Ocular Morbidity among Children of Government Schools of Kathmandu Valley: A Follow-up Study.

INTRODUCTION: Ocular and vision defects are common among school going children. Vision disorders, especially refractive errors are the main disabilities of children and the leading cause of handicapping conditions of childhood. The present study was conducted to find out ocular morbidity among students of government schools of Kathmandu valley. METHODS: In the descriptive and cross-sectional study, 2412 students, comprising of 1114 (46.2%) males and 1298 (53.8%) females were enrolled in to the study from the five government schools of Kathmandu valley from 2012 to 2013. Detailed eye examination included distance visual acuity testing, anterior and posterior segment examinations, retinoscopy and refraction, cover test, near point of convergence, amplitude of accommodation and color vision test. The Chi-square test was performed to analyze the association between ocular morbidity, age and sex. P value was considered significant at 0.05 for 95% confidence interval. RESULTS: Majority of children were age group between 11 and 13 years (n= 783, 32.5%). A male to female ratio was 0.85. Presenting and best spectacle corrected visual acuity of 6/6 was present in 2257 (93.6%) and 2380 (98.7%) respectively. Total ocular morbidity was observed in 515 (21.4%) subjects. The most common types of ocular morbidity were refractive error in 241 (10%), conjunctivitis in 104 (4.3%) and convergence insufficiency in 82 (3.4%). CONCLUSIONS: Refractive error, conjunctivitis and convergence insufficiency represent the most common ocular morbidities among students of government schools.

Cold Pressor Test in Borderline Hypertensive University Students.

Background Hyperactive sympathetic reaction is an important factor for development of hypertension in young individuals. The stress induced increase in blood pressure recovers within very short period of time and those with exaggerated stress induced cardiovascular response at young age have a high risk of blood pressure elevation in future. Objective To determine the cardiovascular reactivity in response to cold and to correlate its relation with factors such as smoking, family history and physical activity. Method Study was conducted in the Department of Pharmacy, Kathmandu University from July to November, 2015. Resting blood pressure was recorded using sphygmomanometer in sitting position after 5 minutes of rest. Out of 130 volunteers, 34 were found to be prehypertensive and equal number of normotensive were recruited randomly to perform the test. The subjects were directed to immerse his/her right hand up to the wrist in cold water of 10˚C for 1 minute. The blood pressure was recorded just before the hand was taken out of the water and then 1.5 minutes and 4 minutes after the withdrawal. Data was analyzed by Student's t test using Microsoft Excel 2007. Result Systolic and diastolic blood pressure increased significantly after cold pressor test in both normal (systolic blood pressure from 110±6.46 to 119±9.45 mmHg and diastolic blood pressure from 71±4.63 to 78±6.15 mmHg) and prehypertensive group (systolic blood pressure from 122±6.75 to 126±8.05 mmHg and diastolic blood pressure from 79±6.78 to 85±7.76 mmHg). Maximum recovery in both systolic and diastolic blood pressure was observed in 2.5 minutes of removal of hand from cold water. Though sharp drop was observed in blood pressure at the end of 2.5 minute in both groups of individuals, the recovery in case of prehypertensive individual was not sharper. In the present study, significant rise in diastolic blood pressure was observed in prehypertensive smoking males. Also the difference was significant (p<0.02) in recovery of diastolic blood pressure between smoker and non smoker prehypertensive group. Conclusion This study suggests that prolonged elevation in blood pressure in response to stress in young individual can be used as marker of development of hypertension in future. Adopting a healthier lifestyle can help to delay the development of hypertension in later life.

Assessment of Color Vision Among School Children: A Comparative Study Between The Ishihara Test and The Farnsworth D-15 Test.

