Distribution and treatment needs of soil-transmitted helminthiasis in Bangladesh: A Bayesian geostatistical analysis of 2017-2020 national survey data

BACKGROUND

In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups.

METHODOLOGY

Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups.

PRINCIPAL FINDINGS

The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh.

CONCLUSIONS/SIGNIFICANCE

For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence.

Prevalence and intensity of soil-transmitted helminth infections in Uganda: Results from population-based prevalence surveys in five districts

BACKGROUND

Soil-transmitted helminth (STH) infections are caused by roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and hookworms (Necator americanus and Ancylostoma duodenale). In Uganda, baseline surveys conducted during the late 1990s and early 2000s suggested STH infections were common, with prevalence >50% among surveyed schoolchildren. In 2003, a national program was launched with mass preventative chemotherapy (PC) and health education for children 1-14 years old. Little evidence is available to show the impact of national deworming.

METHODS

We conducted population-based, cross-sectional household surveys in five districts (Buikwe, Kassanda, Kiryandongo, Kisoro, and Rubanda) in March and May 2022. Our primary objective was to estimate STH prevalence by species due to infections of any intensity and infections of moderate-to-heavy intensity among preschool-aged children (PSAC, 1-4 years old), school-aged children (SAC, 5-14 years old), and women of reproductive age (WRA, 15-49 years old). Laboratory technicians used duplicate Kato-Katz microscopy to determine fecal egg count.

RESULTS

Overall, 3,352 PSAC; 3,884 SAC; and 1,226 WRA provided stool samples. The prevalence of any infection remained high in Kisoro at or above ~50% within all risk groups. In other districts, the prevalence of any infection ranged from approximately 5 to 16% among PSAC, 6 to 23% among SAC, and 12 to 19% among WRA. Moderate-to-heavy intensity infection prevalence was highest in Kisoro (~15-26%), followed by Rubanda (<5%), and was ≤1% in other districts. A. lumbricoides and T. trichiura infections were largely confined to Kisoro and Rubanda, whereas hookworm was most common in other districts.

CONCLUSIONS

The STH prevalence has decreased markedly in three districts in Uganda. Based on our findings, the national deworming program should consider decreasing PC distribution frequency in these districts per the World Health Organization guidelines. Efforts are needed to understand why the Kisoro and Rubanda districts did not demonstrate similar gains.

Community-wide prevalence and intensity of soil-transmitted helminthiasis and Schistosoma mansoni in two districts of Sierra Leone

In Sierra Leone, nationally powered school-based surveys have documented significant progress in the control of soil-transmitted helminthiasis (STH) and schistosomiasis. In order to assess the district-level prevalence and intensity of infection among key at-risk groups outside of school age children (SAC), we conducted a multi-stage, cluster-sample household survey in Bo and Kenema districts in May 2018. From both districts, we examined 1,282 pre-school age children (PSAC), 730 school age children (SAC), and 517 adults over 14 years (including 387 women of reproductive age, or WRA) for STH and Schistosoma mansoni infection using Kato Katz technique. In Bo, STH prevalence was 8.0% (95% Upper Confidence Limit 10.2%) in PSAC, 6.4% (95% Upper Confidence Limit 9.0%) in SAC, 14.1% (95% Upper Confidence Limit 17.4%) in all adults and 11.9% (95% Upper Confidence Limit 17.4%) in WRA. In Kenema, STH prevalence was 18.1% (95% Upper Confidence Limit 20.5%) in PSAC, 17.3% (95% Upper Confidence Limit 20.7%) in SAC, and 16.9% (95% Upper Confidence Limit 20.5%) in all adults and 16.9% (95% Upper Confidence Limit 22.6%) in WRA. Hookworm species were the most prevalent of STH in both districts overall. The overall prevalence of S. mansoni was <10% in Bo and <20% in Kenema, and was similar across age groups. No moderate or heavy intensity STH infections or heavy intensity S. mansoni infections, as per World Health Organization (WHO) classification, were detected in either district. Sanitation variables, such as toilet access and quality, were independently associated with STH and S. mansoni infection. In Kenema, STH prevalence in SAC was within the WHO-defined range for annual treatment, whereas a previous nationally-powered survey estimated it to lie within the range of treatment once per two years. By utilizing community-based sampling, we were able to assess prevalence among WRA and make recommendations based on current guidance from WHO. To continue toward elimination of STH and S. mansoni as a public health problem, resources should be mobilized to increase access to and uptake of improved sanitation at community and household levels.

