Nepalese Army Research Articles

Localized Tetanus: Rare and Elusive

Tetanus is acute and fatal infectious disease which is acquired due to contamination of wound with soil or animal feces containing spores of Clostridium tetani. In this case, 24 old male, serving personnel of Nepalese Army, developed localized tetanus, a rare form of tetanus nearly 3 weeks following crocodile bite in his left thigh. It was painful with involvement of only local flexor muscles at the site of injury. The aim is to incite awareness of the rare form of the Tetanus in adult which is often overlooked in clinical practice.Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/47-49DOI: http://dx.doi.org/10.3126/mjsbh.v12i1.9095

Significance of CA19-9 in Predicting the Prognosis of Urothelial Carcinoma: A Hospital Based Study from Nepal

The present study was undertaken to establish any correlation of elevated levels of CA19-9 with tumor stage or grade of urothelial carcinoma. This hospital based study was carried out in the Department of Biochemistry of Nepalese Army Institute of Health Sciences between 1st July 2012 and 31st December 2012. Approval for the study was obtained from the institutional research ethical committee. CA19-9 was assayed with an ELISA reader for all cases and expressed in U/ml with 37U/ml taken as the cut-off upper value for normal. Out of 20 cases enrolled, 15 were of urothelial carcinoma and the remaining 5 were controls. There was marked difference between the mean values of CA19-9 in cases 40.2±19.3U/ml of urothelial carcinoma and controls 7.98±7.34U/ml. The number of cases in Ta, TI, T2, T3, T4 stages of urothelial carcinoma were 2, 6, 3, 3, 1 respectively. The percentage rise in CA19-9 was less with low grade tumors (22.2%) when compared with high grade tumors (66.6%) (p value 0.001*). The percentage of rise in CA19-9 for muscle invasive tumors was very high when compared to superficial tumors. Similarly, the percentage of rise in CA19- 9 for metastatic disease was very high when compared to non-metastatic disease and it was found statistically significant (p value 0.001*). Serum CA19-9 levels predicts the prognosis of urothelial carcinoma as it is almost invariably raised in tumors having metastatic spread.

The Prevalence of Mental Disorders among Serving Soldier Requiring Admission

Introduction: Numerous studies have been done to study the psychiatric conditions in army personnel but none have been done in Nepalese army personnel. The purpose of the present study was to determine the prevalence of common mental disorders among Nepalese Army Personnel who were admitted in psychiatric ward. Methods: Retrospectively 186 case records of Nepalese Army Personnel, who received treatment at the inpatient psychiatric ward over a period of one year (15th May 2010 to 15th May 2011) , were included in this study. Descriptive analysis of their demographic data and types of psychiatric disorders was done using SPSS v16. Results: Among the 186 patients who were admitted during the study period, 184 (98.92 %) were male. The most common age range was 21-30 years (70.43%). The prevalence of the first ten rank of mental disorders among Nepalese Army Personnel were Major Depression (25.27%), Alcohol dependence (22.58%), Schizophrenia (14.67%), Bipolar disorder (8.6%), Anxiety disorder(6.52%), Substance induced psychotic disorder(4.35%), Schizoaffective disorder(3.26%), Deliberate self harm (2.72%), Malingering(2.72%) and Poly substance dependence (2.72). Conclusions: The most common prevalence of mental disorders among inpatient of Nepalese Army Personnel in psychiatric department in the year 2010-11 were Major depressive disorder, Alcohol dependence and Schizophrenia.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/14-17 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7902

Impact of Various Tumor Markers in Prognosis of Gastric Cancer -A Hospital Based Study from Tertiary Care Hospital of Kathmandu Valley

