A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission.

We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission's conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally.

Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal.

SETTING: Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal. OBJECTIVES: 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures. DESIGN: This was a cohort study using secondary data (December 2017 to April 2018). RESULTS: Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common. CONCLUSION: We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.

LIEU: Hôpital de Dhulikhel, Hôpital Universitaire de Katmandu, Katmandu, Népal. OBJECTIFS: 1) Rapporter l'incidence des infections associées aux soins (HAI), 2) comparer les caractéristiques démographiques et cliniques et les résultats hospitaliers chez les patients atteints et non atteints de HAI ; et 3) vérifier les types bactériens des HAI et des infections communautaires (CAI) parmi les patients hospitalisés avec dispositifs invasifs et/ou ayant subi une intervention chirurgicale. MÉTHODE: Étude de cohorte réalisée en utilisant des données secondaires (décembre 2017 à avril 2018). RÉSULTATS: Sur 1 310 patients hospitalisés, 908 (69,3%) ont subi une intervention chirurgicale, 125 (9,5%) avaient des dispositifs invasifs et 277 (21,1%) avaient à la fois un dispositif invasif et subi une intervention chirurgicale. Au total, 66 ont contracté une HAI (incidence = 5/100 admissions de patients, IC 95% 3,9-6,3). Les patients atteints de HAI avaient un risque 5,5 fois plus élevé de séjour prolongé à l'hôpital (⩾7 jours) et un risque 6,9 fois plus élevé d'être admis en soins intensifs qu'en service de chirurgie. Les résultats défavorables à une sortie d'hôpital étaient plus fréquents chez ceux atteints de HAI (4,5%) que chez ceux non atteints de HAI (0,9%, P = 0,02). Les bactéries les plus fréquemment responsables de HAI (n = 70) étaient Escherichia coli (44,3%), Enterococcus spp. (22,9%) et Klebsiella spp. (11,4%). Sur 98 CAI avec 41 isolats, E. coli (36,6%), Staphylococcus aureus (22,0%) et S. aureus résistant à la méticilline (14,6%) étaient les plus fréquents. CONCLUSION: Nous avons observé une incidence relativement faible de HAI, ce qui reflète de bons standards de contrôle et de prévention des infections. Cette étude sert de référence à de futures actions et stratégies de suivi.

High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal.

SETTING: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated. OBJECTIVE: To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019. DESIGN: This was a cohort study involving secondary programme data. RESULTS: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common. CONCLUSION: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.

CADRE: Neuf centres de traitement de la TB pharmacorésistante, dont certains sont financés par Action Damien au Népal où >80% des patients atteints de TB multirésistante/résistante à la rifampicine (MDR/RR-TB) sont traités. OBJECTIF: Évaluer l'utilisation, l'efficacité et l'innocuité d'un schéma thérapeutique plus court (STR) de 9-12 mois chez les patients atteints de MDR/RR-TB enregistrés de janvier 2018 à décembre 2019. MÉTHODE: Étude de cohorte comprenant des données programmatiques secondaires. RÉSULTATS: Sur 631 patients, 301 (48,0%) ont démarré et poursuivi un STR. Les raisons principales d'inéligibilité à l'instauration/la poursuite d'un STR étaient une résistance initiale ou une exposition aux médicaments de deuxième intention (62,0%), un contact avec des patients atteints de TB ultrarésistante (XDR-TB) ou de pré-XDR-TB (7,0%) et la non-disponibilité des médicaments pour le STR (6,0%). Le taux de réussite thérapeutique était de 79,6%. Les résultats liés à la non-réussite thérapeutique étaient décès (12,0%), perte de vue (5,3%), échec thérapeutique (2,7%) et absence d'évaluation (0,7%). Les résultats liés à la non-réussite thérapeutique étaient significativement associés à l'infection par le VIH et aux patients âgés ⩾55 ans avec un risque relatif ajusté de 2,39 (IC 95% 1,52­3,77) et de 3,86 (IC 95% 2,30­6,46), respectivement. Le taux de récidive post-traitement à 6 et 12 mois était de 0,5% et 2,4%, respectivement. Des évènements indésirables graves (SAE) ont été observés chez 15,3% des patients, le plus souvent hépatotoxicité et ototoxicité. CONCLUSION: Le STR a été associé à une utilisation modérée, à une réussite thérapeutique élevée et à un faible taux de récidive post-traitement. Pour une détection et une prise en charge adéquates des SAE, l'amélioration de la pharmacovigilance peut être envisagée. La disponibilité de tests diagnostiques rapides pour les médicaments de deuxième intention est essentielle à une prise en charge adéquate des patients.

