1
|
Suwal R, Dev MK, Khatri B, Khadka D, Shrestha A, Sharma S, Upadhyay MP. Impact of active vision therapy compared to conventional patching therapy on visual acuity and stereoacuity in children with amblyopia. J Optom 2024; 17:100484. [PMID: 37866177 PMCID: PMC10785416 DOI: 10.1016/j.optom.2023.100484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/28/2023] [Accepted: 06/14/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To compare improvements in visual acuity (VA) and stereoacuity between active vision therapy (AVT) and conventional patching therapy in children with amblyopia. METHODS This study included 65 children aged 5 to 16 years (mean age±SD, 11.00±3.29 years) with unilateral amblyopia. Among them, 31 children underwent active vision therapy (AVT group), and 34 children underwent conventional patching therapy (patching group). AVT group underwent three sequential phases of AVT: Monocular phase (pursuit, saccades, fixation, visuomotor, eye-hand coordination, and central peripheral activities), biocular phase (diplopia awareness, antisuppression, monocular fixation in a binocular field, accommodative activities, bilateral integration, and fine motor activities) and binocular phase (fusion and stereopsis). Patching group patched their fellow eyes as per guidelines by Pediatric Eye Disease Investigator Group. Best-corrected monocular VA and stereoacuity were measured at baseline and after three months of therapy in both groups. RESULTS There were significant improvements in the mean acuities in amblyopic eye (AE) in both AVT (0.32±0.11 logMAR, p <0.001) and patching groups (0.27±0.19 logMAR, p ˂ 0.001). However, there was no significant difference in mean acuity gains in AE between AVT and patching groups (p = 0.059). Mean gains in stereoacuities (log seconds of arc) were statistically significant in both AVT (0.81±0.34, p < 0.001) and patching groups (0.32±0.34, p < 0.001). The stereoacuity gain in the AVT group was significantly higher compared to patching group (p < 0.001). CONCLUSION Active vision therapy had a better impact than conventional patching therapy in terms of improvement of stereoacuity but not in terms of VA when used for treating children with amblyopia.
Collapse
Affiliation(s)
- Rinkal Suwal
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal.
| | - Mahesh Kumar Dev
- School of Optometry and Vision Science, Queensland University of Technology, Australia
| | - Bijay Khatri
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Samata Sharma
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Madan Prasad Upadhyay
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| |
Collapse
|
2
|
Byanju R, Kandel RP, Poudyal B, Bhandari S, Ligal A, Pradhan S, Gautam M, Shrestha P, Sah RK, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay MP, Lietman TM, Keenan JD, O'Brien KS. Risk factors for corneal ulcers: a population-based matched case-control study in Nepal. Br J Ophthalmol 2023; 107:1771-1775. [PMID: 36202599 PMCID: PMC10076439 DOI: 10.1136/bjo-2022-322141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We aimed to examine risk factors for corneal ulcer in a rural and peri-urban setting in Nepal. METHODS This population-based matched case-control study was nested in a cluster randomised trial in 24 village development committees in Nepal. Incidence density sampling was used to match incident corneal opacity cases to controls, matching on time of opacity, age, sex and location. Cases and controls were invited to participate in a survey of risk factors for corneal ulcer. Risk factors were evaluated using conditional logistic regression to account for matching. RESULTS Of the 540 participants with incident opacities identified in the trial, 433 were willing to participate in this substudy and matched to a control. Compared with controls, cases had lower odds of having any education vs no education (adjusted OR, aOR 0.60, 95% CI 0.39 to 0.94), working in non-manual labour occupations vs manual labour occupations (aOR 0.64, 95% CI 0.42 to 0.95) and preferring medical shops for ocular trauma versus eye care system centres (aOR 0.58, 95% CI 0.37 to 0.92). Cases had higher odds of protective goggle use versus no protection (aOR 3.8, 95% CI 1.3 to 11.0) and having an ocular injury vs none (aOR 7.7, 95% CI 4.3 to 13.6) compared with controls. CONCLUSION We found ocular injury, manual labour and lower education to be strongly associated with the development of corneal ulcer. Given the persistent burden of corneal blindness in this area, prevention efforts could target efforts to increase access to care in areas where these factors are common.
Collapse
Affiliation(s)
| | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Nepal
- Seva Foundation, Berkeley, California, USA
| | | | | | - Anju Ligal
- Bharatpur Eye Hospital, Bharatpur, Nepal
| | | | | | | | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Jeremy David Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| |
Collapse
|
3
|
Suwal R, Rai L, Khadka D, Upadhyay MP. Regaining posture after active vision therapy in a case of adult anisometropic amblyopia with postural instability. Clin Exp Optom 2023; 106:686-689. [PMID: 35940169 DOI: 10.1080/08164622.2022.2107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Rinkal Suwal
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Laxmi Rai
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| | - Madan Prasad Upadhyay
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services (CHEERS), Bhaktapur, Nepal
| |
Collapse
|
4
|
Kharel Sitaula R, Khatri A, Karki P, Joshi SN, Gurung H, Shrestha E, Maharjan I, Sharma AK, Upadhyay MP. Classification of Seasonal Hyperacute Panuveitis (SHAPU). Ocul Immunol Inflamm 2022; 30:1751-1755. [PMID: 34214018 DOI: 10.1080/09273948.2021.1944646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Classification are essential part of scientific methodology and has important role in medical reporting system. Even after having 46 years long history, Seasonal Hyperacute Panuveitis (SHAPU), the blinding diseases reported mainly from Nepal lacks a standard classification system. Thus, we aim to contribute in the ophthalmic nosology by purposing a classification system for SHAPU. METHODOLOGY The classification is suggested on the background of prolonged experience of this entity by the group of investigators who have dedicated years of research on this topic. CONCLUSION We are optimistic that the proposed classification system will help in effective planning and evaluation of this ocular emergency condition and deliver the appropriate and reliable information for timely management and prevention of complications.
