Adherence to Periodic Dilated Eye Examinations and Its Determinants Among Nepalese Patients With Diagnosed Diabetes: A Single-Center Hospital-Based Analysis Using Health Belief Model.

Introduction: To find the adherence rate to periodic dilated eye examinations (DEEs) and its determinants among patients with diagnosed diabetes. Research Design and Methods: In this cross-sectional study of 165 participants with diagnosed diabetes (Type 1/2) attending a general hospital with a diabetes clinic, we explored perceptions of barriers and facilitators of DEE at the individual level using a framework adapted from the health belief model (HBM). Patients were compared using t tests for continuous data and chi-square tests for categorical data. Results: The rate of adherence to DEE (as defined by DEE within a year) was 62.4% (95% confidence interval [CI] = 55.0%-69.8%). The mean age of the patients was 56.81 (±13.29) years. We found that the mean benefit score was significantly higher, and the mean barrier score was significantly lower in those adhering to DEE (p < 0.001); but the susceptibility, severity, and self-efficacy scores were not significantly different. Furthermore, those under treatment for diabetes mellitus (DM), those with diabetic retinopathy (DR) in them or their family member, and those with DM duration of 1 year or less were significantly likely to adhere to DEE (p < 0.005). Additionally, those who had received advice for eye screening from their physicians were about 25 times more likely to adhere to DEE (95% CI =6.80-92.05) than those who were not advised. Conclusion: A larger proportion of people with diabetes did not adhere to periodic DEE. Benefits and barriers were found to be determinants in this population. Further exploration in a larger population and the use of HBM to increase adherence to periodic DEE can be tested by targeting behavioral counseling along with other traditional approaches.

Utilisation of eye health services and compliance with spectacles wear among community school adolescents: a mixed-methods study from Bagmati province of Nepal.

OBJECTIVES: This study aims to determine the factors influencing eye care service utilisation and compliance with spectacles wear among school students. DESIGN: Mixed-methods study. SETTING: 27 community schools from 6 districts of Bagmati province of Nepal. PARTICIPANTS: Adolescents with mild vision impairment who were screened at schools by their trained peers for visual acuity measurement and subsequently received subsidised spectacles for refractive error correction. For the quantitative study, 317 students from 21 schools completed the survey. For qualitative study, 62 students from 6 schools participated in 6 focus group discussions. PRIMARY OUTCOME MEASURES: Utilisation of eye care services and compliance with spectacles wear. RESULTS: Among 317 students, 53.31% were aged 15-19, and 35.96% were male. More than half (52.68%, n=167) did not use eye health services. Among students who did not go, 51.50% reported eye health facilities being far away. Thematic analysis showed that distance, COVID-19 and awareness were influential in the utilisation of eye care. The multivariate analysis showed urban residents were likelier (adjusted OR (AOR) 4.347, 95% CI 2.399 to 7.877, p<0.001) to use eye care services. During an unannounced visit to schools after 3-4 months of spectacles distribution, 188 (59.31%) students were wearing spectacles. 20.16% of students not wearing spectacles reported they did not feel the need. Thematic analysis showed the influence of family and peers, affordability, aesthetic appearance, comfortability and symptomatic relief in spectacles compliance. The multivariate analysis showed that urban residents (AOR 2.552, 95% CI 1.469 to 4.433, p<0.001), older adolescents (AOR 1.758, 95% CI 1.086 to 2.848, p=0.022), mothers with paid jobs (AOR 2.440, 95% CI 1.162 to 5.125, p=0.018) and students visiting eye care centres (AOR 1.662, 95% CI 1.006 to 2.746, p=0.047) were more likely to be compliant with spectacles wear. CONCLUSIONS: There are multiple barriers for students to use eye care services and stay compliant with spectacles wear. Eye health programmes should include eye health promotion and be accessible, affordable and equitable.

Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography.

Purpose: To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT). Patients and Methods: For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid. Results: Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia. Conclusion: M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.

Impact of active vision therapy compared to conventional patching therapy on visual acuity and stereoacuity in children with amblyopia.

