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In this work, dust properties around the White Dwarf PG 1225-079 located at RA (J2000): 12h 27m 47.35s, DEC(J2000): -08° 14’ 37.97” is studied extensively using the publicly available data from Improved Reprocessing of IRAS Survey (IRIS), AKARI infrared survey and Wide field Infrared Survey Explorer (WISE). The bipolar dust structure hardly resolved in IRIS (60 μm and 100 μm) is clearly resolved in AKARI (90 μm and 140 μm) and WISE (12 μm and 22 μm) images. The dust color temperature and dust mass are calculated from the infrared flux density. The average value of dust color temperature in isolated dust structure is 27.57 K for IRIS (I1). For isolated upper and lower dust clouds the average temperatures are; 22.64 K and 22.63 K for AKARI (A1 and A2), 295.34 K and 296.85 K in WISE (W1 and W2) data. A wide range of temperatures suggests the bipolar dust structure is dynamically active. The mass of dust is found to be 3.44 × 1025 kg in IRIS (I1), 1.82 × 1026 kg and 5.89×1026 kg in two bipolar regions in AKARI (A1 and A2) and 1.12 ×1026 kg and 1.14×1026 kg in WISE (W1 and W2). A good relation is found between the infrared flux in all survey data with r2 value 0.83 in IRIS (I1) and more than 0.90 in AKARI (A1, A2) and WISE (W1, W2) data. SIMBAD database explore some sources including Supernova Remnants nearby the dust which might be the progenitor of dust as well as the contributor of energetic radiation. The Gaussian modeling of temperature is found to be deviated from normal shape. The contour plot of dust color temperature and dust mass shows non uniform variation among the IRIS, AKARI and WISE survey. The relation between infrared flux, dust color temperature and dust mass within the dust clouds are presented.

During the asymptotic giant branch (AGB) phase, a major fraction of mass is spread by the stars (0.6 - 10 M⊙) in the interstellar medium (ISM) in the form of dust. In the left phase of the post-main sequence evolution in the Hertzsprung-Russell (HR) diagram, these dust are found to be surrounding the white dwarfs (WD). Some small fraction of dust is also formed in the circumstellar shells and cavities around WD which is usually a source of infrared (IR) excess. The formation and evolution of such IR dust structures are the results of high-pressure events such as the Helium shell flash (thermal pulse) and stellar winds, and such structures are crucial in the study of interaction phenomena in ISM. This research project is focused on the study of an isolated dust structure near the white dwarf WD0011-399 located at R.A. (J2000) 00h 13m 47.48s and Dec. (J2000) -39° 370 24.2800 using Improved Reprocessing of the IRAS (IRIS), AKARI and Wide-field Infrared Survey Explorer (WISE) surveys from SkyView Virtual Observatory along with SIMBAD Astronomical Database and Gaia Archive of ESA. The size of the cavity under study is 7.43 pc×2.90 pc, 2.99pc×0.99pc, and 1.26×0.53pc with an inclination angle of 71.12°, 75.73°, and 68.48° respectively in IRIS, AKARI and WISE data suggesting the cavity is neither a face-on nor an edge-on. The relative flux density of the region has been studied through pixel extraction of Far-Infrared (FIR) images and dust color temperature along with dust mass has been calculated. Using IRIS data, the temperature of the isolated region is found between a maximum value of 36.82±4.30 K to a minimum of 22.59±2.32 K with an offset of 14.23 K. The average temperature of the region is 28.22±0.18 K. Following similar procedures for AKARI data, the temperature is found between a maximum of 26.37±3.56 K and a minimum of 16.32±1.47 K with an offset of 10.06K. The average temperature is 19.25±0.15 K. Similarly, using WISE data, the temperature is found between a maximum of 353.72±18.54 K and a minimum of 307.24±4.69 K with an offset of 46.48K. The average temperature is 316.62±0.81 K. High value of offset temperature suggests that the cavity might be evolving with disruptions from background radiative sources. Approximately Gaussian distribution of the temperature in all the surveys implies that the region might be tending towards local thermodynamic equilibrium. The total mass of the structure is estimated to be around 0.03±1.5×10−6M⊙, 1.6×10−3±1.4×10−5 M⊙, and 10−7±3×10−10 M⊙ using IRIS, AKARI, and WISE data respectively. The Jean’s mass of the structure is calculated assuming the structure is a non-degenerate gas, which is estimated around 2001.93M⊙, 178.44M⊙, and 121.47M⊙ respectively using IRIS, AKARI, and WISE data. Since Jean’s mass is much greater than the mass of the structure there seems no possibility of star formation within the region of interest. The color maps illustrate identical distribution for all wavelengths, however, no significant relation is observed between dust color temperature and dust mass.

