Seasonal hyper acute pan uveitis--recent scenario in Nepal

Seasonal hyperacute panuveitis (SHAPU), characterized by an unusual form of unilateral severe hyper acute diffused intraocular inflammation, is one of the mysterious eye diseases of which the definite cause and treatment remains yet to be tound out. In this study, a total of six cases were included. Aqueous and vitreous samples were subjected to direct microscopy and culture (bacterial or fungal). Of the six cases included, two yielded Streptococcus pneumoniae and one Acinetobactor sp. on culture. All three culture positive samples showed pus cells in direct microscopic examination (gram stain). All cases were subjected to vitrectomy and intravitreal antibiotic and steroid injection, along with oral antibiotics and steroid. Five cases were also treated with antiviral agent. After treatment four cases showed reversal of hypotony and three cases recovered some vision.

Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study

A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children's Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.

Intestinal parasitosis among subjects undergoing cataract surgery at the eye camps in rural hilly areas of Nepal

Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others.

Lipid profile of adult Nepalese population

Dyslipidemia is one of the major risk factors of coronary artery disease. Present study was aimed to find out the lipid profile of non-diabetic adult Nepalese population (n = 454; M: 180 and F: 274; Mean age: 42.8+/-15.5 years). The mean +/- SD (mg/dl) level of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 184+/-50.7, 147.4+/-79.9, 111.9+/-42.0 and 45.0+/-11.7, respectively. All lipid levels except LDL were higher among 41 to 60 years age group while LDL was higher among participants aged >60 years. Desirable TC level (<200 mg/dl) was found in 78.0% of the total population while the normal TG (<150 mg/dl) and LDL (<129 mg/dl) was found in 61.5% and 72.0%, respectively. High TC (> or =240 mg/dl) and very high TG (> or =500 mg/dl) and LDL (> or =190 mg/dl) were found in 8.8%, 2.6% and 5.8% of participants, respectively. Higher HDL level (40 mg/dl) was seen in 60.0% of the total population. Higher percentage of women than men (65.3% vs 52.2%) had >40 mg/dl HDL level. Nornal lipid profile (TC <200 mg/dl, TG <150 mg/dl, LDL <129 mg/dl, HDL >40 mg/dl) was seen in 26.7% of participants, and was higher in females (32.1%) than in males (18.3%). The overall mean cholesterol level was within normal limit. Mean LDL level showed increasing trend with age and about one fourth of participants had normal lipid profile.

Morbidity profile of paediatric inpatents at a community health centre and a nearby [correction of near by] district hospital in northern India

The study was conducted to ascertain the morbidity profile among children by retrospective review of inpatient data of children admitted to Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, a model CHC and Badshah Khan (B.K.) hospital, Faridabad, a district hospital over a period of one year. Diarrhea and pneumonia comprised 64% of all admissions at the model CHC and 30% at the district hospital. Thalassemics requiring blood transfusion formed 21% of inpatients at the district hospital. Common paediatric ailments can be managed appropriately at CHC level, provided the infrastructure as recommended by Indian Public Health sandards for CHC under National Rural Health Mission (NRHM) is available. The blood bank or blood storage facility at a CHC is desirable.

Laparoscopic adrenalectomy - a cure for male pattern baldness

A 64-year-old woman presented to a dermatologist with male pattern hair loss and was found to have grossly elevated testosterone levels at 22.3 nmol/l (normal range, 0.0-2.9 nmol/l). The diagnosis of an androgen-secreting adrenal tumour was made and she underwent a laparoscopic retroperitoneal right adrenalectomy with an uneventful speedy recovery, being discharged in less than 48 h, underlining the clear advantage of this approach.

Quality assurance of annual HIV sentinel surveillance 2006: experience of regional institute, central zone

National AIDS Control Organisation (NACO) identified five regional institutes (RIs) to monitor and supervise the 2006 round of annual HIV sentinel surveillance. The task mandated was quality control of both epidemiological data collection and HIV testing. The team at RI consisted of epidemiologist and microbiologist. We describe here the process of quality control and the quality of surveillance in the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkand, and Delhi. The supervisors visited almost 90% of the sentinel sites. Performance of vast majority of the sentinel sites (92%) was satisfactory. The testing laboratories were found to be adhering to standard operating procedures. Concordance rate of test results between testing laboratory and the designated reference laboratory was high. Overall, the quality of sentinel surveillance was good. The lacunae found during the visit have been enumerated along with the recommendations for future surveillance round.

Seasonal distribution of enteropathogens detected from diarrheal stool and water samples collected in Kathmandu, Nepal

A total of 334 diarrheal fecal samples (from 210 males and 124 females) collected in Kathmandu, Nepal, were studied for various kinds of enteropathogens. Overall, 33% (111/334) fecal samples were positive for one or more enteropathogens. There was no difference in detection rates between males and females. Enteropathogen detection rates in summer, winter, spring, and autumn were 61% (40/66), 52% (45/87), 31% (25/81), and 25% (25/100), respectively. Altogether eight species of bacteria, three genera of viruses, and five species of protozoan parasites were detected with considerable seasonal variations. Among the bacterial isolates, enteropathogenic Escherichia coli topped the list followed by Vibrio sp. Only one sample had Shigella (S. sonnei). Rotavirus type A was the most frequently detected among the enteric viruses, followed by human enterovirus and human adenovirus, respectively. Among the enteric protozoan parasites, Giardia intestinalis was the most frequently detected followed by Cryptosporidium parvum. Detection of bacterial and protozoan pathogens showed a slightly high tendency in the summer season compared with that in the other seasons (p>0.05), whereas the detection of viruses was significantly high in the winter season (p<0.05). Of the total 57 water samples, 43 (75%) showed one or more bacterial species out of which 51% (22/43) were E. coli. Among the E. coli isolates, 68% were EPEC. Enterohemorrhagic E. coli (O157) was not detected.

