Prevalence of Refractive Error and Spectacle Compliance in Children of Tokha Municipality.

Background Refractive error is considered as an important component of the priority disease "childhood blindness" within the Vision 2020' initiative to eliminate avoidable blindness. The large majority of vision impairment in school aged children is due to uncorrected refractive error. Hence, refractive errors are considered as a public health challenge. The aim of this study was to estimate the prevalence of refractive error and spectacle compliance among children in Tokha municipality, Kathmandu. Objective The aim of this study was to estimate the prevalence of refractive error and spectacle compliance among children from Tokha municipality, Kathmandu. Method A descriptive, cross-sectional study was conducted by enrolling 1366 children from Tokha municipality from 1st to 3rd week of April 2022 after obtaining the Institutional Review Board (Reference number:60/2079/80). Assent was taken from all children and informed consent was signed by the legal guardians of the children. All the samples underwent a comprehensive ocular history taking, visual acuity and refraction and ocular health assessments. The inclusion criteria was school going children within age group 5-16 years. Result Out of a total of 1366 samples, 10.91% (149) of the school children were identified to have refractive error. The primary type of refractive error observed was compound myopic astigmatism, which accounted for 52.3% (78) of the cases. A spectacle compliance rate of 72.15% was found. Conclusion Refractive error prevalence in this study is consistent with findings from other part of Nepal. The most common type of refractive error was compound myopic astigmatism. The frequency of refractive errors was notably higher among individuals who frequently use electronic devices, attend private schools, and reside in densely populated areas. It is recommended to organize regular community eye camps and conduct vision screenings to identify and promptly address refractive errors in children.

Handwashing Practices in Neonatal Intensive Care Unit, Paediatric Intensive Care Unit and Neonatal Nurseries in Patan Hospital.

BACKGROUND: Hand hygiene has been identified as the single most important factor in minimising hospital acquired infections. However, compliance of handwashing guidelines has remained low. The aim of this study was to study the handwashing practices in the Paediatric and Neonatal intensive care units and Neonatal nurseries in Patan Hospital, and secondly to re-evaluate the improvement on compliance of handwashing guidelines after intervention. METHODS: Pre-intervention study was conducted by covertly observing the handwashing practices by the healthcare workers. The healthcare workers were then shown the video demonstrating correct methods of handwashing as recommended by World health organization. The cycle was completed by discretely re-observing the handwashing practices following intervention. RESULTS: Sixty five samples were collected initially. Only 6 (9.2%) had completed all steps of handwashing correctly. Post- intervention, 51 samples were collected, out of which 35 (68.6%) had correctly completed all the steps. Following audio-visual demonstration, 100% correctly completed 8/10 steps of handwashing with soap and water. 8 (16%) failed to dry hands using a single use towel and 14 (28%) failed to turn off the tap using elbow. Post- intervention, 100% correctly completed 4/7 steps of handwashing using chlorhexidine. Four (15%) still failed to rub backs of fingers to opposite palm, eight (30%) failed to palm to palm with fingers interlaced, and rub thumb to opposite palm. CONCLUSIONS: Compliance in hand hygiene is low despite the known fact that it reduces nosocomial infections. However, a simple intervention like video demonstration can improve the compliance among healthcare workers.

Surgical Results of Non-small Cell Lung Cancer in Nepal.

INTRODUCTION: Surgery remains the only curative modality for early stage of Non small cell lung caner (NSCLC). We reviewed overall scenario of lung cancer and surgical results in Nepal. METHODS: 1000 patients with the pathological diagnosis of lung cancer were analyzed to summarize the overall scenario of lung cancer. 157 NSCLC patients underwent pulmonary resection. cIA, IB, IIA, IIB, IIIA (N1) underwent surgery as initial modality of treatment. cIIIA (N2) patients were taken for surgery after neoadjuvant chemo/ chemoradiation. RESULTS: Analysis of 1000 patients showed squamous cell carcinoma in 41.3%, incurable stage (IIIB/ IV) in 66.8% and rate of curative resection in 6.7% cases. Surgery as a single modality of treatment was used in 38%. Neoadjuvant Chemo/ chemoradiation/ radiation followed by surgery and surgery followed by chemo/ chemoradiation/ radiation was done in 12% and 50%, respectively. In-hospital mortality was 2% (post pneumonectomy: 5.5%; post lobectomy: 1.5%; post sublobar resection: 0%). R0 resction was achieved in 91% cases. Median survival and 5-year overall survival were 36 months and 18%, respectively. Better survival was achieved in pI-II vs pIII/ IV, pN0-1 vs pN2 and pR0 vs pR+ (p <0.05). CONCLUSIONS: Earlier stage (pI-II), R0 resection and pathological pNo-1 has the best five year overall survival in Nepalese patients with NSCLC as well.