INTRODUCTION: Color vision is one of the important attribute of visual perception. The study was conducted at different schools of Kathmandu to compare the findings of the Ishihara Pseudoisochromatic test and the Farnsworth D-15 test. METHOD: A cross-sectional study was conducted among 2120 students of four schools of Kathmandu. Assessment included visual acuity measurement, slit lamp examination of anterior segment and fundus examination with direct ophthalmoscopy. Each student was assessed with the Ishihara pseudoisochromatic test and the Farnsworth D-15 test. The Chi-square test was performed to analyse color vision defect detected by the Ishihara test and the Farnsworth D-15 test. RESULTS: A total of 2120 students comprising of 1114 males (52.5%) and 1006 females (47.5%) were recruited in the study with mean age of 12.2 years (SD 2.3 years). The prevalence of color vision defect as indicated by the Ishihara was 2.6 and as indicated by the D-15 test was 2.15 in males. CONCLUSION: For school color vision screening, the Ishihara color test and the Farnsworth D-15 test have equal capacity to detect congenital color vision defect and they complement each other.

Outcomes of extra corporeal shock wave lithotripsy in renal and ureteral calculi.

BACKGROUND: Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. OBJECTIVE: The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. METHOD: In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. RESULT: Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10 mm, 10-15 mm and > 15 mm was 97%, 97% and 90%. CONCLUSION: ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5 cm.

Retrospective study of spinal cord injury patients admitted to spinal injury rehabilitation center, Sanga, Banepa, Nepal.

Spinal cord injury is a serious problem that affects many facets of an individual's life. This was a retrospective study which included data from all patients admitted to the Spinal Injury Rehabilitation Center (SIRC), Sanga with spinal injuries over a 4 year period between January 2008 and January 2011. The overall objective of the study was to determine the epidemiology of spinal injury patients admitted at the center. Socio-demographic details, mechanism of injury, level of injury, ASIA score and length of hospital stay of the subjects were recorded and analyzed. An incremental pattern was observed in the number of spinal injury patients attending SIRC. In the year 2008, 81 patients of spinal injury were recorded which increased to 122 in 2011. A total of 381 spinal injury patients were included in the study out of which a majority, 73.50% were male, 30.45% belonged to the 21-30 years age group and 23.10% belonged to the 31-40 years age group. A majority of Spinal injury patients, 189 (49.60%), were from the Central region followed by 89 (23.36%) from the Western region. Fall from height (68.24%) was the predominant cause of spinal injury followed by road traffic accident (18.63%). In the study, 213 subjects (55.91%) had ASIA A scoring and thoracic injury (49.34%) was most common followed by lumbar injury (29.66%), cervical injury (17.84%) and sacral injury (3.15%). About Two-fifths (40.42%) of the spinal injury patients were conservatively managed whereas three-fifths (59.58%) underwent surgery and length of stay of patients ranged from 2 to 305 days. This study shows that the young adults, predominantly males in their most productive years of life, are prone to traumatic spinal cord injury which results in personal and family tragedies along with socioeconomic burden to the nation. Thus, recognizing the pattern of traumatic spinal cord injuries, relevant etiological factors and identification of high-risk groups is necessary in designing better methods of prevention.

Dynamical tunneling of a Bose-Einstein condensate in periodically driven systems.

We report measurements of dynamical tunneling rates of a Bose-Einstein condensate across a barrier in classical phase space. The atoms are initially prepared in quantum states that extend over a classically regular island region. We focus on the specific system of quantum accelerator modes of the kicked rotor in the presence of gravity. Our experimental data is supported by numerical simulations taking into account imperfections mainly from spontaneous emission. Furthermore, we predict experimentally accessible parameter ranges over which direct tunneling could be readily observed if spontaneous emission was further suppressed. Altogether, we provide a proof-of-principle for the experimental accessibility of dynamical tunneling rates in periodically driven systems.

Fidelity of the quantum δ-kicked accelerator.