Background: Typhoid and paratyphoid fever (enteric fever) is a common cause of non-specific febrile infection in adults and children presenting to health care facilities in low resource settings such as the South Asia. A 7-day course of a single oral antimicrobial such as ciprofloxacin, cefixime, or azithromycin is commonly used for its treatment. Increasing antimicrobial resistance threatens the effectiveness of these treatment choices. We hypothesize that combined treatment with azithromycin (active mainly intracellularly) and cefixime (active mainly extracellularly) will be a better option for the treatment of clinically suspected and culture-confirmed typhoid fever in South Asia. Methods: This is a phase IV, international multi-center, multi-country, comparative participant-and observer-blind, 1:1 randomised clinical trial. Patients with suspected uncomplicated typhoid fever will be randomized to one of the two interventions: Arm A: azithromycin 20mg/kg/day oral dose once daily (maximum 1gm/day) and cefixime 20mg/kg/day oral dose in two divided doses (maximum 400mg bd) for 7 days, Arm B: azithromycin 20mg/kg/day oral dose once daily (max 1gm/day) for 7 days AND cefixime-matched placebo for 7 days. We will recruit 1500 patients across sites in Bangladesh, India, Nepal, and Pakistan. We will assess whether treatment outcomes are better with the combination after one week of treatment and at one- and three-months follow-up. Discussion: Combined treatment may limit the emergence of resistance if one of the components is active against resistant sub-populations not covered by the other antimicrobial activity. If the combined treatment is better than the single antimicrobial treatment, this will be an important result for patients across South Asia and other typhoid endemic areas. Clinicaltrials.gov registration: NCT04349826 (16/04/2020)

Post-empowerment, the wife of small-scale fishermen, can affect changes in household economic incomes. This study aims to assess the factors that affect household income after the empowerment of fisherwomen. Furthermore, a multiple linear regression estimation model was used in this study. The results showed that fishermen’s wife’s household income after empowerment is influenced by wife’s age, education, and the number of active family members. On the other hand, the number of dependent household members and regional differences had no significant influence. In addition, improving the household economics of fishermen can be further enhanced through the skills needed to process processed fish by providing market intelligence for the sustainability of their business.

The serological test, enzyme linked immunosorbent assay for circulating antigen of Taenia Solium (Ag-ELISA) , was carried out in a series of 90 cases of seizure disorders, aged more than 14 years, presented to B. P. Koirala Institute of Health Sciences, Dharan, Nepal between March 2008 to May 2009. Taenia Solium antigen were detected in 13 (15%) of the patients. The diagnosis of neurocysticercosis was made in 35% cases (26 out of 75) based on clinical and neuroimaging findings. Neuroimaging was not done in 15 cases. Seropositivity was associated with neuroimaging studies consistent with NCC (OR=13.295% CI 1.43- 305.79, P= 0.014). It is significant for multiple ring enhancing lesions (P= 0.00935 for CT Head and 0.00274 for MRI Head) and not found to be statistically significant for single ring enhancing lesion (P= 0.637 for CT Head and 1.00 for MRI Head). Living in kachha house, family members >5 and age > 60 years have higher odds ratio for positive serology of cysticercosis although there was no statistical significance. The serology for cysticercosis had sensitivity of 41.5% and specificity of 98.4%.DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11957

This study aims to identify and analyze the socio-economic characteristics of the community, which then are used to formulate a sustainable community forest management strategy. This article analyses the livelihood profile and the implementation of community forest management by using fishbone analysis and gap analysis. The results obtained in this study are members of farmer groups in general livelihood as a farmer which lack of education. The age of farmers are generally classified as productive age. The average number of dependents household is 3-6 people (72,58%), and the total average income of community forest management yield is around IDR 1,158,582 – IDR 1,411,748 per month. The highest revenue earned from honey commodity is IDR 600,000 – IDR 1,050,000 per month and from palm sugar commodity is IDR 900,000 – IDR 1,000,000 per month. The management strategy of community forest in Saddang watershed formulated in this research is the utilization of multi-purpose tree species by developing business unit managed by forest farmer groups based on creative economy and increasing the capacity of community farmer group members through mentoring and training.

