Showing papers in "Nepal Medical College journal in 2009"

Parasite egg contamination of vegetables from a suburban market in Hanoi, Vietnam

Abstract: Helminth egg contamination of vegetables purchased at suburban market in Hanoi, Vietnam was examined. A total of 317 vegetables were examined and 82 (26%) were revealed to be positive for parasite eggs. Of the 15 varieties, 13 were positive except for horseradish and cucumber. Contamination was highest in leafy vegetables (31%), followed by root vegetables (17%) and fruit vegetables (3%). Throughout the survey, five species of parasite eggs were found: Ascaris sp., Trichuris sp., Toxocara sp., Taenia sp. and Ascaridia galli. In the interview with the villagers, 121 (81%) of 149 adult villagers stated that they usually use not only animal feces but also human feces as a fertilizer. Throughout the survey, a total of 453 eggs were recovered. Number of eggs recovered from vegetables was higher in the dry season (355 eggs) than in the rainy season (98 eggs). The study revealed that vegetables purchased at a market in suburban Hanoi (Vietnam) were highly contaminated with parasite eggs excreted by humans and animals. Considering the eating habits of the Vietnamese and the 17% embryonation rate of detected parasites, vegetables seem to play an important role in soil-transmitted helminth infection in this country.

Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital based study.

Abstract: Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years of age is accidental. Objective of the study was to study the clinical profile and outcome of childhood poisoning and intoxication. This was a retrospective study done in patients who were admitted in pediatric wards and pediatric intensive care unit (PICU) of BP Koirala Institute of Health Sciences with history of ingestion of poison or intoxication or envenomation firom January 2005 to June 2008. The data collected were analyzed with SPSS 12.0 software. There were 122 children enrolled in study. Male: female ratio was 1.4:1. The mean age of presentation was 5.8 years. Among 122 patients, 43.4% received pre-referral treatment in the form of gastric lavage, atropine etc. Organophosphorus poisoning was the commonest poisoning seen in 55 (45.1%) patients followed by hydrocarbon 12 (9.8%), mushroom 10 (8.2%) and organochlorine 10 (8.2%) poisoning. During treatment, 50.0% received antidotes. 55.7% received antibiotics, gastric lavage and anticonvulsants were required in 43.4% and 13.9% respectively. Overall survival was 87.4%. The time interval between intoxication and presentation to hospital, mean Glasgow Coma Scale (GCS) and presence of coma (GCS <8) were significantly different between survivors and expired cases. In conclusion, organophosphorus is the commonest agent involved in childhood poisoning. Overall, the outcome is good with 87.4% survival in our hospital. The time gap between the poisoning and presentation to hospital and presence of coma predict mortality.

Prevalence and determinants of diabetes among the elderly population in the Kathmandu Valley of Nepal.

Abstract: Elderly populations are susceptible to many non-communicable diseases, including diabetes. Lack of awareness regarding disease status and risk factors increase complications and mortality. We conducted a cross-sectional community-based study of 1633 randomly selected participants aged 60 years and above in urban and rural areas in the Kathmandu Valley of Nepal. Study goals were: (i) to determine the prevalence of diabetes in elderly subjects as diagnosed prior to and during the study, and (ii) to identify and compare the determinants of diabetes as diagnosed prior to and during the study. A structured questionnaire was used to collect information regarding prevalence and potential determinants of diabetes diagnosed during and before the survey. Anthropometric measurements, blood pressure measurements and fasting blood sugar tests were also measured. Risk factor analysis was done using multinomial logistic regression; subjects with no diabetes constituted the reference group. We detected an overall diabetes prevalence of 25.9%, 17.3% diagnosed during the survey and 8.6% previously diagnosed. Age, disturbed sleep, and family history of hypertension were marginally significantly (p < 0.10) associated with diabetes diagnosed in the survey. In contrast, education, exercise, health perception, family history of hypertension, having a caretaker at night, receiving help from friends when seeking health care and mean waist circumference were significantly (p pounds 0.05) or marginally associated with diabetes detected before the survey. The high prevalence of diabetes in the elderly population studied, and the low level of prior diagnosis, identify an important public health problem. There is a need for improved screening of diabetes and improved health care and education in the elderly. There is also need for better understanding of risk factors associated with previously undiagnosed diabetes.