Collapse
Affiliation(s)
- Ranju Kharel Sitaula
- Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu, Nepal
| | - Anadi Khatri
- Vitreoretinal Surgeon and Clinical Chief, Birat Aakha Aspatal, Lecturer, Birat Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Pratap Karki
- Department of Ophthalmology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | - Sagun Narayan Joshi
- Deptartment of Ophthalmology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | | | - Eliya Shrestha
- Himalaya Eye Hospital, Eye Care Foundation, Pokhara, Nepal
| | | | - Ananda K Sharma
- Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu, Nepal
| | - Madan Prasad Upadhyay
- Tribhuvan University, Chair Emeritus BP Eye Foundation, Children Hospital for Eye ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| |
Collapse
|
5
|
Shrestha R, Khatri B, Majhi S, Kayastha M, Suwal B, Sharma S, Suwal R, Adhikari S, Shrestha J, Upadhyay MP. Screen time and its correlates among children aged 3–10 years during COVID-19 pandemic in Nepal: a community-based cross-sectional study. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001052. [PMID: 36161845 PMCID: PMC9402449 DOI: 10.1136/bmjophth-2022-001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to determine the prevalence of high screen time among schoolchildren aged 3–10 years in Bhaktapur, its correlates and the parents’ strategies to reduce screen time during the COVID-19 pandemic in Nepal. Methods and analysis This cross-sectional descriptive study was conducted during March 2021. A total of 630 households were selected for the study from 21 randomly selected clusters in Bhaktapur, Nepal. Correlates of high screen time were determined using a logistic model. P<0.002 was taken as significant. Results Among all the participants, the mean (SD) age was 7.0 (2.2) years, with 50.3% male participation. Few participants had online classes (n=24, 3.8%). The prevalence of high screen time among the participants was very high (55.2%, 95% CI=51.3% to 59.1%), which is even higher in boys (61.8%, 95% CI=58.0% to 65.6%). The median screen time before the COVID-19 pandemic was 1.0 hours (mean rank=275.8) which increased to 2.2 hours (mean rank=116.6) during the pandemic (p<0.001). Participants having smartphones were about seven times (adjusted OR=6.9, 95% CI=1.5 to 31.3, p=0.013) more likely to have high screen time than those who did not have the device. Most parents used to reprimand and urge their children to play outside to limit their screen usage. Conclusion During the COVID-19 pandemic, about one in two schoolchildren of 3–10 years had higher screen time than before the COVID-19 pandemic. Parents’ strategies to reduce screen time were not effective. An intervention study is recommended to design and test effective strategies to reduce screen time and its negative effects on children’s health.
Collapse
Affiliation(s)
- Rajan Shrestha
- Academic and Research Department, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Sangita Majhi
- Academic and Research Department, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Manish Kayastha
- Academic and Research Department, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Barsha Suwal
- Department of Ophthalmology, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Samata Sharma
- Department of Ophthalmology, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Rinkal Suwal
- Vision Therapy, Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Santoshi Adhikari
- Ethical Review, Monitoring and Evaluation Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Junu Shrestha
- Central Department of Public Health, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | - Madan Prasad Upadhyay
- Hospital for Children Eye ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| |
Collapse
|
6
|
Khatri B, Kayastha M, Shrestha R, Bhattarai JR, Majhi S, Upadhyay SK, Upadhyay MP, Kafle KK. Diabetes Mellitus among Adult Outpatients Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:592-595. [PMID: 36705205 PMCID: PMC9297346 DOI: 10.31729/jnma.7027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 06/25/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Diabetes mellitus is a chronic metabolic disease characterised by elevated blood sugar levels and is a pandemic of public health importance. Screening programs can help reduce morbidity and mortality by preventing or delaying complications. This study aimed to find out the prevalence of diabetes mellitus among adult outpatients visiting a tertiary care centre. Methods This descriptive cross-sectional study was conducted among outpatients visiting a tertiary care centre between 1 January 2019 to 31 December 2019. Ethical approval was obtained from the Ethical Review Board (Registration number: 408/2020 P). Patients with unknown history of diabetes participating in free random blood sugar examinations were included in the study. Systematic random sampling was used. Point estimate and 95% Confidence Interval were calculated. Results Among 385 adult outpatients, 17 (4.42%) (2.37-6.47, 95% Confidence Interval) had diabetes. The mean random blood sugar level of the diabetic patients was 281.41±57.49 mg/dl. Conclusions The prevalence of diabetes mellitus among adult outpatients was similar to previous studies conducted in similar settings. Random blood sugar test in hospital outpatient settings is feasible to identify people with diabetes mellitus. Keywords diabetes mellitus; hospital; Nepal; outpatient.
Collapse
Affiliation(s)
- Bijay Khatri
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal,Correspondence: Mr Bijay Khatri, Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal. , Phone: +977-9841463005
| | - Manish Kayastha
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Rajan Shrestha
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Janak Raj Bhattarai
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Sangita Majhi
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Sanjib Kumar Upadhyay
- B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Madan Prasad Upadhyay
- B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | | |
Collapse
|
7
|
Upadhyay MP, Upadhyay SK, Bhattarai JR, Khatri B, Shrestha R. Abdominal Obesity among Outpatients in a Tertiary Level Eye ENT Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:63-67. [PMID: 35199664 PMCID: PMC9157661 DOI: 10.31729/jnma.7253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction: Abdominal obesity, as abnormal fat accumulation that presents a risk to health, is a global epidemic. There is evidence to support a trait of abdominal adipose deposition despite normal body mass index in south asian populations with greater cardiometabolic risks. Thus, this study aimed to find out the prevalence of abdominal obesity using the waist to height ratio among outpatients in a tertiary level hospital.
Methods: This descriptive cross-sectional study was conducted among outpatients at a tertiary level hospital in Nepal from January 2016 to December 2018. Ethical approval was taken from the Ethical Review Board of Nepal Health Research Council (Reference no. 207/2019). Convenience sampling was done. The data were entered into excel and analyzed using Statistical Package for Social Sciences version 24. Point estimate at 99% confidence interval was calculated along with frequency and proportion for binary data.
Results: Among 25,511 participants, 21,834 (85.6%) (85.0- 86.2 at 99% Confidence Interval) participants had abdominal obesity using Waist-to-Height Ratio, higher in women 12,397 (86.4%) than men 9,437 (84.5%). The mean age of the participants was 53.37±13.15 years and more than half 17,075 (55.7%) of all participants were female.
Conclusions: The prevalence of abdominal obesity among hospital outpatients is higher than in other community-based studies. As hospitals attract large crowds and provide excellent opportunities for screening patients, their attendants, as well as providing opportunities for health promotion, we recommend the introduction of opportunistic obesity screening in all health facilities using weight to height ratio in a phased manner.
Collapse
Affiliation(s)
- Madan Prasad Upadhyay
- BP Eye Foundation, Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur, Nepal
| | - Sanjib Kumar Upadhyay
- BP Eye Foundation, Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur, Nepal
| | - Janak Raj Bhattarai
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services, Bhaktapur, Nepal
| | - Rajan Shrestha
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services, Bhaktapur, Nepal
- Correspondence: Mr. Rajan Shrestha, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services, Bhaktapur, Nepal. , Phone: +977-9860916172
| |
Collapse
|
8
|
Shrestha R, Upadhyay SK, Khatri B, Bhattarai JR, Kayastha M, Upadhyay MP. BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital outpatients: a cross-sectional, non-inferiority study. BMJ Open 2021; 11:e050096. [PMID: 34824112 PMCID: PMC8628118 DOI: 10.1136/bmjopen-2021-050096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This non-inferiority study aimed to determine the burden of obesity in a hospital outpatient setting of a developing country, using three commonly employed metrics as predictors of hypertension (HTN). DESIGN A cross-sectional study design was adopted. SETTING This study was conducted in Health Promotion and Risk Factor Screening Services of a tertiary hospital for eye and ear, nose, throat in a semiurban area of Nepal. PARTICIPANTS 2256 randomly selected outpatients between 40 and 69 years old. OUTCOME MEASURES The three obesity metrics and HTN were analysed for association using correlation, the area under the receiver operating characteristic (ROC) curve and ORs. RESULTS The prevalence of obesity or overweight by body mass index (BMI) was 58.29%; by waist-to-height ratio (WHtR) was 85.95%, high waist circumference (WC) was observed among 66.76% of participants. Female participants had a greater prevalence of high WC (77.46%) than males (53.73%) (p<0.001). Prevalence of HTN and pre-HTN were 40.67% and 36.77%, respectively. The areas under the ROC curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602) and WC (0.610). CONCLUSION This study showed that WHtR and WC measured were not inferior to BMI as a metric for obesity detection and HTN prediction. Because of its low cost, simplicity of measurement and better ability to predict HTN, it may become a more usable metric in health facilities of low-income and middle-income countries.
