Clinical Profile and Knowledge, Attitude and Practice of Patients Presenting with Headache.

Background Headache disorders are among the most prevalent and disabling conditions worldwide. People, however, do not seek early advice in developing countries. Objective To study clinical profile of patients with headache and their existing knowledge, attitude, and practice regarding primary headaches. Method Descriptive cross-sectional study conducted among 196 patients. Patients were selected using purposive sampling technique fulfilling inclusion criteria. Patients were interviewed based on semi-structural headache questionnaire and data was collected from 4th October to 21st December 2021. Descriptive statistics was used for analysis and interpretation. Result Among 196 participants, 74% were females, 29.6% of patients were between (31 to 40) years of age. The majority were Hindu and belongs to province 3; 36.7% were homemakers, and 32.2% were literate. Migraine headache was the most common type with 14.3% reporting aura. Most reported headache within 1 to 5 years. The commonest triggers were sunlight 64.8%, crowd 54.7%, stress 39.8%, fasting state 31.7%, cold 26.3%. Almost 39% believed that headache could be a chronic neurologic disorder. Majority had knowledge of the causes, triggers, and the relieving factors. Fifty-five percent seek help of a doctor for first time, and the rest seek help of a pharmacist or self-medication. Only 19% tried to manage the headache triggers; 66.8% felt that lifestyle modification is the best treatment for headache comparing drugs. Conclusion Migraine headache was the commonest headache occurring at middle age group with sunlight being the most common trigger factor. Lifestyle modification was perceived to be the best for headache management.

Impact of Albendazole Therapy on Clinical and Radiological Outcomes at One Month in Patients with Active Solitary Neurocysticercosis Patients.

Background Cerebral neurocysticerosis is a common parasitic disease of human nervous system but evidence on duration of albendazole therapy and their outcomes in this condition is inadequate Objective To evaluate the impact of varying duration of albendazole therapy on the clinical and radiological outcomes at one month in patients with active solitary neurocysticercosis. Method This is an interventional study conducted at Upendra Devkota Memorial National Institute of Neurological and Allied sciences, Bansbari over 1 year (2017 March - 2018 February). One hundred eighteen patients with new onset seizure secondary to active solitary cysticercal granuloma either received albendazole therapy for 1, 3, 9 or 21 days with the usual care or only received the usual care. Clinical and radiological outcomes were observed at one month follow-up. The difference in the proportion of the outcome measures between intervention and control groups were assessed using chi-square test. Result Our study included 118 patients with male predominance of 61.9%. Albendazole therapy for 3, 9 and 21 days reduced headache by 57.2%, 70.0% and 63.1% respectively which was higher than those with 1-day therapy or without the therapy. This difference in the proportion was statistically significant at p=0.001. Though seizure recurrence also declined but the difference was not significant (p=0.406) between groups. However, at one-month follow-up, majority of patients who received albendazole for 9 days (14, 70%) and 21 days (14, 73.7%) had normal lesion, while most calcified lesion (21, 67.7%) was observed in those who did not receive albendazole therapy. The difference between lesion among the groups was significant (p < 0.001). Conclusion Albendazole therapy in patients with active solitary neurocysticercosis for 9 days is as effective as 21 days and better than 3 days in headache control and lesion dissolution but seizure control could be achieved irrespective of the treatment.

Electronic, mechanical, optical and piezoelectric properties of glass-like sodium silicate (Na2SiO3) under compressive pressure.

