Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: a cross-sectional study.

OBJECTIVES: To estimate the prevalence of anxiety and depression and identify the associated factors among people with type 2 diabetes mellitus (T2DM) visiting diabetes clinics of Pokhara Metropolitan, Nepal. DESIGN: Cross-sectional study. SETTING: Three diabetes clinics in Pokhara Metropolitan, Nepal, from May to July 2021. PARTICIPANTS: 283 people with T2DM visiting selected diabetes centres of Pokhara Metropolitan. OUTCOME MEASURES: Anxiety and depression were the outcome measures. Face-to-face interviews were conducted using a structured questionnaire comprising information related to participants' sociodemographic profile and several factors along with Hospital Anxiety and Depression-Anxiety subscale and Patient Health Questionnaire-9 to assess the levels of anxiety and depression, respectively. Pearson's Χ2 tests and binary logistic regression were performed to examine association between dependent and independent variables at 5% level of significance. RESULTS: The prevalence of anxiety and depression was 31.4% (95% CI 26.2% to 37.5%) and 36.4% (95% CI 30.8% to 42.0%), respectively. Anxiety was found to be associated with a lower level of perceived social support (adjusted OR (AOR) 2.442, 95% CI 1.020 to 5.845), multiple complications (AOR 2.758, 95% CI 1.015 to 7.334) and comorbidities (AOR 2.110, 95% CI 1.004 to 4.436), severe COVID-19 fear (AOR 2.343, 95% CI 1.123 to 4.887) and sleep dissatisfaction (AOR 1.912, 95% CI 1.073 to 3.047). Economical dependency (AOR 1.890, 95% CI 1.026 to 3.482), no insurance (AOR 2.973, 95% CI 1.134 to 7.093), lower perceived social support (AOR 2.883, 95% CI 1.158 to 7.181), multiple complications (AOR 2.308, 95% CI 1.585 to 6.422) and comorbidities (AOR 2.575, 95% CI 1.180 to 5.617), severe COVID-19 fear (AOR 2.117, 95% CI 1.009 to 4.573), alcohol use (AOR 2.401, 95% CI 1.199 to 4.806) and sleep dissatisfaction (AOR 1.995, 95% CI 1.093 to 3.644) were found to be associated with depression. CONCLUSION: This study showed high prevalence levels of anxiety and depression among people with T2DM. Strengthening social support and focusing on people with diabetes suffering from comorbidity and complications could help to reduce their risk of mental health problems.

A Systematic Review of Factors Associated with Under-Five Child Mortality.

Background: Preventing the life of the newborn and reducing the entrenched disparity of childhood mortality across different levels is one of the crucial public health problems, especially in underdeveloped and developing countries in the world. Sustainable development goals (SDGs)-3.2 is aimed at terminating all preventable under-five child mortality and shrinking it to 25 per 1000 live births or lower than this by 2030. Several factors have been shown to be linked with childhood mortality. Objective: This review is aimed at pointing out the significant determinants related to under-five child mortality by a systematic review of the literature. Methods: EMBASE, PubMed, Scopus database, and Google Scholar search engine were used for the systematic search of the literature. Special keywords and Boolean operators were used to point out the relevant studies for the review. Original research articles and peer-reviewed papers published in the English language till August 10, 2022, were included in the analysis and synthesis of the results. As per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, out of 299 studies identified from different sources, only 22 articles were ascertained for this study. Eligible articles were appraised in detail, and relevant information was extracted and then integrated into the systematic review. Results: Mother's education, size of child at birth, age of mother at childbirth, place of residence, birth interval, sex of child, type of birth (single or multiple), and birth order, along with other socioeconomic, maternal, child, health facility utilization, and community level variables, were observed as important covariates of under-five mortality. Conclusion: Women's education and easy access to quality healthcare facilities should be the apex priority to lessen childhood mortality.

Prevalence, Associated Factors and Awareness of Hypertensive Retinopathy among an Elderly Population with Hypertension in Nepal: The Bhaktapur Retina Study.