Perception of Medical Students Regarding TU-IOM MBBS Curriculum and Teaching Learning Methods in Nepal

Background The present Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum under Tribhuvan University - Institute of Medicine (TU-IOM) was last revised twelve-years back. Though the curriculum was built upon internationally approved recommendations on curriculum design, it is ineffectively practiced in most medical schools of Nepal with major focus on didactic teaching-learning. The curriculum, hence, needs effective implementation and revision. Objective To identify the strengths, weaknesses, and areas of improvement in the medical curriculum through student-based feedback and outline the possibility of incorporating newer evidence-based teaching-learning methodologies in Nepal. Method This is a descriptive and cross-sectional study. With appropriate ethical approval, a questionnaire was developed and disseminated virtually to all medical students of Nepal under TU from MBBS fourth year onwards. The questionnaire comprised of Likert and close-ended questions. The data analysis was followed after receiving the filled questionnaire through Google forms. Result A total of 337 respondents participated in the study. The most effectively implemented components out of the SPICES model were Integrated learning (I) and Communitybased learning (C), with 73.89% and 68.84% responses. There were 94.7% (319) students who favored the incorporation of research in the core curriculum. Only 34.2% (115) students found PowerPoint lectures, the most utilized form of teachinglearning in Nepal, as engaging. The respondents (84.6%) showed a high degree of readiness to incorporate newer evidence-based teaching-learning tools such as flipped learning, blended learning, and peer-to-peer learning. Conclusion This study shows that effective interventions must be rethought on various aspects of the curriculum, taking students' feedback on the table while considering curricular revision.

Post-intervention epidemiology of STH in Bangladesh: Data to sustain the gains

In 2008, Bangladesh initiated Preventive Chemotherapy (PCT) for school-age children (SAC) through bi-annual school-based mass drug administration (MDA) to control Soil-Transmitted Helminth (STH) infections. In 2016, the Ministry of Health and Family Welfare’s Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact assessments with Children Without Worms (CWW) using standardized, population-based sampling to measure the post-intervention STH burden across all ages (≥ 1 yr) for the three STH species. The Integrated Community-based Survey for Program Monitoring (ICSPM) was developed by CWW and was used to survey 12 districts in Bangladesh from 2017–2020. We excluded the first two district data as piloting caused some sampling errors and combined the individual demographic and parasite-specific characteristics from the subsequent 10 districts, linking them with the laboratory data for collective analysis. Our analysis identified district-specific epidemiologic findings, important for program decisions. Of the 17,874 enrolled individuals, our results are based on 10,824 (61.0%) stool samples. Overall, the prevalence of any STH species was substantially reduced to 14% from 79.8% in 2005. The impact was similar across all ages. STH prevalence was 14% in 10 districts collectively, but remained high in four districts, despite their high reported PCT coverage in previous years. Among all, Bhola district was unique because it was the only district with high T.trichuris prevalence. Bangladesh successfully lowered STH prevalence across all ages despite targeting SAC only. Data from the survey indicate a significant number of adults and pre-school age children (PSAC) were self-deworming with purchased pills. This may account for the flat impact curve across all ages. Overall prevalence varied across surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible service and ecological factors. Discrepancies in the impact between districts highlight the need for district-level data to evaluate program implementation after consistent high PCT coverage.

Bangladesh government conducted school-based mass drug administration (MDA) for over 10 years to control soil-transmitted helminth (STH) infections. School-based evaluations of MDA indicate a reduction in STH burden among school-aged children (SAC). To further assess the impact on the community, Children Without Worms and the Ministry of Health and Family Welfare’s Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact surveys in 12 districts. We share the results from the latter 10 districts here (the first two pilots were excluded because of possible sampling errors).

Our analysis of 10,824 interviews and stool samples from 10 districts showed an estimated 14% of community members infected with at least one species of STH. This finding is substantially lower than the baseline STH prevalence (79.8%) estimated in 2005. Bangladesh’s successful impact was achieved across all ages despite only treating SAC. Deworming source data showed significant numbers of adults and pre-school age children (PSAC) self-dewormed with locally purchased pills. Prevalence varied across the surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible ecological and service factors contributing to persistent infections. Variable impact across districts highlights the need for sub-national level data to evaluate program performance following the consistent high intervention and could be attributable to many additional factors.

Visual conditions affecting eye growth alter diurnal levels of vitreous DOPAC

In chicks, the diurnal patterns of retinal dopamine synthesis and release are associated with refractive development. To assess the within-day patterns of dopamine release, we assayed vitreal levels of DOPAC (3,4-dihydroxyphenylacetic acid) using high performance liquid chromatography with electrochemical detection, at 4-h intervals over 24 h in eyes with experimental manipulations that change ocular growth rates. Chicks were reared under a 12 h light/12 h dark cycle; experiments began at 12 days of age. Output was assessed by modelling using the robust variance structure of Generalized Estimating Equations. Continuous spectacle lensdefocus or form deprivation: One group experienced non-restricted visual input to both eyes and served as untreated "normal" controls. Three experimental cohorts underwent monocular visual alterations known to alter eye growth and refraction: wearing a diffuser, a negative lens or a positive lens. After one full day of device-wear, chicks were euthanized at 4-h intervals over 24 h (8 birds per time/condition). Brief hyperopic defocus: Chicks wore negative lenses for only 2 daily hours either in the morning (starting at ZT 0; n = 16) or mid-day (starting at ZT 4; n = 8) for 3 days. Vitreal DOPAC was assayed. In chicks with bilateral non-restricted vision, or with continuous defocus or form-deprivation, there was a diurnal variation in vitreal DOPAC levels for all eyes (p < 0.001 for each). In normal controls, DOPAC was highest during the daytime, lowest at night, and equivalent for both eyes. In experimental groups, regardless of whether experiencing a growth stimulatory input (diffuser; negative lens) or growth inhibitory input (positive lens), DOPAC levels were reduced compared both to fellow eyes and to those of normal controls (p < 0.001 for each). These diurnal variations in vitreous DOPAC levels under different visual conditions indicate a complexity for dopaminergic mechanisms in refractive development that requires further study.