Prevalence of metabolic syndrome in chronic kidney disease: a hospital based cross-sectional study.

BACKGROUND: The components of metabolic syndrome (MetS) are the established risk factors of chronic kidney disease (CKD). Therefore, MetS and interplay of its various components, have deleterious effects on patients with chronic kidney disease. The aims of our study was to find out the prevalence of MetS in chronic kidney disease patients and to find out the association of each component of MetS with chronic kidney disease. METHODS: A Hospital based cross-sectional study was carried out from February 2008 to August 2009. One hundred and sixty confirmed chronic kidney disease diagnosed patients were included in this study. Chronic kidney disease was defined from national kidney foundation guidelines. Anthropometric measurements of subjects were noted in a semi-structured pro-forma. Fasting blood sample was collected for the estimation of fasting blood glucose, triglyceride and HDL-cholesterol. Chronic kidney disease patients were diagnosed as having the metabolic syndrome by using the modified National Cholesterol Education Program Adult Treatment Program III criteria. Data were assessed by the t-test and Chi Square Test. RESULTS: Sixty (37.5%) of the chronic kidney disease patients had MetS according to modified National Cholesterol Education Program Adult Treatment Program III criteria. The prevalence of hypertension, high fasting blood glucose, high triglyceride, low HDL Cholesterol and high waist circumference in chronic kidney disease patients was 112 (70.0%), 36 (22.5%), 74(46.25%), 98 (61.25%) and 30 (18.75%) respectively. Among the five components of the metabolic syndrome, waist circumference has the highest positive predictive value (73.34%) for chronic kidney disease. CONCLUSIONS: MetS occurs in more than one-third of chronic kidney disease patients. The prevalence of individual components of MetS is higher in chronic kidney disease patients.

Dyslipidaemia in chronic kidney disease in Nepalese population.

Patients having chronic kidney disease (CKD) are at higher risk for cardiovascular disease (CVD). Dyslipidaemia is a potential risk factor for CVD in CKD cases. In this study our aim was to find out the dyslipidaemia in patients with different stages of CKD. This hospital based cross-sectional study was conducted in department of biochemistry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Total of 163 CKD cases and 163 non-CKD healthy controls were enrolled. CKD was defined and classified as per national kidney foundation guidelines. We analyzed fasting lipid profile including total cholesterol, HDL-C, LDL-C and TG. Significant difference in mean value of serum total cholesterol, HDL-C, LDL-C and TG were found in different stage of CKD and non-CKD groups (p value <0.05). CKD cases 33.75% and 21.47% of non-CKD controls had hypercholesterolemia (Odds ratio 1.86, p value 0.013). CKD cases 32.5% and 17.18% of non-CKD controls had low HDL-C (Odds ratio 2.32, P-value 0.001). CKD cases 38.03% and 33.13% of non-CKD controls had high LDL-C (Odds ratio 1.24, p value 0.297). CKD cases 35.58% and 19.01% of non-CKD controls had hypertriglyceridemia (Odds ratio 2.35, P-value 0.001). CKD had a higher prevalence of dyslipidaemia compared to non-CKD controls. Dyslipidaemia was also found in early stages of CKD.

Spectrum of thyroid dysfunction in patients visiting Kantipur Hospital, Kathmandu, Nepal.

Thyroid disorder is most common endocrine abnormality in the general population and its prevalence increases with age. The screening of thyroid disorder is advised in high risk population. This hospital based cross-sectional study was conducted in Department of Biochemistry, Kantipur Hospital, Kathmandu, Nepal. Patients having complains of thyroid disease from February 2010 to January 2011 were enrolled in this study. Thyroid parameters such as FT3, FT4 and TSH were measured by ELISA technique. Among total 472 subjects 393(83.27%) were female whereas 79(16.73%) were male. The prevalence of thyroid dysfunction was 36.0% (n=170). The different patterns of thyroid dysfunction in Kathmandu valley were: hypothyroid (11.6%), subclinical hypothyroid (16.9%), hyperthyroid (4.0%), and subclinical hyperthyroid (3.6%) respectively. Subjects having all thyroid parameters normal i.e. euthyroid were 63.9%. In conclusion, this study reveals a higher prevalence of thyroid dysfunction in Kathmandu region. This study recommends community based nationwide epidemiological studies on a regular basis to monitor thyroid dysfunction in Nepalese populations.

Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis.

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis.

Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient.

Parvo B19 is a single stranded DNA virus, which typically has affinity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the first such case report from Nepal.

Assessment of chronic kidney disease in Nepalese people with hypertension.

Hypertension is one of the leading causes to develop chronic kidney disease (CKD) and could be a risk factor for progression of CKD to end stage renal disease (ESRD).Uncontrolled hypertension worsens CKD. Hypertension control may contribute to prevent CKD in early stages and retards the progression of CKD stages to ESRD. Prevalence of CKD in people with diagnosed and chronic hypertension is known to be high, but little is known about the prevalence of CKD in those with newly diagnosed Hypertension. Present work was undertaken to see the prevalence of CKD among people with newly diagnosed hypertension. In this cross-sectional study, we accessed the CKD in newly diagnosed hypertensive patients and determined the association between hypertension and CKD. CKD was defined as either kidney dysfunction or kidney damage or both as per National Kidney Foundation Guidelines. 106 of newly diagnosed patients and 106 of normotensive controls were recruited in the study. 51.9% of newly diagnosed hypertensive patients and 23.6% of normotensive controls had CKD which was statistically significant (p-value <0.001). Difference in the mean value in eGFR and spot urine ACR (mg/mmol) between hypertensive patients and normotensive controls was statistically significant (p-Value <0.001). Both systolic BP and diastolic BP negative significantly correlated with eGFR (p-Value < 0.001 and 0.024 respectively) and positive significantly correlated with ACR (p-Value 0.003 and 0.003 respectively). The prevalence of CKD is high among people with newly diagnosed hypertension. Those, people might benefit from interventions aimed at preventing development and/or progression of both CKD and hypertension.

katG (SER 315 THR) gene mutation in isoniazid resistant Mycobacterium tuberculosis.

UNLABELLED: BACKGROUND Isoniazid (INH) together with Rifampicin (RFP) forms the cornerstone of a short chemotherapy course for tuberculosis (TB) treatment. Mutation at codon 315 of katG gene is most prevalent in isoniazid resistant Mycobacterium tuberculosis (MTB) and is high in area with high TB incidence. Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) has been found to be a reliable and effective tool for the identification of the specific gene alteration. OBJECTIVE: The objective of this study was to screen Ser315Thr mutation of KatG gene of INH resistant MTB strain by PCR-RFLP technique. METHODS: Altogether 37 INHr MTB isolates obtained from German Nepal Tuberculosis Project (GENETUP) Kathmandu Nepal was included in the study. Deoxyribonucleic Acid (DNA) extraction was performed according to protocol of SORPOCLEAN from the culture isolates. Amplification of the fragment with katG codon 315 was performed in a Biometra Thermocycler using primers. The amplified fragment was cleaved with MspI. The restriction fragments obtained were electrophoresed in a 2% agarose gel and were visualized using transilluminator. RESULTS: The katG Ser315Thr mutation was observed in 23 (62.2%) out of 37 INH resistant isolates. The drug susceptibility profile of INHr MTB isolates showed all isolates to be resistant to INH and RFP whereas 26 and 27 MTB isolates were resistant to Ethambutol (EMB) and Streptomycin (S) respectively. Seventeen (17) patients were harbouring katG gene mutated strain among Ethambutol and Streptomycin resistant cases. CONCLUSION: The study identified high prevalence of Ser315Thr mutation in katG. The isolates harbouring this mutation were also simultaneously resistant to RFP. Ser315Th could be a potential genetic marker for predicting MDR-TB.

In-vitro assessment of cell-mediated immunity by demonstrating effector-t cells for diagnosis of tuberculosis in Nepalese subjects.