PURPOSE: To compare improvements in visual acuity (VA) and stereoacuity between active vision therapy (AVT) and conventional patching therapy in children with amblyopia. METHODS: This study included 65 children aged 5 to 16 years (mean age±SD, 11.00±3.29 years) with unilateral amblyopia. Among them, 31 children underwent active vision therapy (AVT group), and 34 children underwent conventional patching therapy (patching group). AVT group underwent three sequential phases of AVT: Monocular phase (pursuit, saccades, fixation, visuomotor, eye-hand coordination, and central peripheral activities), biocular phase (diplopia awareness, antisuppression, monocular fixation in a binocular field, accommodative activities, bilateral integration, and fine motor activities) and binocular phase (fusion and stereopsis). Patching group patched their fellow eyes as per guidelines by Pediatric Eye Disease Investigator Group. Best-corrected monocular VA and stereoacuity were measured at baseline and after three months of therapy in both groups. RESULTS: There were significant improvements in the mean acuities in amblyopic eye (AE) in both AVT (0.32±0.11 logMAR, p <0.001) and patching groups (0.27±0.19 logMAR, p Ë‚ 0.001). However, there was no significant difference in mean acuity gains in AE between AVT and patching groups (p = 0.059). Mean gains in stereoacuities (log seconds of arc) were statistically significant in both AVT (0.81±0.34, p < 0.001) and patching groups (0.32±0.34, p < 0.001). The stereoacuity gain in the AVT group was significantly higher compared to patching group (p < 0.001). CONCLUSION: Active vision therapy had a better impact than conventional patching therapy in terms of improvement of stereoacuity but not in terms of VA when used for treating children with amblyopia.

Kaleidos-based binocular vision analyzer for the estimation of refractive errors and horizontal ocular deviation in children.

CLINICAL RELEVANCE: Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. BACKGROUND: This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. METHODS: Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. RESULTS: The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), -0.06 (95% CI = -0.09 to -0.03, p < 0.001) and 0.009 (95% CI = -0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was -4.5 (Interquartile range = -12.0 to 4.0). For constant strabismus, this difference was insignificant (median= -2.0, interquartile range = -11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). CONCLUSION: 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test.

Physical activity and its correlates among school teachers in a semi-urban district of Nepal.

Regular physical activity (PA) is one of the effective strategies for mitigating non-communicable diseases, promoting healthy ageing, and preventing premature mortality. In South Asia, up to 34.0% of adults are insufficiently active, and up to 44.1% of adults in Nepal. We sought to assess self-reported PA status and its correlates among teachers in the semi-urban district of Nepal. A cross-sectional descriptive study was conducted among teachers at randomly selected public secondary schools in Bhaktapur, Nepal, from November 2018-April 2019. PA status was assessed in Metabolic Equivalent to task minutes per week using the International Physical Activity Questionnaire (IPAQ)-Long Form. Point estimates and odds ratios were calculated at a 95% confidence interval, and a p-value <0.05 was considered statistically significant. Among the 360 participants, the mean (SD) age was 40.3 (10.2) years, with 52.5% female participation. A low level of PA was seen among 11.9% (95% CI: 8.4-15.2) of teachers, and more than half (56.0%) of the activity was only moderate intensity. Domestic and garden work was the main contributor (43.0%) of total PA, while leisure time was the least (14.0%). Among the socio-demographic factors, only sex was significantly associated (p = 0.005) with PA. Participants living in locations with walkable areas were 3.4 times (95% CI: 1.6-7.3) more likely to be engaged in moderate-to-high level PA than those without. In our study, the point prevalence of insufficient PA among teachers working at public secondary schools was higher than the national point prevalence. PA promotion programs targeting sedentary populations like school teachers should be developed to reduce the point prevalence of insufficient PA.

Primary Focal Segmental Glomerulosclerosis among Patients with Glomerular Disease Undergoing Kidney Biopsy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Primary focal segmental glomerulosclerosis is a form of glomerular disease that needs immunosuppressive therapy, which, if untreated, can lead to end-stage renal disease. Ultrastructural analysis by electron microscopy is essential to distinguish primary from other forms of focal segmental glomerulosclerosis. This study aimed to find out the prevalence of primary focal segmental glomerulosclerosis among patients with glomerular diseases undergoing kidney biopsy in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Nephrology from 1 January 2022 to 31 December 2022. Data were collected after obtaining ethical approval from the Institutional Review Committee (Reference number: 473/2079/80). The data from clinical and laboratory records of patients with the glomerular disease who underwent kidney biopsy were obtained. Data was collected by using convenience sampling. Point estimate and 95% Confidence Interval were calculated. Results: Among 213 patients with glomerular disease undergoing kidney biopsy, 22 (10.33%) (6.24-14.42, 95% Confidence Interval) were diagnosed with primary focal segmental glomerulosclerosis. All patients had nephrotic range proteinuria, but 2 (9.09%) patients had no features of nephrotic syndrome. Microscopic hematuria was found in 4 (18.18%) patients. Conclusions: The prevalence of primary focal segmental glomerulosclerosis was lower than in other studies done in similar settings. Keywords: biopsy; hematuria; kidney; proteinuria.

