Care Center In Nepal Research Articles

Knowledge, attitude and practices on the care of the newborn in postnatal mothers delivering at a tertiary care centre in Nepal

Introduction: Neonatal mortality rate per thousand live births in Nepal is 24.2, and the majority of neonates die during the early neonatal period. Objective: To determine the knowledge, attitudes and practices of mothers regarding care of the newborn after delivery at a tertiary teaching hospital in Nepal. Method: A cross-sectional study employing both quantitative and qualitative study approaches was conducted in the Maternal and Child Health (MCH) unit of a tertiary hospital in East Nepal for a period of three months. Using a convenient sampling technique 65 postpartum mothers admitted in MCH unit were enrolled in the study. Structured interview questionnaires were used to collect data. Data was analyzed using descriptive statistics by SPSS 20. Results: Sixty five mothers who delivered at the tertiary care centre were interviewed. Age of mothers ranged from 16 to 40 years, 63% were primipara and 18.4% were illiterate. Whilst 95% of mothers knew about immunisation, few had acquired knowledge regarding cord care, signs of illness in newborn and newborn feeding during antenatal checkups. Maternal knowledge about newborn danger signs was low. Breast feeding practice as observed by interviewer was not satisfactory. Maternal knowledge on newborn hygiene care was unsatisfactory. Conclusion: Maternal knowledge, attitudes and practices regarding care of the newborn after delivery at the tertiary teaching hospital in Nepal requires improvement.

Clinical Profile of Children with Acute Febrile Encephalopathy in a Tertiary Health Care Center of Nepal

Background: Acute febrile encephalopathy is a common and severe neurological syndrome that is associated with significant morbidity and mortality in children. The etiologies differ according to geographical regions and appropriate and efficient protocols for investigations and management requires proper understanding of various potential etiologies.Methods: In this prospective observational study, 54 children of one month to 14 years presenting to the hospital with acute onset of fever with altered sensorium were clinically evaluated and investigated. Clinical examinations included temperature, pulse rate, heart rate, blood pressure, coma severity by GCS, respiratory pattern and detail systemic and CNS examination. Etiology of acute febrile encephalopathy was based on clinical history, examination and relevant laboratory investigations.Results: The incidence of acute febrile encephalopathy was 5.5% of the total hospital admissions. There were 35(64.8%) boys and 19(35.2%) girls. The maximum number of children 24(44.4%) were between one to five years of age. The most common presenting complains besides fever and altered sensorium were seizures and vomiting which was present in 59.3% and 46.3% of children respectively. Signs of meningeal irritation, hypertonia, brisk deep tendon reflexes and extensor plantar response was present in 50%, 24%, 29.6%, and 44.4% respectively. The diagnosis based on clinical findings and laboratory investigations were viral encephalitis 34(63%), bacterial meningitis 12(22.2%), cerebral malaria 4(7.4), enteric encephalopathy 3(5.6%) and hepatic encephalopathy 1(1.9%).Conclusion: Viral encephalitis and bacterial meningitis are the most common cause of acute febrile encephalopathy. Preventive strategies can be done to decrease the incidence.J Nepal Paediatr Soc 2015;35(3):224-230

PS083 Knowledge, Attitude and Practice on Coronary Artery Disease in Patients Attending the Tertiary Health Care Center in Nepal

PS083 Knowledge, Attitude and Practice on Coronary Artery Disease in Patients Attending the Tertiary Health Care Center in Nepal

The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary Intensive Care Unit of a tertiary care center in Nepal.