Perception of Students on Online Assessment: A Descriptive Study among Medical Undergraduates at Basic Sciences.

Background Assessment drives learning. Student assessment cannot be neglected in the long ongoing online learning during COVID-19 pandemic to motivate and assess students' learning. Hence Patan Academy of Health Sciences (PAHS) conducted online assessment to medical undergraduates amidst limitations. Objective To measure the perception of online assessment of students which will provide applicable insights for the further improvement. Method This is a single center, cross-sectional and descriptive study. A Google form containing a semi-structured questionnaire was sent to MBBS students of Basic Science at PAHS who attended online classes and online examination. The responses from close ended questions expressed in percentage and Chi-square test was used to find the association. Open ended questions were analyzed using Braun and Clarke's thematic analysis. Result Of 118 students that responded, 75% passed the online examination. A majority of students (73%) stated that online exam motivated them in learning process and it could be a good alternative during pandemic time. However the most of students (56%) were unsatisfied with the modality of online assessment and reasons that they mentioned were technical problems (89%), inadequate online proctoring (77%), insufficient examination time (58%), lack of orientation to exam, lack of computer skills. Technical problem was worse in rural areas. Conclusion Even though online assessment motivated students' learning during online classes, a large number of students were unsatisfied with assessment modality.

Health Care Associated Infection and Trend of Antimicrobial Resistance in Tertiary Care Hospital -A Study in Low Income Setting.

Background Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the most serious public health problems and overall estimate indicates that at any point, over 1.4 million people are suffering from health care associated infection globally. According to the WHO report, the frequency of nosocomial infection is 10% in South East Asia where as 7% in developed countries. The increasing trend of AMR in pathogenic bacteria leads to complication to treat HAIs and failure in treatment and rise in mortality. Objective The study was conducted with the objective of to explore the incidence of different types of HAIs and AMR pattern in the patients admitted in a tertiary care hospital. Method The cross-sectional study was conducted at the tertiary care hospital and the patient who are one year or older and admitted for more than 48 hours were included in this study. The criteria for classification of HAIs were adapted from Centers for Disease Control. All the samples were collected then antibiotic sensitivity testing was conducted according to CLSI standards. Data were collected using a structured data collection form. Data were entered in EpiData software and analyzed using SPSS version 22. Result Among 2326 patients, female was slightly higher than male patients, where 77 (3.3%) patients experienced at least one episode of HAIs. The surgical site infection (71.42%) is the most common infection followed by Catheter Associated Urinary Tract Infection (18.18%) and Health Care Associated Pneumonia (6.49%). Mean hospitalization days is higher with HAI (14.5 days) compared to non-HAI (6.6 days). Out of 909 specimens, urine, sputum and blood were higher in numbers, where 217 bacterial isolates were isolated with Escherichia coli (83 isolates) was the most common bacteria. It is found that Escherichia coli bacterial isolates were resistance to most common antibiotics. Conclusion The study concludes that surgical site infection is the most common healthcareassociated infection and Escherichia coli is the most common bacteria responsible for HAIs. Further, surgical site infection being the most common infection, there is an urgent need to take effective infection prevention and control prevention.

Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration.

Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.

Incidence and Associated Risk Factors of Postoperative Sore Throat in Tertiary Care Hospital.

