESULTS: Altogether 24 pus samples were included in the study. Positive culture was obtained from 18 samples. Among them one organism was isolated from 13 samples whereas from five samples multiple organisms were isolated. From six samples no organisms could be cultured. Altogether Streptococcus pyogenes was isolated from 12 samples and Staphylococcus aureus from five samples. Other isolated organisms included Haemophlilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Enterococcus species. Penicillin was effective for Streptococcus pyogenes whereas Staphylococcus aureus was resistant to it. Cloxacillin was found to be effective for Staphylococcus aureus. Ciprofloxacin and Ceftazidime were found to be effective for both organisms. CONCLUSIONS: Streptococcus pyogenes and Staphylococcus aureus were more commonly associated with peritonsillar abscess. Streptococcus pyogenes were sensitive to penicillin but all Staphylococcus aureus were resistant to it. This fact should be considered in clinical practice for management of peritonsillar abscess. KEYWORDS: Bacteriology, Peritonsillar abscess, Susceptibility pattern.

Bacteriology and antibiotic susceptibility pattern of peritonsillar abscess

INTRODUCTION

Peritonsillar abscess is a common complication of acute tonsillitis. Its management consists of aspiration or surgical drainage followed by appropriate antibiotics. Appropriate antibiotic treatment depends on the common organisms associated with infection and their antibiotic sensitivity pattern in local scenario.

METHODS

Pus samples aspirated from diagnosed cases of peritonsillar abscess and submitted for culture and sensitivity in last two years were included in this study. Identification of different microorganisms was made on the basis of the microscopic findings, observation of their colony morphology and standard biochemical reactions. Susceptibility pattern to commonly used antibiotics were determined by Clinical Laboratory Standards Institute (CLSI) guidelines.

RESULTS

Altogether 24 pus samples were included in the study. Positive culture was obtained from 18 samples. Among them one organism was isolated from 13 samples whereas from five samples multiple organisms were isolated. From six samples no organisms could be cultured. Altogether Streptococcus pyogenes was isolated from 12 samples and Staphylococcus aureus from five samples. Other isolated organisms included Haemophlilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Enterococcus species. Penicillin was effective for Streptococcus pyogenes whereas Staphylococcus aureus was resistant to it. Cloxacillin was found to be effective for Staphylococcus aureus. Ciprofloxacin and Ceftazidime were found to be effective for both organisms.

CONCLUSIONS

Streptococcus pyogenes and Staphylococcus aureus were more commonly associated with peritonsillar abscess. Streptococcus pyogenes were sensitive to penicillin but all Staphylococcus aureus were resistant to it. This fact should be considered in clinical practice for management of peritonsillar abscess.

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

Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis

BACKGROUND

Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries.

OBJECTIVE

To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing.

MATERIALS AND METHODS

A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method.

RESULTS

Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases.

CONCLUSION

EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration.

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.

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.

The role of sedation and pulse oximetry during upper gastrointestinal endoscopy

INTRODUCTION

To determine the changes in oxygen saturation, blood pressure and pulse rate during endoscopic procedure and to evaluate--oesophagogastroduodenoscopy (OGD) related discomfort assessed by the patient.

METHODS

It is observational case control study. Baseline pulse, blood pressure and oxygen saturation were monitored before procedure, at one minute of procedure, at five minute and soon after procedure. Patients were randomly selected according to lottery system (1: without sedation and 2: with sedation) and divided into two groups; without and with sedation. Before leaving department they were asked about level of discomfort during and after procedure.

RESULTS

Patient's mean age +/- SD: 36.65, +/- 11.42 years and 53.3% were men. Base line mean oxygen saturation among sedated patient were 96.77 +/-1.56 % and 97.23, +/- 2.26 % respectively (P = 0.358). Mild to moderate hypoxia was noted more in sedated patient than in non sedated patient. Severe hypoxia was noted in 3.3% of sedated patient. No statistically significant change was noticed in pulse and blood pressure in both the group. None or only slight discomfort was experienced by 9.4% in non sedated group and 90.6% in sedated group. Severe discomfort by 96.4% in non sedated group and 3.6% in sedated group.

CONCLUSIONS

There is slight more incidence of mild hypoxia in sedated group than in non sedated group but no change in pulse and blood pressure. However, sedated patient have significant less level of discomfort than in non sedated group. Though routine use of pulse oxymeter is not necessary, routine use of sedation during endoscopy is recommended.