The sensitivity of the fidelity in the kicked rotor to an acceleration is experimentally and theoretically investigated. We used a Bose-Einstein condensate exposed to a sequence of pulses from a standing light wave followed by a single reversal pulse in which the standing wave was shifted by half a wavelength. The features of the fidelity "spectrum" as a function of acceleration are presented. This work may find applications in the measurement of temperature of an ultracold atomic sample.

Urinary bladder carcinoma: impact of smoking, age and its clinico-pathological spectrum.

BACKGROUND: Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. OBJECTIVE: The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. METHOD: A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. RESULTS: Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. CONCLUSION: The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade.

Bacteriological study of neonatal sepsis and antibiotic susceptibility pattern of isolates in Kathmandu, Nepal.

Bloodstream infections in neonates are life-threatening emergencies. Identification of the common bacteria causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was done to determine the prevalence of neonatal septicaemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates admitted to the neonatal intensive care unit of Nepal Medical College Teaching Hospital (NMCTH), Kathmandu, Nepal. This descriptive-analytical study was conducted in NMCTH from July 2011 to January 2012. Blood culture of all neonates who were suspected for neonatal sepsis was performed. Bacterial isolation, identification and antimicrobial susceptibility testing were done by standard microbiological method. Out of 120 neonates suspected of having neonatal sepsis, 30.8% (37/120) were blood culture positive (i.e. prevalence = 30.8%). The most common causative agents of neonatal sepsis was Staphylococcus aureus (56.8%; 21/37) followed by Klebsiella pneumoniae (21.7%; 8/37), Pseudomonas aeruginosa (13.4%; 5/37) and others. Neonatal sepsis was more frequent in male neonates (32.5%) while (26.5%) in female neonates in the ratio of 1.2:1 (p > 0.05). Neonatal sepsis was significantly higher (58.3%) in low birth weight (LBW) (< 2.5kg) neonates compared with good birth weight (GBW) (23.9%) (< 0.05). Prevalence was higher in preterm neonates (57.8%; 11/19) as compared with term-babies (25.7%) (P = 0.05). Generally, all of the isolates were sensitive to most of the antibiotics used as the first line drugs like amikacin, gentamicin, cefotaxime and ampicillin except Acinetobacter baumannii. This organisms was only sensitive towards cotrimoxazole, azithromicin, cefotaxime and ceftazidime.

Quality of life among HIV positive individuals in Kathmandu valley and Eastern region of Nepal.

BACKGROUND: The alarming increase of HIV/AIDS, inability to afford highly active anti-retroviral therapy, disability and stigma associated with the disease, loss of productivity due to illness, and chronic nature of the disease has made HIV/AIDS one of the most important public health problems in developing countries. The Quality of life assessment is focused on humanistic element and intervention resulting from this result may lead to better overall patient well being. OBJECTIVE: The aim of our study was to assess and compare the quality of life among HIV positive individuals in Kathmandu Valley and Eastern region. METHODS: The study was conducted among 228 HIV positive individuals from Eastern Nepal and 213 from Kathmandu valley and they were compared with an equal number of age-sex matched controls from the community. The instrument used was the WHO QOL-BREF Nepali questionnaire. RESULTS: The HIV positive individuals had significantly lower (P<0.001) QOL scores than the controls in the overall QOL and all the domains of life: Physical, Psychological, Social and Environmental. HIV positive individuals from Kathmandu valley scored significantly better (P<0.001) scores in the Physical and Environmental domains when compared to HIV positive individuals from Eastern region. HIV positive females had a significantly higher (P<0.02) QOL scores for overall QOL and overall perception of health than the males. CONCLUSION: These findings suggest that HIV positive individuals have a poorer quality of life than the general population in Kathmandu valley and Eastern region of Nepal and interventions could be targeted to improve this aspect of their health.

First case of congenital toxoplasmosis from Nepal.