Background Postoperative sore throat is a relatively minor complaint but a frequent postoperative complication of anesthesia. The incidence of postoperative sore throat varies from 0-50% in most research studies, but some report the incidence is as high as 51-100% following general anesthesia. Objective The aim of this study was to obtain the incidence and determine the associated risk factors of postoperative sore throat in tertiary care hospital. Method Three hundred and seventy six patients who underwent various surgeries under general anesthesia in Dhulikhel Hospital during a four month period were included. Using a predesigned questionnaire with follow up after 24-30 hours after extubation, data was collected. Sore throat was identified using a four point scale (0-3). Result Overall incidence of postoperative sore throat was 50.8%. Patient with airway device endotracheal tubes had the highest incidence (52.2%, 176 of 337), and patient with i-gel had a lower incidence of sore throat (33.3%, 7 of 21). Female patients reported more sore throat than male, more common with older age group and duration of anesthesia more than two hours. Increased incidence of postoperative sore throat was not associated with the type of surgery, number of intubation attempts, category of personnel performing airway managementr and use of oropharyngeal airway. Conclusion Postoperative sore throat is a common complication of airway instrumentation in general anesthesia that can lead to discomfort. The overall incidence of postoperative sore throat in this study was 50.8%. Endotracheal tube, female patients and increased duration of anesthesia were associated with increased postoperative sore throat rates.

Evaluation of OMNIgene®â€¢SPUTUM-stabilised sputum for long-term transport and Xpert® MTB/RIF testing in Nepal.

SETTING: German Nepal TB Project, National Tuberculosis Reference Laboratory, Kathmandu, Nepal. OBJECTIVE: To evaluate whether transporting samples in OMNIgene®â€¢SPUTUM (OM-S) reagent from a peripheral collection site to a central laboratory in Nepal can improve tuberculosis (TB) detection and increase the sensitivity of Xpert® MTB/RIF testing. DESIGN: One hundred sputum samples were split manually. Each portion was assigned to the OM-S group (OM-S added at collection, airline-couriered without cold chain, no other processing required) or the standard-of-care (SOC) group (samples airline-couriered on ice, sodium hydroxide + N-acetyl-L-cysteine processing required at the laboratory). Smear microscopy and Xpert testing were performed. RESULTS: Transport time was 2-13 days. Overall smear results were comparable (respectively 58% and 56% smear-negative results in the OM-S and SOC groups). The rate of smear-positive, Mycobacterium tuberculosis-positive (MTB+) sample detection was identical for both treatment groups, at 95%. More smear-negative MTB+ samples were detected in the OM-S group (17% vs. 13%, P = 0.0655). CONCLUSION: Sputum samples treated with OM-S can undergo multiday ambient-temperature transport and yield comparable smear and Xpert results to those of SOC samples. Further investigation with larger sample sizes is required to assess whether treating sputum samples with OM-S could increase the sensitivity of Xpert testing in smear-negative samples.

Screening retreatment tuberculosis patients for drug resistance in mid-west Nepal: how well are we doing?

SETTING: Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to isoniazid and rifampicin) is poorly detected in Nepal; one reason may be poor functioning of culture and drug susceptibility testing (CDST) services for retreatment tuberculosis (TB) patients. OBJECTIVES: To determine, among retreatment TB patients in mid-west Nepal, 1) the number of patients registered for treatment between July 2011 and July 2012; 2) the number submitting sputum specimens for CDST to the Central Reference Laboratory (CRL), Kathmandu, along with the results; and 3) the length of time for submission and receipt of specimens. DESIGN: Retrospective cohort study involving the review of treatment and laboratory registers from the Nepalgunj TB Referral Centre and the CRL. RESULTS: Of 431 retreatment patients, 66 (15%) submitted sputum samples, of which 63 reached the CRL. Of these, 39 (62%) were culture-positive; 13 (33%) patients had MDR-TB. The CDST results of 19 patients were received back at the TB Referral Centre. The median turnaround time from sending specimens to receipt of results at the TB Referral Centre was 119 days. CONCLUSION: Less than 10% of retreatment TB patients in mid-West Nepal had CDST results recorded, leading to the underdiagnosis of MDR-TB in the region. Urgent solutions are needed to rectify this problem.