Collapse
Affiliation(s)
- Rajan Shrestha
- Hospital for Children, Eye, ENT and Rehabilitation Services, Academic and Research Department, B P Eye Foundation, Bhaktapur, Bagmati, Nepal
| | - Sanjib Kumar Upadhyay
- Hospital for Children, Eye, ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| | - Bijay Khatri
- Hospital for Children, Eye, ENT and Rehabilitation Services, Academic and Research Department, B P Eye Foundation, Bhaktapur, Bagmati, Nepal
| | - Janak Raj Bhattarai
- Hospital for Children, Eye, ENT and Rehabilitation Services, Academic and Research Department, B P Eye Foundation, Bhaktapur, Bagmati, Nepal
| | - Manish Kayastha
- Hospital for Children, Eye, ENT and Rehabilitation Services, Academic and Research Department, B P Eye Foundation, Bhaktapur, Bagmati, Nepal
| | - Madan Prasad Upadhyay
- Hospital for Children, Eye, ENT and Rehabilitation Services, B P Eye Foundation, Bhaktapur, Nepal
| |
Collapse
|
9
|
Gurung H, Kharel Sitaula R, Karki P, Khatri A, Khanal B, Joshi SN, Maharjan I, Upadhyay MP. Sporadic summer outbreak of SHAPU in even years: Does the pattern match with the usual autumn outbreak? Am J Ophthalmol Case Rep 2021; 24:101198. [PMID: 34522825 PMCID: PMC8427219 DOI: 10.1016/j.ajoc.2021.101198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/26/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Seasonal Hyperacute Panuveitis (SHAPU), is a mysterious blinding disease seen only in Nepal with a higher prevalence among children usually seen in autumn every alternate odd year since 1975. This report highlights the sporadic summer outbreak in the even years with atypical presentation. Observations Three patients were diagnosed as SHAPU in the summer (May) of 2020. All of them noted the presence of white moths (Gazalina species) in their environment with or without direct physical contact. The clinical patterns were severe in nature including corneal melting. Two out of three patients (66.6%) developed phthisis bulbi and lost their vision. Conclusions and importance White moth has been associated as a risk factor for SHAPU. Despite the known natural history of appearance after monsoon of every odd year, the few unhatched eggs of the moths may hatch under the favorable circumstances in the summer of the even years and may lead to the sporadic outbreak of SHAPU. Though less in numbers, the clinical presentation of such sporadic SHAPU cases may be atypical with less favorable outcome.
Collapse
Affiliation(s)
| | - Ranju Kharel Sitaula
- Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | - Pratap Karki
- Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | - Anadi Khatri
- Birat Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Bhaiya Khanal
- Natural History Museum, Tribhuvan University, Kathmandu, Nepal
| | - Sagun Narayan Joshi
- Dept of Ophthalmology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | | | - Madan Prasad Upadhyay
- Tribhuvan University, Chair Emeritus BP Eye Foundation, Children Hospital for Eye ENTand Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| |
Collapse
|
10
|
Kharel Sitaula R, Khatri A, Janani MK, Mandage R, Sadhu S, Madhavan HN, Upadhyay MP, Biswas J. Unfolding COVID-19: Lessons-in-Learning in Ophthalmology. Clin Ophthalmol 2020; 14:2807-2820. [PMID: 33061265 PMCID: PMC7532306 DOI: 10.2147/opth.s259857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023] Open
Abstract
Importance An observant Chinese doctor Li Wenliang became the first physician to alert the world about COVID-19. Being an ophthalmologist himself, he has put the additional onus on us. The fact that the ocular manifestation could be the first presenting feature of novel coronavirus pneumonia should not be ignored and the possibility of spread of SARS-CoV-2 through the ocular secretions cannot be ruled out. However, with breakthroughs still evolving about this disease, the calls are now louder for closer examination on the pathogenesis of conjunctivitis associated with it. Hence, we conducted a scoping review of all available literature till date to fill in the "potential" gaps in currently available knowledge on ocular manifestations of SARS-CoV-2 infection in an attempt to establish continuity in the "chain of information" from December 2019 till April 2020. We also summarize a possible hypothesis on much less understood and highly debated topics on regard to the etiopathogenesis of ocular involvement in SARS-CoV-2 based on either presence or absence of ACE2 receptor in the ocular surface. Methods We conducted a scoping review search of published and unpublished SARS-CoV-2-related English language articles from December 2019 till mid of April 2020 from the online databases. The findings were summarized using text, tables, diagrams, and flowcharts. Results The commonest ocular manifestation in SARS-CoV-2 infection is follicular conjunctivitis and has been the first manifestation of SARS-CoV-2 infection in 3 reported cases till date. The ocular surface inoculated with the SARS-CoV-2 leads to the facilitation of the virus to the respiratory system via the lacrimal passage. RT-PCR analysis of the ocular secretions has shown the presence of the SARS-CoV-2 nucleotides indicating the possibility of infection of ocular secretions. ACE2 receptors and its expression on the ocular mucosal surface are linked behind the etiopathogenesis of conjunctivitis. Conclusion Conjunctivitis can be the presenting manifestation but may go unnoticed due to its mild nature. The ocular surface could serve as the entry gateway for the virus and ocular secretions could play a role in virus shed. The eye care personnel, as well as the general people, need to be more vigilant and adopt protective eye measures.