Diabetic Retinopathy among Patients with Prediabetes Attending the Outpatient Department of Ophthalmology in a Tertiary Eye Care Centre: A Descriptive Cross-sectional Study.

Introduction: Diabetic retinopathy is a specific microvascular ocular complication associated with diabetes. However, retinopathy has also been reported in people with prediabetes. The study aimed to find out the prevalence of diabetic retinopathy among patients with prediabetes attending the outpatient Department of Ophthalmology in a tertiary eye care centre. Methods: A descriptive cross-sectional study was conducted among patients with prediabetes attending the outpatient Department of Ophthalmology in a tertiary eye care centre from 1 January 2022 and 30 April 2022. Ethical approval was obtained from the Ethical Review Board (Registration number: 594/2021 P). All patients had their eyes dilated and examined under the slit-lamp with a 90 D convex lens or indirect ophthalmoscopes with a 20 D lens to find retinopathy. All patients aged 40 to 79 years with intermediate hyperglycemia were included in the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 141 patients with prediabetes, diabetic retinopathy was found in 8 (5.67%) (1.85-9.49, 95% Confidence Interval). Among which all patients 8 (5.67%) had mild non-proliferative diabetic retinopathy. Among patients with retinopathy, all 8 (5.67%) were obese, 3 (37.50%) were hypertensive, 5 (62.50%) patients had intermediate hyperglycemia for more than 6 months, and 2 (25%) had a family history of diabetes mellitus. Conclusions: The prevalence of diabetic retinopathy in prediabetes patient was found to be higher than the other studies conducted in similar settings. Keywords: diabetic retinopathy; prediabetes; prevalence.

Utilization of adolescent friendly health services and its associated factors among higher secondary students in mid-western Himalayan mountainous district of Nepal.

Adolescent friendly health services (AFHS) are designed to make health services accommodate the unique needs of adolescents. AFHS are characterized by three basic characteristics (programmatic, health facilities and health service providers) that should be applied. However, limited is known about the use of AFHS in the context of Nepal. This study aimed to assess the extent of AFHS utilization and associated factors among higher secondary students in the Jumla district of Nepal. A cross-sectional quantitative study was conducted in October-November 2017. Data were collected from a random sample of 528 aged 16-19 years old using a self-administered survey in their classroom. Adjusted Odds Ratios (AOR) and a 95% confidence level were estimated to measure the strength of association between the outcome variable (utilization of AFHS) and independent variable using multivariable logistic regression. Knowledge related to AFHS, measured by a seven-item scale, was based on information about the availability of AFHS. More than two-thirds (67.05%) of adolescents had utilized AFHS at least once in the last twelve months before the survey. In multivariable logistic regression analysis, knowledge level [AOR = 14.796, 95%CI (5.326-41.099)], cost of services [AOR = 2.971, 95%CI (1.764-5.003)], satisfaction from services [AOR = 1.817, 95%CI (1.037-3.185)] and availability of waiting room [AOR = 1.897, 95%CI (1.096-3.283)] were significantly associated with the utilization of AFHS. The utilization of AFHS was less than the country's target of universal utilization in this study. Adolescents' knowledge level about AFHS was importantly associated with its utilization. Utilization increases with lower service costs, client satisfaction, and availability of waiting rooms in the health facility. The health planners should make efforts to create a conducive environment for the adolescent by training the AFHS providers, particularly those who work in government institutions, and strengthening the awareness creation strategies among adolescents to increase the utilization of the services.

Hearing Loss among Children Visiting Department of Otolaryngology and HNS of a Tertiary Care Centre.