Aim:C-reactive protein (CRP) is a commonly used biomarker of sepsis, the leading cause of mortality in Intensive Care Units (ICUs). However, sufficient data are still lacking to strongly recommend it in clinical practice. The present study is aimed to find out its reliability in diagnosing sepsis.Materials and Methods:CRP was measured in ICU-admitted patients with systemic inflammatory response syndrome and compared using a cutoff of 50 mg/L with the gold standard for diagnosing sepsis, taken as isolation of organism from a suspected source of infection or the Centers for Disease Control criteria for clinical sepsis.Results:CRP had a sensitivity and specificity of 84.3% and 46.15%, respectively. Area under the receiver operating characteristics curve was calculated to be 0.683 (±0.153, P < 0.05). The cutoff value with the best diagnostic accuracy was found to be 61 mg/L.Conclusion:CRP is a sensitive marker of sepsis, but it is not specific.

A comparative study of free-hand fine needle aspiration cytology and ultrasound guided fi ne needle aspiration cytology in the diagnosis of thyroid swellings at BP Koirala Institute of Health Sciences- a tertiary care centre in Nepal

Background: Thyroid lesions are commonly encountered in clinical practice and it is mandatory to know and record the nature of pathology prior to definitive therapy. Fine needle aspiration cytology (FNAC) is a time tested, cheap, reliable and safe method to establish a cytological diagnosis of the nature of the disease. Ultrasound guided FNAC has the potential to reduce inadequacy rates and is regarded as the optimal cytological method for diagnosis. Objective: To compare the results of free-hand and ultrasound-guided FNAC of thyroid swellings and to find out the diagnostic reliability of free-hand FNAC and ultrasound-guided FNAC using histological diagnosis as the gold standard. Methods: Fifty-five patients with thyroid swelling who were subjected to free-hand and ultrasound-guided FNACs and who subsequently underwent surgery over one year were studied. Results: Ultrasound guided FNAC results revealed 72.75 % benign lesions and 25.45 % of malignant lesions, and free hand FNAC revealed 52.73 % benign and 16.36% malignant cases. A 14.55 % inadequacy rate was seen in the free hand group. Histological gold standard diagnosis comprised of 60 % benign and 40 % malignant cases. Sensitivity and specificity of free-hand and ultrasound guided FNAC in diagnosing malignancy of the thyroid were 56.25% and 100%; and 63.64% and 96.97% respectively. Conclusion: Free hand FNAC of thyroid swellings is more convenient and cost effective as compared to ultrasound guided FNAC. However, the diagnostic yield in ultrasound guided FNAC is significantly more in terms of accuracy especially in cystic and tiny lesions.Health Renaissance 2014;12(2): pp. 78-86

Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal.

BackgroundCorneal ulcer is an important cause of blindness in developing countries. Therapeutic keratoplasty for infective keratitis is a frequently performed surgery in these countries.ObjectiveTo find out the outcome of therapeutic keratoplasty for infective keratitis.MethodsRecords of 5 years were reviewed of patients who underwent therapeutic keratoplasty from 2006 to 2010. Data collected included demographic parameters, indications for surgery, microbiology of the ulcers, type of surgery performed, and donor tissue details. In the follow-up period, ocular status was evaluated in terms of eradication of disease, anatomic success, graft clarity, visual acuity, and development of glaucoma and cataract.ResultsIn all, 180 eyes of 180 patients were enrolled in the study; 59.4% of the patients were male. Average age was 44.4±16.7 years. Overall, 71% of infective keratitis was perforated. A total of 101 (56%) eyes were positive for organisms of which 49 showed pure fungus and 49 showed pure bacteria. The commonest fungus and bacteria isolated were Aspergillus and Streptococcus, respectively. Average follow-up period was 29±23 months. Overall cure rate of infection was 88.8%, anatomical success rate was 89.5%, and graft clarity was 37.2%. Overall, 43.4% had secondary glaucoma. In the postoperative course, 65.8% of phakic eyes had developed cataract. In all, 38.6% of graft had endothelial failure and 24% of the graft failed due to late infective keratitis. Overall functional success with a visual acuity above 6/60 was 25.4%. Bacterial keratitis had a significantly higher cure rate, anatomical success, and graft clarity compared to fungal keratitis.ConclusionTherapeutic keratoplasty is an important procedure to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery. Bacterial keratitis has a better outcome than fungal keratitis.

Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal

Background: Emergency surgeries throughout the world are demanding earlier surgical times. In a developing country like Nepal this cannot be possible because of lot of factors. So we planned to study such factors that could interplay and increase the waiting time for emergency surgeries. Methods: A prospective observational study was conducted over 45 days and all patients diagnosed with general surgical and orthopedic emergencies were followed till they were operated. Results: Out of 1211 patients presenting to emergency department, 92 required emergency surgery. The mean age was 29.72 year and 76.1% of the patients were male. The mean time from presentation to the emergency department to the first surgical consultation was 170 minutes, from surgical consultation to decision of surgery was 28 minutes, from decision of surgery to transfer to operating room was 426 minutes, from arrival in operating room to anesthesia consultation was 18 minutes, and from anesthesia consultation to start of surgical incision was 75 minutes. The total average waiting time from arrival at emergency department to the start of surgery was 717 minutes. The factors were, viz., pre-occupancy of theatre (59.8%), special procedures/intervention required prior to surgery (23.9%), arrangement of logistics/finances by patient family (13%), arrangement of blood products (10.9%), consultations (9.8%), delay in giving consent by patients/family (5.4%), delay in arrangement of supplies (9.8%), and shift change of nursing staff (3.3%). Conclusion: This study shows that various preventable factors increases waiting times for emergency surgeries that should be minimized so that waiting times can be reduced.Journal of Society of Anesthesiologists 2014 1(1): 7-12

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal

Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here. This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed. Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients. Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function.

Clinical and demographic profile of patients presenting to cath-lab in a tertiary care center in Nepal

Background &amp; Objectives: Coronary Artery Disease (CAD) is one of the leading killers in the world. This is a demographic study of patients who underwent coronary angiography for CAD with regard to sex, age, ethnicity and prevalence of risk factors.Materials &amp; Methods: Hospital based retrospective study conducted at the Department of Internal Medicine, B.P. Koirala Institute of Health Science (BPKIHS), Dharan, Nepal.Results: The Study showed that out of 382 patients who presented to the cath-lab 216 patients underwent angiography alone and 166 patients had PCI. The most common indication for presentation to cath-lab was S-T Elevation Myocardial Infarction (STEMI), which accounted for 46.3% cases. The most common age group of presentation was 51-60 years of age with 35% cases. During the procedure, it was found that 32.8% had normal vessels, 29.6% had single vessel disease and 38% had 2 or more vessels involved. The most common coronary artery involved was left anterior descending (LAD), which was implicated in 96.9 % of total cases. Coronary Artery Disease was defined as having at least one vessel 50% obstructed. A total of 158 males and 99 females had CAD with a sex ratio of 1.59. It was found that 36.1% belonged to Brahmin / Chettri ethnicity whereas 34.0% belonged to Janjati. Hypertension was the most common risk factor, present in 67 % of the patients.Conclusion: It appears that among the population of eastern Nepal, the age group most likely to suffer from an episode of ACS leading to invasive evaluation is between 50 to 60 years. And the most significant risk factors associated are hypertension and smoking.JCMS Nepal. 2015;11(1):1-5