Prevalence of anemia amongst adolescents in Nepal: a community based study in rural and urban areas of Morang District

Abstract: Adolescence covers 10-19 years of human age and is the transition period of life. In Nepal around 23 percent population are in this age group. A cross sectional community based study was carried out in Morang district to determine prevalence and distribution of anemia in terms of age, sex and locations (urban and rural) among adolescent population. Sahli method was used to determine the hemoglobin level. Three hundred and eight adolescents (127 urban, 181 rural in terms of location and 151 male, 157 female in terms of sex) participated in the study. The overall prevalence of iron deficiency anemia among adolescent population was 65.6% with the distribution of rural 62.4%, urban 70.0%, male 52.3% and female 78.3%. Sufficiency or deficiency of iron makes the living of adolescents different as it affects their growth requirement and cognitive performance. Iron reserve in female result better reproductive outcome. In Nepal, iron deficiency anemia among male adolescent has not been documented yet and this study reports more than half of them are found anemic which warrant further study.

Prevalence of attention deficit disorder among preschool age children.

Abstract: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood onset psychiatric disorders Although the onset of ADHD is prior to the age of seven years, there is a paucity of data on the prevalence of the disorder in preschool age children This study was performed to determine the prevalence rate of ADHD in preschool age children in kindergartens of south west, Mumbai One thousand two hundred fifty (599 males and 651 females) children aged between 4-6 years, were selected from 40 kindergartens in 6 localities in south west Mumbai The Conner's index questionnaire was completed for each child by teachers and parents Parents of children whose scores were positive for ADHD (>15) were interviewed by a psychiatrist and the ADHD was diagnosed based on DSM-IV criteria Schedule for affective disorders One hundred fifty two (122%) children were diagnosed to have ADHD The prevalence of ADHD in preschool age school in south west of Mumbai is consistent with previous studies in other countries This study recommends the need for diagnosis and treatment of ADHD in preschool age children

The proximal femur--a second look at rational of implant design.

Abstract: Twenty five pairs (50 bones) of cadaveric femora were studied morphologically and radio logically using standardized techniques to obtain anthropometric data to evaluate the applicability of internationally designed implant and to generate a database for proximal femur to help in design for future implant if these were found unsuitable. Measurements : femoral head diameter , femoral neck diameter , diameter of proximal femur, canal width at above and below lesser trochanter and 7.5 cm below lower margin of lesser trochanter, endosteal and extracortical width, isthmus position from lesser trochanter, femoral neck anteversion, neck shaft angle and intramedullary axis of femur. The mean +_ SD of these values were calculated. These values were compared with those reported in the literature for Hong Kong Chinese, Caucasians and were found to be different. The implant designed for western population should be used judiciously and facture implant designed should be specific for ( ours) bones . We found the pyriformis fossa is usually not in line with the intramedullary axis. Thus antegrade itramedullary nailing portal should be anterior and lateral to pyriformis fossa. Keyword: Proximal end femur, anthropometric measurements, western versus ours standard, intramedullary axis of femur.

Study of ovarian tumours in Nepal Medical College Teaching Hospital.

Abstract: This was a retrospective study of all the cases of ovarian tumours operated in Nepal Medical College Teaching Hospital from January 2006 to July 2008. All the cases of ovarian tumour were included, irrespective of whether diagnosed preoperatively or found incidently during operation. The nature of tumour whether benign or malignant, their presenting symptoms, age, parity age of menarche, type of operation and histopathological finding was recorded. The incidence of ovarian tumour was 16.7% among total gynaecological admissions, out of which malignant ovarian tumour was 9.5%. The age range was 18 to 70 years. Benign tumour occurred in all age group 86 (90.5%) while maximum of malignant tumour occurred after 40 years (66.7%). Eleven point six percent were unmarried, 20.0% nulliparous, 7.4% were pregnant and 38.9% were of one to two parity. 10.0% were asymptomatic and commonest symptom was pain in lower abdomen (84.0%). Seventy two point six percent were surface epithelium tumour which is common in older women. Twenty seven percent were germ cell tumour which is common in younger age group. Commonest surface epithelial tumour was serous cyst adenoma (40.0%) and commonest germ cell tumour was Dermoid (25.3%).Commonest complication of ovarian cyst was torsion (12.6%).

Study on the supernumerary heads of biceps brachii muscle in Nepalese.

Abstract: Biceps brachii is a double headed muscle. In terms of number and morphology of its head, it is one of the most variable muscles in the human body. Most common variation is third head, but four, five or even seven heads have been reported. In this study, 32 arms from 16 Nepalese cadavers were studied; supernumerary heads of biceps brachii were observed in 12.5% of 32 arms. Among these three headed biceps brachii was presented on 6.2% and the four headed was also on the same percentage. All the variations were in the right sided arms of males. Third heads of all cases originated from the medial border and adjoining anteromedial surface of humerus distal to the insertion of coracobrachialis thus have been classified as inferomedial humeral head. Fourth head of the four headed biceps brachii originated from the anterior border of humerus nearby the insertion of deltoid muscle. These supernumerary heads might be significant in producing the strong flexion as well as supination of forearm. They may cause compression of neurovascular structures because of their close relationship to brachial artery and median nerve. Variant biceps brachii may confuse a surgeon who performs procedures on the arm and may lead to iatrogenic injuries. The surgeons and traumatologists have to keep such muscular variations in mind.