The structural, mechanical, electronic, optical and piezoelectric properties of Na2SiO3 are studied under varying compressive unidirectional pressure (0-50 GPa with a difference of 10 GPa) using density functional theory (DFT). The calculated structural properties agree well with previously reported results. At 12 GPa, our calculation shows a structural phase transition from orthorhombic Cmc21 to triclinic P1. The mechanical profile of Na2SiO3 structures under different compressive unidirectional pressures are analysed by calculating the elastic moduli, Poisson's ratio and eigenvalues of stiffness matrix. Our study shows the mechanical stability of the system up to a pressure of 40 GPa. Herein, we have obtained an indirect band gap of 2.97 eV at 0 GPa. Between 0-50 GPa, the band gaps are within the range 2.62 to 3.46 eV. The system in our study possesses a wide band gap and high optical absorption in the UV-Vis range of electromagnetic radiation. The calculated static refractive indices η x,y,z (0) are close to unity suggesting its transparency. For piezoelectric properties, we have reported the total Cartesian polarization. Our calculations have revealed that Na2SiO3 is a promising candidate for optoelectronic devices while its application in ferroelectric and piezoelectric devices could be improved with further research.

Work-related Respiratory Symptoms and Associated Factors among Cement Factory Workers in Rupandehi District, Nepal.

Background Cement factory workers are exposed to cement dust at workplace. It leads to a greater prevalence of chronic respiratory signs and symptoms. Objective To identify the prevalence of Work-related respiratory symptoms, its association with various risk factors, and to assess the outcomes like hospitalization and sickness absenteeism. Method Cross-sectional study was conducted in the Argakhanchi Cement factory among 190 workers with minimum work experience of 1 year. Census method was used for data collection. To assess the respiratory symptoms, sputum samples were collected; smears prepared by pick and smear method, and later stained by Leishman and pap stain. Smears devoid of alveolar macrophages were considered unsatisfactory for evaluation. Result The mean age of respondents with standard deviation was 35.56±11.45 years. The prevalence of Work-related respiratory symptoms was 31.6%. Age, no. of years worked, working in the raw materials department, burner and clinker department, cleaning department and wearing mask were the significant risk factors. On cytological analysis of the sputum sample, mild inflammatory cell noticed in 71.6%, moderate inflammation in 23.7%, and dense inflammation in 4.2%. Fungal spores were seen in 3.7%, fungal pseudohyphae in 0.5%, and bacterial colonies in 27% of the sputum samples. Out of 190 participants, 8(4.2%) of them had to be hospitalized and 17(8.9%) were on sick leave due to respiratory symptoms. Conclusion Pre-employment and periodic medical examination, frequent work shift, training on occupational health and safety, use of appropriate personnel protective equipment is recommended to reduce respiratory symptoms.

Clinico-pathological Profile of Kidney Biopsy Patients in a Tertiary Hospital of Central Nepal.

Background Kidney biopsy is an important diagnostic tool in Nephrology. As of now, we don't have a central kidney biopsy registry in our country and there are many studies showing heterogeneous patterns of pathologies observed in the country. We thought of looking on the clinico-pathological profile of kidney biopsy patients prevailing in our centre. Objective This study was carried out with an objective to know the clinico-pathological profile of kidney biopsy patients prevailing in our centre. Method This was a hospital based, prospective, observational study carried out in a tertiary teaching hospital of Chitwan over a period of 3 years from May 2016 to April 2019. All the consecutive kidney biopsy patients were included in the study. The indication of kidney biopsies were the standard indication based on clinical presentation and investigations. The patient`s demographic profile, indication of kidney biopsy and histological patterns were studied and analysed using appropriate statistical tools. Result A total of 210 kidney biopsies were analysed over a period of three years, that makes around 5-6 biopsies per month. The mean age of the patient was 35.7 ± 14.9 years. Male were 106 (50.5) and females were 104 (49.5) with male to female ratio of 1.01. The average number of glomeruli was 23.4 ± 11.0. The commonest indication of kidney biopsy and histological pattern were nephrotic syndrome 56 (26.7) and IgA nephropathy 51 (24.2) respectively. Among nephrotic syndrome group, the commonest histological pattern was minimal change disease 21 (37.5). Non-diabetic kidney diseases in diabetes were seen in eight (53.4) diabetic patients making it a significant problem in diabetes and the commonest histological pattern in them were minimal change disease and idiopathic cresentic glomerulonephritis two (13.3) each. Conclusion The commonest indication and histological pattern of the kidney biopsy were nephrotic syndrome 56 (26.7), and IgA Nephropathy 51 (24.2) respectively. Nondiabetic kidney diseases in diabetes were seen in eight (53.4) of the diabetic patient making it a significant problem in diabetes and the commonest histological pattern in them were minimal change disease and idiopathic cresentic glomerulonephritis two (13.3) each.

