Maternal Health Services Utilisation in Panchkhal Municipality, Kavrepalanchok, Nepal.

Background Maternal Health is a priority program of Nepal. The low utilization of maternal health services is one of the major contributing factors for high maternal morbidity and mortality in developing countries like Nepal. Objective To explore various maternal health services utilized by women and identify various factors affecting the utilization of maternal health services in Panchkhal Municipality. Method A descriptive cross-sectional study was conducted among 355 reproductive-age women who have given birth in the last 2 years in Panchkhal Municipality. The data collection period was from May to July 2020. A convenient sampling method was used to select the study population. The data analysis was done by using Statistical Package for Social Sciences (version 20.0). Variables were defined by the frequency in numbers and percentages. Result The findings from the study showed that the coverage of the antenatal care (ANC) visit was 77% and among them, 25.6% visited at least 4 antenatal care visits as recommended by the government of Nepal. Out of 355 respondents, 52.4% were delivered in the health institution, and only 20% visited postnatal care after the delivery. Among various factors, lack of treatment facilities and health facilities at a far distance were the most common factors for the underutilization of maternal health services. Conclusion The coverage of maternal health services is still low despite free maternal health services with an incentive scheme. A further detailed investigation is required to find the real scenario of the Panchkhal municipality to under-utilization of maternal health services.

Clinico-epidemiological Profile of Children with Chronic Kidney Disease in Tertiary Care Referral Center in Nepal: Prospective observational study.

Background Chronic kidney disease in children has been increasing over the years and is associated with high degree of morbidity and mortality. The cost of treating children with chronic kidney disease is also substantial. Prevention of this disease is the only long term solution in our context. Till date, there is limited data on chronic kidney disease in Nepalese children. Objective To study the epidemiological, clinical and etiological profile of children with Chronic Kidney Disease from 2 to 16 years of age presenting for the first time in tertiary care hospital. Method This is the prospective observational study carried out at the tertiary care hospital over a period of 3 years. Children between 2-16 years who were first time diagnosed of chronic kidney disease and had estimated glomerular filtration rate < 60 ml/ min/1.73 m2 for last 3 months were enrolled. Result There were total of 124 patients, of whom 78 were male with male to female ratio of 5:3 with mean age of 11.8±2.2 years. Chronic glomerulonephritis (23%), reflux nephropathy (23%) and nephrolithiasis (16%) were the commonest etiological diagnosis. Rapidly progressive glomerulonephritis and systemic lupus erythematous accounted for 85% cases of chronic glomerulonephritis. Vesicoureteric reflux and posterior urethral valve accounted for 85% cases of reflux nephropathy. In 32%, the cause could not be determined. Swelling (45%) and dyspnea (20%) were the chief presenting complaints. Pallor were seen in all cases (100%) followed by hypertension in 68% and short stature in 64%. Majority (60%) of the patients with chronic kidney disease presented in the stage V. Conclusion Chronic glomerulonephritis and reflux nephropathy were the commonest etiologies of chronic kidney disease, majority of them following rapidly progressive glomerulonephritis, systemic lupus erythematosis, vesicoureteric reflux and posterior urethral valve. The commonest clinical features were swelling, dyspnea, pallor and hypertension.

A Hospital Based Study of Prevalence of Dry Eye in Tertiary Care Hospital of Nepal.

Background Dry eye is a common disorder of the tear film that results from decreased tear production, excessive tear evaporation, or abnormality in mucin or lipid components of the tear film associated with symptoms of ocular discomfort. Objective To determine the prevalence of dry eye among patients above 40 years attending out-patient department in a Tertiary Care Hospital of Nepal. Method This was a prospective hospital-based study done at the Department of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital for a period of six months from September 2016 to February 2017. All the patients above 40 years of age, attending out patients department were screened by ophthalmologist using the Ocular Surface Disease Index (OSDI). Those patients who were diagnosed of dry eye by OSDI were further evaluated by Schirmer's test and Tear film breakup time (TBUT). Result Out of 4470 patients attending Ophthalmology outpatient department 1599 patients were of age above 40 years. The overall prevalence of dry eye according to OSDI questionnaire was 25% (400). The mean age of patient with dry eye was 54 yrs. 169 were males (42.2%) and 231 were females (57.7%). Among them Schirmer's test was positive in 16.7% (67) and TBUT was positive in 85.7% (343) of the patients with dry eye. Conclusion Dry eye is a common condition among patients attending ophthalmology outpatient department in tertiary care center and is leading cause of ocular discomfort. The prevalence of dry eye was higher among indoor workers than in outdoor workers. Further studies are needed to establish association and risk factor of dry eye.