Antibiotic susceptibility of Group A Streptococcus isolated from throat swab culture of school children in Pokhara, Nepal

Abstract: Group A Streptococcus (GAS) or Streptococcus pyogenes is estimated to be present in 5.0-15.0% of norma individual in the respiratory tract, vagina, skin and anus without any sign of disease. This study was carried out to find out the rate of asymptomatic throat carriage of S. pyogenes and antibiotic susceptibility of the isolates in school children of Pokhara, Western Nepal. A total of 487 randomly selected children younger than 16 years were included in the study. Throat swabs collected were subjected to 5.0% Sheep blood agar supplemented with crystal violet (CVBA).GAS was identified by a-haemolytic colonies, bacitracin sensitivity, cotrimoxazole resistivity, catalase negativity and PYR positivity. Antibiotic susceptibility test was performed on Muller Hinton agar (MHA) containing 5% sheep blood by modified Kirby-Bauer disc diffusion method. Out of total 487 throat swabs, GAS was isolated in 9.2% (n = 45). Among the isolates, 46.6% (n = 21) were from male children where as 53.4% (n = 24) from female children. There was no significant sex difference in colonization of GAS (p > 0.05). Out of 45 isolates, 100.0% isolates were sensitive to antibiotic penicillin-G and amoxycillin where as 15.6%, 6.6%, and 2.2% isolates were resistant to antibiotic erythromycin, tetracycline and azithromycin respectively.

Complications of home delivery: our experience at Nepal Medical College Teaching Hospital.

Abstract: A prospective study was conducted at Nepal Medical College Teaching Hospital to find out the complications of home delivery, maternal and fetal outcome and the main factors leading to home delivery. Among the 114 women who were brought to the hospital after home delivery, one was brought dead and one more died shortly after arrival. Sixty point five percent were housewives with no formal occupation, 68.4% were illiterate, 64.0% were multipara, Maximum no. of women belonged to the age group 20-24 years, 15.8% were adolescents, Lasheta (Lama, Sherpa , Tamang) was the most common ethnic group, Most of the women delivered at full term, whereas preterm delivery occurred in 4 (3.6%). Majority (73.7%) of the women had attended antenatal care at least once and half of the women had attended 4 and more visits. More than half had been fully immunized with tetanus toxoid and taken iron supplementation. As the reasons to deliver at home: 32.5% stated to be due to financial limitations, 30.7% due to ignorance and 16.7% due to transport limitations, and rest due to 'other reasons' which were most commonly stated as to be lack of attendant at home, long distance to hospital or delivery occurring too quickly or too late at night to attend the facility of choice. Ninety four point seven percent delivered at home with no trained assistance. Majority of the women (72.8%) were brought with retained placenta or excessive bleeding per vaginum. Twenty one point nine percent of the women were brought in shock needing active resuscitation. Twenty seven point two percent had postpartum hemorrhage. It was found that antenatal services were well utilized, but mothers were less likely to access good quality delivery/postnatal care. Despite the availability of services however, women still went on to deliver at home without any trained assistance, and this effect was greatest for the t less educated, poorer women. Financial and transport limitations appear to be some of the most important factors in women's inability to access skilled care. This important barrier to care will need to be addressed if we intend to improve delivery service to the most vulnerable of women.

Study of enteric fever and antibiogram of Salmonella isolates at a Teaching Hospital in Kathmandu Valley

Abstract: Enteric fever is one of the common public health problems in Nepal. This study was carried out at Nepal Medical College Teaching Hospital located at peri-urban area in Kathmandu Valley to find out the prevalence of enteric fever and the sensitivity pattern of the Salmonella isolates. A total of 479 patients with fever were included in the study. Venous blood samples collected aseptically were subjected to culture and were studied following the standard bacteriological procedure. The overall prevalence of enteric fever was 5.4% (26/479). Of them more than half (65.4%) were caused by S. paratryphi A whereas remaining (34.6%) by S. typhi. The positive rate was higher in children aged 1-15 years (8.9%) followed by 15-30 years of age (4.3%) and others (1.9%). Gender wise, females to male ratio was 1.4:1. The occurrence of infections was higher in Dalit (7.1%), Khas (Brahmin and Chhetri) (5.9%) and Madeshi (5.9%) whereas lowest was in Adibasi Janajati (4.8%). Prevalence rate of enteric fever among different sex, age and ethnic group was not significant (p > 0.05). Isolates were highly sensitive to Amikacin (100.0%) and Ciprofloxacin (96.1%) whereas least sensitive to Gentamycin (68.7%).

