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Patti Pics (PP) and Lea Symbols (LS) are commonly used by eye care practitioners worldwide. Although the relationship between the two tests is fairly well understood, the availability of different chart designs (single optotypes, multiple optotypes, multiple optotypes with crowding box) merits futher understanding. The purpose of this study is to explore the agreement between the acuity measures obtained with Patti Pics and Lea Symbols in children and adults and compare their performance with the Sloan Letter (SL) chart in adults. Methods: Monocular visual acuity was obtained from ninety-three 3 to 5-year-old children using Patti Pics and Lea Symbols. Acuities were also obtained from 113 adults using the same tests under identical conditions. Acuity results obtained with the pediatric tests were compared with the gold-standard Sloan Letter chart in adults. The Bland-Altman method was implemented to compare the level of agreement between tests. Results: Patti Pics yielded worse visual acuity than the Lea Symbols by approximately half a logMAR line in both children (mean difference: -0.07 § 0.07 logMAR, p

Introduction: This study was done to find out the causes of visual impairment in students studying in schools for the blind in the central development region of Nepal. Materials and Methods: The study was done in six schools for the blind in the central development region of Nepal. It was conducted by a team of Eye care professionals using standard eye examination protocols of the World Health Organization Prevention of Blindness Program in the year 2009. Results: A total of 133 students (5 - 21 years age group) enrolled in six schools for the blind were examined. 52.6% of children were visually impaired at birth and 12% developed vision impairment within one year of age. Twenty-one students (15.8%) had mild visual impairment, 5 students (3.8%) had severe visual impairment and 101 students (76%) were blind. The main cause of vision impairment was found to be lens-related anomaly 23.3% and retinal diseases, 18% followed by corneal lesions, 16.5%, and problems with the whole globe, optic nerve, and glaucoma accounting for 12.03%, 11.3%, and 7.5% respectively. The etiology could not be identified in 48.1% followed by hereditary causes (31.6%) and childhood factors (12%). Of the total students examined, 37.6% were visually impaired due to avoidable causes; preventable in 22.6% and treatable in 15% of cases. Conclusions: A high proportion of childhood blindness in schools for the blind in the central development region of Nepal is avoidable.

Thirty four percent of the total wheat cultivated area is under rain-fed condition in Nepal and that of the Terai is nineteen percent. The objective of this study was to develop drought tolerant and high yielding varieties of wheat for timely sown rain-fed environments. Coordinated Varietal trial (CVT) was carried out in normal wheat growing season during 2016/17 and 2017/18. The research was conducted at five locations (Rampur, Bhairahawa, Doti, Jitpur and Nepalgunj) of five research stations of Nepal Agricultural Research Council (NARC) throughout the Terai region in alpha lattice design with two replications. Data on different yield attributing traits were recorded. In the CVT-TTL 2016/17 highly significant difference (p

Purpose Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age. Methods Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA). Results At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00–17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83–3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (β = −2.66, p = .003). Neither GA (β = 0.21, p = .28) nor BW (β = 0.001, p = .32) showed any relationship with P2 amplitude. Conclusions Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants.

The study was conducted to evaluate the seminal attributes and cryo-banking of Achhami (Bos indicus) bull semen. Of two Achhami bulls, 8 ejaculates from each bull were evaluated for seminal attributes. For semen freezing and cryo-banking, 4 ejaculates (having ≥2 mL semen volume, ≥75% of sperm motility and ≥1,000 × 106 cells/mL of sperm concentration) from each bull were used. Semen samples were diluted in egg-yolk-tris-citrate extender using a two-step dilution protocol, and were frozen in liquid nitrogen (LN2) vapour in a styrofoam box. The mean semen volume, colour, sperm mass activity, motility, viability, concentration, abnormal acrosome, midpiece and tail and, abnormal head of two Achhami bulls were 4.4 ± 0.5 mL vs. 2.5 ± 0.2 mL, 2.5 ± 0.1 vs. 2.4 ± 0.1, 3.5 ± 0.1 vs. 3.5 ± 0.1, 77.0 ± 1.1% vs. 78.3 ± 1.3%, 94.4 ± 0.5% vs. 91.0 ± 0.6%, 1137.7 ± 73.7 × 106 cells/mL vs. 1060.0 ± 44.3 × 106 cells/mL, 10.2 ± 0.5% vs. 10.3 ± 0.5% and 6.7 ± 0.5% vs. 8.2 ± 0.3%, respectively. The post-thawed sperm motility and viability were 53.0 ± 2.0% vs. 50.0 ± 0.0% and 80.2 ± 0.4% vs. 73.2 ± 0.7%, while evaluating by computer-assisted sperm analysis (CASA) system, the percentage of the progressive motility, fast motility, slow motility, local motility and immotile sperm were 75%, 68%, 7.4%, 16.6% and 8.6%, respectively. A total number of 620 doses semen straw were cryo-banked. Due to the acceptable post-thawed sperm motility and viability recorded, cryopreservation of Achhami semen is hereby recommended so as to preserve the Achhami breed. For further validation, the fertility will be observed from the produced frozen semen.