Cement making process required four main raw materials, Lime Stone as a source of CaCO3, Silica Stone as a source of SiO2, Clay as a source of Al2O3 and Iron Sand as a source of Fe2O3. Proportion of raw materials approximately 80% CaCO3, 15% SiO2, 3% Al2O3 and the remaining 2% for Fe2O3. Due to operational constraints in the mine area, Indarung IV plant is experiencing a shortage of SiO2 source material that is Silica Stone, to anticipate this condition selected Pozzolan as alternative raw material because the SiO2 content in Pozzolan is above 60%. This research uses Linear Programming to get formulation model of optimization of raw material composition with Pozzolan as a substitute of Silica stone by minimizing cost. Ash composition factors and calories of fuel are not made into consideration. The results of this study obtained the most optimal raw material composition with minimal cost and meet the standard strength three days clinker min. 200 kg/cm2, by inputting the oxide composition of each raw material and the minimum and maximum constraint into the model formulation. The use of Pozzolan as a substitute raw material for Silica increases raw material costs 265.74 rp/ton.

Deforestation is an activity or process that converts forest cover into non-forest land cover with a certain pattern. Palopo and East Luwu are two districts in South Sulawesi deforested due to the demand of the human need to convert the land into settlements, infrastructure and timber harvesting. This research was conducted to find out the temporal spatial pattern in dealing with deforestation. Analysis of spatial patterns using fragstat software with input data i.e. land cover shapefile data in 1990, 2000, 2010, and 2016 that produced contour in metrics, and its subdivision in metrics. Temporal spatial patterns of deforestation are built by combining three spatial metric values. Based on the description of deforestation analysis in Palopo Municipality covering 852,96 ha and East Luwu with 86,963,46 ha, Palopo Municipality experienced the highest deforestation from 1990 to 2000 amounted to 451.69 ha and continued to decline in the period of 2000-2010 and 2010-2016. Deforestation in East Luwu Regency is the highest in the 1990-2000 period which is 38.655,05 ha. Deforestation in East Luwu Regency has higher contiguity than deforestation occurring in Palopo Municipality indicating that the occurrence of deforestation occurring in East Luwu Regency occurred directly from previously degraded areas to adjacent forest areas. Palopo and East Luwu Regency show fragmentation rates that tend to decrease due to the decreasing number of fillings that are formed the largest combination of spatial patterns occurring during the observation period was the spatial pattern of deforestation grouped, with high density (not fragmented) in 50 villages (61.72%).

Background : Ultrasound has been shown to be effective in the diagnosis of musculoskeletal pathology, and its use continues to increase. Objective : To evaluate the role of ultrasound in detection of pathology of muscle and tendon, where the facility of advanced imaging modality is not available. Methods : Ultrasound evaluation of muscle and tendon was done in referred 550 patients with clinical history of localized pain or trauma. A detailed clinical history was taken before sonography. The clinical findings and provisional diagnosis were recorded. A routine ultrasound examination included imaging of the affected muscle and tendon. The findings were compared with contralateral limb. Results : Ultrasound showed ailment in 130 patients and was useful to detect lateral epicondylitis in 37 patients, tenosynovitis in 26, tear of muscle or tendon in 23, cystic lesions in 9, abscess in 17, myocysticercosis in 4, radiolucent foreign bodies in 3, muscle hernia in 2 and intramuscular hemangioma in 9 patients. Conclusion : High resolution ultrasound is a rapid and inexpensive technique.It can be used as a first line imaging modality for the musculoskeletal pathology particularly in developing countries with limited imaging facilities. Health Renaissance, January-April 2013; Vol. 11 No.1; 54-61 DOI: http://dx.doi.org/10.3126/hren.v11i1.7603