A study of wasp bites in a tertiary hospital of western Nepal.

Abstract: Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are common indications for emergency department visits worldwide. Besides that, sting can cause death as a result of multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Eleven cases (all male, age 35.5 +/- 15.2 years) of wasp bites admitted in the Manipal Teaching Hospital (MTH), Pokhara during 01st February, 2006 to 30th October, 2007 were enrolled in this study. Mean wasp bites number was 48.7 +/- 7.1 (11-100) and mean time to reach the hospital from the bite time was 69.1 +/- 149.7 hours (1.5 h-12 days). Nine patients developed acute renal failure (ARF) and secondary hypertension. Eight patients underwent hemodialysis. Two patients stuck by more than 75 stings developed refractory pulmonary edema and died in the course of treatment. Victims with lesser numbers of wasp envenomation, who received quick initiation of alkaline diuresis and intensive dialytic support had shorter hospital stay and less severe complications.

Comparative study of post operative wound infection following emergency lower segment caesarean section with and without the topical use of fusidic acid.

Abstract: The study was undertaken to see the infection rate of wound following emergency caesarean section with and without the use of topical fusidic acid. The study was carried out at Himal Hospital from April 2006 to Jan. 2008. A total of 70 child bearing patients who underwent emergency caesarean sections were included. All of the patients were given absorbable subcuticular stitches. Out of the 70 patients, 35 patients had topical fusidic acid immediately after subcuticular stitches followed by dry dressing. The other 35 patients had simple dressing with povidone- iodine. Six patients (17.1%) out of the 35 patients who had dressing with povidone-iodine developed wound infection at the surgical site and only 1 patient (2.8%) out of the 35 patients with fusidic acid developed wound infection. The use of fusidic acid reduced the infection rate by six times. The relation of fusidic acid to wound infection was statistically significant (p = 0.0460).

Variation in relation of cords of brachial plexus and their branches with axillary and brachial arteries--a case report.

Abstract: Anatomical variations in the formation, course and distribution of brachial plexus are well documented. The present report describes some rare variations with regard to relation of cords of brachial plexus, median and ulnar nerves with the third part of axillary artery and brachial artery in the left upper limb of an adult male cadaver. All three cords of brachial plexus were noted to be lateral to all three parts of axillary artery. Median nerve was lateral to brachial artery and ulnar nerve was between the brachial artery and median nerve. Further distribution of median and ulnar nerves was normal. The arterial pattern in left arm (axillary and brachial arteries) was also normal. The findings were noted after thorough and meticulous dissection of both the upper limbs (axilla, arm, cubital fossa, forearm and palm) of the same cadaver in the Department of Anatomy, College of Medical Sciences, Bharatpur, Nepal. The right upper limb revealed no abnormality. It is important to be aware of such variations while planning a surgery in the region of axilla and arm as these nerves are more liable to be injured during surgical procedures. Possible embryological explanations and clinical significance have been discussed.

Waist circumference and waist-hip ratio as predictors of type 2 diabetes mellitus in the Nepalese population of Kavre District.

Abstract: The objective of the present study was to find out WHR and WC as predictor of Type 2 DM in the population of Kavre district of Nepal. Sixty-five "known type 2 diabetic" and Thirty-five "self-reported non-diabetic" subjects above thirty years of age were included in the present study. Height, Weight, Waist Circumference and Hip Circumference were recorded for every subject. BMI and WHR were calculated by the standard formula. The data was analyzed using SPSS Evaluation Version 15.0 and STATA Special Edition Version 8.2. Our results showed that the optimal cut-off values for WHR, WC. BMI and age in female are 0.87, 0.85 cms, 21.40 kg/m2 and 40 years respectively and for male the respective values are 0.96, 0.87 cms, 23.63 kg/m2 and 44 years. In female, age (82.9%) is the strongest predictor followed by WHR (78.1%), WC (70.2%) and least for BMI (55.0%) whereas for male WC (87.0%) is the strongest followed by WHR (81.6%), BMI (68.5%) and least: for age (6.4.6%) using Receiver Operating Characteristic (ROC) curves. Optimum sensitivity and specificity obtained from the ROC curves corresponded to these cutoff values and area under curve for their predictive ability. The current study showed that the WC and WHR are the best predictors of type 2 DM in both male and female population of Kavre district.

