Dhulikhel Hospital

About: Dhulikhel Hospital is a healthcare organization based out in Kathmandu, Nepal. It is known for research contribution in the topics: Population & Epilepsy. The organization has 86 authors who have published 59 publications receiving 336 citations.

A Phone App to Diagnose Epileptic Seizures: A Useful Tool to Reduce the Epilepsy Treatment Gap in Poorer Countries (I10-1.009)

Abstract: Objective To devise and test a phone app to enable non-doctors to diagnose epileptic seizures. Background If the epilepsy treatment gap in the developing world is to be closed then health professionals other than doctors must be involved with epilepsy management. To do this they will need some tools to help them. The diagnosis of episodes of altered consciousness as epileptic seizures is key to the management of epilepsy. Traditionally done by doctors and time-consuming, this relies on asking questions and analysing the replies. It should be possible to design a tool to do this using a Bayesian approach. This would enable the diagnosis to be made by non-doctors and so save precious medical time. Design/Methods Sixty-seven consecutive patients attending epilepsy clinics at Dhulikhel Hospital, Nepal and its outreach centres were asked a series of about 26 questions about their episodes. A diagnosis of “epileptic seizure (E)” or “not epileptic seizure (NE)” was reached clinically. Retrospectively, for each question the Likelihood Ratio (LR) of having E or NE was calculated and the most informative LRs identified. These were then used sequentially and incorporated into a mobile phone app. This was then validated in two different populations in Nepal and India and compared with the independent clinical diagnosis. Results Of the 67 patients originally seen, 51 had E giving a pre-test probability of 0.76. Eleven questions were identified with an LR>3 and incorporated into the app. The app was then validated in 132 patients from two different populations. Non-doctors were able to use it with minimal training. The app separated those with E and NE with near-complete reliability. Conclusion A phone app has been designed to diagnose epileptic seizures and works well in practice. It should be particular useful where medical input is scarce or non-existent. Disclosure: Dr. Patterson has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Rajbhandari has nothing to disclose.

Contact lenses for visual rehabilitation in Bilateral Nanophthalmos with Retinal Dystrophy- A case report.

Abstract: Background: Nanophthalmos is an uncommon developmental ocular disorder characterized by a small eye with short axial length, high hyperopia and high lens to eye volume ratio due to arrested development of the globe in all directions. Different types of fundus changes can rarely occur with nanophthalmos. Observations: This is a case report of a 17 years old female who presented with bilateral gradual progressive visual loss and photophobia at Tilganga Institute of Ophthalmology on 3 rd July 2015. Her best corrected visual acuity was 20/300 with +12.00Ds/-1.00Dcyl@180 in the right eye and 20/200 with +12.00Ds/-1.50Dcyl@180 in the left eye. Axial lengths of two eyes were markedly shortened with pigmentary changes at the macula and dull foveal reflex along with retinal flecks in the mid-periphery. Full field ERG showed diminished rod and cone waves suggestive of rod and cone dysfunction. With the use of Rigid Gas Permeable (RGP) contact lenses, the acuity improved to 20/200 and 20/125 in the right and left eye respectively. Conclusion: This study proposes the use of contact lenses and light absorptive filters for better visual rehabilitation.

Profile of Clients of HIV Testing and Counseling in a Tertiary Care Center and Need of Testing in Tuberculosis

Abstract: DOI: https://doi.org/10.3126/njdvl.v17i1.23251 Introduction: Sexually transmitted infection is public health issue that amplifies HIV burden globally. At National Center of AIDS and STD Control, annual reported STI are rising steeply recently. Incidence of HIV is 0.03% while prevalence in adult population is less than 1%. National HIV testing guidelines 2017 recommends HIV tests should be performed in tuberculosis and medical conditions. However, it is not routinely done in Nepal. Objective: To assess profile of STI and HIV among patients attending HIV testing and counseling center of tertiary hospital, and to assess fraction of tuberculosis patients undergoing HIV testing. Materials and Methods: All patients attending HIV testing and counseling center were tested for HIV. Tests for STI were done based on patient symptoms. Data collected were analyzed with SPSS. Results: Suspected STI (41.1%) was commonest cause of HIV testing. Among STI, gram positive diplococcic were noted in 11.5% and 3.4% had PCR positive Chlamydia. Only 19.4% (7 out of 36) of total tuberculosis patients in hospital were screened for HIV, among which, 57.14% (4 out of 7) were seropositive for HIV, which is noteworthy. Conclusion: Our study shows patterns of STI, and that gonorrhea and chlamydia could be underdiagnosed in Nepal. Every patient with tuberculosis should routinely be screened for HIV. But only small fraction of tuberculosis patients underwent HIV screening, out of which HIV positivity was high, reflecting the gap and need for routine HIV screening in TB patients. Keywords: Acquired Immunodeficiency Syndrome, HIV infections, Sexually Transmitted Diseases, Tuberculosis

Boost Up Quality Assurance through Regular Evaluation of Proficiency Testing Performance

Abstract: Background: Participation in External Quality Assessment (EQA) program with practice of Internal Quality Control (IQC) is the excellent indicator of good laboratory practice (GLP) to assure quality services. EQA is an essential component of Quality Assurance to assess the analytical performance compared within same methods of other laboratories. It is also important to detect equipments failure, identifying reagent problems, reviewing staff training as well as to initiate and evaluate corrective action timely.Methods: This is descriptive analysis of the feedback received from EQAS body for twenty routine biochemical parameters which are most commonly performed in the Clinical Biochemistry Laboratory of Dhulikhel Hospital. Variation Index Score (VIS), Overall Mean VIS (OMVIS) and Standard Deviation Index (SDI) of all parameters for the year 2014 and 2015 were analyzed statistically.Results: On the analysis of twenty routine biochemical parameters regularly participated in EQAS, over all mean variation index score (OMVIS) of individual tests found 55%, 30% and 15% under good, very good and satisfactory category respectively.Conclusion: Participation and periodic evaluation of EQAS indicators along with practice of internal quality control has been galvanizing good laboratory practice and scientifically it boost up quality service in clinical laboratories.