Multi-drug Resistant and Extended Spectrum β-lactamase Producing Salmonella Species Isolated from Fresh Chicken Liver Samples

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension.Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Endometrial Tuberculosis a Treatable Cause of Infertility

We present a case of 29 years lady with secondary infertility and amenorrhea. Her clinical findings were normal. Her hormone assays and ultrasonography was normal. She underwent hysteroscopy which showed atrophic endometrium and PCR for mycobacterium tuberculosis was sent which was reported positive for Mycobacterium tuberculosis. She was diagnosed as a case of Endometrial tuberculosis. Anti tuberculosis therapy was started for six months. After the completion of medical therapy she spontaneously conceived and delivered a healthy full term baby. Tuberculosis is a major public health problem among developing country like Nepal.

Induction of labor in Mid-Western Hospital in Nepal: Practice and Solution

 IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery. 

Perceptions of Medical Students About Bedside Teaching in a Medical School

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Perceptions of Medical Students About Bedside Teaching in a Medical School

INTRODUCTION

Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching.

METHODS

This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis.

RESULTS

Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient's uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study.

CONCLUSIONS

The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Microvessel density in Prostatic Lesions : Relevance to prognosis

Background:  Angiogenesis is required for growth and metastasis of tumor tissue. Quantization of angiogenesis by calculating the microvessel density can be done in histopathology specimens with the help of immunochemistry. In this study we used anti CD 34 antibody to highlight the endothelial cells and thus calculate microvessel density. Most studies have shown a positive correlation of microvessel density with increasing pathological grade and have also shown microvessel density as an independent predictor of cancer progression and survival. The present study was to find out the microvessel density in benign and malignant lesions of prostate and also to correlate the vascularity with increasing grade of cancer.Materials and methods:  Sixty five prostatic biopsies were evaluated for microvessel density using CD34 monoclonal antibody. Comparison was done between BPH and Carcinoma Prostate. MVD was correlated with Gleason’s score, weight of specimen and increasing age of patient. Effect of prostatitis on Microvessel density was studied.Results: Microvessel density was significantly higher in carcinoma prostate than in Benign Prostatic Hyperplasia. There was positive correlation of Microvessel density with increasing Gleason’s score. Microvessel was significantly increased in patients having symptoms for more than a year and also with biopsies revealing prostatitis. However, there was no significant correlation between Microvessel density and weight of specimen or increasing age.Conclusion: Since Microvessel density was found to be significantly higher in Prostatic Carcinoma and it showed positive correlation with Gleason’s score it can be added as one of the indicators for predicting the disease outcome. 

Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis

BACKGROUND

Whether behavioral approaches for self-management programs benefit individuals with type 1 diabetes mellitus is unclear.

PURPOSE

To determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect.

DATA SOURCES

6 electronic databases (1993 to June 2015), trial registries and conference proceedings (2011 to 2014), and reference lists.

STUDY SELECTION

36 prospective, controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs.

DATA EXTRACTION

One reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE).

DATA SYNTHESIS

Moderate SOE showed reduction in glycated hemoglobin (HbA1c) at 6 months after the intervention compared with usual care (mean difference, -0.29 [95% CI, -0.45 to -0.13] percentage points) and compared with active controls (-0.44 [CI, -0.69 to -0.19] percentage points). At the end of the intervention and 12-month follow-up or longer, there were no statistically significant differences in HbA1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (-0.28 [CI, -0.57 to 0.01] percentage points) than did youth (-0.12 [CI, -0.43 to 0.19] percentage points). Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial.

LIMITATIONS

All studies had medium or high risk of bias. There was scarce evidence for many outcomes.

CONCLUSION

Behavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown. (PROSPERO registration number: CRD42014010515).

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (PROSPERD registration number: CRD42014010515).

Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis

BACKGROUND

Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs.

PURPOSE

To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes.

DATA SOURCES

6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists.

STUDY SELECTION

Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs.

DATA EXTRACTION

One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias.

DATA SYNTHESIS

Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants).

LIMITATIONS

All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions.

CONCLUSION

Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).

Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center

INTRODUCTION

Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal.

METHODS

This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection.

RESULTS

A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed.

CONCLUSION

There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect.

Survey on Street Dog Population in Pokhara Valley of Nepal

A survey was carried out to determine the population of street dogs and people’s opinion about their persistence in Pokhara Valley, Nepal. Information of street dog population was necessary to construct a future animal birth control (ABC) plans. For this, mark-resight survey method was used. Further, local residents were interviewed to know their opinion about the persistence of street dog population in that area. Among total 1767 dogs, 1072 (60.66%) were male, 641 (36.28%) were female and 54 (3.06%) were puppies. About 367 (57.25%) of the female street dogs were already spayed. A total of 371 local residents were interviewed to know their opinion about the causes of persistent street dogs in Pokhara Valley. Numerous reasons were put forward including unmanaged slaughter house (24.5%), abandoned due to disease (15.4%) and abandoned due to unmanageable estrus behavior (10.2%). Future ABC programs may need to consider these factors responsible for maintaining persistent street dog population, to enable control over street dog population in an efficient and sustainable manner.DOI: http://dx.doi.org/10.3329/bjvm.v13i1.23722Bangl. J. Vet. Med. (2015). 13 (1): 65-70

Perception of Palliative Care among Medical Students in a Teaching Hospital

INTRODUCTION

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. Palliative care must be a part of every medical personnel's practice. But still medical education curriculums have not included palliative care in its syllabus, sufficiently due to which most of the health professional are not aware about this specialty. The purpose of this study is to find out the perception of the medical students in palliative care in a teaching hospital.