Onychomycosis: a clinico-epidemiological study.

Abstract: Onychomycosis is a common nail disorder. Far more than being a simple cosmetic problem, infected nail serves as a chronic reservoir, which can give rise to repeated mycotic infections. The study was undertaken to determine the various clinical patterns of onychomycosis. This prospective cross sectional study was conducted in clinically suspected patients of onychomycosis attending out patients department of dermatology, T.U. Teaching hospital between August 2006 and July 2007. Various data were obtained and clinical patterns were noted. Out of 182 clinically suspected patients of onychomycosis, 52.7% were males with male: female ratio of 1.1:1. Onychomycosis was predominant among the younger patients with slight male preponderance. Fingernails were more frequently involved in females whereas toenails in males. The most common clinical type was distal and lateral subungual onychomycosis. 58.2% had other concomitant fungal infections apart from onychomycosis. Onychomycosis could serve as a good reservoir for recurrent cutaneous superficial fungal infections. Hence, adequate treatment of onychomycosis can prevent from these recurrent cutaneous superficial fungal infections.

Cranio facial anthropometric measurements among Rai and Limbu community of Sunsari District, Nepal.

Abstract: Anthropometry is applied to obtain measurements of living subjects for identifying age, stature, and various dimensions related to particular race or an individual. Population based cross sectional study was carried out in Dharan and its neighbouring areas with the help of departments of Anatomy and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan. This study included 444 healthy people aged 25-50 years belonging to pure race of Rai and Limbu communities. Head length, nasal ergonomics and total stature were measured for each selected individual. Student't' test was applied to identify significance of the variables. Except nasal breadth of Limbu, the results showed a significant variation (p < 0.001) in all parameters between male and female of both the communities. It was also revealed that Limnbu males and females were taller with larger head length, longer nasal length and nasal height. Similarly nasal breadths of Limbu females were broader where as in males, Rai had broader nose than that of the Limnbu. Therefore it was concluded that anthropometric measurements can play significant role in determining the sex and ethnicity of characteristic pure races of national importance.

Consultation liaison psychiatry at Nepal Medical College and Teaching Hospital.

Abstract: The authors reviewed the all referral cases from different inpatient and outpatient department, in Nepal Medical College and Teaching Hospital. It was a descriptive study. There were 484 referred cases during the study period. Around half the referral were from department of medicine (49.8%), surgery (11.2%), Eye/ENT (10.3%). The referral rate was 1.4%, with an average three cases per day. Among the referral cases depression was diagnosed in 26.9%, anxiety in 15.5% and substance related problem in 14.5%. The consultation liaison psychiatry service is satisfactorily used. Depression, substance use problem, anxiety, deliberate self harm is the main diagnoses in liaison psychiatry.

Rare variations in the formation of median nerve--embryological basis and clinical significance.

Abstract: During routine dissection in the Department of Anatomy, CMS, Nepal, anomalous median nerves with regard to their formation were found in three different adult male cadavers. In one cadaver, there was variation in the formation of the median nerve and its relation with the axillary artery. Another cadaver revealed the formation of the median nerve by three roots, while in the third one, the median nerve was found to be formed by four roots. However, in each of the three cadavers the distribution of the anomalous median nerve was normal in arm, forearm and palm. The arterial pattern in the arm (axillary and brachial arteries) was also found to be normal. In each case the opposite upper limb was also meticulously dissected to exclude bilateral abnormality. However, in each case the anomaly was unilateral. Photographs of the abnormalities were taken for proper documentation. The variations related to the formation of median nerve by more than two roots are relatively uncommon as compared to the other types of variations of median nerve. Some embryological explanations are available to explain these variations. Finally, knowledge of these variations is important particularly to the surgeons for carrying out surgical procedures in axilla and arm.

Study of nosocomial isolates of Staphylococcus aureus with special reference to methicillin resistant S. aureus in a tertiary care hospital in Nepal.