Reportedly, nearly half of the Nepalese are Toxoplasma seropositive. However, neither the prevalence of congenital toxoplasmosis (CT) nor the confirmed case to CT is reported from Nepal yet. In this case report, we report the first case of CT in a 53 days old full term male baby (weight: 2,600 grams) delivered by caesarean section. The baby had hepatosplenomegaly and optic nerve coloboma with large scar in the right eye. The TORCH panel test showed significantly high Toxoplasma IgM antibody level (5.77 OD Ratio) compared with IgM antibody level against other agents. The baby was diagnosed as a case of CT and treatment was started accordingly. The baby, however, did not improve with the treatment and died after six days. The immediate cause of death was cardiorespiratory failure with antecedent cause of liver failure, renal insufficiency with thrombocytopenia.

Pattern of refractive errors among patients at a tertiary hospital in Kathmandu.

A hospital based cross sectional study was carried out to determine the pattern of refractive errors among patients attending the out patient department, Department of Ophthalmology, Nepal Medical College Teaching Hospital. A total of 1100 patients were evaluated, (male 43.67%; female 56.33%). Simple myopic astigmatism was the most prevalent type of refractive error accounting for 27.18% followed by simple myopia (21.66%) and compound myopic astigmatism (19.48%). Simple hypermetropia (15.03%) and mixed astigmatism (4.3%) were also noted. Simple myopia was prevalent among the younger age group in the first to third decades, whereas hypermetropia was seen in the older patients in the third to fifth decades.

Ocular morbidity among children attending government and private schools of Kathmandu valley.

INTRODUCTION: Children from the developing world are more prone to going blind from avoidable and preventable causes. In Nepal, children in private schools are reported to have a higher ocular morbidity than those in government schools, with myopia being the major cause of the morbidity. This study was designed to evaluate ocular morbidity in students from both types of school. METHOD: This was a cross-sectional, comparative study among students from government and private schools of Kathmandu. Eye examination was carried out evaluating visual acuity, color vision, refractive status, binocular vision status, and anterior and posterior segment findings. RESULTS: A total of 4,228 students from government and private schools were evaluated. The prevalence of ocular morbidity was 19.56 % with refractive error (11.9 %) being the major cause of the morbidity, followed by strabismus and infective disorders. No significant difference in the prevalence of ocular morbidity and refractive status was found in the students from government and private schools. CONCLUSION: A significant number of children of school-going age have ocular morbidity with no significant difference in the prevalence in the students from government and private schools. Research exploring the effect of various risk factors in the progression of myopia would be helpful to investigate the refractive status in children from these different types of schools.

Ocular manifestations in diabetes, a hospital based prospective study.

Diabetes adversely affects the visual status of elderly persons, lowering their quality of life. Since the incidence of diabetes is increasing in urban Nepal, the present study investigated the ocular status in 128 diabetes patients. The ocular complications of diabetes mellitus are numerous including retinopathy, cataract and others. The ocular evaluations were done including visual acuity, refraction and anterior and posterior segment evaluation. Among 128 diabetes, only 26 patients (20.31%) had some degree of retinopathy; with 13.28% having non proliferative diabetic retinopathy and 7.03% with proliferative diabetes retinopathy.

A study of ocular morbidity of patients attending a satellite clinic in Bhaktapur, Nepal.

A community based retrospective study was conducted in the satellite clinic of Nepal Medical College Teaching Hospital at Jhaukhel VDC of Bhaktapur, from March 2007 to February 2008. A total of 395 patients were examined, where males comprised of 135 patients (32.9%) and females 265 patients (67.1%). The common ocular diseases observed in this study were refractive errors 22.5%, age related cataract 17.5%, extra ocular diseases like conjunctivitis 14.9%, conjunctival degenerations 10.8%.

Laparoscopic cholecystectomy complication and conversion rate.