Jaagsiekte sheep retrovirus Env protein stabilizes retrovirus vectors against inactivation by lung surfactant, centrifugation, and freeze-thaw cycling

Jaagsiekte sheep retrovirus (JSRV) replicates in the lungs of sheep and causes the secretion of copious lung fluid containing the virus. Adaptation of JSRV to infection and replication in the lung and its apparent resistance to the denaturing activity of lung fluid suggest that vectors based on JSRV would be useful for gene therapy targeted to the lung. We show here that a retrovirus vector bearing the JSRV Env is stable during treatment with lung surfactant while an otherwise identical vector bearing an amphotropic Env is inactivated. Furthermore, the JSRV vector was stable during centrifugation, allowing facile vector concentration, and showed no loss of activity after six freeze-thaw cycles. However, the JSRV vector was inactivated by standard disinfectants, indicating that JSRV vectors pose no unusual safety risk related to their improved stability under other conditions.

Contamination of river water by Cryptosporidium parvum oocysts in western Japan

In Japan, only a few rivers have been inspected for Cryptosporidium parvum contamination, and the methods used had low sensitivity. In 1998 and 1999, we used a method with higher sensitivity to examine all large rivers used as sources of water supply in one prefecture (which we divided into four areas) in western Japan for Cryptosporidium oocysts. One sample was collected at each of 156 sites along 18 rivers, and samples were tested for Cryptosporidium oocysts by immunomagnetic separation. Samples were classified as being obtained on an island with livestock and fishing industries, a densely populated urban area, a western region including farming villages, or a still more rural northern area with agriculture and fishing. Restriction fragment length polymorphism analysis was used for identification of the C. parvum found as the bovine or human type. C. parvum was detected in at least one sample from 13 of the 18 rivers and in 47% (74 of 156) of the samples. One-third to all of the samples from each area contained C. parvum oocysts. The number of C. parvum oocysts per 20 liters of river water varied in the same pattern as the number of cattle kept in the four kinds of areas (as determined by the Mantel extension test). Oocysts isolated were of the bovine type; the C. parvum detected in rivers probably came from cattle kept in that valley. As we had expected, when tested with a more sensitive method, river water in western Japan was found to be greatly contaminated with C. parvum oocysts, as reported in other countries.

Candidate tumor suppressor HYAL2 is a glycosylphosphatidylinositol (GPI)-anchored cell-surface receptor for jaagsiekte sheep retrovirus, the envelope protein of which mediates oncogenic transformation

Jaagsiekte sheep retrovirus (JSRV) can induce rapid, multifocal lung cancer, but JSRV is a simple retrovirus having no known oncogenes. Here we show that the envelope (env) gene of JSRV has the unusual property that it can induce transformation in rat fibroblasts, and thus is likely to be responsible for oncogenesis in animals. Retrovirus entry into cells is mediated by Env interaction with particular cell-surface receptors, and we have used phenotypic screening of radiation hybrid cell lines to identify the candidate lung cancer tumor suppressor HYAL2/LUCA2 as the receptor for JSRV. HYAL2 was previously described as a lysosomal hyaluronidase, but we show that HYAL2 is actually a glycosylphosphatidylinositol (GPI)-anchored cell-surface protein. Furthermore, we could not detect hyaluronidase activity associated with or secreted by cells expressing HYAL2, whereas we could easily detect such activity from cells expressing the related serum hyaluronidase HYAL1. Although the function of HYAL2 is currently unknown, other GPI-anchored proteins are involved in signal transduction, and some mediate mitogenic responses, suggesting a potential role of HYAL2 in JSRV Env-mediated oncogenesis. Lung cancer induced by JSRV closely resembles human bronchiolo-alveolar carcinoma, a disease that is increasing in frequency and now accounts for approximately 25% of all lung cancer. The finding that JSRV env is oncogenic and the identification of HYAL2 as the JSRV receptor provide tools for further investigation of the mechanism of JSRV oncogenesis and its relationship to human bronchiolo-alveolar carcinoma.

High Toxoplasma seroprevalence associated with meat eating habits of locals in Nepal

A serosurvey of Toxoplasma gondii infection in apparently healthy subjects (n = 404) living in Achham (n = 215) and Dang (n = 189) districts in western Nepal was carried out. An interview with 249 participants, each representing a household, was also conducted. This interview pertained to their meat eating habits and the keeping of cats in their houses. Toxoplasma antibodies were detected by using the microlatex agglutination test. The overall seroprevalence was 65.3% with no significant difference in the two districts (Achham: 66.9% and Dang: 63.5%) included (p = 0.546). Females and the Indo-Aryan ethnic-group showed marginally higher prevalence compared with their male (p = 0.545) and Tibeto-Burman (p = 0.075) counterparts. The majority of the infections was found to have occurred during childhood. The frequency of meat eating in western and eastern regions differed greatly (p = 0.000) with the people in the eastern region being frequent meat eaters than those in the western region. About one-third of the subjects, all Indo-Aryans, in the western region had the raw meat eating habit but none in the eastern region. Approximately 7.0% of households in both western and eastern regions kept cats. The present findings demonstrated a typical role of meat eating habits of people in the high Toxoplasma seroprevalence in Nepal.