Abstract: To find out the prevalence of Staphylococcus aureus nosocomial infection and methicillin resistant S. aureus (MRSA), clinical samples from nosocomially infected patients were processed by following standard methodology in microbiology laboratory, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Of 149 S. aureus isolates, skin infection isolates contributed a major part 72.5% making nosocomial infection by S. aureus most prevalent in skin infection followed by lower respiratory tract infection 11.41% and urinary tract infection 8.7%. Overall MRSA prevalence was 45.0%. MRSA prevalence was 42.6% in skin infection, 82.3% in lower respiratory tract infection and 30.8% in urinary tract infection. MRSA infection was found associated with lower respiratory tract infection only. Highest occurrence of nosocomial infection was observed in female surgical ward, surgical out patient department, orthopedic ward, male surgical ward and maternity ward. MRSA isolation was high from lower respiratory tract of patients admitted in intensive care unit, coronary care unit, Sub-acute intensive care unit, intermediate coronary care unit, neurology ward and post-operative ward. Whereas methicillin sensitive S. aureus (MSSA) occurrence was higher in patients admitted in orthopedic, Surgical out patient department, and female surgical ward. The occurrence of MRSA did not differ with age but MRSA was found associated with male patients and MSSA was associated with female patients. Since MRSA prevalence was high, regular surveillance of MRSA and nosocomial infections should be done and universal precautions to control nosocomial infections should be followed.

Method for detecting circulating Toxocara canis antigen and its application in human serum samples.

Abstract: Diagnosis of larval migrans (LM) is usually done by immunodiagnostic methods. These methods, however, simply show the presence or absence of antibody but not the active infection of the patients. Therefore, we aimed to establish a diagnostic method for detecting circulating Toxocara canis antigen using a sandwich, ELISA. Monoclonal antibodies (MAb) were produced against the excretory-secretory (ES) antigen of second-stage T canis larvae. Among the MAbs obtained, we selected one MAb (TCMAb12; molecular weight, 30-80 kDa, IgG) for use in the sandwich ELISA. The cross-reactivity of the sandwich-ELISA against thirteen different kinds of parasite antigens were examined. The results revealed that the antibody reacted with T canis ES antigen, T. canis female antigen, and T. canis second-stage larvae antigen, but did not react with any other antigens. From results obtained using an ES antigen concentration standard curve, we confirmed that the detection limit of the sandwich-ELISA was 5 ng/ml, which provides sufficient sensitivity for the diagnosis of toxocariasis (LM). We applied the method to suspected toxocariasis patients and examined the circulating antigen in their sera. We used nine serum samples collected from patients with suspected toxocariasis based on both their clinical symptoms and high antibody titers. Overall, five sera showed antigen-positive reactions, while the remaining four were negative. These results indicated that about 44.0% of the antibody-positive patients were antigen-negative, not ongoing active infection. The results obtained using this technique would provide us for understanding toxocariasis.

Status of drinking water contamination in Mountain Region, Nepal.

Abstract: Status of drinking water contamination was studied in three mountainous districts in Nepal. A total of 43 water samples (Sankhuwasabha: 11, Rasuwa: 12 and Dolpa: 20) were tested for the presence of total coliform (TC) and Escherichia coli as fecal coliform bacilli using commercially available test system called Colilert (Japan). Of the total, 85.7% (36/43) were positive for TC whereas 67.4% (29/43) were positive for Esch. coli. The fecal contamination rates (as indicated by the growth of Esch. coli) in Sankhuwasabha, Rasuwa and Dolpa Districts were 81.8% (9/11), 75.0% (9/12) and 65.0% (13/20), respectively. Most of the water samples collected in district headquarter towns namely Khandbari, Dhunche and Dunai, respectively) showed Esch. coli compared with those collected in remote villages areas.

Rifampin resistance in carbapenem-resistant Acinetobacter baumannii in Siriraj Hospital, Thailand.

Abstract: There is a growing evidence on emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) in Thailand and recent treatment guidelines recommend a combination therapy using carbapenem and/or polymyxin with rifampin. Rifampin would be added in a combination therapy. The susceptibility of this pathogen to rifampin is not known, so we studied the rifampin susceptibility and possible mechanisms of resistance used by CRAB. The disk diffusion test was performed on 111 clinical isolates using 5 microg rifampin disk following CLSI guidelines. The inhibition zone was interpreted based upon the recommendation for Staphylococcus aureus (inhibition zone < 20 mm = resistant). Polymerase chain reaction (PCR) using the primers specific for arr-2 encoding rifampin ADP-ribosyltransferase was performed in all isolates. The rpoB DNA sequences from two isolates, with or without arr-2, were compared. All isolates under study were rifampin resistant. Inhibition zone was < 14 mm for all isolates. The arr-2 was positive for 35 isolates (31.5%) and these isolates correlated with high level of resistance (inhibition zone < 10mm). The DNA sequences of rpoB genes in arr-2 negative isolate showed mutations L904S, P906R, K909N and M1262K that might have roles in rifampin resistance. Mutations of rpoB genes in some isolates and possession of arr-2 in class 1 integron element were mechanisms for rifampin resistance and these resistant determinants can disseminate through both vertical and horizontal gene transfer. Under this circumstance, it is not recommended to use rifampin in the treatment of carbapenem-resistant A. baumannii in Thailand.