A Community Based Cross Sectional Study to Estimate the Prevalence and Associated Factors of Hypertension in Rural Nepal.

Background Hypertension is a major global public health problem because of its high prevalence as it significantly increases the risk of heart attack, stroke, kidney failure and blindness. Epidemiological shift in prevalence of non-communicable diseases have been observed in Nepal and it is also evident that hypertension and related complications are major contributors to death and disability in Nepal. Objective To estimate the prevalence and explore the associated factors of hypertension in study population. Method A community based cross-sectional study was conducted in rural population of Nepal with multistage sampling design. A total of 422 participants aged 18 to 65 years of age participated in the study. The information was obtained using pretested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity. Anthropometric measurements and blood pressure was recorded and hypertension was defined as per JNC VII criteria. Result The overall prevalence of hypertension was 27.7% (male: 32.7%, female: 19.8%). Mean systolic and diastolic BP were 123.79 ± 12.46 mmHg and 81.56 ± 8.32 mmHg, respectively. Age (eldest age group, AOR=4.92: CI: 1.24-19.46), participants with lower level of education (higher education, AOR=0.173: CI: 0.05-0.53), ethnicity (Janajatis, AOR=2.85: CI: 1.44-5.65) and smoking (current smokers, AOR=10.30: CI: 4.39-24.16) are found to be significantly associated with hypertension. Conclusion This study showed the prevalence of hypertension is high in study population. Increasing age, low level of education, ethnicity and smoking were independent risk factors for hypertension.

Prevalence and Associated Factors of Malnutrition in Under Five Children in a Rural Mountainous Area of Nepal: A Community Based Cross Sectional Study.

Background Nutrition is believed to be very essential for socio economic development of the country and is an essential component of sustainable development goals. Malnutrition is a major public health problem in Nepal and is more common among under-five year children. Malnutrition among children is complex problem globally, affecting the physical, mental and social development. Objective To estimate the prevalence and explore the associated factors of malnutrition in study population. Method It was a community based cross-sectional study conducted among rural population of Nepal. Wards were selected by simple random sampling technique and household in each ward were selected by systemic random sampling. The mothers of 302 participants aged 12 to 59 months were interviewed for requisite information using pretested questionnaire and anthropometric measurements were taken using standard technique for each participant. Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Result The prevalence of underweight, stunting and wasting was 36.8%, 37.5%, and 14.6% respectively. We found statistical significant association between underweight and children in lower age group, larger family size, lower level of mother's education and illness in past one month. Factors that are significantly associated with stunting are children in lower age group, lower level of mother's education and illness in past one month and wasting is significantly associated with children in lower age group. Conclusion This study showed the prevalence of malnutrition is high in study population. Factors associated with malnutrition were child's age, family size, mother's education and illness in past one month.

Clinicodemographic Profile and Outcome of Maintenance Hemodialysis Patients in a Tertiary Hospital of Central Nepal, Chitwan.

Background Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients; however their mortality seemed to be rising in our centre. There were no previous studies regarding the clinicodemographic profile and outcome of maintenance hemodialysis patients from this region. Objective This study was carried out with an objective to know the clinicodemographic profile and outcome of maintenance hemodialysis patients in our centre. Method This study was a hospital based prospective observational study carried out over a period of three year, from May 2016 to April 2019, in the hemodialysis unit of the department of nephrology. All the consecutive end stage renal disease patients on maintenance hemodialysis were included in the study. The patient's demographic profile and outcome were studied and analysed using appropriate statistical tools. Result A total of 156 patients were enrolled in the study. Males were 96(61.5%) and females were 60(38.5%). The mean age of the patient was 52.2±15.6 years. The commonest causes of end stage renal disease and reasons for admission were Type 2 diabetes mellitus 68(43.6%) and volume overload with heart failure 101(64.7%) respectively. At the end of three years, 39(25%) were expired, 14(8.9%) were transferred to other centre and four (2.6%) underwent kidney transplantation. The average duration of hemodialysis was 20.3± 17.5 months. Majority of the patients 154(98.7%) had repeat admission ranging from 1 time 21(13.5%) to 10 times two (1.3%). There was a significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively). Conclusion The commonest cause of end stage renal disease and the reason of admission were Type 2 diabetes mellitus 68 (43.6%) and volume overload with heart failure 101 (64.7%) respectively. The overall mortality was 39 (25%) and the commonest cause of mortality was sepsis/health care associated pneumonia 30 (76.9%). There was significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively).