Prevalence of Cryptosporidium parvum infection and pattern of oocyst shedding in calves in Japan

Cryptosporidium parvum infection and the pattern of oocyst shedding were observed in calves. A total of 480 fecal samples were collected from 30 calves (age, < or =30 days) over a period of 10 months from June 1998 to March 1999. A sucrose centrifugal flotation technique revealed 28/30 (93%) calves were passing Cryptosporidium oocysts. Oocyst shedding was first detected on the sixth day after birth, with 8% of the calves testing positive. This rate increased day by day and reached approximately 80% by day 15. Oocyst shedding varied from 1 to 13 days, with a mean of 7 days. Calves infected with C. parvum had a significantly higher rate of diarrhea (33%) than non-infected calves (8%) (P<0.05), suggesting C. parvum infection as the likely cause. The mean number of oocysts excreted by calves < or =30 days old was approximately 6x10(7) per gram of feces. These results indicated that one calf would excrete some 6x10(11) oocysts in the first month after birth, taking both the quantity of feces in a day and the period of excretion into consideration. Accordingly, it is clear that calves are important in the spread of cryptosporidiosis to calves and humans.

Differentiation of Toxocara canis and T. cati eggs by light and scanning electron microscopy

In this study, we investigated the morphological identification of Toxocara canis and T. cati eggs on the basis of light and scanning electron microscopic (SEM) observations. T. canis and T. cati eggs used in this study were recovered from the uteri of respective gravid female worms. Measurement of egg size was not helpful in the differentiation of these species, because approximately 90% of eggs measured were of similar size. Using SEM, we were able to differentiate T. canis eggs from T. cati eggs based on their respective characteristic surface structures. Both species have subspherical eggs with markedly pitted surfaces like those of a golf ball, but the surface pitting in T. canis is more coarse than that in T. cati. In this study, however, these differences were not absolute, as 16% of T. canis and 29% of T. cati eggs showed surface pitting that was uncharacteristic of their species. Of the 16% of T. canis eggs that could not be differentiated by surface structure, 3% had pitting resembling T. cati, and the remaining 13% showed intermediate type surface pitting. Similarly, 5% of T. cati eggs resembled T. canis, and 25% of these were of intermediate type. Light microscopic observation yielded results similar to those of SEM, indicating that light microscopy is also a useful tool for the identification of Toxocara eggs.

Contamination of soil with helminth parasite eggs in Nepal

Contamination of soil with helminth eggs in Kathmandu Valley (n=122) and outside of Valley (n=34) in Nepal was investigated with the use of centrifugal floatation technique using sucrose solution (sp gr 1.200). The overall soil contamination rate was 36.5% (57/156). The prevalence was uniform in Kathmandu Valley (36.9%) and outside of the valley (35.3%). A mean of six helminth eggs per sample were detected out of which more than half were embryonated (potentially infective). In Kathmandu Valley, soil contamination rate was higher (48.3%) during wet season compared with that observed in dry season (33.3%) but without significant difference (p>0.05). Multiple species of helminth eggs were detected in 22.8% of total positive samples (n=57). Altogether five species of nematoda (Ascaris lumbricoides, Toxocarta sp, Trichuris trichiura, Capillaria sp and Trichostrongylus sp) and two species of cestoda (Hymenolepis nana and H. diminuta) were recovered. A. lumbricoides was predominant in Kathmandu Valley while Trichostrongylus was the commonest one in outside of valley.

Retrovirus vectors bearing jaagsiekte sheep retrovirus Env transduce human cells by using a new receptor localized to chromosome 3p21.3

Jaagsiekte sheep retrovirus (JSRV) is a type D retrovirus associated with a contagious lung tumor of sheep, ovine pulmonary carcinoma. Other than sheep, JSRV is known to infect goats, but there is no evidence of human infection. Until now it has not been possible to study the host range for JSRV because of the inability to grow this virus in culture. Here we show that the JSRV envelope protein (Env) can be used to pseudotype Moloney murine leukemia virus (MoMLV)-based retrovirus vectors and that such vectors can transduce human cells in culture. We constructed hybrid retrovirus packaging cells that express the JSRV Env and the MoMLV Gag-Pol proteins and can produce JSRV-pseudotype vectors at titers of up to 10(6) alkaline phosphatase-positive focus-forming units/ml. Using this high-titer virus, we have studied the host range for JSRV, which includes sheep, human, monkey, bovine, dog, and rabbit cells but not mouse, rat, or hamster cells. Considering the inability of the JSRV-pseudotype vector to transduce hamster cells, we used the hamster cell line-based Stanford G3 panel of whole human genome radiation hybrids to phenotypically map the JSRV receptor (JVR) gene within the p21.3 region of human chromosome 3. JVR is likely a new retrovirus receptor, as none of the previously identified retrovirus receptors localizes to the same position. Several chemokine receptors that have been shown to serve as coreceptors for lentivirus infection are clustered in the same region of chromosome 3; however, careful examination shows that the JSRV receptor does not colocalize with any of these genes.

Development of a kinetic assay for band 5b tartrate-resistant acid phosphatase activity in serum

BACKGROUND

Band 5 tartrate-resistant acid phosphatase (TrACP; EC 3. 1.3.2) consists of two isoenzymes, bands 5a and 5b, of which band 5b TrACP is considered to be derived from bone. However, no kinetic method for the specific measurement of band 5b TrACP in serum is available. Our aim was to develop a kinetic assay method for the specific measurement of band 5b TrACP in serum.

METHODS

Band 5b TrACP was measured kinetically in serum as tartrate-resistant fluoride-sensitive heparin-resistant ACP with 2, 6-dichloro-4-acetylphenyl phosphate as substrate at pH 6.6.