Echocardiography based cardiac evaluation in the patients suffering from chronic obstructive pulmonary disease.

Abstract: Chronic obstructive pulmonary disease (COPD) is the most common medical problem in Nepal. Echocardiography based cardiac evaluation in COPD is rare in Nepal. The purpose of this study is to evaluate the echocardiography based cardiac function in consecutively admitted COPD patients (507) in medical wards of Nepal Medical College Teaching Hospital during 13th April 2007 to 12th April 2008. Male female ratio was 0.9:1. Age (mean +/- SD) was 66.1 +/- 10.9 yr. Brahman and Chhetri ethnic group comprised of more than half of total COPD patients followed by similar number of patients in Newar (22.1%) and Mongolian ethnic groups (21.5%). More than half of the COPD patients were in age group 60-75 years, followed by less number of patients (approximately 20.0%) in both 45-59 years and 75-89 years age groups. Of the total patients (507), 141 patients underwent echocardiographic evaluation. Among them significant number of patients had poor LVEF (29, 20.6%) with statistically significant difference in LVEF (36.0 +/- 10.5 vs. 64.3 +/- 8.5%, p value < 0.01). More than half of the total patients showed features of chronic cor pulmonale (56.3%), followed by valvular heart disease (49.3%), diastolic dysfunction (38.7%) and left ventricular hypertrophy (14.1%). Mild pulmonary artery hypertension (PAH) was detected in approximately half of patients (49.1%), followed by moderate PAH in 17.6% patients. Transthoracic echocardiography was found to be very useful to identify various concomitant cardiac abnormalities demanding special treatment consideration in managing clinically COPD like patients.

Multidrug-resistant nosocomial Citrobacter in a hospital in Kathmandu.

Abstract: Citrobacter sp. is a commensal flora and an infrequent nosocomial pathogen to cause nuisance in hospital settings. Recently, the isolation of this pathogen in health care setting is rising and the multidrug resistant strains are emerging. This pathogen cause wide array of infections and the mortality rate is unexpectedly high of 30.0-60.0%. Extended spectrum cephalosporins have been used to treat this pathogen and due to the emergence of resistant strains to these drugs newer treatment protocols have to be devised. Epidemiology and antibiotic susceptibility pattern of clinical isolates of Citrobacter sp. isolated in a hospital were investigated. Specimens were collected from patients and implicated pathogens were isolated. Disk diffusion test was performed on these isolates and resistant patterns were. Antibiogram typing was used to resolve the clones of the isolated bacteria. The results showed that Citrobacter sp. was highly prevalent and commonly isolated from the sputum sample of patients diagnosed as Chronic Obstructive Pulmonary Disease (COPD). The antibiogram pattern suggested the circulation of three clones of Citrobacter sp. They were multidrug resistant and were sensitive to only cefoperazone and sulbactam suggesting the production of â-lactamse inhibitors sensitive molecular class A and D extended spectrum â-lactamases (ESBL). In conclusion, although, ESBL producers are always treated with carbapenems, we recommend to use combination therapy of â-lactam and â-lactamse inhibitors to treat this multidrug resistant Citrobacter sp. and carbapenems should be kept as a reserve drug and we should aim to prevent the spread of this resistant pathogen between different patients to decrease the morbidity and mortality associated with this pathogen.

Psychiatric morbidity among physically ill persons in eastern Nepal.

Abstract: This cross-sectional hospital-based study investigated the prevalence and pattern of psychiatric morbidity among 151 physically ill psychiatric-referred cases admitted various departments in BPKIHS. Consecutive referral cases were initially worked up by junior residents and diagnosis/differential diagnosis was made by consultant according to ICD-10 diagnostic guidelines. Of total 151; M: 77 (50.9%) and F: 74 (49.1); Majority 38 (25.1%) of subjects were young with age 15-24 yrs and 95 (62.9%) were from plains. About 21.8% referrals came from internal medicine followed by emergency department, 9 (5.9%). The highest number of cases 48 (31.7%) had neuropsychiatric illnesses and 17.0% had some medical complications resulted from suicide act. Among psychiatric co morbidity, dissociative/conversion disorders were the commonest 26 (17.2%) followed by alcohol use-related disorders 25 (16.5%) and depressive disorder 20 (13.2%). To conclude, the co-occurrence of medical and psychological/psychiatric conditions is common, which demands timely identification and early interventions in order to reduce morbidity and mortality.