METHODS

A descriptive study was done among 270 undergraduate medical students studying in Institute of Medicine using a self structured pretested questionnaire. Data was entered in Microsoft Excel and analyzed by using SPSS 21.

RESULTS

Of the total 270 undergraduate medical students only 152 has heard the word "palliative care". Only 84 students know, palliative care can be provided early in the life threatening illness. Total 80 students know it doesn't intend to postpone and hasten death. Though only 49 students didn't know PC is not included in our curriculum, 227 are interested to learn about it if given any opportunity.

CONCLUSIONS

The perception of palliative care medicine is low in first couple of year of medical study. It is increased in clinically exposed students but is surprisingly more in fourth year than final year undergraduate medical students. However, it should be included in undergraduate medical study.

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities

Medical Humanities in Nepal: Present Scenario

Humanities have an essential role in medical education. The current gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities. Medical humanities is a relatively new concept even in developed countries, and is at infancy stage in developing countries. In Nepal, modules on medical humanities have been initiated in certain medical schools by enthusiastic faculties and it requires further debates for inclusion in curriculum.

Typhoid Vaccine in EPI; Relatively New Perhaps Overdue Strategy

Theoretically, it is possible to eliminate Salmonella, pathogenic bacteria that can cause a potentially fatal enteric fever. However, given the high prevalence of the disease in low-income countries that lack adequate facilities for sewage disposal and water treatment, and the fact that people can be long-term asymptomatic carriers, this goal is currently unrealistic. This levies constant need of a preventive measure to reduce morbidity and mortality in children associated with Typhoid Fever in endemic countries like Nepal. Currently, the best possible approach is to integrate the Typhoid vaccination into the Expanded Program of Immunization (EPI) until an improved sanitation and sewage disposal system is attained. We must acknowledge that this approach is not definitive until sufficient political and economic attention is received from all stakeholders. DOI: http://dx.doi.org/10.3126/jnps.v33i2.8715 J Nepal Paediatr Soc. 2013; 33(2):152-154

Prevalence of gastrointestinal zoonotic helminths in dogs of Kathmandu, Nepal

INTRODUCTION: Considering the close association of dog and human beings and increasing trend of pet rearing, it is important to know the status of zoonotic helminths of pet and stray dogs and awareness of owners about this in Kathmandu, Nepal. This study was carried out to determine the prevalence of gastrointestinal zoonotic helminth parasites in dogs and to assess the awareness about canine helminth zoonoses in pet owners. MATERIALS AND METHODS: This cross-sectional study was conducted from September- 2012 to December- 2013. A total of 210 fecal samples (105 each from pet and stray dogs) were collected perrectally and examined by using Formalin-Ether Concentration method. Questionnaire survey was carried out among dog owners. RESULTS: The prevalence of gastrointestinal helminths was 46.7% (98/210). Out of 98 positive samples five different parasite species observed were Ancylostoma spp. 52.0% (51/98), Toxocara canis 41.8% (41/98), Taenia/Echinococcus spp. 15/98 (15.3%), Dipylidium caninum, 9.2% (9/98), and Trichuris vulpis, 5.1% (5/98). Prevalence was higher in stray dogs (56.2% vs. 37.1%) (p<0.05); in females (51.6% vs. 39.8%) (p>0.05); in younger dogs up to 2 years of age (56.3% vs. 35.7%) (p<0.05); in non-dewormed dogs (72.7% vs. 33.0%) (p<0.05) and in dogs sharing rooms with owner (46.1% vs. 13.8%) (p<0.05). Only 11.4% of the owners surveyed were aware about canine helminth zoonoses. CONCLUSIONS: Due to potential risk of zoonotic helminths to human beings and low level of zoonoses awareness in pet owners, there is need of generating awareness to pet owners regarding periodic anthelminthic treatment of pet dogs and other prevention and control measures. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8211 Int J Infect Microbiol 2013;2(3):91-94

Seroprevalence of brucellosis in different animal species of Kailali district, Nepal