Hydrogen production by electrolysis of water is seen as a promising technique as it is environment friendly and it can use renewable energy source for the production of hydrogen gas. However, this technology has less than 4% contribution to the production of commercial hydrogen in the market. This is due to the high electricity consumption of the water splitting reaction. The main challenge to make this technology efficient and economically viable is to develop cost effective and highly efficient electrolyzer. Here we have developed a three electrode electrolyzer in which an extra electrode is inserted between conventional electrodes: cathode and anode. This novel electrolyzer utilizes an extra voltage source which reduces the overpotential and increases the anode current of the cell, which is responsible for the hydrogen production. Furthermore, we observed that, the operating resistance of the cell decreases under the application of the new voltage source. Our results demonstrate that the introduction of third electrode improves the performance of electrolysis by consuming less power as compared to the traditional or conventional two electrode electrolyzer system.

Background: Education for hearing impaired (HI) students is always challenging for schools, teachers, parents and even for students themselves. For their education, government has established special schools and included them in mainstream school with hearing peers also called integrated school. Although all these efforts for their education, their academic performance is affected by different factors. Objective: This study is focused to assess factors which affects the academic performance of HI students of Jhapa, Morang and Sunsari districts. Materials and Methods: This study is a cross-sectional study and based on primary data collected through structured questionnaire. Academic Performance is categorized as Below Average, Average and Good. A sample of 238 HI students from eleven schools of three districts were selected using two stage stratified random sampling methods. Sixty teachers were also chosen for assessing some variables. Data were analyzed using descriptive and inferential statistical methods. To determine the significant factors influencing the academic performance of HI students, Multinomial Logistic Regression (MNLR) model was used. Results: From the fitted MNLR model, variables like attendance [Odds Ratio (OR) =0.951], type of school (OR=27.39), level of study (OR=4.551), additional handicapping condition (OR=5.202), communication capacity of students (OR=9.477) and instructional material (OR=3.028) are found to be significant in the model Below Average versus Average level of academic performance of HI students. Similarly, the variables like type of school (OR=7.875 and 9.572), level of study (OR= 0.556), purpose of parents' visit (OR= 0.410) and instructional material (OR= 0.304) are found to be significant in the model Good versus Average level of Academic performance of HI students. Conclusion: The results of the study illustrates that several factors are associated with academic performance of HI students. Concerned authorities are suggested to provide suitable infrastructure, HI students friendly curriculum, special training to teacher and awareness to family, society and hearing peers to improve the academic performance of HI students.

Purpose To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. Methods A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from -6.00 to -12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. Results Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. Conclusions Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.

Chitwan district of Nepal has been known as the dairy kingdom of the country considering its strategic location andpotential to easily provision inputs and produce as well as market quality milk across the country. However, theclimate especially during summer has been a challenge to farmers that potentially compromise the daily milk yieldof cows. Therefore, sixteen crossbred dairy cattle were placed in a RCBD fashion to assess the impacts of cold waterbathing in ameliorating effect of heat stress on their performance and body physiology. Routine assessment of themicroclimate within the experimental shed and blood parameters was made. The results from the experimentinferred that frequency of bathing (none, once, twice or thrice a day) did not have any significant impact onHaemoglobin, Haematocrit, Sodium, Potassium, Chloride and Bicarbonate levels in the blood plasma(p>0.05). Inaddition, the animals did not exhibit any signs of physiological distress clinically either. A detailed study scopingtemperature humidity index and over a number of other milk and blood parameters are to be tested across a numberof other available breeds too in order for the researchers to come to a meaningful strategy to beat the heat stress.