To obtain the maximum additional information about the prognosis of gastric cancer, we compared CA-50 with other previously defined markers. This hospital based study was carried out in the Department of Biochemistry of Nepalese Army Institute of Health Sciences between 1st July 2012 and 31st December 2012. The variables collected were age, gender, AFP, CEA, CA19-9, and CA50, assayed with ELISA reader for all cases. The cut off values for serum AFP, CEA, CA19-9, and CA-50 were 10 μg/l, 10 μg/l, 37 U/ml, and 20 U/ml, respectively according to the manufacturer's instructions. Approval for the study was obtained from the institutional research ethical committee. Of the 40 examined patients, 13 patients had tumors located in the upper third of the stomach, 6 patients had tumors in the middle third, 16 patients had tumors in the lower third, and 5 patients had tumors occupying two-thirds of the stomach or more. The distribution of lymph node staging of the patients was as follows: 7 patients belonged to N0, 9 patients to N1 stage, 10 patients to N2 stage, and 14 patients to N3 stage. The statistical method of Cox proportional hazards using multivariate analysis also illustrated that tumor markers including CEA (2.802), CA19-9 (2.690), CA50 (2.101), were independent prognostic factors, as tumor size (1.603), and lymph node stage (1.614). The tumour markers now available, like CEA, CA 19-9 and CA 50, chiefly perceive advanced gastric cancer. The preoperative rise in those tumour marker level have a prognostic significance and may be clinically helpful in choosing patients for adjuvant management.

Association of type II diabetes mellitus with hepatocellular carcinoma occurrence: A case control study from kathmandu valley

Aim: To assess the association of Type II DM with hepatocellular carcinoma occurrence. Materials and Methods: It was a case control study carried out using data retrieved from the register maintained in the Department of Biochemistry of Nepalese Army Institute of Health Sciences, Nepal between 1st January, 2012 and 31st August, 2012. The variables collected were age, gender, HbA1c. All these biochemical parameters were analyzed in the Central Laboratory of our hospital by standard and validated methods.

Association of Type II Diabetes Mellitus with Hepatocellular Carcinoma Occurrence - a Case Control Study from Kathmandu Valley

To assess associations of Type II DM with hepatocellular carcinoma occurrence in Nepal. This case control study was carried out using data retrieved from the register maintained in the Department of Biochemistry of Nepalese Army Institute of Health Sciences between 1st January, 2012, and 31st August, 2012. The variables collected were age, gender, HbA1c. All biochemical parameters were analyzed in the Central Laboratory of our hospital by standard validated methods. One way ANOVA was used to examine the statistical significant difference between groups with the LSD post-hoc test for comparison of means of case groups. Odds ratios (OR) were calculated using simple logistic-regression analysis. Etiological factors for HCC were HBV, HCV, alcohol and cryptogenic cirrhosis. The highest age group belonged to the etiological category of HCV with a mean of 71.9 ± 3.6 (CI 69.3, 74.5) years and the lowest age group to the etiological category of HBV with 61.7 ± 5.3(CI 57.9, 65.5) years. The main imperative basis of HCC in present study was HCV (39.5%) and second most significant cause of HCC was alcohol (26%). Glycated hemoglobin was found to be more in males with HCC (7.9%) as compared to females (7.3%). The percentage of Type II diabetes mellitus was greater in HCC patients when compared to controls. This difference was statistically significant with an odd ratio of 4.63 (p<0.001). Type II DM influences incidence, risk of recurrence, overall survival, and treatment-related complications in HCC patients.

Diabetes Mellitus and Renal Cell Carcinoma - A Hospital Based Study from Kathmandu Valley

To diagnose renal cell carcinoma at early stages and for better prognosis , the main objective of our current study was to understand any association with diabetes with relation to age, gender, history of disease, diabetic laboratory parameters, tumor size and grade. This hospital based study was carried out using data retrieved from the register maintained in the Department of Biochemistry of Nepalese Army Institute of Health Sciences between 1st December, 2011 and 31st May, 2012. The variables collected were age, gender, HbA1c, serum creatinine, fasting blood glucose. One way ANOVA was applied to examine statistical significance of differences between groups. The LSD post hoc test was used for the comparison of means of case groups. Of the total 140 cases of renal cell carcinoma, 79 patients were also suffering from diabetes mellitus. The number of females (47) was more in diabetic RCC patients when compared to males (32). Significance was observed in levels of serum creatinine for tumor size >10 cm (0.0001*). The highest value of glycated hemoglobin (8.9%) and fasting blood sugar(148.3mg/dl)in cases of renal cell carcinoma along with diabetes mellitus was found in tumour size of 1-5 cm. Diabetes mellitus has independent prognostic significance in RCC in relation to tumour size and grade.