Collapse
Affiliation(s)
- Ranju Kharel Sitaula
- Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - M K Janani
- Sankara Nethralaya Referral Laboratory, Medical Research Foundation, Chennai, India
| | - Rajendra Mandage
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Soumen Sadhu
- Department of Optometry, The SankaraNethralaya Academy, Unit of Medical Research Foundation, Chennai, India
| | - H N Madhavan
- Larson & Turbo Microbiology Research Center, Sankara Nethralaya Referral Laboratory, Chennai, India
| | - Madan Prasad Upadhyay
- Children Hospital for Eye, Ear Nose Throat and Rehabilitation Services, Bhaktapur, Nepal
| | - Jyotirmay Biswas
- Department of Uvea and Ocular Pathology, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India
| |
Collapse
|
11
|
Upadhyay MP, Kharel Sitaula R, Manandhar A, Gower EW, Karki P, Gurung H, Maharjan I, Reuben S, Karmacharya BM, Joshi SN. The Risk Factors of Seasonal Hyperacute Panuveitis. Ophthalmic Epidemiol 2020; 28:250-257. [PMID: 32981405 DOI: 10.1080/09286586.2020.1820533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Seasonal Hyperacute Panuveitis (SHAPU) is an eye disease of unclear aetiology occurring cyclically during the autumn in odd years in Nepal causing blindness within a week. This study is the first of its type to investigate the risk factors of SHAPU. METHODS A multicentric national level case-control study was performed during the 2017 SHAPU outbreak. Cases were matched to controls in a 1:3 ratio based on age, sex and geographic area.Questionnaire-based personal interview was used and risk factors were categorized as biological and behavioral. For univariate analysis, frequency, median and interquartile range was calculated. Chi-squared test with/without continuity correction and Fisher's exact test were used. Multivariate conditional logistic regressions were used for all the independent variables for p <0.1 in the univariate analyses. RESULTS We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79-17.01,p < .001). CONCLUSIONS Direct physical contact with butterflies/moths was associated with significantly increased odds of SHAPU cases.
Collapse
Affiliation(s)
- Madan Prasad Upadhyay
- Professor and HOD Ophthalmology, Tribhuvan University, Chair Emeritus BP Eye Foundation, Children Hospital for Eye ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Ranju Kharel Sitaula
- Uveitis Specialist, Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | - Anu Manandhar
- Consultant Ophthalmologist, Uveitis SpecialistAssociate Professor, NAMS Tilganga Institute of Ophthalmology, Gaushala, Bagmati Bridge, Kathmandu, Nepal
| | - Emily W Gower
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Pratap Karki
- Uveitis Specialist, Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| | - Haramaya Gurung
- Consultant Ophthalmologist and retina specialist, Himalayan Eye Hospital, Pokhara, Nepal
| | - Indraman Maharjan
- Consultant Ophthalmologist and retina specialist, Himalayan Eye Hospital, Pokhara, Nepal
| | - Sameul Reuben
- WHO Health Emergencies Programme (WHE), WHO Country Office for Nepal
| | - Biraj Man Karmacharya
- Public Health and Community Programs, Associate Professor, Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sagun Narayan Joshi
- Uveitis Specialist, Department of Ophthalmology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, B. P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|
12
|
Bhattarai D, Gnyawali S, Silwal A, Puri S, Shrestha A, Kunwar MB, Upadhyay MP. Student-led screening of school children for refractive error correction. Ophthalmic Epidemiol 2017; 25:133-139. [PMID: 28937870 DOI: 10.1080/09286586.2017.1371767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Detection and correction of uncorrected refractive errors among 12 million children is an overwhelming task for the 500 currently available eye-care professionals in Nepal. A mid-term review of VISION 2020 goals in Nepal has recommended utilizing alternative human resources that could screen children for visual impairment. This study was conducted to assess the validity of vision screening of school children by trained high school students when compared to optometrist testing as the gold standard. METHODS A total of 150 students were selected, based on their merit by the headmasters of 25 schools in Nepal and trained for two days by optometrists to screen visual acuity of their peers. Visual acuity ≤ 6/12 in either eye was referred as abnormal vision. A random sample of 1,209 screened students was selected and their visual acuity was reassessed by optometrists under the same settings adopted by trained students. Using optometrist scores as the gold standard, screening results of trained students were analyzed for validity. RESULTS Mean age of screened students was 12.2 ± 3.03 years (range: 4-19 years) and 57.4% of them were female. Sensitivity of vision screening test done by trained students was 81.7% and the specificity was 97.6%. A positive predictive value of the test was 77.3% and negative predictive value was 98.2%. CONCLUSIONS With high sensitivity and specificity values, vision screening done by trained students is effective for screening visual acuity of school children. Countries with limited eye-care professionals and infrastructures can effectively train and utilize students for timely detection of poor vision among children.
Collapse
Affiliation(s)
- Dipesh Bhattarai
- a Institute of Health and Biomedical Innovation & School of Optometry and Vision Science , Queensland University of Technology , Brisbane , Australia.,b B P Eye Foundation , Children Hospital for Eye ENT and Rehabilitation Services , Bhaktapur , Nepal
| | - Subodh Gnyawali
- b B P Eye Foundation , Children Hospital for Eye ENT and Rehabilitation Services , Bhaktapur , Nepal
| | - Arpan Silwal
- b B P Eye Foundation , Children Hospital for Eye ENT and Rehabilitation Services , Bhaktapur , Nepal
| | - Sudan Puri
- c College of Optometry , University of Houston , Houston , Texas , USA
| | - Anita Shrestha
- d School of Economics , University of Queensland , Brisbane , QLD , Australia
| | - Man Bahadur Kunwar
- e Department of Community Medicine and Public Health , Institute of Medicine, Tribhuvan University , Kathmandu , Nepal
| | - Madan Prasad Upadhyay
- b B P Eye Foundation , Children Hospital for Eye ENT and Rehabilitation Services , Bhaktapur , Nepal
| |
Collapse
|
13
|
Pokharel PK, Budhathoki SS, Upadhyay MP. Teaching District Concept of BP Koirala Institute of Health Sciences: An Inter-disciplinary Community Based Medical Education and Health Service Delivery Model in Rural Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:294-298. [PMID: 28814699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community based education trains health professional students to deal with the community health problems. The attitude and skills they gain as planners for health care provision are applicable in both hospital and community settings. BP Koirala Institute of Health Sciences has implemented a model of Community based education which encompasses the health institutions, organisations and the communities of the sixteen districts in eastern Nepal and refers to this concept as the 'Teaching District" concept of B P Koirala Institute of Health Sciences. This paper seeks to describe the concept and its implementation. Almost 20 years have passed since first initiated; and pending a comprehensive evaluation, this concept has gathered a great deal of experience to serve as a model for partnership between academic health sciences institutions with the district health system of Nepal.
Collapse
Affiliation(s)
- P K Pokharel
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - S S Budhathoki
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | |
Collapse
|
14
|
Hii J, Thakur GD, Marasini BR, Pokhrel YR, Upadhyay MP, Rija KR, Adhikar NR, Pant SK, Ortega L, Singh N, Ghimire P. Monitoring the durability of long-lasting insecticidal nets in field conditions in Nepal. WHO South East Asia J Public Health 2014; 3:81-84. [PMID: 28607260 DOI: 10.4103/2224-3151.206891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field is critical for the success of malaria prevention using mosquito nets, as well as contributing to procurement decisions based on the number of years of protection, rather than the current practice of unit cost. Using the recently published guidelines from the World Health Organization (WHO) some progress has been made in the monitoring and assessment of performance of nets in the field. This paper describes the protocol of an ongoing retrospective study of the attrition rate, physical integrity and bioefficacy of three polyester LLIN products that were distributed during 2010 to 2013 in Nepal. It is hoped that robust and auditable data on net survival (physical integrity and bioefficacy) of these three brands in different environments will assist the Nepal National Malaria Control Programme in planning future LLIN-replacement strategies, including behaviour-change communication about LLIN care and maintenance. The advantages and disadvantages of prospective and retrospective cross-sectional approaches are discussed, including appropriate strategies to validate the timing for mass distribution of nets. Similar studies should be done in other countries to (i) track LLIN durability to support management of resupply, and (ii) inform procurement decisions at the global level. New, more predictive, textile laboratory testing is also urgently needed.