AimTo putatively identify and characterise human tear metabolites in a normal subject on an untargeted platform of liquid chromatography-Q exactive-HF mass spectrometry.MethodsFour samples of unstimulated tears were collected from both eyes on four consecutive days between 1 – 2 pm using a microcapillary tube and pooled from both eyes each day. Untargeted analysis of the tears was performed by chromatographic separation of constituent metabolites in both CSH-C18RP (Charged Surface Hybrid-C18 Reversed Phase) and SeQuant ZIC-pHILIC (Zwitterionic-polymeric Hydrophilic Interaction Liquid Chromatography) columns, followed by heated electrospray ionization (HESI) and the acquisition of mass spectra using QExactive-HF mass spectrometer. Compound Discoverer software (v2.0) was used for data analysis.ResultEighty-two metabolites were tentatively identified. Seventy compounds (85.4 %) were observed in all four samples with a coefficient of variation (CV) less than 25 %. Fifty-nine metabolites (71.9 %) were novel in the healthy tears. Amino acids were the most frequently detected metabolites in the tears (28 %), followed by carbohydrates (12.2 %), carboxylic acids (8.5 %), carnitines (6.1 %) and glycerophospholipids (4.9 %), respectively.ConclusionThe current untargeted platform is capable of detecting a range of tear metabolites across several biological categories. This study provides a baseline for further ocular surface studies.

Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.

Background: In this study, a maternal health care service is analyzed under the components of place of delivery (POD). POD is highlighted as ‘home delivery’ and ‘institutional delivery’.Objective: The objective of this study is to analyze factors associated with the utilization of health institute as delivery and estimate the probabilities of institutional delivery using some selected independent variables.Materials and Methods: Data used were extracted from individual recode of a data file of Nepal Demography Health Survey (NDHS) 2006 and 2011. The unit of analysis for this study is Ever Married Women (EMW) who had at least one live birth in the five years preceding the survey. Sample of this study consists of 4182 EMW for 2006 NDHS and 4079 EMW for 2011 NDHS. The dependent variable is place of delivery. The independent variables are mixture of categorical and continuous variables. For building of suitable statistical models, various types of models were explored and different measure of models adequacy test were applied. Finally, two logistic regression models were developed separately for 2006 and 2011 NDHS data.Results: Fitted model showed several variables: education level, wealth index, birth order, residence and ANC by provider were highly significant predictors for the selection of place of delivery for 2006 NDHS but in 2011 NDHS age was also highly significant. Goodness of fit tests (Hosmer-Lemeshow chi-square statistic), multicollinearity diagnostics, residual analysis and outliers (leverage value) showed that both models fit well to the proposed logistic regression model.Conclusion: A Comparative assessment of model coefficients between 2006 and 2011 NDHS, it is found that the values are only slightly different for most of the predictors under consideration demonstrating consistency of associations found in the two surveys.Nepalese Journal of Statistics, 2017, Vol. 1, 55-72

Background: Corneal ulcer is a sight threatening disease of significant public health concern. Early diagnosis with microbiological identification of the causative organism and institution of the proper medical therapy are important for successful visual recovery.Objectives: To find out the demographic and predisposing factors associated with corneal ulcers, evaluate management of ulcers on the basis of clinical features and corneal scraping results.Methods: It was a retrospective clinical study conducted among 1897 subjects with microbial keratitis in Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from January 2010 to December 2014. Assessment included detailed eye examination with slit lamp for size, depth and location of ulcer, presenting visual acuity on internally illuminated Snellen’s chart, and corneal scrapings for Gram’s stain and 10% Potassium hydroxide wet mount. A standard treatment was delivered on the basis of clinical features and corneal scraping results. Subjects were evaluated subsequently after 48 hours, one week, two weeks, three weeks and four weeks of initiation of therapy. Non-responding cases were admitted to perform re-scraping and to modify therapy.Results: Majority of subjects (71.2%) belonged to the age group of 26 to 55 years (71.2%), presented after two weeks (82.3%) and used non-prescription eye drops (71.9%) before visiting to the eye hospital. Ocular trauma (54.5%) was the most commonly reported predisposing factor. The central and paracentral ulcers comprised of 72.8% of ulcers withsize greater than 2mm in 2.7% and moderate ulcer in 71.1%. Microbiological test revealed fungal ulcers in 78.1% subjects. Presenting visual acuity better than 6/18 was reported in 7% only.Conclusion: Corneal ulcer was one of the commonly reported eye disease in Terai region of Nepal. Trauma is the commonest cause of corneal infection. Fungal corneal ulcers werecommonly noted.