RESULTS

Heparin inhibited band 5a TrACP but had no effect on band 5b TrACP in serum or in bone extract. The presence of EDTA or ascorbic acid had no effect, but dithiothreitol inhibited enzyme activity. The within-run (n = 20) and between-run (n = 20) CVs of band 5b TrACP activity were 3.3-5.8% and 5.0-7.3%, respectively. The mean +/- SD values of band 5b TrACP activity in males (n = 25) and females (n = 57) 20-29 years of age by this method were 8.0 +/- 2.2 U/L and 6.4 +/- 1.8 U/L, respectively. The band 5b TrACP value was significantly higher in females >50 years of age compared with the younger subjects (20-29 years). The highest band 5b TrACP values were among children younger than 15 years.

CONCLUSIONS

This kinetic assay is a simple and specific method for the measurement of band 5b TrACP in serum samples and is useful in the evaluation of bone turnover activity.

Construction, expression, and characterization of anticarcinoma sFv fused to IL-2 or GM-CSF

Local production of cytokines by genetically engineered tumor cells decreases their tumorigenicity and elicits protective immune responses against the parental tumor cells. An alternative approach to elicit a therapeutic immune response is to use fusion proteins that can target tumor cells and simultaneously activate effector cells. Fusion proteins between human IL-2, murine or human GM-CSF, and sFv of antihuman carcinoma antibody L6 have been constructed, expressed in both COS and Chinese hamster ovary (CHO) cells, and purified by affinity chromatography. The biologic activity of L6 sFV-hIL-2, L6 sFv-mGM-CSF, and L6 sFv-hGM-CSF was tested on human T cell blasts, factor-dependent FDCP-1, and TF-1 cells, respectively. The ability of soluble L6 sFv-hIL-2, L6 sFv-mGM-CSF, and L6 sFv-hGM-CSF to stimulate the proliferation of the indicator cells was found to be comparable to that of recombinant hIL-2, mGM-CSF, or hGM-CSF. Tumor cells coated with L6 sFV-mGM-CSF or L6 sFv-hGM-CSF were also tested in this way and were found to be potent stimulators, indicating that the cytokines were functionally active when bound to the tumor cell surface. This work demonstrates the feasibility of targeting sFv-cytokine fusion proteins for the activation of effector cells as an alternative to cytokine gene therapy.

Clinical usefulness of serum tartrate-resistant fluoride-sensitive acid phosphatase activity in evaluating bone turnover

This study was carried out to evaluate the clinical validity and usefulness of serum tartrate-resistant fluoride-sensitive acid phosphatase (TrFsACP) activity using 2,6-dichloro-4-acetylphenyl phosphate as substrate at pH 6.2 in metabolic bone diseases. The mean Z-scores of TrFsACP activity in patients on hemodialysis were higher than in healthy subjects (male: 2.04+/-1.98, n = 49, P < .05; female: 1.49+/-2.43, n = 39, P < .05) and increased with duration of hemodialysis (r = .516, P < .01). Bone alkaline phosphatase also was found to be significantly higher in hemodialysis patients (male: 0.93+/-1.49, P < .05; female: 1.66+/-2.42, P < .05) compared with normal subjects: but had lower correlation with duration of hemodialysis than TrFsACP (r = .277, P < .05). Ulcerative colitis (1.37+/-2.21, n = 15) in males showed a significantly higher Z-score of TrFsACP compared with control subjects (P < .05). The relationship of TrFsACP activity and ultrasound findings (stiffness; speed of sound [SOS]; broadband ultra sound attenuation [BUA]) in healthy women aged 30-75 years (n = 95) were inversely and significantly correlated with stiffness (r = -.465, P < .01 ), SOS (r = -.484, P < .01), and BUA (r = -.366, P < .01), but were age dependent. TrFsACP activity significantly correlated with stiffness (r = -.521, P < .05) and SOS (r = -.527, P < .05) only in the age group of 46-55 years. BUA (r = -.313, P > .05) did not correlate significantly in any subject in the present study. We conclude that serum TrFsACP activity is useful in the diagnosis and monitoring of bone turnover.

Toxoplasma antibody prevalence in Nepalese pregnant women and women with bad obstetric history

Sera from randomly selected 345 pregnant Nepalese women aged 16-36 years and 13 women with bad obstetric history (BOH) were tested for the presence of Toxoplasma antibodies using microlatex agglutination (MLA) and ELISA methods. The overall prevalence was 55.4% (191/345). Prevalence was slightly higher (59.0%) in older age-group (27-36 years) compared with younger age-group (16-26 years) (52.2%). No significant difference in antibody prevalence in women belonging to two different ethnic-groups (Tibeto-Burmans 57.8%, Indo-Aryans 52.7%) was observed (p>0.05). MLA antibody titer ranged from 1:16 to 1:2,048. Over three-fourth of the women showed either high (1:510 or over) or low (1:16 or 1:32) antibody titer. Three percent (6/191) of MLA antibody positive subjects had Toxoplasma IgM antibodies by IgM-ELISA. All six IgM antibody positive pregnant women had MLA antibody titer of over 1:510. Of the total 13 women with BOH, 5 (38.5%) had Toxoplasma antibodies of which 2 (40.0%) were positive for Toxoplasma-IgM antibodies.