Prevalence of Hepatitis B and C among HIV Infected Patients in Nepal over 1990-2020.

Background Hepatitis B and C (HBV and HCV) are viral infections caused by corresponding viruses. Here in this study we planned to conduct this meta-analysis to pool data on the prevalence and risk factors of HBV and/or HCV among HIV patients in Nepal. Method We used MOOSE guideline for the systemic review of available literature. We searched online databases using appropriate keywords. We used CMA-3 for data synthesis. Odds ratio, and proportion were used to estimate the outcome with a 95% confidence interval where appropriate. We assessed the heterogeneity using the I-squared (I2 ) test. Result We included nine studies for our synthesis. Pooling of data showed HBV in 4.6% (CI: 3.7-5.6), HCV in 19.7% (CI: 10.8-33.0), both HBV and HCV in 1.3% (CI: 0.5-3.7) in HIV affected individuals. Among HBV co-infected HIV positive patients, 59.5% (CI: 25.5-86.3) were male; 76.1% (CI: 30.1-96.0) were married and 43.6% (CI: 3.8-93.8) had a history of intravenous drug use (IVDU). Among HCV co-infected HIV positive individuals 88.3% (CI: 73.6-95.4) were male; 63.6% (CI: 55.4-71.1) were married; 91.5% (CI: 68.6-98.1) were literate; 59.2% (CI: 49.9-67.9) were on ART; and 92.2% (95%CI: 84.9-96.1) had a history of IVDU. Conclusion The pooled prevalence of co-infection with HBV, HCV, and combined HBV and HCV were 4.6%, 19.7% and 1.3% respectively among HIV positive patients. Thus, it is necessary to appropriately screen for HBV and HCV in individuals diagnosed with HIV and high-risk populations. IVDU remains the most common risk factor found in co-infected individuals.

Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal.

SETTING: There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal. OBJECTIVE: To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. DESIGN: This was a cross-sectional study using secondary laboratory data. RESULTS: Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August. CONCLUSION: Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.

CONTEXTE: La résistance à plusieurs médicaments (MDR) chez les patients atteints d'infections urinaires (UTI) au Népal est un sujet de préoccupations. OBJECTIF: Déterminer le taux de positivité des cultures, les tendances de MDR parmi les infections à Escherichia coli et Klebsiella pneumoniae et les variations saisonnières dans les échantillons d'UTI positifs par culture de 2014 à 2018 au BP Koirala Institute of Health Sciences, Dharan, Népal oriental. MÉTHODE: Il s'agissait d'une étude transversale réalisée en utilisant des données de laboratoire secondaires. RÉSULTATS: Parmi les 116 417 échantillons urinaires testés, 19 671 (16,9%) étaient positifs par culture, avec une tendance à la hausse du nombre d'échantillons testés et du taux de positivité par culture. E. coli était la bactérie la plus fréquente (54,3%), suivie de K. pneumoniae (8,8%). Une MDR a été observée chez respectivement 42,5% et 36,0% des isolats de E. coli et de K. pneumoniae. La MDR était plus élevée chez les hommes et les personnes âgées >55 ans, mais une tendance à la baisse a été observée au fil des ans. Le nombre d'isolats a augmenté au fil des ans, avec un pic toujours observé de juillet à août. CONCLUSION: Le faible taux de positivité par culture est préoccupant et d'autres études sont nécessaires pour améliorer les protocoles diagnostiques. Les tendances à la baisse en matière de MDR sont un signe encourageant. Les informations relatives aux variations saisonnières avec un pic en juillet-août peuvent aider les laboratoires à mieux se préparer en prévision de cette période, en renouvelant les stocks de solutions tampons afin de pouvoir réaliser les cultures et les tests de sensibilité aux médicaments.

The Postural Effects on Electrical Activities of Heart in Apparently Healthy Young Adults.