The Role of Sedation and Pulse Oximetry During Upper Gastrointestinal Endoscopy

Introduction: To determine the changes in oxygen saturation, blood pressure and pulse rate during endoscopic procedure and to evaluate – oesophagogastroduodenoscopy (OGD) related discomfort assessed by the patient. Methods:It is observational case control study. Baseline pulse, blood pressure and oxygen saturation were monitored before procedure, at one minute of procedure, at fi ve minute and soon after procedure. Patients were randomly selected according to lottery system (1: without sedation and 2: with sedation) and divided into two groups; without and with sedation. Before leaving department they were asked about level of discomfort during and after procedure. Results:Patient’s mean age ± SD: 36.65, ± 11.42 years and 53.3% were men. Base line mean oxygen saturation among sedated patient were 96.77 ±1.56 % and 97.23, ± 2.26 % respectively (P=0.358). Mild to moderate hypoxia was noted more in sedated patient than in non sedated patient. Severe hypoxia was noted in 3.3% of sedated patient. No statistically signifi cant change was noticed in pulse and blood pressure in both the group. None or only slight discomfort was experienced by 9.4% in non sedated group and 90.6% in sedated group. Severe discomfort by 96.4% in non sedated group and 3.6% in sedated group .Conclusions:There is slight more incidence of mild hypoxia in sedated group than in non sedated group but no change in pulse and blood pressure. However, sedated patient have significant less level of discomfort than in non sedated group. Though routine use of pulse oxymeter is not necessary, routine use of sedation during endoscopy is recommended. Key Words: discomfort, gastroscopy, oxygen saturation, pulse oximeter

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.

Seasonal hyper acute pan uveitis--recent scenario in Nepal

Seasonal hyperacute panuveitis (SHAPU), characterized by an unusual form of unilateral severe hyper acute diffused intraocular inflammation, is one of the mysterious eye diseases of which the definite cause and treatment remains yet to be tound out. In this study, a total of six cases were included. Aqueous and vitreous samples were subjected to direct microscopy and culture (bacterial or fungal). Of the six cases included, two yielded Streptococcus pneumoniae and one Acinetobactor sp. on culture. All three culture positive samples showed pus cells in direct microscopic examination (gram stain). All cases were subjected to vitrectomy and intravitreal antibiotic and steroid injection, along with oral antibiotics and steroid. Five cases were also treated with antiviral agent. After treatment four cases showed reversal of hypotony and three cases recovered some vision.

Intestinal parasitosis among subjects undergoing cataract surgery at the eye camps in rural hilly areas of Nepal

Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others.

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.

Nutritional status of people living in Dzong village, in the northern mountainous area of Nepal

A nutritional survey was carried out among residents (39 males and 46 females) of Dzong village in the northern area of the Gandaki region of Nepal. The results were compared with our previous findings. The mean body mass index value was under 21 for both sexes, but the mean percentage of body fat of females (17-19 years old, 25.8 +/- 9.4%; 20-29 years old, 31.0 +/- 8.4%) was higher than that of males (17-19 years old, 12.0 +/- 1.0%; 50-59 years old, 24.4 +/- 7.6%). Most serum nutritional markers for both sexes were generally at normal levels although the iron levels were lower and packed red cell volume levels were higher than normal. As determined by results of the 24-hr dietary recall survey, the main food groups consumed by both sexes were cereals, potatoes, pulses, meats and vegetables. The mean daily intake of nutrients was similar for both sexes, with a few exceptions. The relatively high serum TG levels of the subjects may have been due to the high consumption of carbohydrate-laden cereals. The amounts of food consumed were not adequate, resulting in a latent and chronic deficiency of nutrients, especially calcium and iron. These results suggest that improvements in the nutritional status of this group of people are necessary.

Optimal single intraocular lens power for the Nepali population

AIM

To evaluate optimal standard intraocular lens power for Nepalese eye camp cataract patients.

METHOD

A retrospective case series of 5109 preoperative cataract patients.

RESULTS

Average axial length of 23.08 (SD 1.26). Average dioptre intraocular lens power 21.37 (3.04).

CONCLUSION

An increase in the intraocular lens power used at Nepalese eye camps from +21.0 to 22.5 dioptres would improve overall visual outcome.