Collapse
Affiliation(s)
- J Hii
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Australia
| | - G D Thakur
- Epidemiology and Disease Control Division, Department of Population Health, Kathmandu, Nepal
| | - B R Marasini
- Epidemiology and Disease Control Division, Department of Population Health, Kathmandu, Nepal
| | - Y R Pokhrel
- Epidemiology and Disease Control Division, Department of Population Health, Kathmandu, Nepal
| | - M P Upadhyay
- Epidemiology and Disease Control Division, Department of Population Health, Kathmandu, Nepal
| | - K R Rija
- Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - N R Adhikar
- Kantipur College of Medical Sciences, Kathmandu, Nepal
| | - S K Pant
- Vector-Borne Disease Research and Training Center, Department of Population Health, Hetauda, Nepal
| | - L Ortega
- Country Office and South-East Regional Offices, World Health Organization, Nepal and India
| | - N Singh
- Country Office and South-East Regional Offices, World Health Organization, Nepal and India
| | - P Ghimire
- Country Office and South-East Regional Offices, World Health Organization, Nepal and India
| |
Collapse
|
15
|
Shrestha JB, Gnyawali S, Upadhyay MP. Causes of Blindness and Visual Impairment among Students in Integrated Schools for the Blind in Nepal. Ophthalmic Epidemiol 2012; 19:401-6. [DOI: 10.3109/09286586.2012.722245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Abstract
DOI: 10.3126/nepjoph.v2i1.3696 Nep J Oph 2010;2(1):1-2
Collapse
|
17
|
Srinivasan M, Upadhyay MP, Priyadarsini B, Mahalakshmi R, Whitcher JP. Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics. Br J Ophthalmol 2006; 90:1472-5. [PMID: 16916874 PMCID: PMC1857535 DOI: 10.1136/bjo.2006.103028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To determine whether topical antifungal prophylaxis distributed by paid village health workers (VHWs) in south India is necessary after corneal abrasion to prevent fungal keratitis in a population where half of the ulcers are fungal. METHODS Two panchayaths (village administrative units in Madurai district with a combined population of 48 039 were followed prospectively for 18 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions. Patients fulfilling the eligibility criteria were randomised into two groups and treated with either 1% chloramphenicol and 1% clotrimazole ointment or 1% chloramphenicol and a placebo ointment three times a day for 3 days. Patients, doctors and VHWs were blinded to treatment. RESULTS During the 18-month period, 1365 people reported to VHWs with ocular injuries, of whom 374 with corneal abrasions were eligible for treatment. Of these, 368 (98.5%) abrasions healed without complications. Two patients had mild localised allergic reactions to the ointment, two dropped out and two patients in the placebo group developed microscopic culture-negative corneal stromal infiltrates that healed in 1 week with natamycin drops. CONCLUSIONS Both fungal and bacterial ulcers that occur after traumatic corneal abrasions seem to be effectively prevented in a village setting using only antibiotic prophylaxis.
Collapse
Affiliation(s)
- M Srinivasan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
18
|
Maung N, Thant CC, Srinivasan M, Upadhyay MP, Priyadarsini B, Mahalakshmi R, Whitcher JP. Corneal ulceration in South East Asia. II: a strategy for the prevention of fungal keratitis at the village level in Burma. Br J Ophthalmol 2006; 90:968-70. [PMID: 16707522 PMCID: PMC1857195 DOI: 10.1136/bjo.2006.094706] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To prove that topical antifungal and antibiotic prophylaxis distributed by grass roots village health workers (VHWs) in Burma is an effective public health intervention for the prevention of post-traumatic microbial keratitis in a population where the majority of ulcers are fungal. METHODS Three villages in Bago District with a combined population of 16,987 were selected for the study. This defined population was followed prospectively for 12 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria. RESULTS During the 12 month period 273 individuals reported to VHWs with an ocular injury and 126 were found to have a corneal abrasion. All 126 were treated with 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days, and all healed without sequelae. CONCLUSIONS Both fungal and bacterial ulcers that occur following traumatic corneal abrasions can be effectively prevented in a village setting by using relatively simple measures that local volunteer public health workers can easily be taught to employ.
Collapse
Affiliation(s)
- N Maung
- Trachoma Control and Prevention of Blindness Programme, Department of Health, Yangon, Burma
| | | | | | | | | | | | | |
Collapse
|
19
|
Getshen K, Srinivasan M, Upadhyay MP, Priyadarsini B, Mahalaksmi R, Whitcher JP. Corneal ulceration in South East Asia. I: a model for the prevention of bacterial ulcers at the village level in rural Bhutan. Br J Ophthalmol 2006; 90:276-8. [PMID: 16488943 PMCID: PMC1856957 DOI: 10.1136/bjo.2005.076083] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To prove that antibiotic distribution by grassroots volunteer village health workers (VVHWs) in Bhutan is an effective and efficient public health intervention for the prevention of post-traumatic corneal ulceration. METHODS 55 villages in two districts in Bhutan were selected for the study. A defined population of 10 139 individuals was followed prospectively for 18 months by 31 VVHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria. RESULTS During the 18 month period 135 individuals reported to VVHWs with an ocular injury and 115 were found to have a corneal abrasion. All 115 were treated with 1% chloramphenicol ointment three times a day for 3 days and all healed without sequelae CONCLUSIONS Corneal ulcers that occur following traumatic corneal abrasions can be effectively prevented, even in the setting of isolated rural conditions such as those that exist in villages in Bhutan, by using relatively simple preventative measures that local VVHWs can easily be taught to employ.
Collapse
Affiliation(s)
- K Getshen
- Jigme Dorji Wangchuk National Referral Hospital, Thimu, Bhutan
| | | | | | | | | | | |
Collapse
|
20
|
Rai SK, Upadhyay MP, Shrestha HG. Toxoplasma infection in selected patients in Kathmandu, Nepal. Nepal Med Coll J 2003; 5:89-91. [PMID: 15024774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Seroprevalence of Toxoplasma infections in 272 patients with ocular diseases (uveitis, retinochoroiditis), malignancy (including leukemia), women with bad obstetric history (BOH) and others (patients with fever, lymphadenitis and encephalitis) have been was studied. Toxoplasma antibodies were detected by microlatex agglutination and IgM ELISA techniques. Overall, 50.7% (138/272) patients included in this study had Toxoplasma antibodies, out of which 5.7% (8/138) had IgM antibodies. Patients with malignancy had highest positive rate [68.7% (22/32)] followed by group of others. Of the different groups, women with BOH had highest Toxoplasma IgM positive rate [25.0%; (2/8)].