Background The electrical activities of heart recorded as electrocardiogram (ECG) are mostly done in supine postures. The body postural changes have effects in these electrical activities in heart which needs to be properly recognized. Objective To find the variations in electrocardiogram during postural changes from supine to upright i.e. sitting and standing postures among apparently healthy young adults. Method A cross sectional study was carried out in Manipal College of Medical Sciences after the institutional ethical clearance. The apparently healthy 30 Nepalese male medical students between 18-25 years of age were enrolled. The electrocardiography was elicited in supine, sitting and standing postures in the participants after 5 minutes' interval between each procedure in each participant. Result The highest mean amplitudes of Q wave were seen in sitting postures (0.12±0.04 mm), R wave in standing postures (1.46±0.55 mm) and S wave also in standing postures (0.23±0.2 mm). The mean amplitudes of Q and S waves showed statistically significant difference when compared between supine and upright postures. The maximum QRS duration was found while sitting (0.08±0.01 ms)and maximum heart rate in standing posture (82.43±10.59/min). The mean comparison of heart rate was statistically highly significant when compared between supine and standing postures. The mean QRS frontal axis was comparatively increased while standing (64.30±39.29). Conclusion The electrical activities of heart vary during postural changes among apparently healthy young adults. These changes are most prominent when compared between supine and standing postures which urges for careful interpretation of electrocardiogram if it is done in upright postures.

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal.

BACKGROUND: In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding practices of pre-school children and their associated factors. METHODS: A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured questionnaire was administered to 145 mothers. Descriptive analyses were conducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers' perception of their current feeding practices. RESULTS: We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01-0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices. CONCLUSIONS: Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-economic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures.

Risk factors and patterns of household clusters of respiratory viruses in rural Nepal.

Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1-4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40-3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05-3.61) and no electricity in household (IRR 2.70; 95% CI 1.41-5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.

Pt-free solar driven photoelectrochemical hydrogen fuel generation using 1T MoS2 co-catalyst assembled CdS QDs/TiO2 photoelectrode.

The solar-to-hydrogen generation from the TiO2-CdS-ZnS-MoS2 (TCZM) heterointerface was demonstrated. We found that a Pt-free CdS quantum dot-sensitized TiO2 mesoporous electrode with a metallic-type 1T MoS2 co-catalyst resulted in 0.11 ml cm(-2) h(-1) H2 fuel generation in unassisted potential mode, which was strikingly improved to 1.47 ml cm(-2) h(-1) under 1 V applied potential.

Pulmonary Functions are Impaired among Carpet Factory Workers: A Spirometric Evaluation.

INTRODUCTION: Carpet factory produces various types of dusts and workers occupationally get exposed to them continuously. It has adverse health effects and most notably to the pulmonary functions. Nepal is one of the carpet exporter developing countries and still does have many factories within Kathmandu valley. However, the health hazards especially the status of pulmonary function of carpet factory workers from Nepal has not been studied. METHODS: A cross-sectional comparative study was designed to recruit carpet factory workers and healthy controls to assess their pulmonary functions. A total of 118 subjects (59 males and 59 females) were recruited (60 carpet factory workers and 58 controls). Pulmonary function tests were carried out using Medical International Research Spirolab II portable spirometer. RESULTS: The carpet factory workers had significantly less FEV1 (90.37 ±16.6 % vs. 103.89±9.79%, p<0.001), FVC (87.78 ± 15.48 % vs. 102.81 ± 8.41 %, p < 0.001) and PEFR (66.19 ± 20.29 % vs. 102.81 ± 11.09 %, p < 0.001) as compared to control group. Similarly the carpet factory workers had significantly higher FEV1/FVC ratio (89.96 ± 6.42 % vs. 87.12 ± 4.58 %, p = 0.007) as compared to control. CONCLUSIONS: Carpet industry dusts exposure adversely affects pulmonary functions among its workers. The findings significant increase in the FEV1/FVC ratio and decrease in FEV1, FVC, and PEFR suggest that the effects are both restrictive and obstructive patterns of lung disease.

Acute hypophosphatasemia.