INTRODUCTION: Hypertensive retinopathy is a common complication in patients with hypertension. This study aims to assess the prevalence, associated factors and awareness of hypertensive retinopathy among an elderly population with hypertension in Bhaktapur, Nepal. MATERIALS AND METHODS: This is a population-based, cross-sectional study conducted from 2013 to 2015 in Bhaktapur district, Nepal. The sample size was 2100 subjects aged 60 years and above. From this sample, all diagnosed patients with hypertension were analyzed. A detailed history was obtained, and an ocular examination was performed. RESULTS: Information was complete for 1860 (88.57%) subjects. The age of the study population ranged from 60 to 95 years with the mean age of 69.64±7.31 years. Hypertension was found in 643 subjects (34.61%), of which 224 (12.04%) were newly diagnosed cases. Among the subjects with hypertension, hypertensive retinopathy was found in 81 cases (12.6%). Hypertensive retinopathy was more frequent in the age group 70-79 years (15.23%), males (13.25%), illiterates (13.56%), diabetics (16.49%), and body mass index (BMI) ≥25 kg/m2 (14%). None of the factors was found to be statistically significant. Among the study participants, awareness regarding the effect of hypertension on eye, retina and vision was found to be 13.84%, 8.4%, and 11.98% respectively. CONCLUSION: Prevalence of hypertension and hypertensive retinopathy among an elderly population of 60 years and above in Bhaktapur district, Nepal were similar to other countries. Hypertensive retinopathy was higher among males, illiterates, diabetes and BMI> 25kg/m2. Awareness of hypertensive retinopathy was 8.4% among hypertensive subjects. Emphasis should be directed toward improving awareness campaigns.

Effect of different molecular coatings on the heating properties of maghemite nanoparticles.

In this work, the effect of different molecular coatings on the alternating magnetic field-induced heating properties of 15 nm maghemite nanoparticles (NPs) in water dispersions was studied at different frequencies (159-782 kHz) and field amplitudes (100-400 G). The original hydrophobic oleate coating was replaced with dimercaptosuccinic acid (DMSA) or polyethylene glycol trimethoxysilane (PEGTMS), while cetrimonium bromide (CTAB) or stearic acid-poloxamer 188 (SA-P188) was intercalated or encapsulated, respectively, to transfer the dispersions into water. Surface modification, based on intercalation processes, induced clustering phenomena with the formation of spherical-like assemblies (CTAB and SA-P188), while ligand-exchange strategies kept the particles isolated. The clustering phenomenon has detrimental effects on the heating performances compared with isolated systems, in line with the reduction of Brown relaxation times. Furthermore, broader comprehension of the heating phenomenon in this dynamic system is obtained by following the evolution of SPA and ILP with time and temperature beyond the initial stage.

Self-Limitations of Heat Release in Coupled Core-Shell Spinel Ferrite Nanoparticles: Frequency, Time, and Temperature Dependencies.

We explored a series of highly uniform magnetic nanoparticles (MNPs) with a core-shell nanoarchitecture prepared by an efficient solvothermal approach. In our study, we focused on the water dispersion of MNPs based on two different CoFe2O4 core sizes and the chemical nature of the shell (MnFe2O4 and spinel iron oxide). We performed an uncommon systematic investigation of the time and temperature evolution of the adiabatic heat release at different frequencies of the alternating magnetic field (AMF). Our systematic study elucidates the nontrivial variations in the heating efficiency of core-shell MNPs concerning their structural, magnetic, and morphological properties. In addition, we identified anomalies in the temperature and frequency dependencies of the specific power absorption (SPA). We conclude that after the initial heating phase, the heat release is governed by the competition of the Brown and Néel mechanism. In addition, we demonstrated that a rational parameter sufficiently mirroring the heating ability is the mean magnetic moment per MNP. Our study, thus, paves the road to fine control of the AMF-induced heating by MNPs with fine-tuned structural, chemical, and magnetic parameters. Importantly, we claim that the nontrivial variations of the SPA with the temperature must be considered, e.g., in the emerging concept of MF-assisted catalysis, where the temperature profile influences the undergoing chemical reactions.

Prevalence and Causes of Visual Impairment and Blindness in Three Ecological Regions of Nepal.

INTRODUCTION: Visual impairment and blindness are significant public health issues worldwide. The objective of this study was to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Number of participants from each region was distributed as per the prevalence findings of pilot study, with 2815 participants enrolled in Dolakha, 1509 in Dhading and 910 in Sarlahi. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using standard software. For categorical data, frequency, percentage and 95% CI were calculated and statistical tests were done using Chi-square/Fisher exact test. RESULTS: Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (495). It was 4.7% (133) in the mountainous region, 11.2% (169) in the Hill and 21.2% (193) in the Tarai. In those aged 15-49 years, MSVI prevalence was 1.5% (52) and 25.1% (433) in ≥50 years. The overall prevalence of blindness was 0.9% (47). It was 0.2% (6) in 15-49 and 2.3% (41) in ≥50 age groups. More than 95% visual impairment and blindness were due to cataract and uncorrected refractive error. Cataract was the leading cause of visual impairment and blindness (290, 53.5%), followed by uncorrected refractive error. CONCLUSION: The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The management of uncorrected refractive error and operable cataract would reduce nine in ten cases of moderate to severe visual impairment and blindness.