Physical Properties and Theoretical Study of NixCo3-xO4 (0 ≤ x ≤ 1.5) Nanostructures as High-Performance Electrode Materials for Supercapacitors.

Study evaluates the electrochemical performance of off-stoichiometric NixCo3-xO4 compounds. The off-stoichiometric samples were prepared via hydrothermal technique by systematically varying Co/Ni molar ratio. Physical and electrochemical properties of NixCo3-xO4 were observed to be stoichiometry dependent. The increase in Ni/Co ratio in NixCo3-xO4 leads to the morphological transformation from fibrous bundles to urchin like nanospheres with a concomitant increase in the surface area reaching up to 132 m2/g. The optimal specific capacitance of 225 F/g at a current density of 1 A/g and 524 F/g at 10 mV/s scan rate was observed of x 1.0 sample, with an increased retention capacity ∼120% measured at 2 A/g current density. The hybrid density functional theory (DFT) calculations of the electronic density of states identified Ni1.0Co2O4 with optimal band-gap of 2.38 eV with an expectation of displaying higher electrocapacitive performance. Experimentally, Ni0.92Co2.08O4 displayed superior electrocapacitive performance among all Ni/Co ratio in NixCo3-xO4. The DFT study also predicted Ni preference to the octahedral site, which is in-line with the observed increase in ferromagnetic nature, decreased lattice parameter, and increased structural disorder with increasing Ni/Co ratio. The improved electrochemical performance of NixCo3-xO4 (x > 0) is attributed to the mesoporous hierarchical structure, with a high electroactive surface which can effectively improve structural stability, and reduce the ionic and electron diffusion length. Compared to the pure Co3O4, the reduction of Co content in NixCo3-xO4 is desired due to the high cost and toxicity of Co element.

Magnetic Stimulus Responsive DDS Based on Chitosan Microbeads Embedded with Magnetic Nanoparticles.

In this paper, we have presented a novel Drug Delivery Substrate (DDS) that that is responsive to external stimuli of high-frequency alternating magnetic fields. The DDS is constituted of chitosan crosslinked with PEGDMA (polyethylene glycol dimethacrylate), loaded with Fe3O4 magnetic nanoparticles and vancomycin. In another experiment, a 19-hour elution was observed where three magnetic stimuli of 25 mT, 109.9 kHz were given for 60 min to the test samples. The stimuli were separated by several hours. After excitation span, it was observed that the stimulated samples released a significantly higher amount of vancomycin by as much as 21% compared to non-stimulated samples. In another study, preliminary results showing the effect of different PEGDMA chain lengths have been discussed. These results show evidence of a smart, controllable DDS that allows modulation of its normal passive antibiotic elution by applying external stimuli per personalized needs.

Evaluation of Pyrethroid Insecticides and Insect Growth Regulators Applied to Different Surfaces for Control of Trogoderma granarium (Coleoptera: Dermestidae) the Khapra Beetle.