Introduction: Brucellosis is a contagious disease of livestock with significant economic impact. It is also a zoonotic disease, highly infectious for humans causing a disease called undulant fever or Malta fever. This study was carried out to determine the sero-status of Brucella spp. infection in cattle (cows), buffalo and goat in Kailali district of Far Western Region of Nepal. Materials and Methods: This cross-sectional study was conducted in Kailali district of Nepal during a period from September, 2012 to January, 2013. A total of 233 animal blood samples (50 Cattle, 67 Buffalo and 116 Goat) were collected and tested for Brucella antibody by plate agglutination test (PAT). Results: The seroprevalence of Brucellosis was 12% (28/233). Thirty two percentage (16/50) of cattle, 13.4% (9/67) of buffaloes, and 2.6% (3/113) goats were sero positive (p<0.05). Seroprevalence was higher in females (14.6% vs. 10.6%) (P>0.05) and was higher in younger cattles and older buffalo and goats (p>0.05). Conclusions: This study showed that brucellosis exists as a potential threat in animals of Kailali district. This could be a potential source of infection to humans. Considering the high economic losses it can impart on livestock sector and the possible human health abnormalities, timely facilitation of awareness generation program and adoption of proper prevention and control strategies are recommended. DOI: http://doi.dx.org/10.3126/ijim.v2i1.8005 Int J Infect Microbiol 2013;2(1):22-25

Evaluation of Clinical and Administrative Data to Augment Public Health Surveillance

Objective

To assess the utility of inpatient and ambulatory clinical data compiled by public and commercial sources to enhance the Centers for Disease Control and Prevention’s surveillance activities.

Introduction

Medical claims and EHR data sources offer the potential to ascertain disease and health risk behavior prevalence and incidence, evaluate the use of clinical services, and monitor changes related to public health interventions. Passage of the HITECH Act of 2009 supports the availability of standardized EHR data for use by public health officials to obtain actionable information. While full adoption of EHRs is still years away, there are presently publicly- and commercially-available EHR and medical claims data sets that could enhance public health surveillance at a national, regional and state level. The purposes of this evaluation were to i.) demonstrate the feasibility of gaining access to such data, ii.) evaluate their ability to augment current surveillance activities by developing measures for twenty separate healthcare indicators (e.g., HIV screening), iii.) evaluate each data source across a set of criteria needed for an effective surveillance system, and iv.) assess the ability of the data sources to evaluate changes in healthcare utilization and preventive services that may be a result of the 2009 Health Reform legislation.

Methods

Ten separate data sources were selected for inclusion in the study based on a number of criteria, including availability, representativeness, population, data structure and content, cost, and longitudinality. In collaboration with staff from seven Divisions across the CDC, detailed specifications were developed for twenty separate indicators of healthcare utilization or preventive services using best practices in healthcare quality measurement. Specifications were developed separately for EHR and medical claims data due to their differing structure, content and use of medical code sets and terminologies. Specifications for EHR data sources relied on the National Quality Forum (NQF) Meaningful Use (MUse) clinical quality measure specifications. The use of NQF MUse specification guidelines allowed us to gauge the current ability of each data source to measure healthcare utilization and preventive services as recommended by NQF, the national leader in healthcare measurement. Each of the data sources was also evaluated across established public health surveillance criteria, including data quality, representativeness, and flexibility, among others. Data analysis was performed using SAS 9.3 (SAS Institute, Cary, NC).

Results

All twenty of the healthcare indicators were developed for at least one data source; however, many of the indicator specifications had to be modified due to the low frequency of certain code sets (e.g., CPT-4 II, LOINC). The observed strengths of medical claims data were the relatively low cost, ability to track patients longitudinally, and the standardized representation of procedures and diagnoses through use of medical codes, such as ICD-9-CM, CPT-4 and HCPCS. The observed strengths of EHR data sources were the availability of information related to health behavior (e.g., current smoker), health assessment (e.g., BMI), prognostic indicators (e.g., vital signs, laboratory result), diagnostic testing, and functional status. While EHR data also capture diagnoses using ICD-9-CM, procedures such as medical and laboratory procedures remain documented through use of free text or semi-structured text fields, making it difficult to process.

Conclusions

Currently available healthcare data can improve the timeliness of health outcome monitoring and add complementary information on healthcare utilization to improve our interpretation of traditional public health surveillance data. Medical claims data support measurement of health outcomes and healthcare services provided to patient populations; however, without clinical encounter information, they cannot develop measures estimating the impact of services received on quality of care. EHR data have richer clinical information; however, the continued use of non-standards-based medical codes and free and semi-structured text fields make it difficult to analyze data at scale. Meaningful Use and other HITECH initiatives are changing this by incentivizing the standardization and aggregation of electronic healthcare data. In time, these data may yield timely, accurate and actionable information for public health surveillance.

LOINC and SNOMED CT Code Use in Electronic Laboratory Reporting—US, 2011

Objective

To examine the use of LOINC and SNOMED CT codes for coding laboratory orders and results in laboratory reports sent from 63 non-federal hospitals to the BioSense Program in calendar year 2011.

Introduction

Monitoring laboratory test reports could aid disease surveillance by adding diagnostic specificity to early warning signals and thus improving the efficiency of public health investigation of detected signals. Laboratory data could also be employed to direct and evaluate interventions and countermeasures, while monitoring outbreak trends and progress; this would ultimately result in better outbreak response and management, and enhanced situation awareness. Since Electronic Laboratory Reporting (ELR) has the potential to be more accurate, timely, and cost-effective than reporting by other means of communication (e.g., mail, fax, etc.), ELR adoption has been systematically promoted as a public health priority. However, the continuing use of non-standard, local codes or text to represent laboratory test type and results complicates the use of ELR data in public health practice. Use of structured, unique, and widely available coding system(s) to support the concepts represented by locally assigned laboratory test order and result information improves the computational characteristics of ELR data. Out of several coding strategies available, the Office of the U.S. National Coordinator for Health Information Technology has recently suggested incorporating Logical Observation Identifiers Names and Codes (LOINC) for laboratory orders and Systemized Nomenclature of Medicine- Clinical Terms (SNOMED CT) codes for laboratory results to standardize ELR.