Prevalence, Pattern and Risk Factors of Retinal Diseases Among an Elderly Population in Nepal: The Bhaktapur Retina Study.

INTRODUCTION: Retinal diseases are an emerging cause of visual impairment in the developing world. The aim of this study was to explore the prevalence, pattern, and risk factors of retinal diseases in Nepal. METHODS: This is a population-based, cross-sectional study conducted from 2013 to 2015. The sample size was 2100 subjects age 60 years and above from 30 clusters of Bhaktapur district, Nepal. Detailed history, visual acuity, and anterior and posterior segment examinations were performed. Blood sugar and blood pressure were measured. RESULTS: Complete information was available for 1860 (88.57%) subjects. Mean age was 69.64±7.31 years, ranging from 60 to 95 years. The prevalence of any retinal disorder was 52.37% (95% confidence interval (CI): 50.07-54.66%). The prevalence of retinal disorders increased with ageing: 51.26% between 60 and 69 years and 53.05% among those age 80 years and above. Age-related macular degeneration (AMD) was the most common retinal disease (35.43%), followed by hypertensive retinopathy (4.35%), epiretinal membrane (ERM) (3.66%), branch retinal vein occlusion (BRVO) (2.90%), and diabetic retinopathy (DR) (2.15%). Other rare retinal disorders included myopic fundus (0.86%), chorioretinal scar (0.54%), retinal holes (0.32%), retinitis pigmentosa (0.32%), retinal detachment (0.16%), and coloboma (0.11%). In multivariate logistic regression analysis, those with prior cataract surgery (odds ratio (OR), 1.71; 95% CI: 1.32-2.22, p < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001-1.47, p = 0.049) had significantly increased retinal disorders. CONCLUSION: Prevalence of retinal disorder was 52.37% at age 60 years and above. AMD, hypertensive retinopathy, ERM, BRVO, and DR were the most common retinal disorders. Retinal disorders increased with ageing. Retinal disorders were found associated with hypertension and prior cataract surgery. Timely screening, control of blood sugar and high blood pressure, and regular eye check-ups could help to save vision from retinal diseases.

Magnitude and Determinants of Computer Vision Syndrome (CVS) among IT Workers in Kathmandu, Nepal.

INTRODUCTION: Computer Vision Syndrome (CVS) is developed among computer workers due to long time working with computers or viewing of the video display terminal (VDT). The objective of this study is to determine the magnitude and determinants of CVS symptoms among IT officers. MATERIALS AND METHODS: A cross sectional study of IT office workers was conducted at Kathmandu from March to April 2019. Self-administrated questionnaire and observation of researcher was applied to collect information. CVS defect was considered if the participants were having minimum of one symptom during /following use of VDT. The proportion of CVS and its association with different independent factors was carried out. RESULTS: The prevalence of CVS reported by 263 participants was 82.5% (95% CI: 81.3% - 83.6%), of them 163(62.0%) were not aware about bad effects of computers to the visual apparatus. Goggles were used as protection against CVS by 140(53.2%) participants. CVS symptoms included headache 127(48.0%), tired eyes 123(47.0%) and eye strain 114(43.0%). Use of computer for more than 4.75 hours/day experienced CVS. The mean office work included 7.7 ± 2.02 hours computer work. The video display gadgets usage in home was 2.7 ± 2.35 hours/ day. Not taking breaks (OR:7.3; 95% CI:2.2 - 24.9), not massaging eyes (OR:7.5; 95% CI:1.2 - 47.7), unusual viewing distance (OR:9.0; 95% CI:2.0 - 44.5), improper posture (OR:3.6; 95% CI:1.3 - 10.3), computer usage for more than 10 hours/ day (OR:5.4; 95% CI:1.6 - 18.2) and not aware of CVS (OR:7.2; 95% CI:2.6 - 20.3) were significant predictors of CVS in IT workers. CONCLUSION: Most of the IT workers had CVS. Health education and care of IT workers based on predictors found need to be strengthened in the study area.

Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study.

AIM: Diabetic retinopathy (DR) is an emerging cause of blindness in developing countries. This study aimed to explore the prevalence and risk factors of DR in an elderly population in Nepal. SUBJECTS AND METHODS: This is a population-based, cross-sectional study. A total of 1860 subjects at the age 60 years and above participated (response rate 88.6%). A detailed history was obtained, presenting and best-corrected visual acuity were measured, and anterior segment and posterior segment examinations were carried out. Blood pressure and random blood sugar were recorded; body mass index was calculated, and abdominal girth was measured. DR was graded by clinical examination using Early Treatment Diabetic Retinopathy Study criteria. RESULTS: Diabetes was found in 168 (9%) subjects (mean age 69.6 years), 31 (18.5%) of whom were newly diagnosed. The prevalence of DR was 23.8% (95% confidence interval [CI]: 17.7%-31%) among the persons with diabetes. The prevalence of DR among newly diagnosed subjects with diabetes was 6.5% (95% CI: 0.8%-21.4%). The prevalence of vision-threatening DR was 9.5% (95% CI: 5.5%-15%) and was higher in males. The prevalence of DR was 83.3% (95% CI: 35.9%-99.6%) among those with diabetes for over 20 years. In multivariable logistic regression analysis, duration of diabetes, hypertension, and alcohol consumption were significantly associated with DR. CONCLUSION: DR is a common problem among the elderly population with diabetes in Nepal. The duration of diabetes, hypertension, and alcohol consumption are the risk factors for the development of DR. Strategies have to be developed for timely diagnosis of diabetes and screening for DR.

Prevalence and causes of low vision and blindness in an elderly population in Nepal: the Bhaktapur retina study.

BACKGROUND: This study aims to explore the prevalence and causes of low vision and blindness focused on retinal disease in a population above 60 years in Nepal. METHODS: Two thousand one hundred subjects were enrolled in a population-based cross-sectional study. History, presenting and best corrected visual acuity after subjective refraction, anterior and posterior segment examinations was obtained in detail. RESULTS: Among the total subjects, 1860 (88.57%) had complete information. Age varies from 60 to 95 (mean age: 69.64 ± 7.31) years. Low vision and blindness in both eyes at presentation was found in 984 (52.90%, 95% confidence interval (CI): 50.60-55.19) and 36 (1.94%, 95% CI: 1.35-2.66) subjects respectively. After best correction, bilateral low vision and blindness was found in 426 (22.92%, 95% CI: 21.01-24.88), and 30 (1.61%, 95% CI: 0.10-2.30) subjects respectively. As compared to 60-69 years old, risk of visual impairment was four times higher (95% CI:3.26-5.58) in the 70-79 year olds and 14 times higher (95% CI: 9.72-19.73) in the age group 80 years and above. Major causes of bilateral low vision were cataract (68.07%), followed by retinal disorders (28.64%), and for blindness; retinal disorders (46.66%), followed by cataract (43.33%). Illiteracy was significantly associated with visual impairment. CONCLUSION: Among the elderly population, prevalence of visual impairment was high. Refractive error, cataract and retinal disorders were the major cause of low vision. Screening the population at the age 60 years and above, focused on cataract and posterior segment diseases, providing glasses and timely referral can help reduce visual impairment.

Prevalence, pattern and risk factors of retinal vein occlusion in an elderly population in Nepal: the Bhaktapur retina study.

BACKGROUND: This study aims to explore the prevalence, pattern and risk factors of retinal vein occlusion (RVO) in an elderly population of Nepal. METHOD: One thousand eight hundred sixty subjects of age 60 years and above were enrolled in a population-based, cross-sectional study. Detailed history, visual acuity, anterior segment and posterior segment examinations were done. Blood pressure, non-fasting blood sugar, body mass index and abdominal girth were measured. Retinal vein occlusions were further divided into branch retinal (BRVO), hemi-retinal and central retinal vein occlusion (CRVO). RESULT: Age ranged from 60 to 95 years with a mean of 69.64 ± 7.31 years. Overall population prevalence for RVO was 2.95% (95% Confidence interval (CI): 2.23-3.83), BRVO 2.74% (95% CI: 2.05-3.58) and CRVO 0.21% (95% CI: 0.06-0.55). BRVO was seen in 51 subjects (92.73%) and CRVO in 4 (7.27%). Among the total RVO, unilateral and bilateral involvement was 85.45% and 14.55%, respectively. Among the subjects with BRVO and CRVO, 37.25% and 50% had low vision, respectively. The risk of RVO increased with ageing and was more among males. There was an increased risk of RVO among those with hypertension, and with diabetes and hypertension. There was also an increased risk of RVO among subjects with hypermetropia, those with pseudophakia and those who were smokers and consumed alcohol. CONCLUSION: Retinal vein occlusion is a common retinal vascular disorder in the elderly population of Nepal. The main risk factors for RVO were increasing age and hypertension.