Collapse
Affiliation(s)
- Shiba Kumar Rai
- Department of Microbiology, Nepal Medical College, Attarkhel, Jorpati-7, Post Box No. 13344, Kathmandu, Nepal.
| | | | | |
Collapse
|
21
|
Abstract
This hospital-based study highlights the spectrum of eye ailments in 35,273 patients who attended the Department of Ophthalmology at the B P Koirala Institute of Health Sciences, Eastern Nepal, during a 5-year period with varied clinical diagnosis. The attendance each year showed a progressive increase with a male preponderance. More than 13% of the patients were children. Cataract was the most common problem for which patients needed ophthalmic advice; diabetic and hypertensive retinopathy were frequent occurrences and infection was a common problem. Over 21% of the eyes examined had a refractive error: as high as 2.54% were amyblyopic caused by non-correction of refractive errors. Allergic conjunctivitis was frequently encountered. As shown by the magnitude of the problem, the existing eye care facilities must be enhanced and new strategies developed.
Collapse
Affiliation(s)
- Anita Panda
- Department of Ophthalmology, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | | | | | | | | |
Collapse
|
22
|
Upadhyay MP, Karmacharya PC, Koirala S, Shah DN, Shakya S, Shrestha JK, Bajracharya H, Gurung CK, Whitcher JP. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol 2001; 85:388-92. [PMID: 11264124 PMCID: PMC1723912 DOI: 10.1136/bjo.85.4.388] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine the incidence of ocular trauma and corneal ulceration in the district of Bhaktapur in Kathmandu Valley, and to determine whether or not topical antibiotic prophylaxis can prevent the development of ulceration after corneal abrasion. METHODS A defined population of 34 902 individuals was closely followed prospectively for 2 years by 81 primary eye care workers who referred all cases of ocular trauma and/or infection to one of the three local secondary eye study centres in Bhaktapur for examination, treatment, and follow up by an ophthalmologist. All cases of ocular trauma were documented and treated at the centres. Individuals with corneal abrasion confirmed by clinical examination who presented within 48 hours of the injury without signs of corneal infection were enrolled in the study and treated with 1% chloramphenicol ophthalmic ointment to the injured eye three times a day for 3 days. RESULTS Over the 2 year period there were 1248 cases of ocular trauma reported in the population of 34 902 (1788/100 000 annual incidence) and 551 cases of corneal abrasion (789/100 000 annual incidence). The number of clinically documented corneal ulcers was 558 (799/100 000 annual incidence). Of the 442 eligible patients with corneal abrasion enrolled in the prophylaxis study, 424 (96%) healed without infection, and none of the 284 patients who were started on treatment within 18 hours after the injury developed ulcers. Four of the 109 patients (3.7%) who presented 18-24 hours after injury developed infections, and 14 (28.6%) of the 49 patients who presented 24-48 hours subsequently developed corneal ulceration. CONCLUSIONS Ocular trauma and corneal ulceration are serious public health problems that are occurring in epidemic proportions in Nepal. This study conclusively shows that post-traumatic corneal ulceration can be prevented by topical application of 1% chloramphenicol ophthalmic ointment in a timely fashion to the eyes of individuals who have suffered a corneal abrasion in a rural setting. Maximum benefit is obtained if prophylaxis is started within 18 hours after injury.
Collapse
Affiliation(s)
- M P Upadhyay
- Bhaktapur Eye Study, BP Koirala Lions Center for Ophthalmic Studies, Tribhuvan University Institute of Medicine and Teaching Hospital, Kathmandu, Nepal.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ 2001; 79:214-21. [PMID: 11285665 PMCID: PMC2566379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Diseases affecting the cornea are a major cause of blindness worldwide, second only to cataract in overall importance. The epidemiology of corneal blindness is complicated and encompasses a wide variety of infectious and inflammatory eye diseses that cause corneal scarring, which ultimately leads to functional blindness. In addition, the prevalence of corneal disease varies from country to country and even from one population to another. While cataract is responsible for nearly 20 million of the 45 million blind people in the world, the next major cause is trachoma which blinds 4.9 million individuals, mainly as a result of corneal scarring and vascularization. Ocular trauma and corneal ulceration are significant causes of corneal blindness that are often underreported but may be responsible for 1.5-2.0 million new cases of monocular blindness every year. Causes of childhood blindness (about 1.5 million worldwide with 5 million visually disabled) include xerophthalmia (350,000 cases annually), ophthalmia neonatorum, and less frequently seen ocular diseases such as herpes simplex virus infections and vernal keratoconjunctivitis. Even though the control of onchocerciasis and leprosy are public health success stories, these diseases are still significant causes of blindness--affecting a quarter of a million individuals each. Traditional eye medicines have also been implicated as a major risk factor in the current epidemic of corneal ulceration in developing countries. Because of the difficulty of treating corneal blindness once it has occurred, public health prevention programmes are the most cost-effective means of decreasing the global burden of corneal blindness.
Collapse
Affiliation(s)
- J P Whitcher
- Proctor World Blindness Center, Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, Box 0944, 95 Kirkham Street, San Francisco, CA 94143-0944, USA.
| | | | | |
Collapse
|
24
|
Abstract
Diseases affecting the cornea are a major cause of blindness worldwide, second only to cataract in overall importance. The epidemiology of corneal blindness is complicated and encompasses a wide variety of infectious and inflammatory eye diseses that cause corneal scarring, which ultimately leads to functional blindness. In addition, the prevalence of corneal disease varies from country to country and even from one population to another. While cataract is responsible for nearly 20 million of the 45 million blind people in the world, the next major cause is trachoma which blinds 4.9 million individuals, mainly as a result of corneal scarring and vascularization. Ocular trauma and corneal ulceration are significant causes of corneal blindness that are often underreported but may be responsible for 1.5-2.0 million new cases of monocular blindness every year. Causes of childhood blindness (about 1.5 million worldwide with 5 million visually disabled) include xerophthalmia (350,000 cases annually), ophthalmia neonatorum, and less frequently seen ocular diseases such as herpes simplex virus infections and vernal keratoconjunctivitis. Even though the control of onchocerciasis and leprosy are public health success stories, these diseases are still significant causes of blindness--affecting a quarter of a million individuals each. Traditional eye medicines have also been implicated as a major risk factor in the current epidemic of corneal ulceration in developing countries. Because of the difficulty of treating corneal blindness once it has occurred, public health prevention programmes are the most cost-effective means of decreasing the global burden of corneal blindness.