The immune response against mycobacterium tuberculosis (MTB) is cell mediated. T-cells become sensitized when they encounter MTB antigens and subsequently activated effector T-cells produce a number of cytokines including interferon- gamma (INF-gamma) to fight the infecting organisms. Demonstration of either production of INF-gamma or presence of effector T-cells sensitized to MTB specific antigens in vitro can be diagnostic for TB infection. Aim of this study was to determine the efficacy of commercially available T-SPOT.TB kit which is used for the in vitro diagnosis of TB infection and to determine if this test has any cross reactivity in leprosy patients. Blood sample was taken from 30 sputum AFB positive, 30 sputum AFB negative healthy controls and 10 cases of paucibacillary leprosy patients. The blood samples were processed to separate peripheral blood mononuclear cells. The final cell suspensions were cultured along with MTB specific antigens namely- Early Secretory Antigenic Target (ESAT-6) and Culture Filtrate Protein (CFP 10) along with negative and positive controls. The production of INF-gamma was demonstrated by enzyme linked immunospot (ELISPOT) assay technique. All AFB positive samples produced INF-gamma after exposure to MTB specific antigens. 4 (16.6%) of healthy controls were also found reactive for INF-gamma. The sensitivity and "specificity" for active disease of the ELISPOT (T-SPOT.TB) in respect to AFB microscopy was 100% and 85.7% respectively. Assessment of CMI against tuberculosis, by demonstrating effector T-cell sensitized to MTB antigens can be use to aid the diagnosis of tuberculosis. T-SPOT.TB has no cross reactivity with leprosy patients.

Use of protein: creatinine ratio in a random spot urine sample for predicting significant proteinuria in diabetes mellitus.

Present study was undertaken during a period of 6 months (September 2008-February 2009) to see an correlation of 24 hours urine protein estimation with random spot protein-creatinine (P:C) ratio among a diabetic patients. The study comprised of 144 patients aged 30-70 years, recruited from Kantipur hospital, Kathmandu. The 24-hr urine sample was collected, followed by spot random urine sample. Both samples were analyzed for protein and creatinine excretion. An informed consent was taken from all participants. Sixteen inadequately collected urine samples as defined by (predicted creatinine--measured creatinine)/predicted creatinine > 0.2 were excluded from analysis. The Spearman's rank correlation between the spot urine P:C ratio and 24-hr total protein were performed by the Statistical Package for Social Service. At the P:C ratio cutoff of 0.15 and reference method (24-hr urine protein) cutoff of 150 mg/day, the correlation coefficient was found to be 0.892 (p < 0.001). The area under ROC curve at different cutoffs was 0.88 at 95.0% CI. The sensitivity and specificity of the P:C ratio to detect significant proteinuria at the cutoff of 0.15 are 96.6% and 74.4%. So the P:C ratio can predict significant proteinuria in diabetic subjects, avoiding the inconvenient 24-hr urine collection but the cutoff should be carefully selected for different patients group under different laboratory procedures and settings.

Scenario of HIV/AIDS patients in a government hospital of Nepal.

BACKGROUND: With the increase in the severity of immunosupression, due to HIV infection, there is increase in the flow of patients seeking care and support services. Antiretroviral drugs minimize chance of developing AIDS related opportunistic infection and therefore there would be the prolongation of life of the patients. The objectives of this study are to assess the chief complaints, major opportunistic infections, complications of ART and treatment outcome of hospital admitted HIV patients. METHODS: A cross sectional study was carried out between December 2008 to May 2009 among 66 HIV patients undergoing indoor treatment in Seti Zonal Hospital, Dhangadhi. RESULTS: Of the total cases, 36 (54.5%) were male and 30 (45.5%) were females with predominant age group of 31- 40 years (47%). About 24% of admitted patients had CD4 count less than 50/cu mm blood. Thirty five (53%) cases presented fever as the major clinical presentation of HIV/AIDS due to different opportunistic infections followed by cough (28.8%), loss of appetite (28.8%), weight loss (27.3%), and diarrhea (24.2%). Tuberculosis was found to be the major opportunistic infection accounting 27.3% followed by gastroenteritis (21.2%) and oral candidiasis (15.5%). Treatment outcome of hospital admitted patients showed the 83.3% recovery rate and 4.3% death rate. CONCLUSIONS: Hospital admission was found to be efficient to treat the major opportunistic infections and management of ART hypersensitivity reactions. While tuberculosis was the leading opportunistic infection, the most common clinical manifestation was found to be fever among the admitted HIV/AIDS patients.