Prevalence of and risk factors for age-related macular degeneration in Nepal: the Bhaktapur Retina Study.

AIM: This study aimed to explore the prevalence of and risk factors for age-related macular degeneration (AMD) in an elderly population in Nepal. SUBJECTS AND METHODS: This is a population-based, cross-sectional study. A sample size of 2,100 was calculated. A total of 1,860 (88.6%) subjects aged >60 years were enrolled for the study from 30 clusters in the district. Detailed history, visual acuity, and anterior segment and posterior segment examinations were performed. AMD was graded according to the International ARM Epidemiological Study Group. RESULTS: Among the total study population, 659 subjects had any AMD (35.43%; 95% confidence interval [CI]: 33.25-37.65), 484 had mild dry AMD (26.02%; 95% CI: 24.04-28.08), 143 had intermediate dry AMD (7.69%; 95% CI: 6.52-8.99), 19 had geographic atrophy (1.02%; 95% CI: 0.61-1.59), and 13 had wet AMD (0.70%; 95% CI: 0.37-1.19). The overall prevalence of early and late AMD was 33.71% and 1.72%, respectively. Among subjects with dry and wet AMD, 36.53% and 46.1% had visual impairment, while 2.78% and 23.08% were blind, respectively. In multivariate analysis, AMD was significantly higher in subjects with an increased number of cigarettes smoked per day (odds ratio [OR] 1.02, 95% CI: 1.01-1.04; P=0.007) and in subjects with pseudophakia (OR 1.45, 95% CI: 1.12-1.87; P=0.005). CONCLUSION: One-third of the population aged ≥60 years have some form of AMD. There was a significant association with the number of cigarettes consumed and with previous cataract surgery.

Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study.

BACKGROUND: Early detection can reduce irreversible blindness from retinal diseases. This study aims to assess the intra- and inter-rater agreement of retinal pathologies observed on fundus photographs between an ophthalmologist and two-mid level ophthalmic personnel (MLOPs). METHOD: A population-based, cross-sectional study was conducted among subjects 60 years and above in the Bhaktapur district of Nepal. Fundus photographs of 500 eyes of 500 subjects were assessed. The macula-centered 45-degree photographs were graded twice by one ophthalmologist and two MLOPs. Intra-rater and inter-rater agreements were assessed for the ophthalmologist and the MLOPs. RESULT: Mean age was 70.22 years ± 6.94 (SD). Retinal pathologies were observed in 55.6 % of photographs (age-related macular degeneration: 34.2 %; diabetic retinopathy: 4.2 %; retinal vein occlusion: 3.8 %). Twelve (2.4 %) fundus pictures were non-gradable. The intra-rater agreement for overall retinal pathologies, retinal hemorrhage, and maculopathy were substantial both for the ophthalmologist as well as for the MLOPs. There was moderate inter-rater agreement between the ophthalmologist and the first MLOP on second rating for overall retinal pathologies, [kappa (k); 95 % CI = 0.59 (0.51-0.66)], retinal hemorrhage [k; 95 % CI = 0.60 (0.41-0.78)], and maculopathy [k; 95 % CI = 0.52 (0.43-0.60)]. Inter-rater agreement between the ophthalmologist and the second MLOP for second rating was moderate for overall retinal pathologies [k; 95 % CI = 0.52 (0.44-0.60)], substantial agreement for retinal hemorrhage [k; 95 % CI = 0. 68 (0.52-0.84)], moderate agreement for maculopathy [k; 95 % CI = 0.59 (0.50-0.67)]. CONCLUSION: There is moderate agreement between the MLOPs and the ophthalmologist in grading fundus photographs for retinal hemorrhages and maculopathy.