Pregnancy Related Acute Kidney Injury at a Tertiary Care Center in Nepal

Aims: This was performed to study the characteristics of Pregnancy Related Acute Kidney Injury (PRAKI), its management and outcome in patients at a tertiary level referral centre. Methods: A hospital based prospective observational study was conducted in Tribhuvan University Teaching Hospital (TUTH) over a period of 18 months. All patients diagnosed with PRAKI were included in the study. Patient profiles in terms of age, parity, gestational age were studied along with time of occurrence of PRAKI, preceding event, etiology, management and maternal outcome. Descriptive and univariate analyses were conducted and qualitative variables were expressed as percentages while quantitative variables as means. Results: There were fifteen cases of PRAKI during the study period with incidence of 2.1 per 1000 deliveries. The average age was 25.23± 3.8 years and 9(60%) were primipara. Fourteen (93.3%) developed PRAKI in the postpartum period with 10(66.6%) cases following Lower Segment Caesarian Section (LSCS). The commonest etiology of PRAKI was severe preeclampsia/ Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome and pregnancy hemorrhages each consisting 4(26.6%) cases. The stage of Acute Kidney Injury (AKI) according to RIFLE (Risk, Injury, Failure, Loss, ESRD-End Stage Renal Disease) criteria was as follows: risk in 1(6.6%), injury in 3(20%) and failure in 11(73.3%) cases. Hemodialysis was necessary in 12(80%) cases while 3 cases (20%) improved with medical management only. The average duration of hospital stay was 25.2±14.7 days and 7(46.6%) needed ICU admission. Twelve (80%) cases recovered completely while two patients were dialysis dependent at the time of evaluation. There was one death. Conclusions: PRAKI occurred mainly in the postpartum period with severe preeclampsia/HELLP syndrome and hemorrhages as the most common causes. It is associated with high maternal morbidity, prolonged hospital stay and even mortality. Multidisciplinary team management is essential.

Knowledge, Attitude and Stigma in Epilepsy: A Study From A Tertiary Care Centre in Nepal

Introduction: Epilepsy is a common health problem which engenders a variety of medical, social, psychological and economic burdens. Stereotyped assumptions about people with conditions such as epilepsy are inherent in many cultures and Nepal is not exception .Better information about epilepsy among the people can remove the stigma associated with it. Objective: The aim of the present study was to assess the knowledge, attitude and stigma regarding epilepsy among patients with epilepsy. Methods: It is a hospital based, cross-sectional descriptive study of 47 patients visiting BPKIHS psychiatry OPD. A semi structured Proforma, knowledge attitude questionnaire and the Stigma Scale developed by M. King et.al. Was administered to collect the data. Results: Majority (66.0%) of subjects were male. Generalized seizure (76.6%) was most common presentation. Majority of subjects believed that their disease should be kept secret. Almost 81% subjects thought they could work with persons suffering from epilepsy whereas 23.4% subjects objected even to travel together with them. About 32% subjects felt bad about having epilepsy, 40.4% agreed that they were angry the way people react to their illness, and 76.6% thought that they would have had better chances in life if they did not have epilepsy. Conclusion: Knowledge about epilepsy is still patchy among patients. Despite this, attitude towards epilepsy is generally positive. Still there is significant stigma attached to this illness. These findings call for comprehensive educational program aimed at improving the knowledge and reducing the stigma in the population at large.DOI: http://dx.doi.org/10.3126/hren.v12i1.11979 Health Renaissance 2014;12(1):11-17

A clinical approach to ocular myasthenia gravis

Myasthenia gravis is a common disorder of the neuromuscular junction characterized clinically by muscle weakness and fatigability. Ocular myasthenia is often misdiagnosed in the initial stages due to the fluctuating nature of ptosis and diplopia. Here, we describe the clinical characteristics of ocular myasthenia gravis along with the diagnostic difficulties in a tertiary eye care center in Nepal. We retrospectively reviewed the charts of the patients diagnosed as ocular myasthenia gravis in Neuro-ophthalmology clinic, BPKLCOS, from 2010 to 2013. The diagnosis of ocular myasthenia was based on the association of typical history and signs together with at least one of these features: unequivocal improvement of ocular signs after injection of neostigmine, positive response to electrophysiological tests and detection of serum antibodies to acetylcholine receptors. There were 24 cases of diagnosed ocular myasthenia gravis during the 3 years. Among them 11 cases (45.8%) were males and 13 cases (54.1%) were females. The mean age was 32.04±19.56 years with the age range from 9 years to68 years. The most common symptoms among patients were drooping of the lids (45.8%, n=11), followed by both double vision and drooping of the lids (37.5%, n=9) and only intermittent double vision in16.6% (n=4). In two patients (9.09%) CT-scan findings were suggestive of thymoma. The symptoms were resolved with anticholinesterases alone in 66.6% (n=16) and anticholinesterases were supplemented with immunosuppressive drugs in 33.3% (n=8) patients. Ocular myasthenia is often misdiagnosed in the initial stages due to its fluctuating nature. With a high index of clinical suspicion simple clinical tests accompanied by pharmacological tests can be useful in diagnosing the condition.DOI: http://dx.doi.org/10.3126/jcmc.v4i3.11931Journal of Chitwan Medical College 2014; 4(3): 5-8