Contexte : La tuberculose multi-résistante (TB-MDR, définie comme une résistance à l'isoniazide et à la rifampicine) est mal détectée au Népal; une des raisons pourrait être le mauvais fonctionnement des services de culture et de tests de sensibilité aux médicaments (CDST) pour les tuberculeux en retraitement.Objectifs : Déterminer parmi les patients tuberculeux du Centre Ouest du Népal 1) le nombre de patients enregistrés pour un traitement de juillet 2011 à juillet 2012; 2) le nombre de patients ayant eu un examen de crachats pour CSDT au laboratoire central de référence (CRL) à Katmandou ainsi que les résultats; et 3) le délai de fourniture et de réception des échantillons.Schéma : Etude rétrospective de cohorte par revue des registres de traitement et de laboratoire du centre de référence de la TB Nepalgunj et du CRL.Résultats : Sur 431 patients en retraitement, 66 ont fourni des échantillons de crachats dont 63 (15% du total) sont parvenus au CRL. Parmi eux, 39 (62%) étaient positifs; 13 patients (33%) avaient une TB-MDR. Les résultats du CDST sont parvenus au centre de référence de la TB pour 19 patients. Le délai médian entre l'envoi des échantillons et la réception des résultats au centre de référence de la TB était de 119 jours.Conclusion : Dans le Centre Ouest du Népal, moins de 10% des patients ont eu des résultats d'examens de CSDT, ce qui induisait un sous-diagnostic de la TB-MDR dans cette région. Il est urgent de trouver des solutions à ce problème.

Marco de referencia: La detección de la tuberculosis multidrogorresistente (TB-MDR), que se define como la presencia de resistencia a isoniazida y rifampicina, es precaria en Nepal. Una de las causas podría ser una deficiencia en el funcionamiento de los servicios de cultivo y pruebas de sensibilidad a los medicamentos (CDST), en el caso del retratamiento de los pacientes tuberculosos.Objetivos: Determinar los siguientes aspectos de los pacientes registrados en retratamiento en el occidente medio de Nepal: 1) el número de pacientes registrados en tratamiento entre julio del 2011 y julio del 2012; 2) el número de pacientes cuyas muestras de esputo se remitieron al Laboratorio Central de Referencia (CRL) en Katmandú para CDST y los resultados obtenidos; y 3) el tiempo transcurrido entre la obtención de la muestra y la recepción de los resultados.Métodos: Fue este un estudio retrospectivo de cohortes en el cual se examinaron los registros de tratamiento y de laboratorio del Centro de Referencia de Tuberculosis de Nepalgunj y del CRL.Resultados: De los 431 pacientes en retratamiento, en 66 se recogieron muestras de esputo y de estas muestras, 63 llegaron al CRL (15%). De esos, 39 obtuvieron un cultivo positivo (62%) y 13 pacientes exhibieron TB-MDR (33%). En el Centro de Referencia de TB, se recibieron los resultados del cultivo y las pruebas de sensibilidad de 19 pacientes. La mediana del tiempo necesario a la obtención del resultado desde el envío de las muestras fue 119 días.Conclusión: En menos del 10% de los pacientes en retratamiento se practicaron el CDST a los medicamentos antituberculosos en el occidente medio de Nepal, lo cual origina una deficiencia en el diagnóstico de la TB-MDR en la región. Se precisan con urgencia intervenciones que solucionen esta carencia.

Association of hypertension with microalbuminuria and lipid profile in the local population of Patan.

There is increasing prevalence of hypertension worldwide. Hypertension is an important risk factor for cardiovascular disease and renal disease which are the leading cause of death in the world. It is, therefore, very important to prevent progression of hypertension into these fatal diseases through appropriate treatment and monitoring. Microalbuminuria and dyslipidemia has been regarded as a predictor for cardiovascular and renal dysfunction in hypertension. In this study, we have included 130 hypertensive and 100 normotensive individuals of age > or = 25 years. Patients with a history of urinary tract infection, hematuria, renal failure, women with menstruation at the time of sample collection were excluded from this study. Measurements of anthropometric parameters; blood parameters like lipid profile, fasting blood sugar (FBS), creatinine after 8 hrs fasting and urine parameters like microalbumin and creatinine were done. The prevalence of microalbuminuria and macroalbuminuria is 17.7% and 3.1% respectively in hypertensive patients. Also, there was 9% prevalence of microalbuminuria in normotensive people. There was a significant association of hypertension with microalbuminuria and dyslipidemia, triglyceride, low density lipoprotein, high density lipoprotein, microalbumin creatinine ratio (MCR), body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) were significantly higher in hypertensive than in normotensive persons. These higher lipid levels, WC and MCR in hypertensive patient are established risk factors for progressing into diabetes and cardiovascular diseases. Hence, monitoring of these parameters would be beneficial for hypertensive patients in preventing the disease progression in this population.