Summary Objectives To assess the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) co-infections among people living with HIV (PLHIV) in Nepal. Methods A sample of 677 PLHIV representing key affected populations (KAP) in Nepal, who were undergoing antiretroviral (ART) therapy in ART clinics around the country, were voluntarily enrolled in the study. Rapid kit-based testing followed by ELISA for validation was performed, focusing on HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV). A multivariate logistic regression model was used to identify factors associated with HBV and HCV co-infection. Results HCV and HBV co-infection among the 677 PLHIV was found to be 19% (95% confidence interval (CI) 16.6–22.7%) and 4.4% (95% CI 3.1–6.6%), respectively. The Eastern Region had the highest percentage of HCV infection (48%). The age group with the highest rates of co-infection was 30–39 years (58% and 70%, respectively, for HCV and HBV co-infection). After adjusting for confounding, males were more likely to have HBV co-infection than females (adjusted odds ratio (AOR) 4.61, 95% CI 1.42–14.98). Similarly, PLHIV who were male (AOR 5.7, 95% CI 2.06–15.98), had a secondary level of education (AOR 3.04, 95% CI 1.06–8.70), or who were drug users (AOR 28.7, 95% CI 14.9–55.22) were significantly more likely to have HCV co-infection. Conclusion This first ever national assessment of HIV, HBV, and HCV co-infection performed among PLHIV in Nepal demonstrates that HCV and HBV infections are a health threat to this population and that interventions are required to mitigate the effects of co-infection and to prevent further morbidity and mortality.

The anecdotal burden of morbidity secondary to motorbike accidents is thought to enormous by personnel involved in trauma care. The objective of the present study is to ascertain patterns and association of injuries and causes of mortality in a cohort of motorbike accident victims.A retrospective chart review of 1337 motorbike accident admissions B and B Hospital in Kathmandu between January 2009 and December 2010 was undertaken.Majority of victims were between 20 to 50 years [1230 (92%) males]. Lower extremity injuries comprised on 816 (61% of total admissions). Tibia fractures were the most common injury in isolation, multiple injury, as well as polytrauma, and a vast majority of these were open fractures. Multiple injuries were seen in 82 (6.1%) patients and 33 (2.5% of Total) patients were polytraumatized. An amputation was necessary in 16 (1.2%) patients and emergent fasciotomy for compartment syndrome was necessary in 23 (1.7%) cases of tibia fractures and 39 (2.2%) of foot and ankle injuries. A floating joint injury was present in 24 (1.8%) patients.. A fat embolism syndrome (FES) was diagnosed in 8 (0.6%) patients. The overall mortality was 0.45% (6 patients).Motorbike accident is an important cause of morbidity and mortality in Kathmandu, and often involves a very productive age group. There is an imminent need to address this public health problem.

Hearing loss is the most common sensory deficit in the elderly, and is becoming a severe social and health problem. Presbycusis is the result of aging which can lead to communication problems compromising the quality of life (QoL).Since the elderly population is increasing worldwide, presbycusis is showing a similar trend. This study intended to identify the impact of hearing loss in the social life of the elderly. A total of 70 elderly patients attending Nepal Medical College Teaching Hospital who were found to have sensorineural hearing loss (SNHL) on pure tone audiometry (PTA) were recruited for this study.None of the patients had used hearing aids in the past. To assess their handicap due to hearing impairment a Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was used and patients were graded as: no handicap, mild to moderate handicap and significant handicap. Pure-tone averages (PTA) were calculated for the thresholds at 0.5, 1 and 2 kHz in each ear. Patients with their PTA values between 26 to 40 dBHL were interpreted as having mild SNHL, those between 41 to 55dBHL as moderate SNHL and those above 55 dBHL as severe SNHL. Out of 70 patients, 65 had some degree of handicap ranging from mild to severe. The severity of handicap was significantly associated with the degree of hearing loss in both ears.

Background:Leishmaniasis is vector borne disease caused by protozoa.Visceral Leishmaniasis is a major public health problem in Nepal. Different manifestations in otorhinolaryngology includes nasal bleeding, granulomatous mass mucosal ulceration in oral cavity. polypoidal growth in larynx, chronic non- healing painless ulcer, nodule , sensorineural deafness . Methods:This is a prospective cross sectional study where eighty diagnosed cases of leishmaniasis were included from January 2007 to January 2008. Diagnosis was made by Rk-39 from peripheral smear & LD bodies from bone marrow. Before starting anti –kalaazar treatment, ENT examination and Pure tone audiometry (Amplaid 460, Italian machine) was done and finding noted. Results:Visceral leismaniasis occur from age 4 yr to 70 yr. Otolaryngological manifestations found in 47 % of cases. Among them epistaxis was observed in 19 (24%) cases. Hearing loss had 8 (10%) of cases. Laryngeal Leishmaniasis was seen in one patient. Mortality was seen in one patient. Conclusion:Otolaryngological manifestation of Visceral Leishmaniasis is not uncommon in the patients belonging to endemic area like ours. Epistaxis & hearing loss are common.&nbsp