Prevalence and Causes of Anemia in Six to Sixty Months Old Children: A Cross-Sectional Study at Kathmandu Medical College and Teaching Hospital

Introduction: Anemia is one of the most common problems in children, especially in the developing countries. Nutritional anemia is associated with impaired performance of a range of mental and physical functions in children. This study was conducted to evaluate the prevalence and possible causes of anemia in children attending tertiary care center in Nepal. Material and Methods: This was a prospective hospital based cross-sectional study done at Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal over a period of 10 months from March to December 2012. Children between the age group of 6 months to 60 months attending the Paediatric Out-Patient Department were randomly selected. The haemoglobin concentration was measured with an Automated Haematology Counter (Sysmex, Japan) following the manufacturer’s instructions. Anemia in children is defined as a hemoglobin level less than 11 gm/ dl. Results: There were 500 children enrolled in the study, out of which 191 (38.2%) were found to be anemic. Mild anemia was observed in 31.2%, moderate in 6.6% and severe in 0.4%. The commonest age group affected was between 24 months to 35 months old children. Anemia was more common in female children (41.9%) compared to males (35.8%). 118 anemic children were further investigated for the cause of anemia and 103 (87.3%) had iron deficiency anemia. Conclusion: This study reflects that prevalence of anemia still remains high and iron deficiency is the leading cause of nutritional anemia in children. Timely intervention can both prevent and treat childhood anemia. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8847 J. Nepal Paediatr. Soc. 2013;33(3):163-165

Outcome of the patients with post-operative cluster endophthalmitis referred to a tertiary level eye care center in Nepal

The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors. To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis. An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome. Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks. Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome.

Psychiatric Illnesses among the Patients Admitted for Self-poisoning in a Tertiary Care Hospital of Nepal

Background and Aims- Self-poisoning is the commonest mode of suicide in our part of the world. Patients attempting suicide by self-poisoning usually land up in the Emergency. They are admitted for management of medical complications and subsequently referred to Psychiatry for evaluation of possible Psychiatric illnesses. The aim of this study was to explore the patterns of psychiatric illnesses in the patients admitted for self-poisoning in a tertiary care center in Nepal. Methods- The study population included those patients who were admitted and being managed for self-poisoning and brought for psychiatric evaluation during the period of one year (1st June 2011- 30th June 2012) at Dhulikhel Hospital, Nepal. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details including sociodemographic data, psychiatric diagnosis, and treatment offered and outcome was tabulated and analyzed using SPSS-16. Results- Among the total patients (N=100), 43 were in the age group 21-40 years, median age being 27.5. There was almost equal gender distribution. Majority was of Mongolian ethnicity, homemaker by occupation and married. More than 90% were single-attempters, suicidal attempt using organophosphorus compounds. Almost 50% had depression; family dispute (19%) and marital disharmony (17%) were the most common psychosocial precipitant. Conclusion- Patients with history of self-poisoning are commonly brought to the Emergency Department of any tertiary care hospital. It is widely prevalent on younger age group. It is usually by the use of Organophosphorus compound in our setting and most commonly associated with depression. Hence, psychiatric care is essential for these patients. Journal of Advances in Internal Medicine 2013;02(01):10-13 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7630