UNLABELLED: The temporal evolution of a low serum alkaline phosphatase value may relate to its cause. Precipitous lowering of serum alkaline phosphatase below the lower range of normal is uncommon and may indicate severe physiologic stress and increased short-term mortality. INTRODUCTION: The differential diagnosis of a low serum alkaline phosphatase (ALP) value (hypophosphatasemia) is wide ranging, anecdotal, and unfamiliar. The temporal evolution of hypophosphatasemia may relate to its cause. The purpose of this study is to report conditions and circumstances associated with precipitous lowering of serum ALP below the lower range of normal. METHODS: Marshfield Clinic IRB approved use of their electronic medical record to search for subjects with at least two serum ALP values ≤ 40 U/L (normal 40-125 U/L). When the temporal evolution of the qualifying ALP values indicated a precipitous lowering from usually normal serum ALP values, the subject was deemed to have acute hypophosphatasemia. Thirty years of laboratory data and 10 years of clinical narrative were analyzed. Associated diagnoses, clinical circumstances, and short-term mortality were recorded. RESULTS: A total of 458,767 subjects had 2,584,051 serum ALP values, and 5,190 (1.1 %) subjects had at least two serum values ≤ 40 U/L. A detailed review of 1,276 subjects selected on the basis of their lowest ALP value and age identified 190 subjects with acute hypophosphatasemia. Acute hypophosphatasemia was recorded during periods of major trauma/surgery, multisystem failure, acute anemia, blood product transfusions (often massive), apheresis, hypomagnesemia, and acute caloric restriction. Twenty-eight subjects (15 %) died within 35 days of their nadir serum ALP. CONCLUSION: Acute hypophosphatasemia is associated with profound illness or physiologic stress and followed by increased short-term mortality. The temporal evolution of hypophosphatasemia may relate to its cause.

Validation of simulation of calcifications for observer studies in digital mammography.

Studies using simulated calcifications can be performed to measure the effect of different imaging factors on calcification detection in digital mammography. The simulated calcifications must be inserted into clinical images with realistic contrast and sharpness. MoCa is a program which modifies the contrast and sharpness of simulated calcification clusters extracted from images of mastectomy specimens acquired on a digital specimen cabinet at high magnification for insertion into clinical mammography images. This work determines whether the use of MoCa results in simulated calcifications with the correct contrast and sharpness. Aluminium foils (thickness 0.1-0.4 mm) and 1.60 µm thick gold discs (diameter 0.13-0.8 mm) on 0.5 mm aluminium were imaged with a range of thicknesses of polymethyl methacrylate (PMMA) using an amorphous selenium direct digital (DR) system and a powder phosphor computed radiography (CR) system (real images). Simulated images of the tests objects were also generated using MoCa. The contrast of the aluminium squares and the degradation of the contrast of the gold discs as a function of disc diameter were compared in the real and simulated images. The average ratios of the simulated-to-real aluminium contrasts over all aluminium and PMMA thicknesses were 1.03 ± 0.04 (two standard errors in the mean) and 0.99 ± 0.03 for the DR and CR systems, respectively. The ratio of the simulated-to-real degradations of contrast averaged over all disc diameters and PMMA thicknesses were 1.007 ± 0.008 and 1.002 ± 0.013 for DR and CR, respectively. The use of MoCa was accurate within the experimental errors.

Geriatric health in Nepal: concerns and experience.

Ageing is a natural phenomenon and an inevitable process. Population ageing is pervasive since it is creating humanitarian, social and economic problems in many countries of the world including Nepal. Nepalese society is in a phase of modernization. There is modification in the cultural norms and traditional family support systems for elderly in Nepal which have placed substantial strain in caring elderly people. In Nepal, there were 1.5 million in 2001 and 2.1 million in 2011, elderly inhabitants, which constitute 6.5 percent and 8.1% of the total population in the country. During the years 1991-2001, the annual elderly population growth rate was 3.39 percent, higher than the annual population growth rate of 2.3 percent. Growing numbers of elderly people are suffering problems in different aspect, but there are limited studies in relation to general morbidities as well as specific in this group of people. The government of Nepal has formulated a National policy, act and regulations on ageing and the problems of elderly; however, this has not been operationalised because of limited resources. In this background of problems that elderly people are facing and government slow initiatives, this paper is illustrated with the objective to explore the different dimensions of ageing and health and health related services for aging people in Nepal using different information for the purpose of further concrete steps in the benefits for elders.