Introduction: Hearing loss is defined as the partial or total reduction in auditory acuity. Hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children. This study aimed to find out the prevalence of hearing loss among children visiting the Department of Otolaryngology and HNS of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children visiting the Department of Otolaryngology and HNS between 1 January 2022 and 31 December 2022 after obtaining ethical approval. All the patients who underwent pure tone evaluation were included in the study. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 3051 children, 328 (10.75%) (9.65-11.85, 95% Confidence Interval) had hearing loss. Among children with hearing loss, 170 (51.83%) of children were female. The mean age of children with hearing loss was 13.31±3.39 years. The mean pure tone average among 452 ears with hearing loss was 44.60±17.71 dB. The commonest degree of hearing loss was mild hearing loss 266 (58.85%), and the commonest type was conductive hearing loss 310 (68.58%). Among children with hearing loss, 124 (37.80%) had bilateral hearing loss. Conclusions: The prevalence of hearing loss among children visiting the Department of Otolaryngology and HNS was found to be lower than similar studies done in similar settings. Keywords: audiology; audiometry; hearing loss; outpatients; prevalence.

Chronic Otitis Media among Patients Visiting Community-Based Static Outreach Clinics.

Introduction: Chronic otitis media is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharges or otorrhoea through a tympanic perforation for the past 3 months. It is a common cause of hearing impairment, disability, and poor scholastic performance and can lead to fatal intracranial infections and acute mastoiditis. This study aimed to find out the prevalence of chronic otitis media among patients visiting community-based static outreach clinics. Methods: A descriptive cross-sectional study was conducted among patients visiting the community-based static outreach clinics from 1 January 2017 to 31 December 2019. The ethical approval was taken from the Ethical Review Board. The diagnosis of chronic otitis media was done using otoscopy. The records of patients coming to outreach clinics visiting for ear, nose and throat care were reviewed using a pre-designed study proforma. A systematic random sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 385 patients, 37 (9.61%) (6.67-12.55, 95% Confidence Interval) had chronic otitis media. The mean age of patients with chronic otitis media was 27.59±13.24 years, with 28 (75.67%) patients aged between 18-60 years. Among them, 30 (81.08%) had unilateral and 34 (91.89%) had a mucosal type. Conclusions: The prevalence of chronic otitis media was lower than in other studies done in similar settings. Keywords: community health services; otitis media; patients; prevalence.

Effect of Educational Intervention Based on Theory of Planned Behaviour on Physical Activity Intention among Secondary School Teachers of Nepal.

Any bodily movement produced by skeletal muscle which requires energy expenditure is known as physical activity (PA). WHO has recommended that at least 150 minutes of moderate or 75 minutes of vigorous-intensity PA or a combination of both per week is required for health benefits. Physical inactivity is one of the strongest risk factors for noncommunicable diseases (NCDs) and other conditions and is attributable to 6% of global premature death. However, data on the PA of teachers are unavailable in Nepal. They are considered one of the risk groups for NCDs because of the less active nature of their job. So, we aimed to evaluate the effect of the educational intervention based on the theory of planned behaviour on PA intention among secondary school teachers in Bhaktapur district, Nepal. For this study, we recruited 126 teachers from 6 schools. Each intervention and control group contained three randomly selected secondary schools. All the teachers from the selected schools were enrolled in the respective groups. A quasiexperimental (pretest-posttest control group) study design was used to test the effectiveness of the intervention on attitude, behaviour control, subjective norms, and intention for engaging in regular PA. Both groups underwent baseline and follow-up assessments at four weeks using the self-administered questionnaire developed for this study. The intervention group delivered a one-hour lecture session supported by audio-video materials for PA promotion. The effect was analysed by comparing the changes in the theory of planned behaviour (TPB) constructs within and between intervention and control groups. The difference in scores between and within the groups was tested using Student's t-test. Adjusted difference-in-difference scores were calculated through linear regression. Data analysis was done using Statistical Package for Social Science version 26.0. The adjusted mean score increase in TPB constructs due to the interaction of time and intervention increased from 0.641 to 1.381. The highest gain (beta = 1.381) was seen in the intention score, while a minor improvement was seen in perceived behavioural control (beta = 0.641). After the intervention, the net increase in PA intention score was 9.35% compared to the control group. Thus, the promotion package was effective in increasing PA intention. The findings of this study and educational package could be helpful in encouraging teachers to engage in PA in other schools.

Screen time and its correlates among children aged 3-10 years during COVID-19 pandemic in Nepal: a community-based cross-sectional study.