Population awareness of diabetic eye disease and age related macular degeneration in Nepal: the Bhaktapur Retina Study.

BACKGROUND: Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are among the leading causes of visual impairment and blindness in developing countries. This study aims to explore the awareness of these retinal diseases in Nepal. METHOD: A population based cross-sectional study conducted among individuals 60 years and older from the Bhaktapur district of Nepal. One thousand consecutive subjects were enrolled and subjected to a structured questionnaire. RESULT: Subject age ranged from 60 to 93 years with a meanof 69.5 years ± 7.1(S.D.). Males and females comprised 45.1 and 55.9 % of the population, respectively. The majority was illiterate (78.2 %), and agriculture was the predominant occupation (79.8 %). 12.1 % were aware of the effect of diabetes on the eye, and among them, 99 % were aware that diabetes was a blinding disease caused by DR.11.5 % of the subjects were aware of DR, and 10.1 % were aware that subjects with diabetes should undergo periodic eye examinations. Only 7.6 % of subjects were aware of AMD.7.5 and 7.4 % were aware about its aggravation with smoking and sunlight exposure, respectively. Younger age group, males, literates, service holders, best corrected visual acuity >0.3 LogMAR, were each significantly associated with an increase in awareness of diabetic retinopathy. Smokers and those with agricultural occupations were less aware regarding AMD. Those with diabetes,with or without DRwere significantly more aware than those not having the disease. CONCLUSION: Among the Bhaktapur population, awareness of DR and AMD was only 11.5 and7.6 % respectively. Older age groups, females, illiterates, farmers, and those with poor visual acuity were less aware of these blinding diseases. We recommend community-based eye health education programs targeted at raising awareness of these diseases and preventive measures.

Prevalence and pattern of vitreo-retinal diseases in Nepal: the Bhaktapur glaucoma study.

BACKGROUND: Vitreo-retinal diseases are among the leading causes of visual impairment and blindness worldwide. This study reports the prevalence and pattern of vitreo-retinal diseases in the Bhaktapur Glaucoma Study (BGS), a population based study conducted in Nepal. METHODS: BGS was a population based cross-sectional study involving 4800 subjects aged 40 years and over from Bhaktapur district. Subjects were selected using a cluster sampling methodology and a door-to-door enumeration. All subjects underwent a detailed ocular examination at the base hospital which included log MAR visual acuity, refraction, applanation tonometry and a dilated fundus examination. Fundus photography, optical coherence tomography and fundus fluorescein angiography were performed where indicated. RESULTS: Complete data was available for 3966 (82.62%) out of the total of 4800 enumerated subjects. The mean age was 55.08 years (SD 11.51). The overall prevalence of vitreo-retinal disorders was 5.35% (95% CI, 4.67 - 6.09). Increasing age was associated with a higher prevalence of vitreo-retinal disorders (P < 0.001). The prevalence of diabetes mellitus was 7.69% (95% CI, 6.88 - 8.56). Age-related macular degeneration (AMD) was the most common vitreo-retinal disorder with a prevalence of 1.50% (95% CI, 1.15 - 1.94), increasing significantly with age. The prevalence of diabetic retinopathy among the study population was 0.78% (95% CI, 0.53 - 1.11) and among the diabetic population 10.16% (95% CI, 7.01 - 14.12). The population prevalence of other retinal disorders were hypertensive retinopathy 0.88%, macular scar 0.37%, retinal vein occlusion 0.50%, macular hole 0.20%, retinitis pigmentosa 0.12%. and retinal detachment 0.10%.The prevalence of low vision and blindness due to vitreo-retinal disorders was 1.53% (95% CI, 1.18 - 1.97) and 0.65% (95% CI, 0.43 - 0.96), respectively. The prevalence of low vision and blindness was 28.77% (95% CI, 22.78-35.37) and 12.26% (95% CI, 8.17-17.45), respectively among cases with vitreo-retinal disorders. Blindness was observed to be unilateral in 19 cases (73%), and bilateral in 7 cases (27%). CONCLUSIONS: The prevalence of vitreo-retinal disorders in this Nepalese population was 5.35%, which increased significantly with age. AMD was the predominant retinal condition followed by diabetic retinopathy. One fourth of the subjects with vitreo-retinal disorder had low vision. Taking into consideration the aging population and emerging systemic diseases such as diabetes mellitus and hypertension, vitreo-retinal disorders could be of future public health importance.