Methods

We assessed the use of LOINC and SNOMED CT codes in laboratory data reported to BioSense, a near real-time national-level, electronic syndromic surveillance system, managed by the Centers for Disease Control and Prevention. ELR data reported by 63 non-federal hospitals to BioSense in 2011 were analyzed to examine LOINC and SNOMED CT use in coding laboratory orders and results. We used Relma software, developed and distributed by Regenstrief Institute Inc for identifying LOINC codes.

Results

In 2011, a total of 14,028,774 laboratory test order or result reports from 821,108 individual patients were reported from the 63 hospitals in 14 states. Since, by design the BioSense Program monitors a select set of syndromes mainly representing infectious conditions, 94% of the total reports were microbiology test orders or results. Seventy-seven percent of all test orders (n = 10,776,494) used LOINC codes. Of all test results with at least one value either in observation identifier (OBX3) or observation value (OBX5) segments of their Health Level 7 (HL7) ELR message (n = 12,313,952), 81% had only LOINC codes, 0.1% had only SNOMED codes, 7% had both LOINC and SNOMED codes, and 12% used no codes. In total, 1,428 unique LOINC and 608 unique SNOMED codes were used to describe the results, and 805 unique LOINC codes were used to describe the orders. Of the 608 unique SNOMED codes, 111 (18.3%) did not have corresponding LOINC codes. Fifty-one (46%) of these 111 SNOMED codes could have been matched to corresponding LOINC codes based on the concept. However, our search for matching LOINC codes in Relma for certain SNOMED concepts indicated that LOINC does not have codes for select types of laboratory test results, particularly qualifier (such as reactive, negative, and resistant) or structural (labia, urethra, and vagina) concepts.

Conclusions

Our analysis showed that the use of SNOMED CT codes for laboratory test results by non-federal hospitals reporting laboratory data to BioSense was extremely limited. These hospitals more frequently used LOINC codes than SNOMED CT in reporting test results. We found that a large percentage of test results with SNOMED CT codes could be represented by LOINC codes that exactly or closely match SNOMED CT codes. Using LOINC codes to report both test order and results in these databases could increase the availability and use of laboratory data in public health and surveillance activities. However, to increase the sensitivity of the coding further, a small number of tests could benefit by using LOINC along with SNOMED CT codes. Evaluation of use of syndromic surveillance case definitions that incorporate laboratory result information is required to determine if it improves syndromic surveillance performance for enhanced outbreak detection or improved situation awareness.

Transcriptomic analysis identifies candidate genes and functional networks controlling the response of porcine peripheral blood mononuclear cells to mitogenic stimulation

It is difficult to obtain phenotypic data on disease susceptibility directly from swine in an industry setting. The magnitude of the proliferative response of peripheral blood mononuclear cells (PBMC) to the T cell mitogen concanavalin A (Con A) has long been used as an indirect measure of the responsiveness of the immune system to antigenic stimulation. This trait is known to exhibit moderate heritability in swine, but little is known about the identity of the genes that control the response. In this study, we carried out a time-course microarray experiment to measure gene expression at 3 different stages (3, 20, and 68 h) poststimulation of PBMC with Con A. A total of 46, 452, and 418 differentially expressed (DifEx) genes were identified at each time point, respectively. Expression changes for a subset of these genes were subsequently confirmed by real-time PCR. Functional annotation analyses of the microarray results successfully identified sets of genes involved in processes associated with multiple aspects of cell division, such as DNA and protein synthesis, and control of mitosis. However, the discovery of genes that controlled the response of PBMC to mitogen was limited with this approach, because the drastic changes in the transcriptional program necessitated by cells undergoing division masked changes in smaller immune response gene sets. Pathway and network analyses that focused on immune cells proved to be a more effective strategy for the identification of genes that coordinate aspects of the mitogenic response that are specific to PBMC. The cytokine gene IL15 was shown to be central to the highest scoring network at 20 h and affect the expression of 16 other DifEx genes, including some genes known to regulate T cell activation, such as IL7R, JUN, TNFRSF9, and ZAP70. The IL15 gene maps to a previously identified QTL interval for immune responsiveness to Con A on SSC 8, which also contains the related IL2 gene. At 68 h, a distinct downregulation of major histocompatibility complex class II antigen presentation genes was observed. Overall, the gene expression profile of the Con A-stimulated porcine PBMC points to a Th(1) bias in immune activation. Further work is required to determine whether polymorphisms linked to genes identified in this study affect this immune response trait in pig populations and whether the trait itself correlates with decreased susceptibility to intracellular pathogens in swine.