OBJECTIVE: This study aims to determine the prevalence of high screen time among schoolchildren aged 3-10 years in Bhaktapur, its correlates and the parents' strategies to reduce screen time during the COVID-19 pandemic in Nepal. METHODS AND ANALYSIS: This cross-sectional descriptive study was conducted during March 2021. A total of 630 households were selected for the study from 21 randomly selected clusters in Bhaktapur, Nepal. Correlates of high screen time were determined using a logistic model. P<0.002 was taken as significant. RESULTS: Among all the participants, the mean (SD) age was 7.0 (2.2) years, with 50.3% male participation. Few participants had online classes (n=24, 3.8%). The prevalence of high screen time among the participants was very high (55.2%, 95% CI=51.3% to 59.1%), which is even higher in boys (61.8%, 95% CI=58.0% to 65.6%). The median screen time before the COVID-19 pandemic was 1.0 hours (mean rank=275.8) which increased to 2.2 hours (mean rank=116.6) during the pandemic (p<0.001). Participants having smartphones were about seven times (adjusted OR=6.9, 95% CI=1.5 to 31.3, p=0.013) more likely to have high screen time than those who did not have the device. Most parents used to reprimand and urge their children to play outside to limit their screen usage. CONCLUSION: During the COVID-19 pandemic, about one in two schoolchildren of 3-10 years had higher screen time than before the COVID-19 pandemic. Parents' strategies to reduce screen time were not effective. An intervention study is recommended to design and test effective strategies to reduce screen time and its negative effects on children's health.

Urinary Tract Infection among Post-renal Transplant Patients in the Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Urinary tract infection is the most common infection among renal transplant recipients and increases the risk of hospitalization or even death. The study aimed to find the prevalence of urinary tract infection among post-renal transplant patients in the Department of Nephrology of a tertiary care centre. Methods: This is a descriptive cross-sectional study which was conducted among 217 post-renal transplant patients at the Department of Nephrology of a tertiary care centre from 1st November, 2017 to 31st October, 2018. The study was approved by the Institutional Review Committee (Reference number: 245(6-11-E)2074-75). Convenience sampling was used. The data were entered in Microsoft Excel 2011 and analyzed using the Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean with standard deviation for continuous data. Results: Among 217 patients, urinary tract infection was seen in 27 (12.44%) (8.05-16.83 at 95% Confidence Interval). One (3.70%) patient had the infection within three months of transplant, and 17 (62.96%) had infection after more than a year of transplant. Conclusions: The prevalence of urinary tract infection among kidney transplant recipients in our study was lower than previous studies done in similar settings. Keywords: Escherichia coli; hypertension; kidney; transplants.

Surgical Removal of a Long-Standing Impacted Firearm in Neck: A Case Report.

The gunshot neck injury is an emergency and must be addressed immediately. However, as our case report, a long-standing retained foreign body (firearm) in the deep neck is rare. Surgical removal of a long-standing foreign body is challenging for the operating surgeon. A 36-year-old male with a history of a firearm injury to the neck dating 16 years back with complaints of recent onset of pain was evaluated. A computed tomography scan of the neck showed a metallic foreign body located in close proximity to the right common carotid artery. Neck exploration was performed under general anaesthesia, and the foreign body was removed without complications. The patient has recovered following the intervention and has resumed his normal activities. The use of methylene blue helps to locate the foreign body during surgery. However, the choice of intervention for a stable patient with a penetrating neck injury remains based on cases. Keywords: case reports; firearms; foreign body; neck.

Abdominal Obesity among Outpatients in a Tertiary Level Eye ENT Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Abdominal obesity, as abnormal fat accumulation that presents a risk to health, is a global epidemic. There is evidence to support a trait of abdominal adipose deposition despite normal body mass index in south asian populations with greater cardiometabolic risks. Thus, this study aimed to find out the prevalence of abdominal obesity using the waist to height ratio among outpatients in a tertiary level hospital. METHODS: This descriptive cross-sectional study was conducted among outpatients at a tertiary level hospital in Nepal from January 2016 to December 2018. Ethical approval was taken from the Ethical Review Board of Nepal Health Research Council (Reference no. 207/2019). Convenience sampling was done. The data were entered into excel and analyzed using Statistical Package for Social Sciences version 24. Point estimate at 99% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Among 25,511 participants, 21,834 (85.6%) (85.0- 86.2 at 99% Confidence Interval) participants had abdominal obesity using Waist-to-Height Ratio, higher in women 12,397 (86.4%) than men 9,437 (84.5%). The mean age of the participants was 53.37±13.15 years and more than half 17,075 (55.7%) of all participants were female. CONCLUSIONS: The prevalence of abdominal obesity among hospital outpatients is higher than in other community-based studies. As hospitals attract large crowds and provide excellent opportunities for screening patients, their attendants, as well as providing opportunities for health promotion, we recommend the introduction of opportunistic obesity screening in all health facilities using weight to height ratio in a phased manner.