Ultrasonographic evaluation of carotid intima-media thickness in hypertensive and normotensive individuals.

Abstract: This was a case control study designed to evaluate carotid intima-medial thickness (IMT) by high-resolution ultrasound in hypertensive and normotensive individuals. High-resolution carotid ultrasound was done in 203 hypertensive patients (cases) and 101 normotensive individuals (control). Scanning of bilateral common carotid artery (CCA) was performed in anteroposterior projections. To obtain a better image sound wave was adjusted perpendicularly to the arterial surface of the posterior wall of the vessel, yielding two parallel echogenic lines which correspond to lumen-intima and media-adventitia interfaces. Intima-medial thickness was measured in the far wall 1-1.5 cm proximal to the bulb bilaterally. The age of the study population ranged from 35 to 65 years. Mean IMT was significantly high in hypertensive patients compared to the control group, p<0.001 (in cases, IMT in right side was 0.968 mm and that of left side was 0.969 mm and in control group IMT of right side was 0.551 mm and that of left side was 0.555 mm). A significant difference in IMT of bilateral common carotid arteries was found between the smoker and non-smoker hypertensive patients (p<0.02). IMT was found to increase progressively with age. In conclusion, the study revealed a strong correlation between IMT of common carotid artery and hypertension. Hence, IMT measurement of CCA by high-resolution ultrasound in hypertensive patients is a helpful tool to assess the atherosclerosis and to identify individual at risk of cardiovascular and cerebrovascular complications.

Investigation of Burkholderia cepacia complex in septicaemic patients in a tertiary care hospital,India

Abstract: Burkholderia cepacia complex (BCC) is being increasingly recognized as an important pathogen of humans. During the year 2007-8, 39 putative BCC isolates were obtained from 21 cases and subjected to recA PCR RFLP. Twenty-four isolates were confirmed as Burkholderia cenocepacia IIIA (nineteen isolates, recA PCR RFLP type G and five isolates, recA PCR RFLP type I), six were confirmed as B. cepacia (recA PCR RFLP type E). BCC were isolated from inpatients of different wards of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh with increased isolation from children admitted to different wards of Advanced Pediatric Centre (11/21 cases). BCC isolates are often resistant to most commonly used antibiotics and an early use of effective antimicrobial therapy can decrease morbidity and mortality.

Comparative evaluation of microscopy and polymerase chain reaction (PCR) for the diagnosis in suspected malaria patients of Nepal.

Abstract: Microscopy has been the most common technique for the diagnosis of malaria in Nepal. This study was undertaken at CDM, TU, Kathmandu, and Department of Clinical Tropical Medicine, Mahidol University, Bangkok to compare the efficiency of microscopy and PCR for malaria diagnosis in Nepalese context. During July-August 2007, blood samples were collected in glass slides and on filter papers from suspected malaria cases of Kanchanpur, Jhapa and Morang Districts. Sample transportation and storage was done using standard protocol. Microscopy was done at the heath posts in the district in Nepal while Nested PCR using previously standardized primers was carried out at Mahidol University. Among 824 malaria suspected cases, 19.2% (157) were laboratory confirmed as malaria cases (P. vivax 10.9%, P. falciparium 7.7% and 0.4% were of mixed infection) by microscopy. The parasite count range was detected as 320-25020 parasites/microl. Among total 132 samples (114 microscopic positive, 18 negative) were processed for nested PCR. Among microscopic positive samples with increase of the parasitaemia/microl of the blood, the rate of detection by PCR (75.4%) was increased though the PCR failed to detect 2 cases having the parasitaemia 5000-15000/microl of blood however 4 microscopic negative cases were detected as P. vivax infection. Among the microscopy positive samples for P. falciparum, 3 were found P. vivax and 2 were found as mixed infection of Pv and Pf and 6 P. vivax were found positive for P. falciparum by PCR. Two microscopy positive samples for mixed infection were found be positive for one Pv and one Pf by PCR. PCR could be good tool in confirming the clinically strongly suspected but microscopically negative malaria cases and advanced molecular epidemiological studies, although its use in routine diagnosis may not be feasible.

Mad honey poisoning: a rare case report of seven cases.

Abstract: The cause of mad honey poisoning is the toxin grayanotoxin, found in honey obtained from the nectar of Rhododendron species on the higher altitudes. This case report is about seven cases of grayanotoxin poisoning that occurred after consumption of wild honey that was brought from the Himalayan belt of Nepal. Most of them presented with symptoms of blurring of vision, diplopia, nasea and vomiting and two of them presented with symptoms of cardiac depression. All of the cases responded well to intravenous fluid and/ or pressor agents while none proved to be fatal