Background The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. Objective The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. Methods Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. Conclusion Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening. DOI: http://dx.doi.org/10.3126/kumj.v9i3.6300 Kathmandu Univ Med J 2011;9(3):174-8

Tuberculosis is a common disease and its incidence is in rising tendency in developed world because of AIDS and transglobal migration. Abdominal tuberculosis is more common in immunocompromised population and manifests as infection of peritoneum, hollow or solid abdominal organs and abdominal lymphatics with mycobacterium tuberculosis organism. The peritoneum and ileo-cecal region are the most likely sites of infection and are involved in the majority of cases by hematogenous spread or through swallowing of infected sputum from primary pulmonary tuberculosis. Pulmonary tuberculosis is evident in less than half of patients either in active or latent form. Abdominal tuberculosis has a protean manifestation although the most common clinical feature is the triad of abdominal pain, fever and weight loss. The diagnosis is often delayed because of non-specific presentation and is usually made through a combination of radiologic, microbiologic, histopathologic, endoscopic and molecular techniques. None of them provide a gold standard by themselves. However, an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosis of abdominal tuberculosis which primarily necessitates a clinical awareness of this serious health problem. Abdominal tuberculosis is a serious condition and if untreated outcome is fatal. Early diagnosis and immediate initiation of treatment along with dietary support is crucial for better outcome. Antimicrobial treatment is the same as for pulmonary tuberculosis and management often requires combination of antitubercular drugs and surgery – for diagnosis as well as therapy. Key Words: Tuberculosis; Abdominal Tuberculosis; Extrapulmonary Tuberculosis.

This longitudinal study was conducted in BP Koirala Institute of Health Sciences (BPKIHS), a Medical University situated in eastern Nepal, between May 2001 and December 2001. The main objective of the study was to identify the role of adenosine deaminase (ADA) activity in patients with visceral leishmaniasis (VL) for management. There was a significant increase in mean ADA activity in sera of 49 patients with VL (323.71±184.51 IU/L) compared with 50 samples of control groups (47.11±24.94 IU/L) from the same endemic area ( P

A medical order is a medical and legal document and careful writing of this document is necessary. In Nepal the medical order in the admitted patients is written on a cardex which is utilised by the nurses to dispense medicines and to follow the doctor's orders. However, with the dawn of the electronic age this is being replaced by a computerized system, which is suggested to be better. The aim of this study was to identify if the existing cardex was adequate for the purpose of writing orders, or whether this needed modification. This was a prospective observational study were 240 cardexes from eight different Departments from the same Medical College Hospital were randomly looked into for errors. Thirteen different parameters were looked into including the legibility/readability of the handwriting. The results suggested the error rates to be high in certain parameters viz. utilization of the columns (77.9%), documentation of allergy history (77.5%), writing the prescribers name (89.6%) and writing date of discontinuation of medicines (62.5%). The handwriting was unreadable or difficult to read in 49.2% of the documents. However, the other parameters also had errors and no parameter was error free. The study suggested the need of the hour was to modify the existing cardex and also to educate the doctors to minimise errors. However, in the future we may have to move towards a computerized system in order to avoid errors related to bad handwriting.

The Visceral Leishmaniasis (VL) control program in Nepal launched in 1993 includes provision of free diagnostic test, treatment along with vector control by indoor residual spraying. However, even after 14 years the disease is far from being controlled. Elimination of VL by 2015 has recently been identified as a regional priority with high level of political commitment. We analyzed the VL control effort in Nepal over the period 1994-2006 and tried to formulate recommendations for the VL elimination initiative. To document performance of the VL control program in Nepal we used literature review and a case study. First, we reviewed articles on VL in Nepal published in medical journals through Pubmed, ISI Web of Science, Google scholar and by hand searching. Secondly, the grey literature, mainly the reports on VL drafted by the Ministry of Health was reviewed for the period 1994-2006. Thirdly, a case study is presented to analyze the performance of the VL elimination program in a "pilot district", where the program was launched in 2006. There are only few studies available on VL in Nepal discussing the epidemiology, diagnosis, treatment, vector bionomics, human behavior and prevention. The review of the grey literature from 1994-2006 revealed that the VL incidence rate remained almost constant since 1993 despite the control efforts. The case study showed that there is a lack of trained human resources, laboratory facilities and treatment guidelines which is hindering the decentralization of the VL elimination program.