Collapse
Affiliation(s)
- J P Whitcher
- Proctor World Blindness Center, Francis I. Proctor Foundation for Research in Ophthalmology, University of California at San Francisco, Box 0944, 95 Kirkham Street, San Francisco, CA 94143-0944, USA.
| | | | | |
Collapse
|
25
|
Snellingen T, Shrestha JK, Huq F, Husain R, Koirala S, Rao GN, Pokhrel RP, Kolstad A, Upadhyay MP, Apple DJ, Arnesen E, Cheng H, Olsen EG, Vogel M. The South Asian cataract management study: complications, vision outcomes, and corneal endothelial cell loss in a randomized multicenter clinical trial comparing intracapsular cataract extraction with and without anterior chamber intraocular lens implantation. Ophthalmology 2000; 107:231-40. [PMID: 10690817 DOI: 10.1016/s0161-6420(99)00008-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine clinical outcomes of primary intracapsular cataract surgery with and without implantation of anterior chamber lenses. DESIGN A multicenter randomized clinical trial. PARTICIPANTS One thousand two hundred twenty-nine male and female patients 40-75 years of age with senile cataract. METHODS Study patients were recruited from screening eye camps and outpatient clinics. Randomization to the two treatment groups was performed after screening for predetermined inclusion and exclusion criteria. Demographics, visual acuity, intraocular pressures, and corneal endothelial cell data were recorded before surgery and at 6 weeks, 12 months, and 24 months after surgery. Monitoring of the study was secured by a standardized image documentation procedure on all patients using the IMAGEnet digital imaging system. Analysis of corneal endothelial cell images was performed with the Cell Soft software (Topcon Corporation, Japan). MAIN OUTCOME MEASURES Visual acuity and central corneal endothelial cell loss. RESULTS The patients were randomized to intraocular lens (IOL; n = 616) and no IOL (n = 613) implantation. Surgical complications were reported in 177 (14.4%) patients (IOL = 14.8%; no IOL = 14.0%). The most frequent complication observed was vitreous loss which occurred in 10.3% of eyes (IOL = 11.2%; no IOL = 9.5%). At the final examination (2 years after surgery), 88% of the operated eyes had a best corrected vision of 6/18 or better (IOL = 88.8%; no IOL = 86.6%). Analysis of corneal endothelial cell data showed a small but significantly greater cell loss 6 weeks after surgery in eyes with IOL compared with those without IOL, but no overall difference was found between the treatment groups in the long term follow-up. CONCLUSIONS The findings indicate that there is a rationale for the use of anterior chamber intraocular lenses in primary intracapsular cataract surgery.
Collapse
Affiliation(s)
- T Snellingen
- Department of Ophthalmology, Institute of Clinical Medicine, University of Tromsø, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Snellingen T, Shrestha BR, Gharti MP, Shrestha JK, Upadhyay MP, Pokhrel RP. Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract management study. Br J Ophthalmol 1998; 82:1424-8. [PMID: 9930276 PMCID: PMC1722440 DOI: 10.1136/bjo.82.12.1424] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have shown that, despite an increasing availability of cataract surgery, important socioeconomic barriers exist in the acceptance of surgery in many rural areas of south Asia. Nepal has developed a comprehensive national network of eye hospitals but the surgical coverage for the treatment of cataract blind is still low. AIMS To determine the utilisation of cataract surgery and the level of physical and psychosocial impairment and the socioeconomic barriers to surgery in a group of non-acceptors of surgery. METHODS Of 319 cataract patients identified in a field screening 96 non-acceptors of surgery were interviewed 1 year after an offer to undergo surgery. The interview included questions on visual function, quality of life, and socioeconomic variables on acceptance of cataract surgery. The quality of life questionnaire was based on the field validated protocol addressing the impact of visual impairment on physical and psychosocial functions. The questionnaire was adapted to the local conditions after pretesting. Data were analysed by degree of visual impairment. RESULTS Of 319 cataract patients identified only 45.5% accepted surgery, with men accepting surgery more readily than women (RR = 1.31; 95% CI = 1.04-1.67) because of a significantly greater acceptance of surgery in men in the non-blind group. The acceptance rate was significantly higher in the blind group (RR = 1.74; 95% CI = 1.36-2.22) compared with those patients having impairment of vision and severe loss of vision. Of 96 non-acceptors interviewed only a further 13% accepted surgery after a second counselling. The most frequent reasons given for not accepting surgery were economic (48%) and logistical (44.8%) constraints followed by fear of surgery (33.3%) and lack of time (18.8%). Half of the subjects complained of problems with self care but only 10% needed help for their most basic every day activities. 17.7% said they needed help to visit neighbours and 26% needed help to attend the field or market. CONCLUSIONS It was found that in this population with a majority of patients with severe vision loss and blind, even when offered transport and free surgery the utilisation of cataract surgery is below 60%. Medicine tends to be prescriptive based on technological advances that it is able to offer. Medical practice needs to develop a more holistic understanding of the needs of the communities cultivating a greater capability to analyse the role of cultural, social, and economic factors when planning medical services for the population.
Collapse
Affiliation(s)
- T Snellingen
- Institute of Clinical Medicine, University of Tromsø, Norway
| | | | | | | | | | | |
Collapse
|
27
|
Rai SK, Nakanishi M, Upadhyay MP, Rai CK, Hirai K, Ohno Y, Shrestha HG, Ono K, Uga S, Matsumura T. Effect of intestinal helminth infection on some nutritional parameters among rural villagers in Nepal. Kobe J Med Sci 1998; 44:91-8. [PMID: 10036863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- S K Rai
- Department of Medical Zoology, Kobe University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Rai SK, Kubo T, Yano K, Shibata H, Sumi K, Matsuoka A, Uga S, Matsumura T, Hirai K, Upadhyay MP, Basnet SR, Shrestha HG, Mahajan RC. Seroepidemiological study of Toxoplasma infection in central and western regions in Nepal. Southeast Asian J Trop Med Public Health 1996; 27:548-53. [PMID: 9185267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- S K Rai
- Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Upadhyay MP, Karmacharya PC, Koirala S, Tuladhar NR, Bryan LE, Smolin G, Whitcher JP. Epidemiologic characteristics, predisposing factors, and etiologic diagnosis of corneal ulceration in Nepal. Am J Ophthalmol 1991; 111:92-9. [PMID: 1985498 DOI: 10.1016/s0002-9394(14)76903-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Corneal ulceration is one of the most frequent causes of blindness in developing countries. Between September 1985 and August 1987, 405 patients with corneal ulceration were examined at Tribhuvan University Teaching Hospital in Kathmandu, Nepal. Males and females were equally affected. The most common predisposing cause of ulceration was corneal trauma, usually with organic agricultural materials. Microorganisms were grown from 324 (80%) of the ulcers. Pure bacterial cultures were obtained from 256 (63.2%) of the patients, whereas pure fungal cultures were obtained from 27 (6.7%) of the patients. In 41 patients (10.1%), corneal cultures yielded a mixed growth of bacteria and fungi. Of a total of 398 bacterial isolates, 124 (31.1%) were positive for Streptococcus pneumoniae, the most commonly isolated organism in the series. Other frequently isolated bacteria included Staphylococcus epidermidis, S. aureus, and Pseudomonas species. Of 68 positive fungal isolates obtained, 32 (47.0%) were identified as Aspergillus species. Candida species and Fusarium species were less commonly seen.