Study of Mumps in Children attending a Tertiary Care Centre

Introduction: Mumps is a self-limiting viral infection of the salivary glands with systemic manifestations and complications. It primarily affects young children, with increased incidence in winter and spring. Mumps infection is endemic in developing countries because of poor vaccination coverage. This study is intended to highlight the increased number of mumps cases in children attending tertiary care center in Nepal and thus to emphasize the importance of mumps vaccination, so as to decrease the disease occurrence and disease burden by vaccinating all children. Materials and Methods: This was a prospective study done in Civil Service Hospital of Nepal over a period of 2 years from November 2009 to October 2011. All children less than 14years of age with symptoms of fever and parotid swelling were included in the study group. A detailed history pertaining to the disease was taken, that included; history of exposure and prior vaccination against mumps. Children were asked to follow up either after 5 days or in case of noticing any signs and symptoms of complication. Results: There were total 113 cases diagnosed clinically as mumps of which there were 71 males (62.83%) and 42 females (37.16%) with the peak incidence of disease in the month of March and September with 22 cases (19.46%) in each month. The increase incidence was seen in 4-6 years of age with 58 cases (51.32%). There were 70 patients (61.94%) that had history of exposure to mumps infection. All the patients in this study had either unilateral or bilateral parotitis. None of the children were vaccinated against mumps. And all the school going children had to be off school for a period of 3-5 days. Conclusion: There were large number of children with mumps and none of them were vaccinated. Child can be prevented from the infection by vaccination and thus avoiding possible sufferings and complications. Thus we recommend the use of mumps vaccination in Routine immunization programme. Key words: Mumps; Parotitis; School absenteeism; Nepal; Vaccine DOI: http://dx.doi.org/10.3126/jnps.v32i1.5499 J. Nepal Paediatr. Soc. Vol.32(1) 2012 53-56

Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre, Nepal

Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years. Materials and Methods: This was a descriptive study in a hospital setting. A review of pediatric cataract cases operated between November 2007 and June 2009 in Tilganga Institute of Ophthalmology (TIO), a tertiary eye care centre in Nepal was carried out. The personal profile, preoperative and intra-operative details were noted. In the statistical analysis p value less than 0.05 is considered as significant. Results: A total of 175 eyes of 132 children had presented during study. The sex ratio was 1.6 male per female with mean age of 6.7 years (SD ±4.3). About one-third (32%) presented within the age of three years where as more than two-fifths (46%) presented at the age eight years and above. Seventy two cases were collected through door to door enumeration and screening clinics for children. The proportion of cataract was higher in males than in females (P&gt;0.05). Visual acuity ranged from 6/18 to follows light. Conclusion: Nearly half of the paediatric cataract had presented after the age of eight years mainly from hilly region through the screening program. Most of the pediatric cataract cases presented with the whitish pupillary reflex with more than two-thirds of visual acuity of less than 3/60. The most common type of the cataract surgery performed was lens aspiration with anterior vitrectomy with lens implantation. The earlier the surgery better is the visual prognoses. Hence, community screening through as door to door screening and one day screening clinics will help for early referral and earlier surgery to reduce visual disabilities due to paediatric cataract. Key words: Cataract; Cataract surgery; Childhood blindness; Nepal DOI: http://dx.doi.org/10.3126/jnps.v32i1.5378 J. Nepal Paediatr. Soc. Vol.32(1) 2012 14-18

The Spectrum of Ocular Involvement in Systemic Lupus Erythematosus in a Tertiary Eye Care Center in Nepal

Manifestations of Systemic lupus erythematosus are protean and the eye can get affected in more than a third of the cases. This study was conducted to evaluate the spectrum of ocular manifestation among Nepalese patients diagnosed with Systemic lupus erythematosus. In this hospital based cross-sectional study, 91 established cases of Systemic lupus erythematosus were enrolled from January 2008 to June 2009 AD. Patient particulars including age, sex, duration, systemic involvement, laboratory findings and treatment history were noted. Detailed ophthalmological examination was carried. Out of 91 patients, 94.5% were females and 5.5% were males. Female/Male ratio was 17:1. Mean age of the patients was 26.59 ± 10.33 years. Ocular involvement was present in 47.3% (43) of the patients, the commonest manifestation being dry eye (39.5%) followed by lupus retinopathy (21%) and drug induced ocular complications (21%). Ocular manifestations in Systemic lupus erythematosus are not uncommon.