Ear diseases are a common presentation in the ENT out-patient department. These diseases can have sequelae if not treated early which may cause increased morbidity, hearing disability and even mortality. Identifying these conditions early and treating them can reduce these unwanted sequelae. A prospective study over a period of three years was undertaken in a tertiary care hospital in Kathmandu. All children presenting with ear diseases consecutively in the ENT out-patients were included and their data was recorded in a pro forma. The data was analysed for frequency and cross-tabulated. The study included 2218 children with ear diseases among which 868 (39.1%) were pre-school and 1350 (60.9%) were school going children. The male to female ratio was 1.5:1. The most common otological problem was wax impaction (40.2%), followed by acute otitis media (AOM) with 24.3%, chronic suppurative otitis media (CSOM) with 17.7% and acute otitis externa (AOE) with 7.5% of the total cases. The other conditions were otitis media with effusion (2.8%), foreign bodies in the ear (2.3%), otomycosis (1.7%), preauricular sinus (1.1%), sensorineural hearing loss (0.8%), trauma to the ear (0.7%), keloids (0.3%), microtia (0.2%) and perichondritis (0.2%).The three year olds had the highest number of otological diseases with 9.2% of the total among the ages studied. It is felt that proper education of health care providers regarding ear diseases and also awareness in the community can prevent and reduce the disability and complications of these conditions.

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.

To document ownership and use of bednets with its determinants in the visceral leishmaniasis (VL)-endemic region where mainly non-insecticide impregnated nets are available through commercial channels, and bednets are being considered as a leishmaniasis vector control measure.In August-September 2006, semi-structured household (HH) questionnaires and observation guides were used in a random sample of 1330 HHs in VL-endemic districts of India and Nepal to collect data on VL knowledge, HH socio-economic status, bednet ownership and use patterns. An asset index was constructed to allow wealth ranking of the HH. A binary logistic response General Estimating Equations model was fitted to evaluate the determinants of bednet ownership and use.The proportion of HHs with at least one bednet purchased on the commercial market was 81.5% in India and 70.2% in Nepal. The bednets were used in all seasons by 50.6% and 54.1% of the Indian and Nepalese HH owning a bed net. There was striking inequity in bednet ownership: only 38.3% of the poorest quintile in Nepal owned at least one net, compared to 89.7% of the wealthiest quintile. In India, the same trend was observed though somewhat less pronounced (73.6%vs. 93.7%). Multivariate analysis showed that poverty was an important independent predictor for not having a bednet in the HH [OR 5.39 (2.90-10.03)].Given the inequity in commercial bednet ownership, free distribution of insecticide-treated bednets to the general population seems imperative to achieve a mass effect on vector density.

Pyogenic granuloma is relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. A 5 year retrospective analysis (January 2001 – December 2006) of histopathological record of patients diagnosed as cases of pyogenic granuloma were done to analyze the prevalence, common site, age of presentation and to see correlation between clinical and histopathological diagnosis. Total number of cases studied were 175. The age of the patient ranged from 1.5 to 70 years. There were 89 (50.85 %) males and 86 (49.14 %) females. Male to female ratio was 1.03 : 1 . All patients had solitary lesions. In 105 (60 %) patients the tumor was located in head and neck region with scalp being the commonest site. Plethora of common clinical diagnosis made were papilloma (12%), sebaceouscyst (6.29%), parasitic lesion (3.43%), melanoma (3.43%), squamous cell carcinoma (3.43%), mucous retention cyst (3.43%) and naevus ( 2.86 %) . Keywords : Pyogenic granuloma, lobular capillary hemangioma, Eastern Nepal Sudanese Journal of Dermatology Vol. 6 (1) 2008: pp. 1-9