The khapra beetle, Trogoderma granarium Everts (Coleoptera: Dermestidae), is a serious pest of stored products and is the only stored product insect pest that triggers a quarantine response when it is found in the United States. The larvae of T. granarium feed on a wide range of dry food products of plant and animal origin, including cereals, dried fish, and museum specimens. In this study, we evaluated the residual efficacy of two pyrethroid insecticides, deltamethrin and cyfluthrin, applied on concrete, wood, painted wood, vinyl flooring tile, and metal surfaces using small and large T. granarium larvae. Residual efficacy of two insect growth regulators (IGRs), methoprene and pyriproxyfen was also evaluated on concrete, metal, and wood surfaces. In both studies, larvae were exposed with provision of a food source on the treated surfaces and residual assays were conducted at 0 months (1 d), 1, 2, and 3 months post treatment. In general, both of the pyrethroids provided a high level of control of T. granarium larvae, though small larvae were much more susceptible than large larvae. The IGRs were comparatively less effective, with more larval survival and adult emergence of exposed larvae compared with the pyrethroids. Residues of the pyrethroids and IGRs were most persistent on the metal surface. Results can be used to help to control and eradicate infestations of T. granarium when they are detected in the United States.

Intradialytic Muscle Cramp and its Association with Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis.

INTRODUCTION:  Muscle cramp is a common intradialytic complication observed in hemodialysis patients. Similarly Peripheral arterial disease is a common condition in the hemodialysis population. METHODS:  Fifty patients with a diagnosis of End Stage Renal Disease who were on hemodialysis were studied over a period of one year. Muscle cramp was defined clinically as contractions of a large muscle group and Peripheral arterial disease was diagnosed on the basis of the ankle -brachial index (ABI). RESULTS:  A total of 50 End Stage Renal Disease patients were analyzed. The major causes of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20). Muscle cramps were present in 26% (n=13) cases. Peripheral arterial disease was present in 30% (n=15) of patients. However there was no statistically significant association between the presence of Intradialytic Muscle cramps and peripheral arterial disease (p value =0.18) CONCLUSIONS: Intradialytic Muscle cramps and peripheral arterial disease were common occurrence in end stage renal disease patients on hemodialysis patients, however there was no association between the presence of intradialytic Muscle cramps and peripheral arterial disease.

Prevalence of Peripheral Arterial Disease (PAD) in End Stage Renal Disease (ESRD) Patients on Hemodialysis: a study from central Nepal.

BACKGROUND: Peripheral arterial disease is a common condition in the hemodialysis population with an estimated prevalence ranging from 17-48%. Many studies have been conducted to know the prevalence of peripheral vascular disease in hemodialysis population. However no such study has been conducted so far in Nepal. OBJECTIVE: This study was carried out with an objective to assess the prevalence of Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis. METHOD: Fifty patients with a diagnosis of End Stage Renal Disease (irrespective of the underlying cause), and those who were on hemodialytic support for more than 3 months were studied over a period of one year. Peripheral arterial disease was diagnosed on the basis of the ankle -brachial index, which was the ratio of the resting systolic blood pressure in the arteries of the ankle to that of the brachial artery, measured by using a standard mercury manometer with a cuff of appropriate size and the Doppler ultrasound. Patients with ankle -brachial index ≤0.9 were considered positive for peripheral arterial disease. RESULT: A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the patient was 49.81±12.63 years. The age range was from 18- 79 years. Majority of them were males 64% (n=32). Peripheral arterial disease defined by ankle -brachial index ≤ 0.9 was present in 30% (n=15) of patients. The three major cause of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20), Type 2 Diabetes Mellitus 28 % (n=14) and Hypertension 24 % (n=12). Type 2 Diabetes Mellitus was the commonest cause 53% (n=8) of End Stage Renal Disease in patients with peripheral arterial disease followed by hypertension 33% (n=5). On univariate analysis, peripheral arterial disease was found to be significantly associated with age > 40 years (p value= 0.003; OR=14.8; CI=1.75-125.27), Type 2 Diabetes Mellitus (p value= 0.009; OR=5.4; CI=1.44-21.14), parasthesia of lower limbs (p value= 0.001; OR=10; CI-2.31-43.16), and intact PTH >300 ng/ml (p value =0.006; OR=5.7; CI=1.55-21.50). However on multivariate analysis only parasthesia of lower limbs and intact PTH >300 ng/ml were significantly and independently associated with peripheral arterial disease, while other variables were not significant. CONCLUSION: Peripheral arterial disease was common occurrence in End Stage Renal Disease patients on hemodialysis. Ankle -brachial index needs to be included as a routine assessment in End Stage Renal Disease patients to detect peripheral arterial disease at its earliest.