Status of tuberculosis in bovine animals raised by tuberculosis infected patients in Western Chitwan, Nepal

INTRODUCTION: Bovine tuberculosis (bTB) is an important public health concern worldwide. This study was conducted to determine the status of bTB in animals raised by tuberculosis patients in Western Chitwan, Nepal. MATERIALS AND METHODS: This cross-sectional study was conducted from August, 2011 to January, 2012. A total of 100 bovines (cattle and buffalo) raised in 60 farms of tuberculosis patients were tested with single intradermal tuberculin test considering various animal factors. Well designed questionnaire survey was taken with 70 tuberculosis patients of same 60 families focusing knowledge, awareness and various practices related to bovine tuberculosis. RESULTS: Overall 15% bovines were positive for tuberculosis (13.6% cattle and 15.4% buffaloes). Age of animal was significantly associated with tuberculosis (p<0.05) while sex and species were not. 24% tuberculosis patients had raw milk consuming habit while very few of them (9%) were aware of zoonotic aspect of bovine tuberculosis. CONCLUSIONS: There is high chance of tuberculosis transmission form animals to humans or vice versa. Further detailed study is needed in large scale with stronger intersectoral collaboration of medical and veterinary health sector to determine the scale of problem and find out prevention and control strategies against zoonotic tuberculosis. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7407 Int J Infect Microbiol 2012;1(1):49-53

Cubitus varus in adults correction with lateral closing wedge osteotomy and fixation with posterior plating

To share the result of lateral closing wedge osteotomy and fixation with posterior reconstruction plate in correction of cubitus varus in adults. It is a retrospective case analysis of 8 cases of cubitus varus in adult treated with lateral closing wedge osteotomy through posterior triceps retracting approach. Internal fixation was done with two posterior reconstruction plates. All cases were from 15 to 29 years of age (mean 22.3 ) with 3 female and 5 male. All had cubitus varus ranging from 15- 28 deg (mean 20.16 deg) due to childhood malunited supracondylar fracture of humerus. Indication for operation was cosmetic reason only. Follow up duration was 4-22 months (mean 12.5 months). All the osteotomy united clinically in mean duration of 9 weeks ( range 8-12 weeks) with mean carrying angle 8.33 degree in postoperative phase. There was no loss of motion, no loss of fixation, no surgical site infection, nonunion or neurovascular deficit. Lateral closing wedge corrective osteotomy and fixation with posterior reconstruction plate is easy technique with satisfactory result in correction of cubitus varus in adults. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 49-53 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6839

Multifaceted support for a new medical school in Nepal devoted to rural health by a Canadian Faculty of Medicine and Dentistry

Nepal and Alberta are literally a world apart. Yet they share a common problem of restricted access to health services in remote and rural areas. In Nepal, urban-rural disparities were one of the main issues in the recent civil war, which ended in 2006. In response to the need for improved health equity in Nepal a dedicated group of Nepali physicians began planning the Patan Academy of Health Sciences (PAHS), a new health sciences university dedicated to the education of rural health providers in the early 2000s.

Beginning with a medical school the Patan Academy of Health Sciences uses international help to plan, deliver and assess its curriculum. PAHS developed an International Advisory Board (IAB) attracting international help using a model of broad, intentional recruitment and then on individuals’ natural attraction to a clear mission of peace-making through health equity. Such a model provides for flexible recruitment of globally diverse experts, though it risks a lack of coordination. Until recently, the PAHS IAB has not enjoyed significant or formal support from any single international institution.

However, an increasing number of the international consultants recruited by PAHS to its International Advisory Board are from the University of Alberta in Edmonton, Alberta, Canada (UAlberta). The number of UAlberta Faculty of Medicine and Dentistry members involved in the project has risen to fifteen, providing a critical mass for a coordinated effort to leverage institutional support for this partnership. This paper describes the organic growth of the UAlberta group supporting PAHS, and the ways in which it supports a sister institution in a developing nation.

Extended spectrum beta-lactamase producing multidrug resistant urinary isolates from children visiting Kathmandu Model Hospital

A study was conducted to analyze the status of the multidrug resistant (MDR) isolates producing Extended Spectrum of beta-lactamase (ESBL) among the uropathogens infecting children less than 15 years from November 2010 to April 2011 in the Bacteriology laboratory, Kathmandu Model Hospital. Urine samples received in the laboratory were processed for routine culture. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute (CLSI) recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be multidrug resistant was resistance to two or more drugs of different structural classes. Isolates were confirmed for ESBL-production by performing the Inhibitor Potentiated Disk Diffusion (IPDD) Test/ Combined Disk Assay for ESBL confirmation. Out of 252 urine samples received in the laboratory, 59(23.41%) showed significant growth of which 54.23% (32/59) were MDR isolates. Additionally, 25 isolates (21 Escherichia coli and 3 Citrobacter freundii and single Enterobacter aerogenes) among them were ESBL producers. Among the first line drugs used against gram negative isolates, Nitrofurantoin was drug of choice; meanwhile among the second line drugs Cefoperazone/Sulbactum was drug of choice, whereas, Cephotaxime, Ciprofloxacin, Norfloxacin and Gentamicin were the drug of choice for Gram positive isolates. Significant association was found between ESBL production and spectrum of drug resistance (p < 0.05).

The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions

BACKGROUND

Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions.

OBJECTIVES

To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy.