Status and future of clinical pathology in Nepal

Clinical Pathology (CP) in Nepal is still in primitive stage. All most all CP tests are done manually. In many health institutions, even a basic CP test facilities are not available leading to an empirical treatment. Even the so-called big medical centers are lacking many important CP test facilities forcing the patients (those who can afford) to proceed to foreign countries for investigation and treatment of their health problem. With regard to the training of man power in the field of CP, Tribhuvan University Institute of Medicine began an academic training course called Proficiency Certificate Level in Health Laboratory Technology (PCL Health Lab.) in 1972. Presently, undergraduate and post-graduate courses, namely, Bachelor in Medical Laboratory Technology (BMLT) and MD Pathology are also being run since 1987 and 1996, respectively. Presently, CP services in Nepal are being rendered at both public and private sectors. CP services in private sector are provided by small so-called CP laboratories usually attached to a medical shops to a well set laboratories run by qualified man power. All most all private CP laboratories in Nepal function at morning and/or evening as they are run by the people working at the hospitals or other medical institutions during day time. Beside, newly emerged nursing homes are also providing CP services. However, quality control system in CP service in Nepal, is not effective yet. Thus, establishment of a national institution functioning as both referral CP center and quality monitoring body on CP services, and introduction of mandatory CP license examination appears to be an urgent need of the days to provide a qualitative CP service to the needy people.

Hsp72-mediated augmentation of MHC class I surface expression and endogenous antigen presentation

Efficient recognition of tumor cells by cytolytic T lymphocytes (CTL) is often dependent on the presentation of cytosolic peptides in the context of MHC class I molecules. This process may be influenced by various molecular chaperones. To analyze this influence, we have utilized B16 melanoma cells, which are not effectively recognized by MHC class I-restricted CTL. This resistance to CTL is apparently due to a very low level of surface MHC expression. We have found that stably transfected clones of B16 which constitutively express the human heat shock protein 72 (Hsp72) exhibit significantly increased levels of MHC class I antigens on their surface. This Hsp72-mediated up-regulation of surface MHC class I antigen represents an increase in the amount of functional MHC-peptide complexes as measured by conformation-dependent antibodies and recognition by MHC class I-restricted CTL. Expression of Hsp72 did not improve the antigen presentation defect in cells lacking the activity of the transporter associated with antigen presentation (TAP). Moreover, mice immunized with Hsp72-expressing B16 cells, but not with control-transfected B16 cells, display significantly increased resistance to a subsequent challenge with live, wild-type B16. Together, our data demonstrate that the immune recognition of tumor cells can be substantially enhanced by the suitable expression of a molecular chaperone.

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in Nepal

We report the prevalence of intestinal helminthiasis and its impact on health of Nepalese in two different rural Village Development Committees (VDC) in Nepal. A total of 261 school children from Okharpauwa VDC in Nuwakot district (Central Region) and 242 inhabitants of Boya VDC in Bhojpur district (Eastern Region) in Nepal were included in this study. The overall prevalence in these two different districts were 57.5% and 55.4%, respectively. Altogether four types of helminths were detected. In both districts, Ascaris lumbricoides was the commonest helminth. Mixed helminth infection in both study areas accounted for less than 5.0%. All helminth infected subjects were treated with a single dose of albendazole. Heavy Trichuris trichiura infection needed a second dose. Blood hemoglobin and serum total protein level in school children in Okharpauwa VDC increased significantly after chemotherapy (P < 0.05). Eosinophil count (10.1%; SD 5.0325) returned to normal (4.8%; SD 4.6997). Helminth infection in Boya VDC was more common in children than in adults. Serum total protein, albumin, total cholesterol and triglycerides levels were not influenced by the presence or absence of helminths among the inhabitants of Boya VDC. In both districts, more than 80.0% of the household had no latrine. In Boya VDC, 94.0% of inhabitants interviewed were not aware of other intestinal parasite other than A. lumbricoides.

Cryptosporidium infection in HIV-seropositive and seronegative populations in southern Thailand

The prevalence of Cryptosporidium infection in 61 HIV-seropositive and 61 HIV-seronegative subjects (aged less than one to 67-year-old) in Songkhla City, southern Thailand was studied by a centrifugal flotation technic using sucrose solution. Most of the HIV-seropositive subjects (72%) were 20 to 39 years old. Cryptosporidium oocysts were detected in 10% (6/61) of HIV-seropositive and in 2% (1/61) of HIV-seronegative subjects. Infection rates in these two groups, however, were not statistically significant (p > 0.05). The number of Cryptosporidium oocysts observed in 20 microscopic fields ranged between one and over 12,000. Among the seven Cryptosporidium-positive subjects, six were adults (18 to 42-year-old) and one was three-year-old child. All of the Cryptosporidium infected subjects were male, and two of them were passing formed (normal) feces. Biochemical findings revealed dishepatica in five of six Cryptosporidium infected HIV-seropositive subjects.

Use of polymerase chain reaction in the diagnosis of toxocariasis: an experimental study

In this paper we report the usefulness of polymerase chain reaction technique in the diagnosis of visceral larva migrans in a mouse model. Liver samples obtained from two set of experimentally infected mice (10, 100, 1,000 and 10,000 embryonated Toxocara canis eggs per mouse) along with the eggs of T. canis, T. cati and Ascaris suum were included in this study. Polymerase chain reaction (PCR) was performed using Toxocara primers (SB12). The first PCR product electrophoresis revealed very thin positive bands or no bands in liver samples. However, on second PCR a clear-cut bands were observed. No positive band was shown by A. suum eggs. Our findings thus indicate the usefulness of PCR technic in the diagnosis of visceral larva migrans (VLM) in liver biopsy materials specifically by means of double PCR using the primer SB12.