Hospital-based study in children with rotavirus gastroenteritis and other enteropathogens.

BACKGROUND: Rotavirus is the most common cause of life threatening gastroenteritis in infants and young children in the world. The objective of the study is to find out current trends and incidents of rotavirus, including other enteropathogens related with children diarrhoea and lastly identify the most common rotavirus serotypes that circulate in Nepal. METHODS: A total of 1721 stool samples from less than 5 years of children were collected. Rotavirus in the stool samples were detected by Enzyme Immuno Assay (EIA) and strains were genotyped by Reverse-Transcription Polymerase Chain Reaction (RT-PCR). Bacteria and parasites were detected by following standard microbiological procedures. RESULTS: In between 2009 to 2010, of the total 1721, the prevalence of rotavirus was 24.7%. Of them, 906 (52.6%) were collected in the year 2009 and 815(47.5%) in the year 2010. Rotavirus was frequently detected in inpatients (31.6%) than outpatient (16.8%). Rotavirus detection was higher in female (26.4%) than male (23.7%). The prevalence was seen higher in age group 0-23 months in both years. Among six different bacterial isolates, Escherichia coli was most frequently isolated (6.5%). Similarly, Giardia lamblia (1.3%) was most common among six different parasites detected. A total of rotavirus positive 425 stool samples were detected over 2 years (2009-230, and 2010-195), G12P6 was the predominant strain circulating in both (45% in 2009 and 28% in 2010) years. G9P6 emerged in 2010 (6%). There were significant numbers of mixed infections (14.0% in 2009 and 29.8% in 2010). Thirty five samples were partially typed and 15 were completely untyped over the two year period. CONCLUSIONS: The study helps comprehend the prevalence of rotavirus along with other intestinal pathogens including bacteria and parasites. Major genotypes of rotavirus are also introduced in the study.

Oxygen saturation of hemoglobin in healthy children of 2-14 years at high altitude in Nepal.

BACKGROUND: Individuals residing at higher altitude may have oxygen saturation of hemoglobin different to those living at lower altitude. OBJECTIVES: To find out the baseline value of SpO2 in healthy Nepali children (2-14 years) living permanently at high altitude using pulse oximeter and also to study the relation of SpO2 with age, sex and ethnicity. METHODS: A descriptive observational study was conducted at 4 different altitudes ranging from 2700 to 3800 m in Mustang district. The mean pulse oximery values at different altitudes were calculated and compared. RESULTS: One hundred six children were enrolled with the median age of 10 years. The mean SpO2 value of children permanently residing at altitude 2700m was 95.18%, at 2800m was 94.82%, at 3550m was 94.1% and 3800m was 93.1%.The difference in the SpO2 values at different altitude was statistically significant. No sex or age wise differences were noted on the mean SpO2 values in the study group. CONCLUSIONS: The mean SpO2 values were higher than several other studies done in the altitude above 2500 meters. Enrollment of older children and the different ethnic background could be the contributing factors for the differences.

Vitamin D status among individuals attended in Health Home Care Centre, Lalitpur, Nepal.

There is widespread prevalence of vitamin D deficiency from new-born to infancy, childhood and adult male and female. Despite the numerous reports of the association of vitamin D with spectrum of development, disease treatment and health maintenance, vitamin D deficiency is common. There is limited information of the vitamin D status in Nepalese people. Based on the information in relation to importance of Vitamin D, we proposed to see the level of vitamin D among the care seeker individuals attended in this Health Home Care Centre, Nepal. Within three months interval (March to May 2012), whole blood test was done by 148 individuals. Among them vitamin D3 test was recommended for 50 individuals done by doctor on the basis of relevant health problems in relation to vitamin D deficiency. Analysis was done with SPSS package 17 version to see the relation between Vitamin D deficiency and other health related tests. The study found significant association between vitamin D deficiency with calcium level and hemoglobin level. There are presences of studies with evidences regarding relation of vitamin D with different health outcomes in different parts of the world. The widespread deficiency of vitamin D merits consideration of widespread policies including increasing the awareness among the public and health care professionals. In addition the study results highlight the need for additional high quality studies in Nepal in order to prevent the impacts of vitamin D deficiency and also to plan for prevention of vitamin D deficiency.