NEPAL: AN INCOMPLETE PEACE

A description of the agonisingly slow peace process in Nepal as the Maoists wrestle with the unfamiliar demands of parliamentary democracy and they and the competing political parties try to build upon the Comprehensive Peace Agreement, signed in November 2006. But the promised constitution has yet to be promulgated. So where did things go off track? Perhaps at the 2008 elections, from which the Maoists emerged as the party with the most seats in the new Constituent Assembly, but also because of the complete impasse in integrating the Maoist fighters into the Nepalese Army. And then there is the lack of progress on human rights/ national reconciliation. Securing effective economic development is the key to Nepal's problems. This is a challenge for India and China, as well as for the rest of the international donor community. But above all it is a challenge for Nepal's politicians.

Windows into a revolution: ethnographies of Maoism in South Asia

A red corridor stretching from Nepal in the North, to the state of Andhra Pradesh, India, in the South, grips the public imagination in South Asia. Despite the collapse of socialism and the demise of communist governments across the world, in South Asia, Maoist movements have (re)emerged as a significant force in the region. India and Nepal have had people across the country mobilised in protracted guerrilla war aimed at annihilating class enemies, creating liberated zones and seizing state power through the barrel of the gun. In Nepal, a ‘People’s War’ was declared in February 1996. The objective was to overthrow the old order, which included monarchic and privileged rule by an establishment of landed families and to replace it with a New People’s Democracy. The following years saw the spread of the Maoists from their strongholds in Nepal’s mid-western districts, attacks on the Royal Nepalese Army, the deployment of the army and the suspension of democratic powers. In 2003 and 2004, Nepal had the highest number of disappearances in the world (Human Rights Watch 2004), and more than 14,000 people have lost their lives since 1996. However, from November 2005, the Maoists were set to formally shape the country’s political future as they collaborated with seven mainstream political parties to agree on a programme intended to restore democracy. Following a successful People’s Movement in April 2006, King Gyanendra, who had staged a coup in February 2005, relinquished power. The government and the Maoists signed a peace accord in November 2006, declaring a formal end to the 10-year insurgency. And finally, in April 2008, the Maoists won a stunning victory gaining

Health status of the Ex-British Nepalese army men who underwent General Health check-up in TUTH

Background: Most Nepalese without major recognizable medical symptoms in their lives, do not feel the need for a whole body checkup. If we timely evaluate their health, we can prevent ongoing major complications and even sudden unexplained death. If we do regular good health checkups every 1- 2 year generally after 35 yrs. of age,. we can detect diseases in its very early stage. This simple measure help to prevent major serious complications. Methods: The total number of candidates between age groups of 33-46 years ,during the 1 August 2004 to 30 July 2005 was 100 Nepalese Ex-British army men. They were presenting to. IOM, TUTH General health checkup department with the detail evaluations of their clinical histories, signs and all basic investigations without meat diet 18 hours before were done. All candidates came in fasting at 9 AM to the department for investigation of, total Hb, Sugar, Urea, Creatinine, SGPT, Lipid profile, Uric Acid, VDRL, Urine R/E, Stool R/E, Blood grouping, E.C.G., X-ray chest, USG of Abdomen, HBsAg, HIV, etc. Results: Amongst the 100 Nepalese Ex-British army men between 33 to 46 yrs. of age. They thought that they were physically and mentally fit for the work without any ongoing major problems. On routine whole body examination: 22% of the candidates were diagnosed with hypertension, which they did not know before evaluation. Similarly 74% of candidates had high BMI ranging from 25-29.9%. Most of them were unaware of increased body weight. There was a correlation between high BMI and hypertension. The higher the BMI, higher was the Blood Pressure 66.66%. Similarly lower the BMI was lesser the Blood Pressure 7.69%. 18% of them were detected with high Triglyceride level (TG). 30% had raised Uric Acid level. 19 % of them had fatty liver. A high BMI is related to rise in TG level. i.e.11.54% among normal BMI and 66.67% in high BMI cases. Fatty liver was 11.53 % among non-Alcohol and 21.62% among alcohol using groups. Raised TG level from 11.53% among non Alcohol to 17.53% among Alcohol group. Use of Alcohol was not related to raised BMI. Similarly with Uric Acid also, not much difference was detected with non-alcohol group. Among Alcohol taking group, 21.62% had fatty liver and slight rise of TG 17.53%. Conclusion: The casual whole body checkup showed very significant and alarming findings. If they hadn't come for whole body checkup in order to work abroad as guards, they probably might have stayed at home with all the correctable problems and could have developed any complications in near future. The data collection showed a clear relationship between high BMI and High Blood Pressure, high Triglyceride and Fatty liver. If we are able to maintain our standard body weight, then one might have very good robust health. A alcohol intake showed certain percentage of Fatty liver and high TG. One must not take more than standard amount of alcohol in order to maintain normal BMI &amp; BP. Journal of Institute of Medicine Vol.28(1) 2006