Anatomical and Visual Outcome following Macular Hole Surgery at a Tertiary Eye Care Centre in Nepal

Macular hole (MH) leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal. This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8) from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA) and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT) at six weeks, three months and at the last follow-up following surgery were recorded. A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D) were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D). Idiopathic macular hole comprised of 31 cases (86.1 %) and traumatic of five cases (13.9 %). The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 %) at six weeks and in 28 cases (77.8%) at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 %) than in the traumatic (60 %) and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases. The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic.

Awareness of diabetic retinopathy among diabetic patients in Nepal

Dear Editor, D iabetes mellitus is a chronic disease with increasing prevalence worldwide. Among the total diabetic patients expected in 2030, half will be in Asian countries (Wild et al. 2004). This increase has been attributed to the rapid economic, demographic, and nutritional transition in the developing countries (Wild et al. 2004). Almost one-fourth of people 20 years and older and one-third 40 years and older in urban areas of Nepal exhibited diabetic tendencies in one populationbased study from Nepal (Singh & Bhattarai 2003), and now diabetes is considered as an epidemic health problem there. Urbanization, changing dietary patterns from a rough fiber diet to a more refined one with abundant fatty foods, and an increasingly sedentary life style are likely to contribute to additional cases in the future. Likewise, the tradition of excessive feeding of fatty and sweet foods following delivery appears to have increased obesity and diabetic predisposition in women in Nepalese society (Singh & Bhattarai 2003). Diabetic retinopathy (DR) is one of the common complications of diabetes mellitus. As in developed countries, DR could soon become one of the most common causes for blindness in developing nations like Nepal. Nepal’s situation is compounded by a low literacy rate and presumed lack of awareness of diabetic ocular complications. Since early detection and timely ocular treatment may prevent many of the blinding ocular complication of diabetes, enhanced awareness of these complications among diabetic patients and the general public could be an effective public health measure. Previous population-based and secondary health care level studies from Nepal have shown that only 50% of the diabetic patients were aware of potential diabetic ocular complications (Shrestha et al. 2007; Paudyal et al. 2008). When we surveyed new diabetic patients who presented to a tertiary eye care center in Nepal for ophthalmic evaluation, we found that 37% of patients were unaware of diabetic ocular complications even though a majority of the patients had been referred for further evaluation and management. Our unawareness rate was substantially higher than rates reported in studies from neighboring countries (Saikumar et al. 2007). In our series, almost half of the patients were illiterates who must rely on non-print sources for information on DR. Only half of those who were aware of diabetic ocular problems received their information from primary care physicians or from the referring ophthalmologist. This may reflect the small amount of time physicians and ophthalmologists can devote to discussion of diabetic complications with patients in a developing country with a low doctorto-patient ratio. The other major source of awareness was from family members, especially since one-third of cases had a positive family history in at least one-first-degree relative, presumably due to genetic predisposition and common environmental factors such as food habits and lifestyle. Media (magazines and radio) played a less important role in disseminating information in our patient group, in contrast to the study by Saikumar et al. (2007) in which media was the main source for awareness. This finding emphasizes the need for better media coverage to spread the awareness in our country. Although 51% of the total diabetic patients had a history of diabetes of more than 10 years duration, almost half of the subjects had never even had a fundus evaluation prior to their initial visit to the Tilganga Institute of Ophthalmology. Improved awareness campaigns and increased collaboration with primary-care physicians and comprehensive ophthalmologists to ensure timely and regular referrals of at-risk patients are imperative to reduce DR related blindness in countries such as Nepal.