Study on Cyclospora Cayetanensis in Kathmandu Valley

Cyclospora caytanensis, a human pathogenic coccidian parasite owes its recognition as an emerging parasite, which continues to be found throughout the world. Its prevalence was investigated in Kathmandu valley, Nepal in 2003. Stool examination was performed with a total of 500 specimens from 3 Hospitals, 1 Geriatric Centre (Briddhaashram), 1 Infectious and Tropical Disease Research Center/Nepal and 8 Slum areas by direct smear technique. Out of these specimens, Cyclospora caytenensis oocysts were found in 7% of specimens with the age range from 2 months to 67 years. To identify possible sources for Cyclospora infection, water samples from 3 rivers, 134 fecael samples of animals and 43 samples of green leafy vegetables wash were collected and examined by formal-ether sedimentation and floatation technique. As a result, oocyst of Cyclospora was identified only in chicken stool sample, which could be possible reservoir host for Cyclospora infection. However, further studies are needed to shed light on possible sources of infection.Key Words: Cyclospora caytanensis, coccidian parasite, diarrhoea, faecal specimens.

Ketamine anaesthesia for paediatric ophthalmology surgery

AIMS

Children with treatable, vision impairing conditions may not have access to surgical care when they live in regions where anaesthesia is unavailable. The use of ketamine anaesthesia in a developing region was studied to determine its safety and effectiveness.

METHODS

This is a consecutive series of 679 children who had a variety of paediatric eye disorders necessitating a short general anaesthesia. Ketamine was administered intravenously by a paediatrician with training in paediatric resuscitation procedures. Both intraocular and extraocular procedures were performed. The location of treatment was the Tilganga Eye Hospital in Kathmandu, Nepal, a developing region of the world. The study took place over a 5 year period.

RESULTS

All procedures were performed without any anaesthetic complications. No child required unanticipated resuscitation or laryngeal intubation. Postoperative dysphoria occurred occasionally and was difficult to measure quantitatively. This side effect of ketamine resolved by the first postoperative day.

CONCLUSION

Ketamine is an effective agent for both intraocular and extraocular surgery in the paediatric age group. None of the children in this series needed resuscitation or intubations, and the ophthalmic surgery was carried out safely. Ketamine can be used safely in any ophthalmic procedure of short duration by a person having some training in anaesthetic resuscitation procedures. Because of its simplicity and safety, ketamine may be useful in a simple ophthalmic setup in the developing word.

The structure and function of catalytic domains within inositol polyphosphate 5-phosphatases

Phosphoinositide signaling pathways regulate many essential cellular functions including proliferation, differentiation and survival, cytoskeletal organization, and vesicular trafficking. The inositol polyphosphate 5-phosphatases regulate the cellular levels of several bioactive phosphoinositide species. This review describes the structure and function of the 5-phosphatase and Sac1 catalytic domains of these enzymes. The crystal structure of the 5-phosphatase domain has been solved and shares homology with members of the AP endonuclease family. The phosphoinositide polyphosphatase activity of the Sac1 domain, found in some inositol polyphosphate 5-phosphatases, is defined by a motif, CX5 R(T/S), also found in both protein and lipid phosphatases.

The inositol polyphosphate 5-phosphatases and the apurinic/apyrimidinic base excision repair endonucleases share a common mechanism for catalysis

Inositol polyphosphate 5-phosphatases (5-phosphatase) hydrolyze the 5-position phosphate from the inositol ring of phosphatidylinositol-derived signaling molecules; however, the mechanism of catalysis is only partially characterized. These enzymes play critical roles in regulating cell growth, apoptosis, intracellular calcium oscillations, and post-synaptic vesicular trafficking. The UCLA fold recognition server (threader) predicted that the conserved 300-amino acid catalytic domain, common to all 5-phosphatases, adopts the fold of the apurinic/apyrimidinic (AP) base excision repair endonucleases. PSI-BLAST searches of GENPEPT, using the amino acid sequence of AP endonuclease exonuclease III, identified all members of the 5-phosphatase family with highly significant scores. A sequence alignment between exonuclease III and all known 5-phosphatases revealed six highly conserved motifs containing residues that corresponded to the catalytic residues in the AP endonucleases. Mutation of each of these residues to alanine in the mammalian 43-kDa, or yeast Inp52p 5-phosphatase, resulted in complete loss of enzyme activity. We predict the 5-phosphatase enzymes share a similar mechanism of catalysis to the AP endonucleases, consistent with other common functional similarities such as an absolute requirement for magnesium for activity. Based on this analysis, functional roles have been assigned to conserved residues in all 5-phosphatase enzymes.