Study of rifampicin and isoniazid resistance mutation genes of M. tuberculosis isolates in Nepal.

We studied the rifampicin (RIF) and isoniazid (INH) resistant genes in Mycobacterium tuberculosis isolated from sputum samples of re-treated TB cases using phenotypic drug susceptibility test (DST) and rapid molecular method (Genotype; MTBDR plus, Hains Life Science, Nehren, Germany). Of the total 207 isolates included in this study, 90 (42.0%) were RIF resistant, 107 (50.7%) were INH resistant whereas 86 (41.5%) were multidrug resistant (MDR) by DST. According to genotypic analysis, 37.0% (77/207) were RIF resistant, 50.2% (105/207) INH resistant and 70 (33.8%) were MDR. Among the total 90 RIF resistant isolates, 85.5% (77/90) showed mutation in 81 bp of rpoB gene and the mutation locus were distributed as follows; MUT1 Asp516Val (16.7%; 15/90), MUT2A His526Tyr (6.6%; 6/90), MUT2B His526Asp (5.5%; 5/90) and MUT3 Ser531Lue (56.7%; 51/90). Among the total 107 INH resistant isolates, the mutation located in katG gene was 98.1% (105/107) and in inhA MUT1 gene was (16.8%; 18/107). The mutation locus were distributed as follows; MUT1 Ser315Thr (77.6%; 83/107), MUT2 Ser315Ile (3.7%; 4/107) in katG and in inhA MUT1Cys15Thr (16.8%; 18/107). The highest frequency of mutations in rpoB gene was found at the region of codon Ser531Leu (56.7%) while the frequency of mutation in katG and inhA gene were found at the region of codon Ser315Thr (77.6%) and Cyst15Thr (17.1%), respectively. The rapid molecular test kit used in this study was found to be sensitive as well as specific for detection of RIF and INH resistant gene and also helpful in early detection of MDR-TB.

Risk of relapse and failure after retreatment with the Category II regimen in Nepal.

SETTING: Kathmandu Valley urban area, Nepal. OBJECTIVE: To study the probabilities of failure and relapse and of amplifying drug resistance to isoniazid (INH) and rifampicin (RMP) after the Category II retreatment regimen. DESIGN: Cohort study of smear-positive tuberculosis (TB) retreatment cases. RESULTS: Of 250 cases started on Category II retreatment, 209 were relapse cases; of these, 18 were INH-resistant RMP-susceptible, 18 were INH+RMP-resistant and nine were culture-negative. Of 19 return after interruption cases, two were INH-resistant RMP-susceptible and one was INH+RMP-resistant. Among 22 failures, no case was INH-resistant RMP-susceptible, six were INH+RMP-resistant and 14 were culture-negative. No INH-susceptible RMP-resistant cases were observed. Among 182 INH+RMP-susceptible cases, one failed and four relapsed during follow-up. Two of the five cases became INH+RMP-resistant and the remaining three remained susceptible. Among 20 INH-resistant RMP-susceptible cases, two failed and none relapsed. One of the two became INH+RMP-resistant and the other case remained INH-resistant RMP-susceptible. DISCUSSION: The proportion of resistance among retreatment cases in Kathmandu Valley was not high. The risk of relapse with amplification of RMP resistance among INH-resistant RMP-susceptible cases on the Category II retreatment regimen was 5% (1/20), and that among INH+RMP-susceptible cases was 1% (2/182).

Variation of total serum cholesterol among the patient with thyroid dysfunction.