Village health and sanitary profile from eastern hilly region, Nepal

A report on the health and sanitary status from Boya Village Development Committee (VDC) is presented as studied by a team of Nepali and Japanese investigators in 1996 and 1997. The purpose of this study was to find out the health and sanitary status in a remote hilly village in eastern Nepal. Data were collected from questionnaire and from a temporary field clinic. The number of households having latrine increased significantly (P < 0.05) in one year period but without significant impact on the reduction of intestinal helminth infection (P > 0.05). Ascaris lumbricoides was the commonest intestinal parasite followed by hookworm and others. Public piped water was accessible to 32.6% households while remaining 48.4% and 19.0% were using Dhara (natural tap) and Kuwa (sallow well) water, respectively. No association between the type of water source and gastro-enteritis was observed. The overall hygienic condition was poor. More than half of the residents first consult Dhami-Jhankri and Bijuwa (traditional/faith/shamanic healer) and believe on Devi-Deuta (local deities/divine spirit) and Bhut-Pret and/or Bayu (devils) and Boksi (witch) instead of visiting Health Post. Approximately one quarter of residents were smoker while two-third had habit of drinking alcohol. Medical complaint rate significantly increased from 59.6% in the year 1996 to 71.2% in 1997 (P < 0.01) and was attributed to conjunctivitis epidemic during second visit. Majority of complaints were gastrointestinal. People belonging to Tibeto-Burman ethnic group were found to consume meat relatively more frequently than Indo-Aryan.

Timed appearance of lymphocytic choriomeningitis virus after gastric inoculation of mice

Arenaviruses present an emerging health threat in agrarian areas of Africa and South America; however, the natural routes of arenaviral infections are not clearly understood. Our previous studies with lymphocytic choriomeningitis virus (LCMV), the prototype arenavirus, implicate oral and intragastric routes as natural routes of infection. Our studies raised many questions about the primary site of infection and the route of dissemination after gastric infection. In this report, we use in situ hybridization to detect LCMV in various organs at different time points (0 to 96 hours). After gastric inoculation, the gastric mucosa is the initial site of viral infection, followed by infection of the spleen and liver, then ileum and last, lung, kidney, brain, and esophagus. Furthermore, our observations suggest that virus is disseminated lymphatically rather than by a hematogenous route. Infectious center assays using mononuclear cells from stomach, blood, and spleen of mice infected by the gastric route confirmed active infection with LCMV and the presence of mononuclear cells producing infectious virus in these tissues. This is the first identification of gastric epithelia as a primary site of virus infection.

Restoration of MHC class I surface expression and endogenous antigen presentation by a molecular chaperone

Presentation of cytosolic peptides in the context of major histocompatibility complex (MHC) class I antigen is crucial for immune recognition of virus-infected and malignant cells. This process, which is often defective in cancer cells, involves a series of cellular events which may be facilitated by heat shock proteins (molecular chaperones). To address the influence of chaperone function on the presentation of cytosolic peptides, we have utilized B16 melanoma cells (H-2b). These tumour cells are resistant to lysis by MHC class I-restricted cytotoxic T lymphocytes (CTL), due to a very low level of surface MHC expression. The authors found that stably transfected clones of B16 expressing a heterologous heat shock protein (Hsp65) exhibit significantly increased levels of MHC class I antigens on their surface, and are effectively lysed by alloreactive CTL. These MHC class I molecules can form functional MHC-peptide complexes which are recognized by virus-specific CTL. Moreover, mice immunized with Hsp65-expressing tumour cells, but not with control-transfected tumour cells, display a significantly increased resistance to a subsequent challenge with live, wild-type B16. Together, these results indicate that the suitable expression of a molecular chaperone can overcome a defect in MHC class I expression and antigen presentation, and suggest a novel approach to cancer immunotherapy.

Murine infection with lymphocytic choriomeningitis virus following gastric inoculation

Laboratory studies of arenaviruses have been limited to parenteral routes of infection; however, recent epidemiological studies implicate virus ingestion as a natural route of infection. Accordingly, we developed a model for oral and gastric infection with lymphocytic choriomeningitis virus to enable studies of mucosal transmission and vaccination by this additional route.

Seroepidemiological study of Toxoplasma infection in central and western regions in Nepal

The present study was carried out to ascertain the seroprevalence rate in different geographical areas in Central and Western Regions in Nepal. A total of 1,237 serum samples collected from Nuwakot (217), Kathmandu valley (402) and Chitawan (159) districts in Central Region, and Mustang (143), Surkhet (64) and Banke (252) districts in Western Region in Nepal were included in this study. Toxoplasma antibodies were detected by micro-latex agglutination (MLA) and enzyme linked immunosorbent assay (IgM-ELISA) methods. The seropositive rate in Central and Western Regions were found to be 48% and 49%, respectively; with an overall positive rate of 48 percent. Districtwise, the seropositive rate in Nuwakot, Kathmandu valley, Chitawan, Mustang, Surkhet and Banke districts were 38, 46, 64, 51, 67 and 44%, respectively. Interestingly, the relatively newly inhabited Surkhet district in Western Region and Chitawan district in Central Region showed significantly higher seropositive rate compared with those of two other districts in the respective Regions (p < 0.05). Ethnically, Tibeto-Burmans showed higher seropositive rates in Central Region (p > 0.05). In contrast, Indo-Aryans showed higher seropositive rate in Western Region (p > 0.05). Age related increase in seropositivity was observed only in Central Region. One percent of Toxoplasma antibody positive samples also showed Toxoplasma IgM antibody positivity.

Seroepidemiological study of Toxocara infection in Nepal

Seroepidemiological study of Toxocara infection in Nepalese people aged more than fourteen years was carried out by enzyme linked immunosorbent assay (ELISA) using T. canis soluble embryonated egg antigen. Of the total 200 subjects included in this study, 162 (81%) were found to possess antibodies to Toxocara spp. Males showed higher (85%) antibody positive rates than females (77%). Inhabitants of Kathmandu valley showed higher antibody positive rates (84%) compared with those living outside of the valley (78%). These differences, however, were not significant statistically (p > 0.05). Ethnically, Newar, Rai/Limbu, Tamang/Sherpa, Brahmin/Chhetri, Jha/Yadavs, and others (Kami, Damai) showed Toxocara antibody positive rates of 85, 85, 83, 70, 77 and 100%, respectively. Half of the Toxocara antibody positive subjects (49%) showed an elevated level (two plus) of antibody.