METHODS

Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured.

RESULTS

We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment.

CONCLUSIONS

This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.

Knowledge and practices of pig farmers regarding Japanese encephalitis in Kathmandu, Nepal

Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population.

Malarial nephropathy in a tertiary care setup--an observational study

Malaria is endemic in Nepal. Its poor outcome is associated with acute renal failure (ARF), hepatopathy and cerebral malaria. The clinical profiles, biochemical parameters and outcome of 25 patients of falciparum malaria diagnosed either by optimal test, peripheral blood smear (PBS) or Quantitative buffy coat (QBC) admitted in BP Koirala Institute of Health Sciences were studied. Majority of patients (84%) was from the age group 15-45 years. Mean age was 33 +/- 16 years. There were 16 males and 9 females. All had history of fever. Twenty patients were optimal positive, 9 positive in PBS and 12 were QBC positive for Plasmodium falciparum. Mean duration of fever was 13 +/- 9 days. Patients with renal or hepatic involvement presented earlier. Renal dysfunction (S. creatinine > 1.5 mg/dl) was present in 60%. Ten patients had ARF (S. creatinine > 3 mg/dl); five out of them were oliguric/anuric. S. creatinine in patients without renal dysfunction, with renal dysfunction but without renal replacement therapy (RRT) and who underwent RRT were 1.1 +/- 0.24, 3.98 +/- 1.9 and 4.53 +/- 1.72 mg/dL respectively. Serum creatinine of patients with and without hepatic dysfunction respectively were 3.26 +/- 1.98 and 1.26 +/- 0.48 mg/dL (p = 0.001 (CI 0.9-3.10)). Total bilirubin of > 2.5 mg/dl was present in 77%. Total bilirubin of patients with renal dysfunction who underwent and who did not undergo RRT were 10.3 vs. 3.76 mg/dL (p = 0.024 (CI 1.07-12.0)). Fourteen patients had cerebral malaria. Eight patients underwent RRT (hemodialysis or peritoneal dialysis). Six patients died. Five died within 48 hrs of presentation. Patients who had renal and/or hepatic dysfunction had increased morbidity and mortality.

Oncoprevention in Gynecology

Gynaecological cancers are one of the preventive cancers. There are some preventive factors like change in life style, food habits and some screening tests. Cancer can be prevented and premalignant conditions can be detected before invasion. Cervical cancer can be detected early by VIA, VILI, Pap smear, colposcopy and HPV testing. Identifying high risk population, transvaginal ultrasound to determine endometrial thickness and endometrial sampling by endocervical curettage, dilation and curettage, fractional curettage and hysteroscopy guided endometrial biopsy are the various modalities for earlier detection of endometrial cancers. For ovarian cancer, prevention or early diagnosis is done by identifying high risk factors, creating awareness in women, routine pelvic examination, ultrasonogram, checking tumour marker and prophylactic oophorectomy in indicated cases. The main screening methods for early detection of breast cancer are clinical breast examination and mammography. Oral contraceptive and HRT are associated with small increase in breast cancer risk. Vulval and vaginal carcinomas are not so common. All molar pregnancies should be followed after evacuation to look for malignant transformation. Hereditary/familial gynaecological cancer like ovarian and breast cancer are manifestation of genetic disorder. Mass screening for gene mutation is very expensive so it is not recommended.

Oncoprevention in gynecology

Gynaecological cancers are one of the preventive cancers. There are some preventive factors like change in life style, food habits and some screening tests. Cancer can be prevented and premalignant conditions can be detected before invasion. Cervical cancer can be detected early by VIA, VILI, Pap smear, colposcopy and HPV testing. Identifying high risk population, transvaginal ultrasound to determine endometrial thickness and endometrial sampling by endocervical curettage, dilation and curettage, fractional curettage and hysteroscopy guided endometrial biopsy are the various modalities for earlier detection of endometrial cancers. For ovarian cancer, prevention or early diagnosis is done by identifying high risk factors, creating awareness in women, routine pelvic examination, ultrasonogram, checking tumour marker and prophylactic oophorectomy in indicated cases. The main screening methods for early detection of breast cancer are clinical breast examination and mammography. Oral contraceptive and HRT are associated with small increase in breast cancer risk. Vulval and vaginal carcinomas are not so common. All molar pregnancies should be followed after evacuation to look for malignant transformation. Hereditary/familial gynaecological cancer like ovarian and breast cancer are manifestation of genetic disorder. Mass screening for gene mutation is very expensive so it is not recommended.

Pesticide Application and Food Safety Issue in Nepal

It has been increasing pest population including weeds, invasive species, insects and insect vectors and plant diseases, which lead to increase pesticides on crop production. Some of the pesticides also contribute to global warming and the depletion of the ozone layer. Pesticides are the potential health hazards which have drawn attention to everyone. The current practice adopted in pesticides control in Nepal appears not enough in line with food safety. This has created a promising threat in food safety and human health. In turn, global warming is also likely to increase pesticide use and degrade food safety situation. Necessary measures should be adopted to curb upcoming alarming situation in food safety.Key words: Food safety; Global warming; Pesticides; NepalThe Journal of Agriculture and Environment Vol:10, Jun.2009 Page: 128-132