Trauma is an important cause of monocular blindness in the developing world. This study aims to determine the demo­graphic profile and visual outcome of cataract surgery among the children with traumatic cataract. It was a prospective and longitudinal study of 189 consecutive children below 16 years who underwent cataract surgery with intra ocular lens (IOL) implantation for traumatic cataract at Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from October 2012 to March 2014. Assessment included visual acuity measurement in the Snellen’s chart or the Cardiff card, anterior segment examina­tion with slit lamp, dilated fundus examination with the help of +20D lens in indirect ophthalmoscope, B-scan ultrasonogra­phy of posterior segment and objective and subjective refraction. Follow up was scheduled at first post-operative day, at dis­charge, one month and three months. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Among 189, majority of them were males (73%) and the average age was 8.8±3.6 years. The time of presentation ranged from 3 days to 8 years (median age two months). Wooden stick was the most common cause of injury (34.4%). The average preoperative visual acuity in logMAR scale was 1.6. The average postoperative visual acuity in logMAR scale was 0.8. Eye injuries with traumatic cataract are associated with significant visual impairment. Cataract surgery with intraocular lens implantation restores vision significantly.

with the tremendous growth in the number of internet users and the frequency with which individuals engage with social media, it has become necessary to understand the relationship between social media marketing and the impact on its users. This is particularly important in terms of choices of health clinics that provide oral and maxillofacial services (OMS or OMFS). This study aims to determine the nature of effective communication patterns and methodologies to attract patients as potential customers for OMS clinics. It focuses on critical points of interaction in social media marketing (SMM) with the aim of improving coverage to attract potential customers to OMS. A further aim is to develop a framework for marketers to map out effective approaches to social media as there are significant opportunities for OMS clinics to extend their reach to a larger client base. Among the drivers of this expansion, Brand Trust is of high significance, created through connected social media, positive electronic word of mouth (PeWOM), brand awareness and social media content marketing (SMCM).

A field experiment was conducted at Chitwan, Nepal to evaluate the effects of manure and irrigation application on soil nutrients content, water use efficiency and maize productivity. The experiment was laid out in a factorial complete randomized block design with three replications. The treatments were consisted of two manure levels: no manure and manure with fertilizer based on 120 kg ha-1 nitrogen recommended. Similarly, another factor was irrigation water application with five levels which were control (no irrigation) and irrigation applications of 300, 600, 900 and 1200 mm during growing period. The manure application significantly affected the total nitrogen (0.13%) and available phosphorus (37.5 kg ha-1) content in the soil. Interestingly, different irrigation treatments enhanced soil nutrient content differently except soil nitrogen. Similarly, the highest grain yield was observed on 1200 mm irrigation which corresponded to 169% increment over control irrigation treatment but not significant with 600 and 900mm irrigation. The 1200 mm irrigation showed the lowest irrigation water use efficiency (IWUE) (5.96 kg ha-1 mm-1), while 300 mm irrigation showed maximum (18.37 kg ha-1 mm-1) followed by 600 mm irrigation (7.04 kg ha-1 mm-1) based on grain yield. In conclusion, it seems that 600 mm irrigation treatments are quite suitable for the maize production in spring season with benefits of increasing IWUE and saving water around 50% of water which will help in growing more areas and in managing the limited water resources in Chitwan, Nepal.