pharmacists, physicians, and other health professionals committed to careers that include global health. Structure/Method/Design: Program Goals: 1) provide training in global health systems, with a focus on health care delivery in resourceconstrained settings; 2) establish an interprofessional cohort for global health action; 3) facilitate longitudinal mentorship for attendees Participants: The goal was to recruit clinicians with exposure to but not extensive service in global health, who were committed to dedicating part of their career to this pursuit. Although most participants were US-based, scholarships for participants from international resource-constrained settings were provided to strengthen the diversity of perspective in the cohort. Capacity Building: The curriculum was based upon the findings of a needs assessment and was further developed through frequent consultations with a team of interdisciplinary experts. We will continue to seed these skills annually, fostering connectedness across a wider group. Outcomes & Evaluation: All 35 participants successfully completed the course. Initial feedback was overwhelmingly positive (average 4.8/ 5.0 for overall quality and 4.7/5.0 for relevance to practice). All respondents indicated an intention to change their practice as a result of the Bootcamp, with 88% planning to better integrate social determinants of health into their understanding of global health delivery. We plan a one year post-survey to evaluate the impact on community building and project development. A participant: “I have a much stronger concept of some of the ethical and systems related to global health that I am already using as the chair of a committee in my college on global engagement for students and faculty. I thought I already understood a lot of that, but the Bootcamp gave me a better grounding, both practically and theoretically. Really useful course.” Going Forward: Challenges: (1) connecting all sessions thematically, (2) increasing the interactivity across all sessions, (3) supporting participation from resource-constrained settings. Unmet goals: No, though we hope to increase community health worker participation as teachers. Future change: We may need to consider some tele-education options to increase participation of our international colleagues. Funding: Faculty support for curriculum development, filming costs, as well as scholarships for international participants were supported philanthropically by an anonymous donor. We will use the revenue from CME fees collected to sustain the Global Health Bootcamp. Abstract #: 01ETC104

Spinal tuberculosis is usually secondary to lung or abdominal involvement and may also be the first manifestation of tuberculosis. Spinal tuberculosis (often called Pott's disease) is by definition, an advanced disease, requiring meticulous assessment and aggressive systemic therapy. Physicians should keep the diagnosis in mind, especially in a patient from a group with a high rate of tuberculosis infection. This review aims on updating the knowledge on spinal tuberculosis and its management. Skeletal involvement has been reported to occur in approximately 10% of all patents with extrapulmonary tuberculosis, and half of these patients develop infection within the spinal column. Symptoms of spinal tuberculosis are back pain, weakness, weight loss, fever, fatigue, and malaise. It is much more prone to develop neurological manifestation, paraplegia of varying degree. The palpation of spinous process in routine clinical examination is the most rewarding clinical method and is an invaluable measure for early recognition. Diagnosis of spinal tuberculosis is made on the basis of typical clinical presentation along with systemic constitutional manifestation and the evidence of past exposure to tuberculosis or concomitant visceral tuberculosis. Magnetic resonance imaging can define the extent of abscess formation and spinal cord compression. The diagnosis is confirmed through percutaneous or open biopsy of the spinal lesion. Surgery is necessary as an adjunct to antibiotic therapy if the vertebral infection produces an abscess, vertebral collapse, or neurologic compression. Some patents need aggressive supportive care owing to tuberculous meningitis or encephalopathy. Moreover, the importance of immediate commencement of appropriate treatment and its continuation for adequate duration along with the proper counseling of the patient and family members should not be underestimated for successful and desired outcome.

Currently there are no effective orally administered drugs or visceral leishmaniasis or kala-azar, a parasitic disease affecting about 0.5 million people a year, majority of whom are in India and adjacent areas of Nepal. Symptoms of affected patients are fever, cachexia, hepatosplenomegaly and pancytopenia. The disease is usually fatal, if left untreated. Traditionally kala-azar is treated with four weeks of injections of sodium stibogluconate, a pentavalent antimonial. However, this treatment has not only shown resistance in 37-64% patients of the current Indian epidemic in Bihar (the epicentrre) but also life-threatening cardiotoxicity in 7-10% and treatment-related deaths in 5-10% cases, besides being unsuccessful at times. Parenteral amphotericin B is used as a secondary agent that shows 95% effectiveness but its toxicity and high cost of even the well tolerated liposomal complex precludes its wide use in the developing countries, where the disease is present in epidemic proportions. Recently, miltefosine (hexadecylphosphocholine), a compound originally developed as an antitumour agent has been shown to be an orally effective drugs against kala-azar. All clinical trials with this drug are conducted in India in patients of visceral leishmaniasis. A regimen of 100 mg per day or 50 mg twice daily for 3-4 weeks was observed to produce a cure rate of 100%. Gastrointestinal side effects were frequent (62%) but no patient discontinued the therapy. A phase III trial involving 300 HIV-negative adults and adolescents is underway in India and the drug is hoped to be licensed in the next 2-3 years. Few studies of phase II clinical trials mainly conducted in Kenya with another drug, sitamaquine or kalazaquine (WR 6026), an 8-aminoquinoline has also shown promise as an orally effective agent (in a dose of 1 mg/kg/day for two weeks) for visceral leishmaniasis. These Studies with two orally effective compounds, it appears, will open new vistas for orally effective, affordable and acceptable drugs in the armamentarium for the treatment of kala-azar. It is expected that in future we would have effective ways to prevent and treat all forms of leishmaniasis without discomforting the patient.