Amblyopia among Patients Attending the Outpatient Department of Ophthalmology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Amblyopia is defined as a reduction in visual acuity unilaterally or bilaterally without any detectable cause. It is a major public health issue in developing and underdeveloped countries. Its prevalence is usually underestimated because of proper study and lack of awareness. The aim of the study was to find out the prevalence of amblyopia among patients attending the Outpatient Department of Ophthalmology of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among outpatients visiting a tertiary care centre in the Outpatient Department of Ophthalmology between 1 January 2017 to 31 December 2019. Ethical approval was obtained from the Institutional Review Board (Registration number: 407/2020 P). All patients had gone through a comprehensive eye examination. Convenience sampling was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 82972 patients, prevalence of amblyopia was 344 (0.41%) (0.37-0.46, 99% Confidence Interval). Amblyopia was more common in anisometropia 263 (63.50%). A total of 117 (34%) patients had no history of eye examination and were newly diagnosed with amblyopia. Astigmatism was the most common type of refractive error among 224 (56.70%) amblyopic patients. Conclusions: The prevalence of amblyopia was found to be lower than in previous studies conducted in similar settings. Early detection and diagnosis of amblyopia can help to design more effective plans and treatments to reduce amblyopia through optical correction and amblyopia therapy. Keywords: amblyopia; anisometropia; astigmatism; refractive errors.

Diabetes Mellitus among Adult Outpatients Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Diabetes mellitus is a chronic metabolic disease characterised by elevated blood sugar levels and is a pandemic of public health importance. Screening programs can help reduce morbidity and mortality by preventing or delaying complications. This study aimed to find out the prevalence of diabetes mellitus among adult outpatients visiting a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among outpatients visiting a tertiary care centre between 1 January 2019 to 31 December 2019. Ethical approval was obtained from the Ethical Review Board (Registration number: 408/2020 P). Patients with unknown history of diabetes participating in free random blood sugar examinations were included in the study. Systematic random sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 385 adult outpatients, 17 (4.42%) (2.37-6.47, 95% Confidence Interval) had diabetes. The mean random blood sugar level of the diabetic patients was 281.41±57.49 mg/dl. Conclusions: The prevalence of diabetes mellitus among adult outpatients was similar to previous studies conducted in similar settings. Random blood sugar test in hospital outpatient settings is feasible to identify people with diabetes mellitus. Keywords: diabetes mellitus; hospital; Nepal; outpatient.

Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience.

PURPOSE: To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. METHOD: Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria. RESULT: Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. CONCLUSION: With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study.

OBJECTIVE: This non-inferiority study aimed to determine the burden of obesity in a hospital outpatient setting of a developing country, using three commonly employed metrics as predictors of hypertension (HTN). DESIGN: A cross-sectional study design was adopted. SETTING: This study was conducted in Health Promotion and Risk Factor Screening Services of a tertiary hospital for eye and ear, nose, throat in a semiurban area of Nepal. PARTICIPANTS: 2256 randomly selected outpatients between 40 and 69 years old. OUTCOME MEASURES: The three obesity metrics and HTN were analysed for association using correlation, the area under the receiver operating characteristic (ROC) curve and ORs. RESULTS: The prevalence of obesity or overweight by body mass index (BMI) was 58.29%; by waist-to-height ratio (WHtR) was 85.95%, high waist circumference (WC) was observed among 66.76% of participants. Female participants had a greater prevalence of high WC (77.46%) than males (53.73%) (p<0.001). Prevalence of HTN and pre-HTN were 40.67% and 36.77%, respectively. The areas under the ROC curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602) and WC (0.610). CONCLUSION: This study showed that WHtR and WC measured were not inferior to BMI as a metric for obesity detection and HTN prediction. Because of its low cost, simplicity of measurement and better ability to predict HTN, it may become a more usable metric in health facilities of low-income and middle-income countries.