Collapse
Affiliation(s)
- M P Upadhyay
- Department of Ophthalmology, Tribhuvan University, Kathmandu, Nepal
| | | | | | | | | | | | | |
Collapse
|
30
|
Larsson S, Shrestha MP, Pokhrel BM, Upadhyay MP, Shrestha KB. The glutaraldehyde test as a rapid screening method for pulmonary tuberculosis: a preliminary report. Ann Trop Med Parasitol 1990; 84:111-7. [PMID: 2116775 DOI: 10.1080/00034983.1990.11812443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
When equal parts of EDTA-blood and 2.5% glutaraldehyde solution were mixed, a shorter gelification time was observed in blood from patients with pulmonary tuberculosis--diagnosed by clinical and X-ray examination--than in blood from patients with other respiratory diseases or with non-respiratory diseases, or from healthy volunteers. Of a total of 539 persons tested, 267 had pulmonary tuberculosis as judged by clinical and X-ray examination and 238 of these reacted positively to the glutaraldehyde test with a gelification time of less than 10 minutes. When clinical examination and X-ray evaluation are used as bases for the diagnosis of pulmonary tuberculosis, the glutaraldehyde test gives a sensitivity of 89% and a specificity of 95%. It is suggested that this simple and cheap method, together with clinical examination, might be a useful screening tool for identifying cases of pulmonary tuberculosis in peripheral health posts in developing countries where X-ray and other facilities are lacking.
Collapse
Affiliation(s)
- S Larsson
- Department of Community Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | | | | |
Collapse
|
31
|
Abstract
A nationwide sample survey was conducted between July 1980 and June 1981 to determine the prevalence of xerophthalmia among Nepalese children. Population proportionate random samples were drawn from the 12 geopolitical subdivisions of the country by employing multistage sampling technique. The survey population was defined as the child population of rural Nepal between the ages of 0 and 14 years. The per cent prevalence of xerophthalmia in Nepal was 1.65 for Bitot's spots, 0.02 for corneal ulcer, and 0.03 for corneal scar. While cases of Bitot's spots were more prevalent in the plains of Nepal, followed by the mountains and the hills, the reverse was true for corneal lesions. Vitamin A deficiency was found to be responsible for one-third of acquired bilateral blindness in preschool children. All corneal cases in the study were accompanied by diarrhea and malnutrition, indicating xerophthalmia to be symptomatic of the whole spectrum of malnutrition.
Collapse
|
32
|
Abstract
In Southern Nepal 100 eyes were examined on which a couching operation (reclination of the lens) had been performed by "quacks". The postoperative period extended from 1 month to more than 10 years. At the time of the examination 42 eyes were found to be blind; 26 of these were still blind immediately after the operation or went blind again during the following 6 months. In the eyes in which vision was preserved throughout the first postoperative year, subsequent loss of vision was less than 10% a year. These surgical results may not appear desirable but they are at least acceptable considering that the couching had been performed in regions of Nepal where modern ophthalmic care is not yet available.
Collapse
|
33
|
Upadhyay MP, Rai NC, Ogg JE, Shrestha BR. Seasonal hyperacute panuveitis of unknown etiology. Ann Ophthalmol 1984; 16:38-44. [PMID: 6703576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A severe form of unilateral uveitis, which in most cases leads to blindness within hours of its onset, has been seen in Nepal since 1975. This disease appears with the onset of autumn in early September and lasts until the end of December in two-year cycles (1975, 1977, 1979). However, some cases occurred in 1980 as well. As expected there was an outbreak of this disease in 1981. Although early cases were seen in patients from Western Nepal, the disease has since been identified in patients from various parts of the country. In one of the outbreaks (1977) in western Nepal some patients or their parents gave a history of a white moth sitting on the child's face or arm prior to the onset of ocular symptoms. Some of these were claimed to be followed by blister formation at the point of contact. These moths were presumed to be responsible for producing this uveitis in those cases. The present report describes the clinical features of the cases seen from the time the disease was first recognized, case histories of four cases seen during the last outbreak, results of laboratory experiments using the aqueous humor of these patients, and the results of experiments using three different varieties of moths.
Collapse
|
34
|
Abstract
In Kathmandu, Nepal, 133 cases of corneal ulcers were examined and scraped by the investigators during 1981. Corneal ulcers were seen to be more common in females during the active years of life, occurring more frequently during monsoon and autumn seasons. Trauma by vegetative matter was the common antecedent. Organisms were grown in about 50.0% of the cases. Bacteria were seen to be responsible in about 75.0%, and fungi in about 25.0% of growth-positive cases. Sensitivity tests in vitro showed that carbenicillin, chloramphenicol, cephaloridine, methicillin, and lincomycin were most effective against bacteria and clotrimazole was most effective against fungi.
Collapse
|
35
|
Abstract
A case of Aspergillus flavus keratitis treated successfully with 4% suspension of thiabendazole is reported. This seems to be the first case of successful treatment of keratomycosis with thiabendazole. All other reported cases treated with this drug either had their eyes removed or did not retain any useful vision. Its ability to penetrate ocular tissues, ability to remain in concentrations higher than the minimal inhibitory concentration of many fungi, and broad spectrum of activity make it a worthwhile drug for further investigation in keratomycosis.
Collapse
|
36
|
Gnyawali S, Bhattarai D, Upadhyay MP. Utilization of primary eye health services by people from a rural community of Nepal. Nepal J Ophthalmol 1970; 4:96-101. [DOI: 10.3126/nepjoph.v4i1.5859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Preventable and treatable eye diseases are still major causes of blindness in rural communities. Objective: To find the factors influencing utilization of primary eye health services among the people in a rural community of Nepal. Materials and methods: This was a population-based study with a cross-sectional and descriptive design. Lete Ilaka in Mustang District of Nepal was the study site. Data of knowledge on eye diseases, availability of services and utilization of available services were obtained from female care takers. Association among variables was observed by bivariate analysis. Results: A total of 216 female care takers participated in the study. The median age of the respondents was 39 years. Almost 80 % of the respondents had agriculture as their major occupation and more than a quarter were from lower castes (dalit) community. Low level of educational attainment (OR = 3.1, 95 % CI = 1.6-6.1) and poverty (OR = 2.0, 95 % CI = 1.13-3.43) among respondents were found to be significantly associated with a low level of awareness on eye diseases. The risk of not knowing about eye diseases increased more than 3.5 times when people were illiterate. Locally available eye health services and skills amongst the health workers were found inadequate. Conclusion: Low level of education, poor knowledge of eye diseases and great distance from home to health facilities were found to be factors on the demand side while inadequacy of eye health services and perceived inadequate skills among health workers were identified as factors in the supply side affecting utilization of eye health services among people of Mustang District. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5859 NEPJOPH 2012; 4(1): 96-101
Collapse
|