BACKGROUND: Laparoscopic cholecystectomy has become standard method for treating gallstone. However, different centres have reported different complications and conversion rate. The objective of this study was to evaluate complications and conversion of laparoscopic cholecystectomy into open cholecystectomy in Dhulikhel Hospital, Kathmandu University, Nepal. METHODS: Files of all patients who had laparoscopic cholecystectomy from January 2005 to December 2009 were reviewed. Out of 119 laparoscopic cholecystectomy cases, 102 were included in the study as complete information was lacking in the rest. RESULTS: Out of 102 cases, 80 were female. Symptomatic cholelithiasis were 76.47%. The mean hospital stay was 2.48 days. Postoperative complications occurred in 5.88% patients. Conversion rate to open cholecystectomy was 3.92%. CONCLUSIONS: Laparoscopic cholecystectomy is a reliable and safe surgery. With growing experience in laparoscopic technique, it is possible to bring complications and conversion rate to minimum. However, there will be no significant improvements once learning curve is reached. Rather, the nature of biliary injury may become more severe.

Color vision defects in school going children.

INTRODUCTION: Color vision defect can be observed in various diseases of optic nerve and retina and also a significant number of people suffer from the inherited condition of red and green color defect. METHODS: A cross-sectional descriptive study was designed with purposive sampling of students from various schools of Kathmandu Valley. All children were subjected to color vision evaluation using Ishihara Isochromatic color plates along with other examination to rule out any other causes for color deficiency. RESULTS: A total of 2001 students were examined, 1050 male students and 951 females with mean age of 10.35 (+/- 2.75) and 10.54 (+/- 2.72) respectively. Among the total students examined, 2.1% had some form of color vision defects. Of the male population, 3.9% had color vision defects while none of the female was found with the deficiency. CONCLUSIONS: The prevalence of color vision defect in Nepal is significant and comparable with the prevalence quoted in studies from different countries.

Haemorrhoidectomy: Ferguson's (closed) vs Milligan Morgan's technique (open).

This study was done to compare the efficacy of closed Vs open haemorrhoidectomy. The study design was unblinded randomised control trial at Dhulikhel Hospital, Kathmandu University Hospital. Total number of patients was 56 all with 3rd and 4th degree haemorrhoids. Post operative pain was taken as main outcome measures. Operation time varied from 200 seconds for each haemorroidal cushion with open technique to 626 seconds by closed technique. The blood loss was not quantifiable in closed technique. Pain was scored on visual analogue scale. In closed group, the pain score was 4.9 immediate post operative period and 2.3 (24 hours later). In the other group, the scores were 7.8 and 6.9. These differences were significant. At the end of study we came to a conclusion that haemorrhoidectomy using closed technique has more advantages.

Management of urethral strictures and their outcome.

Urethral stricture is a challenging surgical problem since the ancient time. Its outcome is very poor because of the high recurrence rate 40.0-50.0% whatever procedure is conducted to treat the condition. Between January 2004 to December 2007, 61 cases with urethral stricture were treated in our hospital. Management of stricture was decided according to the grading of urethral stricture. Of 61 cases, 42 (68.8%) had grade I-II, 10 (16.4%) had grade III and 9 (14.8%) had grade IV strictures. They were treated with optical internal urethrotomy (OIU), modified railroading and end to end anastomotic urethroplasty respective to gradings. During the average 2 years follow up period, outcome of strictures were analyzed. Recurrence of stricture was noted 31.0% in grade I-II after OIU and 11.0% in grade IV after urethroplasty. However, in cases with grade III stricture recurrence rate was observed in 60.0% after modified railroading. During the follow up period, 50.0% of the grade III strictures were converted to urethroplasty. It is suggested that, OIU is still a gold standard procedure to manage the lower grade (I-II) strictures with low morbidity, minimally invasive and success rate is 69.0%. End to end anastomotic urethroplasty for grade IV stricture has very good result (89.0%) but needs skilful mobilization of distal urethra to prevent chordee. However, grade III stricture needs open urethroplasty or modified railroading by using flexible cystoscopy which may reduce recurrence rate.