The State of Child Health and Human Rights in Nepal

Nepal is one of the poorest countries in the world, with a per capita gross national product of US$240. Nearly 40% of the 25 million people living in Nepal do so on less than a dollar a day [ 1]. About 90% of the population lives in rural areas. The high-intensity (more than 1,000 deaths per year) conflict between the Communist Party of Nepal (Maoist) rebels and the government forces led by the Royal Nepalese Army has affected the health, education, and other rights of the most vulnerable members of society, especially women and children [ 2]. The conflict, which began in 1996, has resulted in widespread human rights violations by both parties as it draws the population into the conflict as both soldiers and victims. In this article we examine the evidence on the current state of child health and human rights in Nepal ( Box 1). We argue that time is running out for the children of Nepal, as they face an uncertain future if their health and human rights concerns are not addressed by local governments, nongovernmental organizations (NGOs), and the international community in a timely manner. We also suggest possible solutions to the current problem. Box 1. Search Strategy In order to identify information for our article, we searched Medline, Google Scholar, POPLINE, World Health Organization reports, United Nations Development Programme–Nepal reports, the UN Office for the Coordination of Humanitarian Affairs (IRINnews) Web site, and Eldis Development Gateway, using the terms “Nepal,” “child health,” “human rights,” and “conflict.” We searched reports of several non-governmental organizations including Save the Children, Family Health International, and CARE Nepal. We selected articles for inclusion based on their relevance to the topic and their ability to advance our understanding of the impact of the conflict on child health and human rights. In addition, we identified unpublished research through contacts with authors and experts in the field. We acknowledge the lack of epidemiological studies directly linking the conflict to child health care in Nepal; documentation on crucial aspects of the conflict was often impossible to obtain and we rely on newspaper articles and eyewitness accounts at times. We drew from the collective expertise of the authors (SS, EB, KD) involved in delivering health care in Nepal and incorporated suggestions from international health experts and NGOs active in this field.

Nepalese Army HIV/AIDS STIs Prevention and Control Programme Project Report

Nepalese Army HIV/AIDS STIs Prevention and Control Programme Project Report

Nepal's war on human rights: a summit higher than Everest.

Nepal has witnessed serious human rights violations including arbitrary arrests, detentions, "disappearances", extra judicial executions, abductions and torture carried out by both the Royal Nepalese Army and the Maoist rebels in the 10 years of the "peoples war". Women and children have borne the brunt of the conflict. Massive displacement has led to adverse social and psychological consequences. While the reasons for the conflict are mainly indigenous and rooted in the social and economic in-equities, remedies for health inequities must come not only from the health sector but also from broad social policies and adopting a participatory and conflict-sensitive approach to development. Meanwhile the international community needs to use its leverage to urge both sides to accept a human rights accord and honor international human rights and humanitarian laws, while investigating allegations of abuse and prosecute those responsible.

Civil-Military Relations and the Maoist Insurgency in Nepal

This article examines the role of the Royal Nepalese Army (RNA) in the current Maoist insurgency in Nepal. The RNA has largely escaped public gaze until recently when it has come to play an increasingly important part in the Nepalese national life. The authors examine its structure and doctrines and argue that the army can only provide a structure of security while more basic political reforms are pursued in order to take the heat out of the insurgency.

An Efficacy Trial of Recombinant Hepatitis E(rHEV) Vaccine in the Royal Nepalese Army

An Efficacy Trial of Recombinant Hepatitis E(rHEV) Vaccine in the Royal Nepalese Army

Clinical Images

Clinical Images

Neuro-Psychiatric Complication of HIV/AIDS in Royal Nepalese Army

Neuro-Psychiatric Complication of HIV/AIDS in Royal Nepalese Army