BACKGROUND: Thyroid hormone has its effect in the lipid metabolism. Thus, thyroid disorder is usually associated with the dyslipidaemia. Hypercholesterolemia is an established risk factor for the cardiovascular disease (CVD) and therefore in case of overt hypothyroidism which is associated with hypercholesterolemia, CVD is most likely to occur. OBJECTIVES: controversies still persist about the hypercholesterolemia and sub clinical hypothyroidism. Hence, we conducted our study to elucidate the relation of thyroid hormone with cholesterol in different thyroid disorder. MATERIAL AND METHOD: All patients suspected of thyroid disorder within a period of one year were included in the study and free thyroxine-3 (fT3), free thyroxine-4 fT4, Thyroid Stimulating Hormone (TSH) and total cholesterol (TC) in the serum were estimated. Statistical analysis was carried out by using SPSS. 13. RESULTS: Among the 169 cases, 32.5% of the patients were having thyroid disorder. In which 8.3% were of hypothyroid, 7.1% were of sub clinical hypothyroid, 8.3% were of hyperthyroid, 7.7% were of sub clinical hyperthyroid and 1.2% cases were of pan hypothyroid. We observed significant negative correlation between TC & fT3(r = -0.226, p = 0.003), significant negative correlation between total cholesterol & fT4(r = -0.197, p = 0.010) and significant positive correlation between TC & TSH(r = 0.365, p = 0.000). Total cholesterol was significantly raised in hypothyroidism (Mean ±SD 283 ± 53, p = 0.000) in comparison to euthyroid population (mean ±SD, 195 ± 58). But cholesterol was not significantly increased in sub clinical hypothyroidism (mean ±SD, 240 ± 46) CONCLUSION: Our results show that total cholesterol level in serum is affected by the blood thyroid hormone level. Therefore, screening for hypercholesterolemia could be useful in patients with hypothyroidism to reduce associated disease.

Microalbuminuria and macroalbuminuria in type 2 diabetes.

BACKGROUND: Type 2 diabetes is the leading cause of end stage renal disease worldwide. Prevalence of diabetic nephropathy (DN) varies in the different ethnic groups. Nepal is country with great ethnic diversity. This study has been done to find the prevalence of microalbuminuria and macroalbuminuria in the two ethnic groups Jyapu and Brahmin. METHODS: In our study we have included two ethnic groups Jyapu and Brahmin type 2 diabetic patients. INCLUSION CRITERIA: Age ≥ 30 years, clinically diagnosed type 2 diabetic patients. EXCLUSION CRITERIA: Patients with a history of urinary tract infection, hematuria, renal failure, intercaste marriage and women with menstruation at the time of sample collection. RESULTS: The overall prevalence of albuminuria was 49.05%. The prevalence of microalbuminuria was 35.89% in Jyapu and 37.73% in Brahmin which was comparable. There was significantly higher prevalence of macroalbuminuria in Jyapu 20.75% and Brahmin 3.77%. Association of dietary habit was seen with microalbuminuria and macroalbuminuria in both ethnic groups. CONCLUSIONS: The overall prevalence of albuminuria in type 2 diabetes of our study was high and there was significantly higher macroalbuminuria in Jyapu compared with Brahmin. It, therefore, predicts a higher risk of having kidney disease in Jyapu population.

Oxidative stress, antioxidant status and lipid profile in ischemic heart disease patients from western region of Nepal.

Disturbed lipid profile is one of the most important and potent risk factors in ischemic heart disease (IHD). In recent years, it has been demonstrated that raised oxidative stress promotes several undesirable pathways including the formation of oxidised LDL (O-LDL) and oxidized cholesterol which encourages cholesterol accumulation in arterial tissues. We, therefore, aimed to ascertain the redox balance by measuring oxidative stress (OS) and total antioxidant activity (TAA) along with lipid profile to determine their possible association with IHD. Our study group comprised of 28 confirmed cases of IHD. The inclusion criterion was history of chest pain, ischemic changes in the ECG and good left ventricular (LV) function. Patients with diabetes mellitus, poor LV function, previous infarct and valvular heart disease were excluded. Lipid profile, plasma thiobarbituric acid reactive substances (TBARS), plasma total antioxidant activity (TAA) and urinary TBARS were estimated in these patients by standard procedures and the values were compared with 30 age, sex and socioeconomically matched normal healthy control subjects. Body mass index (BMI) and waist/hip ratio (W/H ratio) was also noted in both the groups. Lipid profile and OS (TBARS levels) were significantly raised in IHD patients. Though statistically not significant but TAA tended to be lower and urinary TBARS levels tended to be higher in patients. BMI, W/H ratio, smoking and alcohol did not show discernible association with lipid profile, OS or TAA. OS is significantly raised in majority of IHD patients. The non association of BMI, W/H ratio, smoking and alcohol with lipid profile, OS and TAA suggest that there are other risk factors which primarily contribute to the initiation and progression of IHD.