First Report of Cucumber mosaic virus Infecting Blephilia hirsuta in North America.

Blephilia hirsuta (Pursh) Benth. var. hirsuta, an ornamental plant known as hairy pagoda or hairy wood mint (Lamiaceae), is native to eastern North America and is listed as an endangered species or a species of special concern in several northeastern states ( http://www.ct.gov/dep/cwp/view.asp?a=2702&q=323482&depNav_GID=1628 and http://www.mass.gov/dfwele/dfw/nhesp/species_info/mesa_list/mesa_list.htm ). B. hirsuta, grown as an ornamental on the University of Arkansas campus in Fayetteville, exhibited mottling symptoms indicative of viral infection. Double-stranded RNA extractions (3) yielded four bands of approximately 3.2, 2.9, 2.2, and 0.9 kb, a pattern identical to that of Cucumber mosaic virus (CMV [2]). Nicotiana benthamiana and Chenopodium quinoa seedlings were mechanically inoculated with sap from symptomatic tissue. N. benthamiana inoculated plants were stunted and developed systemic mosaic and C. quinoa inoculated plants developed local lesions, whereas mock inoculated plants remained symptomless. Dot-blot and indirect ELISA using antisera against CMV (developed by H. A Scott) gave strong reactions when testing symptomatic tissue from B. hirusta, N. benthamiana, and C. quinoa compared with no reaction for symptomless plants. Total nucleic acid extractions (4) from symptomatic tissue was subjected to reverse transcription-PCR using Cucumovirus degenerate primers (1). An amplicon of approximately 940 bases was obtained and sequenced. The sequence, deposited in GenBank under Accession No. GU453918, confirmed the results of the immunological assays that B. hirsuta was infected with CMV. The nucleotide identities between the B. hirsuta isolate and those of the Fny CMV group exceeded 98%. To our knowledge, this is the first report of CMV infecting B. hirsuta, not only in North America, but globally. This finding has major implications for the ornamental industry and the viability of the endangered species. Given the wide range of CMV, B. hirsuta may act as a reservoir for the virus and facilitate transmission to ornamentals and other plants. In addition, the virus may reduce host fitness and undermine the efforts to preserve the species in areas that is threatened. References: (1) S. K. Choi et al. J. Virol. Methods 83:67, 1999. (2) I. E. Tzanetakis. Plant Dis. 93:431, 2009. (3) I. E. Tzanetakis and R. R. Martin. J. Virol. Methods 149:167, 2008. (4) I. E. Tzanetakis et al. Virus Res. 127:26, 2007.

Abnormal hepatic function and splenomegaly on the newly diagnosed acute leukemia patients.

To evaluate the liver function, splenomegaly and related factors in the newly diagnosed acute leukemia patients. One hundred of fifty eight acute leukemia patients admitted in our hospital from March 2003 to April 2006 were studied. The related factors such as peripheral WBC count, bone marrow blasts, peripheral blasts, sex, age, AML, ALL affecting the liver function and splenomegaly were evaluated. Sixty two (39.24%) patients presented with splenomegaly. Twelve (7.59%) patients presented with hepatomegaly. Serum ALT was elevated in 54 (34.17%) patients. Similarly, serum AST, GGT, ALP, and Direct bilirubin were elevated in 26 (16.45%), 32 (20.25%), 20 (12.65%), and 22 (13.92%) patients, respectively. Low serum albumin was found in 40 (25.31%) patients. PT was prolonged in 62 (39.24%) patients. Statistical study shows that there is a relation between high WBC counts and elevated serum ALT (P<0.05) and high WBC counts and splenomegaly (P<0.05). Acute leukemia patients with leukocytosis are more prone to develop abnormal liver function and splenomegaly.

Shape evolution of lead telluride and selenide nanostructures under different hydrothermal synthesis conditions.

Face-open nanoboxes of lead telluride and selenide have been synthesized by a simple hydrothermal method. Nano- and microcrystals of various morphologies, including microflowers, semi-microflowers, cubic nanoparticles, etc., have also been observed at different synthesis conditions. Temperature, time, and concentrations of various reactants play a major role in controlling the morphology and shape evolution of the product. This simple synthesis technique for the growth of various nano- and microstructures opens a new route to prepare hierarchical structures of a variety of binary semiconducting materials in a large quantity. A possible growth mechanism of such nano- and microstructures has been proposed.