Association of pro-inflammatory cytokines, adipokines & oxidative stress with insulin resistance & non-alcoholic fatty liver disease.

BACKGROUND & OBJECTIVES: The cytokines, adipokines, and oxidative stress have been implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD); however, such data remain scarce in India. The present study evaluated pro-inflammatory cytokines, adipokines, and markers of oxidative stress in patients with non-alcoholic fatty liver disease (NAFLD), and their association with degree of adiposity, insulin resistance and markers of disease severity. METHODS: The present prospective cross-sectional pilot study included 79 subjects; 34 NAFLD, 22 chronic hepatitis B (CH-B) and 23 healthy controls (HC). The parameters studied were adiponectin, leptin, tumour necrosis factor α (TNFα), interleukin-1 and 6 (IL-1, IL-6), and systemic markers of oxidative stress. RESULTS: The mean body mass index (kg/m 2 ) in NAFLD patients, CHB, and HC were 26.4±3.7, 21.3±2.3, and 22.3±2.7, respectively. The median serum levels of all pro-inflammatory cytokines were significantly higher (P<0.001) in NAFLD compared to control groups. Compared to HC, levels of adiponectin and leptin were significantly (P<0.05, P<0.01) reduced in both NAFLD and CHB. IL-6 showed marked and selective increase only in NAFLD patients. The levels of IL-6 were significantly (P<0.02) higher in NAFLD patients with advanced histology grade and correlated with IR (r=0.42, P=0.02). In a sub-group, markers of oxidative stress were significantly higher, and that of antioxidant potential were significantly lower among NAFLD patients compared to control subjects. INTERPRETATION & CONCLUSIONS: Patients with NAFLD revealed significantly elevated levels of pro-inflammatory cytokines, increased oxidative stress, and a significant association of IL-6 with IR and advanced histopathology.

Persistent hyperammonemia is associated with complications and poor outcomes in patients with acute liver failure.

BACKGROUND & AIMS: Patients admitted to the hospital with acute liver failure (ALF) and high arterial levels of ammonia are more likely to have complications and poor outcomes than patients with lower levels of ammonia. ALF is a dynamic process; ammonia levels can change over time. We investigated whether early changes (first 3 days after admission) in arterial levels of ammonia were associated with complications and outcomes and identified factors associated with persistent hyperammonemia. METHODS: We performed a prospective observational study that measured arterial ammonia levels each day for 5 days in 295 consecutive patients with ALF. We analyzed associations of changes in ammonia levels during the first 3 days with complications and outcomes. RESULTS: Patients with persistent arterial hyperammonemia (≥122 µmol/L for 3 consecutive days), compared with those with decreasing levels, had lower rates of survival (23% vs 72%; P < .001) and higher percentages of cerebral edema (71% vs 37%; P < .001), infection (67% vs 28%; P = .003), and seizures (41% vs 7.7%; P < .001). Patients with persistent hyperammonemia had greater mortality, with an odds ratio (OR) of 10.7, compared with patients with baseline levels of ammonia ≥122 µmol/L (OR, 2.4). Patients with persistent hyperammonemia were more likely to progress to and maintain advanced hepatic encephalopathy than those with decreasing levels. Patients with persistent, mild hyperammonemia (≥85 µmol/L for 3 days) were also more likely to have complications or die (P < .001) than patients with serial ammonia levels <85 µmol/L. Infections (OR, 4.17), renal failure (OR, 2.20), and decreased arterial pH (OR, 0.003) were independent predictors of persistent hyperammonemia. CONCLUSIONS: Patients with ALF and persistent arterial hyperammonemia for 3 days after admission are more likely to develop complications and have greater mortality than patients with decreasing levels or high baseline levels. Infection, renal failure, and decreased arterial pH are independent predictors of persistent hyperammonemia.

A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur Glaucoma Study.

