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BackgroundIn Nepal, tuberculosis (TB) is a major problem. Worldwide, six previous epidemiologic studies have investigated whether indoor cooking with biomass fuel such as wood or agricultural wastes is associated with TB with inconsistent results.ObjectivesUsing detailed information on potential confounders, we investigated the associations between TB and the use of biomass and kerosene fuels.MethodsA hospital-based case-control study was conducted in Pokhara, Nepal. Cases (n = 125) were women, 20-65 years old, with a confirmed diagnosis of TB. Age-matched controls (n = 250) were female patients without TB. Detailed exposure histories were collected with a standardized questionnaire.ResultsCompared with using a clean-burning fuel stove (liquefied petroleum gas, biogas), the adjusted odds ratio (OR) for using a biomass-fuel stove was 1.21 [95% confidence interval (CI), 0.48-3.05], whereas use of a kerosene-fuel stove had an OR of 3.36 (95% CI, 1.01-11.22). The OR for use of biomass fuel for heating was 3.45 (95% CI, 1.44-8.27) and for use of kerosene lamps for lighting was 9.43 (95% CI, 1.45-61.32).ConclusionsThis study provides evidence that the use of indoor biomass fuel, particularly as a source of heating, is associated with TB in women. It also provides the first evidence that using kerosene stoves and wick lamps is associated with TB. These associations require confirmation in other studies. If using kerosene lamps is a risk factor for TB, it would provide strong justification for promoting clean lighting sources, such as solar lamps.

BackgroundStudies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients.MethodsA retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis.ResultsThe age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12-3.68) and female gender (OR 1.69, 95% CI 1.12-2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB.ConclusionResults suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.

Young children are at greatest risk of exposure to lead and its effects. Although lead is one of the most widely used elements with known health hazard, there is little data on the blood lead level (BLL) of children in the Kathmandu Valley. Thus, this study aimed to assess factors associated with high BLL in children who were 6–36 months of age and resided in the Kathmandu Valley. In this hospital-based cross-sectional study 6–36 month-old children visiting the Paediatrics Outpatient Department of Tribhuvan University Teaching Hospital, Patan Hospital, and Siddhi Memorial Hospital were enrolled. All three hospitals are located in different areas inside the Kathmandu Valley. Written informed consent was obtained from the parents, and exposure data were collected using a structured questionnaire. Portable Anodic Stripping Voltammetry (ASV) was used to determine BLLs in children. Data were analyzed using SPSS version 16. Of 312 children enrolled in the study, 64.4% had BLLs ≥5μg/dl. A significant association was found between BLL and exposure to enamel paints in the household in the form of painting materials used in different parts of the house like walls, windows and doors (p = 0.001). Furthermore, multivariate analyses showed that BLLs were 4.5 times higher in children playing with dirt and dust (p = 0.006) and that children belonging to the community of lower caste/ethnicity groups had significantly higher BLLs compared to those from the upper caste groups (p = 0.02). Our study demonstrated that children living in households that have used enamel paints, children belonging to lower caste/ethnic groups, and children frequently playing with dirt and dust had significantly higher BLLs. The results of this study highlight the importance of policy decisions to limit environmental lead contamination, and to roll out awareness building measures designed to limit lead exposure and break the poverty cycle associated with chronic lead poisoning. [ABSTRACT FROM AUTHOR]

AIM: Snake bite is a significant public health problem in many countries with large number of cases of envenoming and deaths being reported, although it is difficult to define the actual number of snake bite victims. Clinical and Epidemiological aspects of human snake bite amongst the victims admitted to emergency ward of Manipal Teaching Hospital Pokhara, Nepal was studied. METHOD: This retrospective hospital record based study involved a total of 77 snake bite victims admitted to emergency ward of hospital during 1st November 2004 to 31st October 2005. Information on demographic data, identification of the snake, time and place of bite, symptoms of snakebite, time lapsed between bite and seeking treatment and snakebite case management and outcome was collected. SPSS windows version 14.0 software was used to analyze the data. Percentages were applied to find out the results. RESULTS: Majority of the victims were from Kaski district (79.2%). Higher proportion of victims were aged between 10-59 years (80.5%) and were males (55.8%). Majority of the victims were farmers (37.7%) and illiterate (58.4%). Most of the snake bite cases were reported in the months of June to September (84.4%). The most common place of bite was field (36.4%) and the most common site of bite was foot (55.8%). Most of the snakes could not be identified (59.7%). The symptom commonly encountered was cellulitis (46.8%). Majority of victims were applied tourniquet as first aid measure (59.7%). Time lapsed for seeking hospital treatment was half to 1 hour in 29.9% of the cases. Majority of the individuals recovered after snake bite (89.6%). CONCLUSION: Public health interventions should focus on improving victims' rapid transport to adequate treatment centers for anti snake venom. [ABSTRACT FROM AUTHOR]

Background: Bronchogenic carcinoma is the most common cancer in Nepal. There is no information available about the incidence and clinicopathological features of bronchogenic carcinoma from Nepal. We aimed to study the clinicopathological features of primary bronchogenic carcinoma treated in a tertiary care hospital. Methods: A retrospective case-series analysis of 136 cases of primary bronchogenic carcinoma treated between September 2001 and August 2005 in a tertiary care hospital of western Nepal was performed. Results: The median age of the male and female patients was 67 (interquartile range 60, 71.75) and 66 (interquartile range 60, 70) years, respectively. The maximum number of patients was in the 60–69 year age group. One-hundred and thirteen (83.1%) of these patients were smokers. Among the male patients, 83.3% (60/72) were smokers and females 82.8% (53/64) were smokers. The male to female ratio of the patients was 1.1: 1. The most common histological type was squamous-cell carcinoma (51.5%), followed by small-cell carcinoma (17.6%) and adenocarcinoma (8.1%). Ninety-eight (72.1%) patients were diagnosed in late stages of the disease (IIIb and IV). Conclusion: The clinicopathological features are in accordance with reports from other studies. The results of the present study indicate that bronchogenic carcinoma has a higher average age incidence, higher proportion of female patients and higher proportion of diagnosis of the disease in late stages. The higher rate of bronchogenic carcinoma among females indicates scope for further research into risk factors. Intervention measures for prevention and early diagnosis of bronchogenic carcinoma are to be undertaken. [ABSTRACT FROM AUTHOR]