The use of PCR in detecting toxoplasma parasites in the blood and brains of mice experimentally infected with Toxoplasma gondii

Polymerase chain reaction (PCR) has been extensively used for diagnosis recently because of its very high sensitivity and specificity. We studied the applicability of PCR to the early diagnosis of toxoplasmosis in a murine model orally infected with Toxoplasma gondii (S-273). PCR was performed using EH24 and HE27 primers synthesized by the phosphoramidite method. Mice blood and brains collected on various post infection days (PID) were analysed by PCR (35 cycles). A portion of the brain tissue from each mouse was examined microscopically for the presence of parasite cysts. Blood and brain PCR were positive on the 9th and 12th day post-infection (DPI). Toxoplasma cysts in brain tissue appeared only on the 18th PID. The results showed that Toxoplasma parasites can be detected earlier in the blood than in the brain during primary infection, indicating that blood PCR is the more useful procedure.

Seroprevalence of hepatitis B and C viruses in eastern Nepal

The seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in 303 serum samples collected from that apparently healthy population inhabitating different areas in eastern Nepal was studied. Samples were collected at Dharan Municipality, Sunsari85), Pancha Kanya Village Development Committee, Ilam86), Dhankuta Hile, Dhankuta82) and Basantapur Village Development Committee, Tehrathm50). HBsAg and anti-HBsAg antibody was screened by reverse passive haemagglutination (RPHA) and passive haemagglutination (PHA) respectively and positivity was confirmed by enzyme linked immunosorbent assay (ELISA). Anti-HCV antibody was detected by ELISA. None of the samples were positive for HBsAg. Anti-HBsAg antibody was positive in 1.9% (6/303). The positive rate increased with age reaching 25% positivity among the elderly. The anti-HBsAg antibody positivity was 2.35, 2.32, 1.22 and 2.00 in Dharan, Ilam, Dhankuta and Tehrathum respectively Anti-HCV antibody was detected only in one sample (15-year-old boy) collected in Dharan. These findings indicate that the HBV and HCV infections are not active in eastern Nepal.

Immunoglobulin M and G antibodies in mice in response to Toxoplasma gondii (S-273) infection and their antigen recognition patterns in western blotting on various post-infection days

Immunoglobulin M and G antibody responses in mice experimentally infected with Toxoplasma gondii (S-273) and the reaction patterns with T. gondii (RH) tachyzoite antigens were studied on various post-infection days (PIDs) (2nd to 36th PIDs) using a commercially available IgM and IgG enzyme linked immunosorbent assay (ELISA) test systems and Western blotting (WB) technique. IgM antibody in ELISA test appeared to be positive on 12th PID (absorbance 0.764) and reached its peak level on 16th PID (absorbance 1.338) showing a slow decline thereafter with an absorbance of 0.800 even on 36th PID. Positivity of IgM was confirmed by WB except for 36th PID. IgG appeared on 16th PID with an absorbance of 0.248 and showed a steady increasing tendency even on 36th PID (absorbance 1.747). However, IgG positivity on WB was observed only on 29th PID and afterwards. On Western blots, both IgM and IgG showed interesting antigen recognition patterns on various PIDs. At the most IgM recognised seven antigens of 14kDa to 53kDa while IgG recognised eight antigens of 17kDa to 53kDa. Major antigens recognised by IgM were of 53kDa and 21kDa while the major band recognised by IgG was of 19kDa. The major bands, however, showed variability in their consistency during various PIDs. All the antigens recognised by IgM and IgG were not identical.

Seroepidemiological study of toxoplasmosis in two different geographical areas in Nepal

A total of 302 serum samples collected from Chitawan (159) and Mustang (143) districts of Nepal were included in this study. Anti-toxoplasma antibody was detected using micro-latex agglutination (MLA) and ELISA methods. An overall positive rate was found to be 57.9%. The positive rate in Chitawan was significantly higher (64.1%) (less than 1,000 m altitude) compared to that in Mustang (51.0%) (more than 3,000 m altitude) (p < 0.05). Females in Chitawan showed significantly higher positive rate (71.2%) compared to males (56.9%) (p < 0.05). On the contrary, though insignificantly, males showed higher positive rate (57.9%) compared to that of females (43.3%) in Mustang. Almost equal positive rate was observed among males in both study area. Females in Chitawan showed significantly higher (71.2%) positive rate compared to their counterparts in Mustang (43.3%) (p < 0.001). A slight increase in positive rate with age was observed in Chitawan while in Mustang a decreasing trend was noticed. Ethnically though statistically not significant, Indo-Aryans showed a higher positive rate (69.2%) compared to the positive rate shown by Tibeto-Burmans (63.1%) in Chitawan while the reverse was true in Mustang (Tibeto-Burmans: 53.8% and Indo-Aryans: 38.4%). Interestingly, 2.9% and 1.3% of MLA positive samples showed toxoplasma IgM antibody. None of the IgM positive samples were positive for toxoplasmic antigens.

Status of soil-transmitted helminthic infection in Nepal

A retrospective evaluation of the status of soil-transmitted helminthic infection in Nepal during the period from 1985 to 1992 was conducted at the Parasitology Laboratory, Department of Pathology, TU Teaching Hospital in Kathmandu. An average of 6,537 faecal samples were examined each year for the presence of various types of intestinal parasites. The annual rate of positivity of these samples for soil-transmitted helminthiasis ranged from 18.0 to 36.6%. The annual incidence decreased every successive calendar year in both adults and children, irrespective of sex. Among the various types of helminths, the most common was Ascaris lumbricoides (roundworm), followed by hookworm. The incidence of A. lumbricoides remained constant throughout the study period, while that of other parasites markedly decreased each year.