Kinship care at community is better model to ensure psychosocial and economic security to orphans living with HIV than from care homes.

BACKGROUND: There were about 24,000 children affected by AIDS living in Nepal in 2010; of these 5,000 AIDS orphans were in need of immediate support. The objective of this study was to investigate which model of care and support is more appropriate for improving psychosocial and economic security of AIDS orphans. METHODS: With the documented 5200 cases of AIDS orphans from 42 districts at National Association of People Living with HIV, we purposively selected five districts - one from each development region, based on the highest number of AIDS orphans reported. From five districts, 56 HIV positive double orphans aged 8-18 years and their 42 caregivers were interviewed to find their psychosocial and economic situation. RESULTS: Thirty nine (70%) orphans were found living in kinship care, while 17(30%) were living in institutional care homes. Orphans living in kinship were more optimistic, as they were backed by their close relatives 35 (90%), had birth certificates 35 (90%), ensured inherent family property 21 (54%), obtained basic needs like food, education and shelter from grandparents 23 (59%), and had more than five friends who visited their homes 26 (67%). While, the orphans living in institutional care homes 17(30%) had no birth certificates, fewer contacts with siblings 2 (12%), and none had friends outside the care homes. CONCLUSIONS: Kinship care is better model for psychosocial and economic security for AIDS orphans in Nepal, rather than institutional care. Families can provide good protection to AIDS orphans if government provides minimum support to them.

Pneumonia in South-East Asia Region: public health perspective.

Globally, pneumonia is the leading cause of death in young children and burden of disease is disproportionately high in South-East Asia Region of WHO. This review article presents the current status of pneumonia disease burden, risk factors and the ability of health infrastructure to deal with the situation. Literature survey was done for the last 20 years and data from country offices were also collected. The estimated incidence of pneumonia in under five children is 0.36 episodes per child, per year. Risk factors are malnutrition (40% in India), Indoor air pollution, non-breast feeding, chronic obstructive pulmonary disease, etc. Strengthening of health care delivery system for early detection and treatment and as well as minimization of preventable risk factors can avert a large proportion of death due to pneumonia.

Peritonitis in Continuous ambulatory peritoneal dialysis.

INTRODUCTION: Access to hemodialysis is limited in Nepal due to geographical terrain and hemodialysis centers being mostly limited to major city. Therefore, continuous ambulatory peritoneal dialysis is likely to be a better option in Nepal. In 1998, CAPD was initiated in Nepal without success. High rate of peritonitis was cited for failure. Hot tropical climate and poor sense of hygiene among patients was thought to be responsible for the high rate of peritonitis. A new CPD program was started in 2002 in our institute. We reviewed the incidence of peritonitis and factors predisposing. METHODS: All chronic renal failure patients on CAPD since 2002 to 2007 were included in the study. They were followed up for complications and treatment outcome. Patients complicated with peritonitis (N=19) and patients without peritonitis (N=31) were compared. RESULTS: A total of 50 patients were enrolled and mean duration of dialysis was 12 month per patients (Total patients month=600). Twenty six episodes of peritonitis in 19 patients were recorded during this period. Fourteen episode of peritonitis were culture positive. Culture sterile peritonitis was recorded in 12 episodes. Low serum albumin was predisposing factors for peritonitis and peritonitis rate was higher in end stage disease related due to diabetes mellitus. CONCLUSION: Peritonitis rate was comparable in our new program. Thus peritonitis is not a limiting factor for growth of CAPD in Nepal. Hypoalbuminemic and diabetic patients are prone for CAPD related peritonitis.

Skin disease is common in rural Nepal: results of a point prevalence study.