A study of oxidative stress, antioxidant status and lipid profile in diabetic patient in the western region of Nepal.

AIMS AND OBJECTIVES: Diabetes mellitus (DM) is often termed as a disease of premature aging. Several studies have indicated lopsided redox balance due to pro oxidant environment as one of the important etiological factors. Some recent researches also indicate a causal relationship with oxidative stress (OS). So far, no study has been undertaken on this aspect in Nepali populations. We, therefore, aimed this maiden study in Nepali population to examine redox balance by measuring OS and antioxidant status along with lipid profile in 37 patients of DM type- 2 and 30 matched normal subjects. METHODOLOGY: Thirty seven patients of DM type-2 without any complications (mean age= 57.6+/- 10.6 years) and 30 normal subjects (mean age= 55.8 +/- 14.8 years) were included in this study. Body Mass Index (BMI) and Waist/Hip (W/H) ratio were measured. Fasting blood sample was collected for the analysis of total antioxidant activity (TAA), plasma and urinary thiobarbituric acid reactive substances (TBARS) and lipid profile by standard procedures in both the groups. The statistical analysis was done with SPSS 10 version. RESULTS: Total cholesterol, triglyceride, VLDL-cholesterol, LDL-cholesterol, plasma and urinary TBARS were significantly raised whereas, plasma TAA was significantly reduced in DM type-2 patients as compared to controls. The comparison of old and fresh cases revealed that though TAA was lower and PTBARS and UTBARS were higher in patients but did not attain the level of significance. W/H ratio is significantly higher in patients compared to normal subjects. But, no significant correlation of BMI and W/H with lipid profile is observed in both control and patients. CONCLUSION: Oxidative stress is raised in type 2 DM patients. This along with deranged lipid profile and decreased antioxidant status could be the risk factors in the development of complications associated with DM.

Cigarette smoke induced oxidative insult in local population of Pokhara.

OBJECTIVES: To assess the effect of cigarette smoking on lipid peroxidation induced oxidative stress, antioxidants, uric acid and blood sugar in normal subjects. METHODS: The study included 61 normal subjects with regular smoking habit and 57 never-smokers normal subjects matched in respect to socio-economic status, age and BMI. Information regarding smoking habit and other personal details were collected by oral questionnaire. Total antioxidant activity (TAA), reduced glutathione (GSH), alpha-tocopherol (alpha-T), ascorbic acid (AA), uric acid (UA), plasma and urinary thiobarbituric acid reactive substances (TBARS), fasting blood sugar (FBS) and urinary creatinine (Cr) were estimated by standard procedures in both the groups. Ferric Reducing Antioxidant Power (FRAP) procedure is used to estimate TAA which measures total dietary antioxidants. Statistical analysis was done with SPSS version 10. RESULTS: The mean pack years smoked by smokers was 14.4 +/- 15.8. The plasma TBARS level in smokers and never-smokers was 2.6 +/- 0.8 and 2.5 +/- 0.6 micromol/L respectively. The respective figure for urinary TBARS level was 4.6 +/- 2.7 and 3.7 +/- 1.4 micromol/gmCr. Smokers did not show any significant difference from never-smokers with respect to GSH, alpha-T, AA, plasma TBARS and FBS. However, the smokers had significantly lower levels of TAA (p<0.05) and raised level of urinary TBARS (p<0.05) and uric acid (p<0.01) as compared to never-smokers. CONCLUSION: Our study suggests that smoking induces mild lipid peroxidation but the body is able to compensate for it by removing its adducts. Importantly it also indicates enhanced oxidation of purines which are essential components of both DNA and RNA. Dietary antioxidants are consumed to scavenge free radicals (FR) and other reactive species (RS) in smoke. Female smokers are more prone to oxidative insult than male smokers. In summary RS present in smoke induce mild lipid peroxidation but are not the major contributors of redox imbalance in smoke induced toxicity in the selected subjects.