Serological study of Japanese encephalitis in Nepal

Antibodies against Japanese encephalitis virus (JEV) were examined in 356 serum samples from individuals visiting Tribhuvan University Teaching Hospital using neutralization test. A total of 13.2% (47/356) seropositivity was observed. Antibody positivity against both Nakayama-NIH and Beijing-1 strains was seen in 7.9% subjects. Infection by Nakayama-NIH strain alone was seen to be 4.2% while 1.1% of study populations were found to be infected only by Beijing-1 strain. High antibody titer was observed in the 20-40 years age-group and did not increase with age. Seropositivity was more common in zone-A (Tarai) area compared to zone-B (Hills) and zone-C (Mountains). Spectrum of antigenicity of JEV in zone-A as shown by neutralization test was identical to Indian isolates (strains). Difference in seropositivity was observed against Nakayama-NIH and Beijing-1 strain in zone-B and C indicating recent spread of JEV in these areas.

Seroepidemiology status of Nepalese against hemolytic streptococcal infection in Katmandu

Immune status of apparently healthy Nepalese against hemolytic streptococci was studied by measuring antibodies to various streptococcal antigens such as streptolysin-O (SO), streptokinase (SK), deoxyribonuclease-B (DN-B) and streptococcal polysaccharide (SP). The normal range of anti-streptolysin-O (ASO), anti-streptokinase (ASK), anti-deoxyribonuclease-B (ADN-B) and anti-Streptococcus polysaccharide (ASP) was 60-480 (T.U.), 40-1024 (titer), 60-1280 (titer) and less than 2-128 (Unit), respectively. No difference was observed between the two sexes. ASO and ADN-B were measured by the neutralization method. Passive hemagglutination (PHA) was used to measure ASK and ASP. These values were 2-3 fold higher than those obtained on the Japanese subjects.

Serological and virological studies of Japanese encephalitis in the Terai region of Nepal

In 1987 and 1990, serum samples were collected from people living in the two districts (Itahari and Chitwan) of the Terai region of Nepal. Antibodies against Japanese encephalitis (JE) virus in these sera were detected by the hemagglutination inhibition (HI) and neutralization (N) tests. By the HI test, 26 out of 172 (15.1%) sera from Chitwan and 15 out of 137 (10.9%) sera from Itahari showed positive titers. Higher positive rates were shown by the N test, where 46 out of 172 (26.7%) sera from Chitwan and 22 out of 137 (16.1%) sera from Itahari had antibodies against JE virus. A JE strain was isolated from a blood specimen of a pig raised in Kathmandu. When the nucleotide sequence of the pre-M region of the strain was compared to the same region of the other JE virus strains reported, the highest similarity was observed to the strains isolated in Nepal in 1985. These results suggest that the Terai region has been an epidemic area of JE.

Seroepidemiological study of herpes viruses in Nepal

The antibody positive rates among Nepalese, in a community, to herpes simplex virus (HSV), varicella-zoster virus (VZV) and cytomegalovirus (CMV) were studied. Immune adherence hemagglutination test (for VZV) and complement fixation test (for HSV and CMV) were used to measure the antibodies. An 80% positive rate of anti-HSV antibodies was found in early childhood (1-4 years) that further increased with age (96.1% positive in greater than 15 years age). Only 25% of children 1-4 years old showed antibodies to VZV but the number of positives increased rapidly with age (82.9% in greater than 15 years age). Antibody against CMV was positive in all the subjects studied.

Generation of reactive oxygen species by blood monocytes in human Plasmodium falciparum and P. vivax infections

Generation of reactive oxygen radicals by peripheral blood monocytes was measured by luminol-dependent chemiluminescence in 23 P. vivax- and 7 P. falciparum-infected patients. The chemiluminescence index (CLI) was not found to be significantly higher in P. vivax-infected cases than in healthy controls. But in patients with P. falciparum infection, the CLI was significantly higher compared to controls as well as to P. vivax-infected patients. In two severe and complicated P. falciparum-infected cases, CLI was found to be higher than in mild cases. As immunosuppression is more marked in falciparum malaria than in vivax cases, the role of oxygen radical generation in immunopathology and causation of immunosuppression in falciparum malaria needs further investigation.

Neurologic deficits associated with sacral wing fractures

Twelve of 96 patients with pelvic fractures suffered neurologic deficits. Four secondary to acetabular fractures were excluded from the study. Of the remaining eight, five were found by CT scan to be secondary to fractures of the sacral wing extending through the sacral foramina. On the basis of this study, it is believed that the neurologic injuries were due to sacral root injuries rather than lumbosacral plexus injuries. This concept potentially could lead to surgical approaches for decompression of sacral root trauma.

Comparative bacterial study of oral rehydration solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley

Result of bacterial study on Oral Rehydration Solution (ORS) prepared in plain unboiled and boiled drinking water of Kathmandu valley is reported. Of the total 100 water samples collected from different sources and area all the samples, as a base line study, were subjected for the examination of bacterial presence. Eighty eight percent of the water samples studied were found to be unsatisfactory for drinking. Thirty five percent of the ORS prepared in unboiled water and kept for 24 hours at room temperature showed increased bacterial count whereas none of the ORS prepared in 5 minute boiled water and kept for 24 hour at room temperature showed any bacterial growth. Decreased bacterial count was not found in any of the ORS prepared in unboiled water. Typical coliform bacilli were found grown in 57.0% of the ORS prepared in unboiled water samples.