OBJECTIVE: To determine the prevalence and types of glaucoma in a Nepalese population. DESIGN: Cross-sectional, population-based survey. PARTICIPANTS: A total of 4800 subjects aged 40 years or older from the Bhaktapur district of Kathmandu valley. METHODS: Subjects aged 40 years or older were selected using a cluster sampling procedure and door-to-door enumeration for a population-based, cross-sectional study. All subjects underwent a detailed ocular examination at the base hospital, which included logarithm of minimal angle of resolution visual acuity, refraction, applanation tonometry, gonioscopy, Lens Opacities Classification System II cataract grading, retinal examination, and Swedish Interactive Thresholding Algorithm standard perimetry when indicated. MAIN OUTCOME MEASURES: Diagnosis of glaucoma was based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. RESULTS: A total of 4003 subjects underwent a comprehensive eye examination (response rate 83.4%), and complete data were available in 3991 subjects. The mean intraocular pressure was 13.3 mmHg (97.5th and 99.5th percentiles, 18 and 20 mmHg, respectively), and the mean vertical cup-to-disc ratio was 0.26 (97.5th and 99.5th percentiles, 0.6 and 0.8 mmHg, respectively). There were 75 subjects with glaucoma, an age- and sex-standardized prevalence of 1.80 (95% confidence interval [CI], 1.68-1.92). Age- and sex-standardized prevalence was 1.24% (95% CI, 1.14-1.34) for primary open-angle glaucoma (POAG), 0.39% (95% CI, 0.34-0.45) for primary angle-closure glaucoma (PACG), and 0.15% (95% CI, 0.07-0.36) for secondary glaucoma. The prevalence of glaucoma increased with an increase in age with no significant difference in gender. Primary angle-closure glaucoma was 3 times more common in women. Nine eyes were blind, and 2 subjects were bilaterally blind from glaucoma. CONCLUSIONS: The overall prevalence of glaucoma was 1.9%. Of all glaucoma cases, POAG accounted for 68%, PACG accounted for 22.67%, and secondary glaucoma accounted for 9.33%. Among the subjects with POAG, 96.08% had not been previously diagnosed.

Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure.

OBJECTIVE: It is difficult to predict the outcome in patients with acute liver failure (ALF) using existing prognostic models. This study investigated whether early changes in the levels of dynamic variables can predict outcome better than models based on static baseline variables. DESIGN: 380 patients with ALF (derivation cohort n=244, validation cohort n=136) participated in a prospective observational study. The derivation cohort was used to identify predictors of mortality. The ALF early dynamic (ALFED) model was constructed based on whether the levels of predictive variables remained persistently high or increased over 3 days above the discriminatory cut-off values identified in this study. The model had four variables: arterial ammonia, serum bilirubin, international normalised ratio and hepatic encephalopathy >grade II. The model was validated in a cohort of 136 patients with ALF. RESULTS: The ALFED model demonstrated excellent discrimination with an area under the receiver operator characteristic curve of 0.91 in the derivation cohort and of 0.92 in the validation cohort. The model was well calibrated in both cohorts and showed a similar increase in mortality with increasing risk scores from 0 to 6. The performance of the ALFED model was superior to the King's College Hospital criteria and the Model for End stage Liver Disease score, even when their 3-day serial values were taken into consideration. An ALFED score of ≥4 had a high positive predictive value (85%) and negative predictive value (87%) in the validation cohort. CONCLUSION: The ALFED model accurately predicted outcome in patients with ALF, which may be useful in clinical decision-making.

Central corneal thickness and intraocular pressure in a Nepalese population: the Bhaktapur Glaucoma Study.

PURPOSE: The purpose of the study was to evaluate the characteristics of central corneal thickness and its association with age, sex, and intraocular pressure in a Nepalese population. PATIENTS AND METHODS: The study design was a cross-sectional, population-based survey. Two thousand three hundred thirty patients aged 40 years and older were examined at Tilganga Institute of Ophthalmology, a tertiary referral eye centre in Kathmandu, Nepal. All patients underwent a complete ophthalmic examination that included measurements of central corneal thickness with an ultrasonic pachymeter and intraocular pressure with a Goldman type applanation tonometer. RESULTS: The main outcome measures were central corneal thickness and intraocular pressure. Mean age of the 2330 patients examined was 51.3 years (SD±9.56). The mean central corneal thickness and mean intraocular pressure was 539.10 µm (SD±33.73) and 13.33 mm Hg (SD±2.26), respectively. Central corneal thickness showed an average decrease of 2.67 µm (95% confidence interval, 2.21-4.1) per decade increase in age. A 100 µm increase in central corneal thickness was associated with a 1.03 mm Hg (95% confidence interval, 0.79-1.26) increase in intraocular pressure after adjusting for age and sex. CONCLUSIONS: The changes in central corneal thickness values cause a significant variation in intraocular pressure in this population, suggesting that measurement of central corneal thickness will have implications in the diagnosis and management of glaucoma.