We report a case of exclusive involvement of lymph node in leishmaniasis presenting as generalized lymphadenopathy. The diagnosis of lymphatic leishmaniasis was confirmed by the presence of Leishmania donovani body in fine needle aspiration cytology, positive direct agglutination test and anti-rK39 antibodies. The bone marrow aspiration was negative for Leishmania donovani body. This is the first case of lymphatic leishmaniasis reported from Nepal.

To study the prevalence, clinico-haematological and management profile of aplastic anaemia (AA) among severely anaemic patients treated at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.A retrospective analysis of 18 cases of biopsy proven AA patients was done between September 1995 and August 1997.Over a period of 2 years, 140 patients with severe anaemia were admitted to our institution. Eighteen patients were diagnosed with AA. The ages of the AA patients ranged from 7 to 56 (median 15) years, with a male: female ratio of 1.23:1. Pallor, bleeding diathesis, weakness and fever were the most common presenting complaints. Blood counts showed pancytopenia in 16 cases. Bone biopsies of all the cases were hypoplastic. Sixteen cases were non-severe AA and the remaining 2 were severe. Of the 18 cases, 16 were idiopathic; 1 case each was associated with chloramphenicol toxicity and hepatitis B infection respectively. Most of the patients were treated with corticosteroids or androgens or a combination of both. Only six patients came for regular follow-up.The high (12.85%) prevalence of AA among patients admitted with severe anaemia in this hospital (which acts as a catchment area for the Eastern region) may not reflect the actual prevalence of the disease in the local community. However, a prospective study may delineate the causative factors peculiar to this region. The clinico-haematological profile is typical of the disease. However, the management profile is incomplete without a proper follow-up. This limitation may be overcome by providing free or subsidized treatment.

Background: Alcohol drinking is cardio-protective; however its beneficial and harmful effects depend on the amount consumed. This work is designed to assess the impact of prolonged non-moderate drinking in left ventricular mass index and left ventricular ejection fraction and the correlation of their severity with total lifetime intake amount. Materials and methods: Fifty non-moderate drinkers (>25 g/day) for last 10 years and 50 non-drinker-volunteers were selected. Detail echocardiographic assessment was done and findings were compared and severity was correlated with lifetime amount. Results: Mean daily intake, duration and lifetime intake amount of alcohol were 64.1 g, 21.9 years and 501.9 Kg respectively. The mean ejection fraction and left ventricular mass index were 47.2% and 105.3 g/m2. There was significant difference when compared with controls. Eighty-two percent drinking subjects had abnormal echo, most common were regurgitations (52%), diastolic dysfunction (46%), raised ventricular mass (44%), systolic dysfunction (40%), and dilated left atrium and ventricle (38%). Thirty-four percent of subjects had echo features consistent with dilated cardiomyopathy. Palpitation and dyspnea in combination were the only symptoms associated with severity of echo changes. There was strong negative correlation of lifetime intake amount with ejection fraction (r = -0.91, p0.05). Conclusions: Prolonged non-moderate drinking causes significant echocardiographic abnormalities mainly systolic dysfunction and increased left ventricular mass index. The total lifetime and daily amount of alcohol are well correlated with systolic dysfunction; however their relationships with the left ventricular mass index were non-conclusive. Key words: Alcohol; left ventricular mass; cardiomyopathy DOI: 10.3126/jcmsn.v6i1.3598 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 18-28