Prevalence study of H. pylori infection in dyspeptic patients coming to Nepal Medical College Teaching Hospital, Jorpati, Kathmandu.

Helicobacter pylori (H. pylori) is one of the most common human infections worldwide particularly in the developing countries. It has been established as etiology of chronic gastritis and peptic ulcer disease, gastric adenocarcinoma and mucosal associated lymphoid tissue lymphoma (MALT). During this decade, there have been some reports showing a decline in global prevalence of H. pylori infection and peptic diseases including many Asian countries. Hence to determine prevalence of Helicobacter pylori infection in dyspeptic patients, this descriptive, non-interventional study was carried out at the Endoscopy sub-unit of the Surgery Department from April 2011 to February 2012. Three hundred nineteen dyspeptic patients (Male 161 and female 152) with a mean age of 20.12 years were examined for the presence of H. pylori infection by histology staining. The prevalence of H. pylori infection was 50.47%. The most common endoscopic findings was gastritis (47.6%) followed by normal findings 57 (17.87%). A total of 8.47% of gastric Ulcer, oesophagitis 5.64% and gastric cancer 0.94% were detected. All three cases of gastric cancer were positive for H. pylori infection. Among gastritis, H. pylori was observed in 67 (44%) cases and 18 out of 57 (5.6%) of normal gastric mucosa showed H. pylori. The endoscopic findings such as gastritis, gastric ulcer, duodenal ulcer and gastro duodenal reflux are significantly associated with H. pyloric infection. The prevalence of H. pylori infection is still high in peptic diseases. H. pylori infection is significantly correlated with peptic ulcer diseases than with non-ulcer dyspepsia. Further studies are required to establish the H. pylori positive cases with that of other tests such as serological detection of anti H. pylori antibody by ELISA/ICT and culture to establish a diagnosis quickly without any invasive method and institute proper management thus reducing morbidity.

A case of precocious puberty in a setting with limited resources.

Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.

Changing tuberculosis trends in Nepal in the period 2001-2008.

To assess the trends on indicators of TB control in Nepal over a period from 2001-2008. Retrospective analysis of information from Annual Reports of NTP, Nepal from 2001-2008. The incidence of New Smear Positive (NSP) TB declined from 58.9 in 2001 to 53.4 in 2006 per 100000 populations then reversed in the period 2006-2008. This TB incidence decreased in males and the age group <45 years (except 0-14 years). The notification rate of all cases of TB declined by 3 % overall over the entire period from 2001 to 2008. Mortality among smear negative and extra pulmonary declined significantly. The failure rate and defaulter rate were declined significantly and the case detection rate (CDR) was increased significantly within the study period. Increasing trend in CDR, Treatment success rate and decreasing trend in failure rate, defaulter rate are the evidence of progress of NTP, in Nepal. Since there is reversal of incidence of NSP from 2006, a detailed analysis of existing TB control measures is required. If the success is continued and quality care is provided as per International Standard of TB Care, the Millennium Development Goals will be an achievable target.

Generation, storage, collection and transportation of municipal solid waste--a case study in the city of Kathmandu, capital of Nepal.

Solid waste management (SWM) services have consistently failed to keep up with the vast amount of solid waste produced in urban areas. There is not currently an efficient system in place for the management, storage, collection, and transportation of solid waste. Kathmandu City, an important urban center of South Asia, is no exception. In Kathmandu Metropolitan City, solid waste generation is predicted to be 1091 m(3)/d (245 tons/day) and 1155 m(3)/d (260 tons/day) for the years 2005 and 2006, respectively. The majority (89%) of households in Kathmandu Metropolitan City are willing to segregate the organic and non-organic portions of their waste. Overall collection efficiency was 94% in 2003. An increase in waste collection occurred due to private sector involvement, the shutdown of the second transfer station near the airport due to local protest, a lack of funding to maintain trucks/equipment, a huge increase in plastic waste, and the willingness of people to separate their waste into separate bins. Despite a substantial increase in total expenditure, no additional investments were made to the existing development plan to introduce a modern disposal system due to insufficient funding. Due to the lack of a proper lining, raw solid waste from the existing dumping site comes in contact with river water directly, causing severe river contamination and deteriorating the quality of the water.