BACKGROUND: Skin problems are the commonest reason for people accessing healthcare services in Nepal but there is little information about the prevalence of skin disease. OBJECTIVES: To perform a point prevalence study of skin disease in the Terai region of Nepal. METHODS: Five villages were randomly selected in Bara District in the Terai region of Nepal, and 878 people were examined. RESULTS: The number of individuals identified as having a skin disease was 546. The point prevalence of identifiable skin abnormalities was 62.2% (546 of 878) (with 95% exact confidence intervals 58.9-65.4%). A wide range of dermatoses was identified. The six most prevalent were dermatophyte infections (11.4%), followed by pityriasis versicolor (8.9%), acne (7.7%), melasma (6.8%), eczema (5.6%) and pityriasis alba (5.2%). Overall, treatable skin infections and infestations were by far the commonest skin diseases identified. CONCLUSIONS: Our study has demonstrated a very high point prevalence (62.2%) of skin disease in rural Nepal. This study represents the first formal survey of skin disease in Nepal and demonstrates a large burden of disease, in particular treatable infections.

Host finding by Uscana lariophaga (Hymenoptera: Trichogrammatidae) in stored cowpea: the effect of distance, time interval, host patch size and spatial orientation.

Host finding and parasitization by Uscana lariophaga Steffan, a potential biocontrol agent of the storage pest Callosobruchus maculatus (Fabricius), were investigated in stored cowpea. Host finding was shown to be a function of distance, time, host patch size and the spatial position of U. lariophaga relative to the host patch. Uscana lariophaga females were able to find hosts up to 75 cm horizontal distance from the host patch, which was the largest distance tested. The probability that a host patch was found when an individual U. lariophaga female was released at 2.5 cm horizontal distance from the host patch ranged from 0.6 after 2 h foraging time to 0.9 after 8 h foraging time. At 10 cm from the host patch, host finding probability ranged from 0.2 to 0.45 at these respective foraging times. Finding probabilities doubled compared to horizontal distances when U. lariophaga was released below the host patch, and halved when it was released above the host patch. The negative geotaxic response was shown not to be an artefact of the release method. The median net displacement rate in the direction of the host patch was two beans per hour (1.4 cm h(-1)). The results suggest that U. lariophaga females start searching for hosts regardless of the quality of the olfactory information they receive. Additional observations indicated that U. lariophaga is adapted to a host with a patchy distribution, which implies that host finding over larger distances is relevant for U. lariophaga.

Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal.

Cyclospora is a coccidian (previously referred to as cyanobacterium-like bodies) that has been implicated in cases of prolonged diarrhoea. The average duration of symptoms is more than three weeks, and no specific treatment has been shown to shorten the illness. A case report suggested that co-trimoxazole may be effective. Expatriate persons with gastrointestinal complaints and cyclospora detected on examination of faeces were recruited from two clinics in Kathmandu, Nepal, between May and August, 1994. Participants were assigned in a randomised, double-blinded manner to receive either cotrimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole) or placebo tablets twice daily for 7 days. Of 40 patients included in the study, 21 received cotrimoxazole and 19 placebo. There were no significant differences between these two groups in age, sex, time in Nepal, duration or severity of illness, or presence of other enteric pathogens. After 3 days, 71% of patients receiving co-trimoxazole still had cyclospora detected, compared with 100% of patients receiving placebo (p = 0.016). After 7 days, cyclospora was detected in 1 (6%) of 16 patients treated with co-trimoxazole who submitted stool specimens compared with 15 (88%) of 17 patients receiving placebo (p < 0.0001). Eradication of the organism was correlated with clinical improvement. There was no evidence of relapse of infection among treated patients followed for an additional 7 days. Treatment with co-trimoxazole for 7 days was effective in curing cyclospora infection among an expatriate population in Nepal.

Painful dysphagia in a case of mediastinal tuberculous lymphadenopathy.

A patient with mediastinal tuberculous lymphadenopathy is described. Presentation was with rapid onset of painful dysphagia following trauma to the neck. Early diagnosis was achieved by mediastinoscopy.