Background: Congenital Cataract is the most important cause of treatable childhood blindness. Rubella is one of the major causes of preventable disease in many countries. There are scanty reports on congenital cataract in Nepal. Objective: To find out the demographic and etiological factors of congenital cataract in children. Method: In a hospital based cross sectional study, 46 children with congenital cataract were evaluated to find out morphology of cataract, laterality, associated ocular and systemic abnormality, visual status and etiology of cataract. Assessment included antenatal, birth and neonatal history, a detailed eye examination in slit lamp or the operating microscope under general anaesthesia, serum serology for TORCH infections, random blood sugar, urine reducing substance and thyroid profile. Result: Among 46 children with congenital cataract, 76.1% children presented before 5 years of age and 78.2% had bilateral onset. Male to female ratio was 1.3:1. Most of the children were legally blind (79.3%) in cataractous eye. Family history of congenital cataract was present in 15.2% cases. The most common mode of presentation was leukocoria in 91.3%. Microcornea (28.3%), resolved uveitis (13.0%), and iris atrophy (8.7%) were the most common ocular associations. Delayed developmental milestone (21.7%) and cardiac anomalies (10.9%) were the most common systemic anomalies. Lamellar cataract (51.3%) was the most common morphology of cataracts observed. The maternal infection was the major cause of congenital cataract in 17.4% cases with predominantly rubella infection in 13% cases. Conclusion: Most of the children with cataract are legally blind. Maternal infection in the antenatal period is the major cause of congenital cataract. DOI: http://dx.doi.org/10.3126/hren.v12i1.11975 Health Renaissance 2014;12(1):3-10

Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsychiatric and hepatic manifestations as well as appearance of Kayser-Fleischer ring. This is a retrospective review of the records of the patients of Wilson’s disease who attended Neuro-ophthalmic clinic for the identification of Kayser-Fleischer (K-F) ring from January2010 to June 2012. Detailed eye examination included visual acuity assessment, slit lamp biomicroscopy and intra-ocular pressure measurement. Data regarding clinical features, laboratory investigations and the status of K-F ring was recorded. Seven cases of Wilson’s disease with age range of 9-15 years were included in the study. Among them four (57.1%) had neuropsychiatric symptoms, two (28.5%) had hepatic disease and one (14.3%) was asymptomatic, diagnosed by positive family history and laboratory tests. Among four subjects having K-F ring, three (75%) subjects had neuropsychiatric symptoms and one subject had hepato-billiary disease. Besides K-F rings, other ophthalmic findings were sunflower cataract (14.3%) and vernal keratoconjuctivitis (14.3%). The identification of K-F ring is a simple and cost effective screening test for the diagnosis of Wilson’s disease. K-F is present in majority of the patients with neurological manifestations. DOI: http://dx.doi.org/10.3126/jcmc.v4i3.11934Journal of Chitwan Medical College 2014; 4(3): 17-20

Background: This study was conducted to determine clinical profile and etiological factors for phlyctenular keratoconjunctivitis (PKC) in our patients. Materials and Methods: In the descriptive study, 50 pediatric cases of PKC were enrolled into the study from outpatient department of BP Koirala Lions Center for Ophthalmic Studies between August 2011 and August 2012. The age, sex, exposure to tuberculosis, ocular symptoms, and systemic complaints were recorded. Morphological description of PKC such as number, type, location and scars HISTORY and number of recurrence was also noted. The conjunctival swab was taken from all patients and sent for microbiological examination. Report of systemic involvement, worm infestation was also noted. Mantoux testing for possibility of tuberculosis was also performed. Results: PKC was detected in 59 eyes of 50 children having mean age of 8.0 ± 6.2 years including 54% males, unilateral involvement in 82%, the limbal involvement in 52% and multiple PKC in 34% children. Associated ocular disorder was blepharitis in 12 (24%) children. Conjunctival swab and culture revealed Staphylococcus infection in 10 (20%) children. Of eight recurrent cases, two had urinary tract infection managed with systemic antibiotics, three had parasitic infestation treated with antihelmentics, one had mantoux positive without having evidence of tuberculosis and two cases had blepharitis as a local factor. Conclusions: PKC is mostly presented as unilateral disorder of conjunctiva. PKC is associated with blepharitis, Staphylococcus infection, worm infestation and systemic infection.

Introduction: There are several limitations of the Amsler chart as a screening tool due to its low sensitivity and high false-negative results. The Berkeley central visual field test (BCFT), which is a simple power-point presentation of a 50-point scoring system for the central 10-degree of the visual field, was devised as an alternative to the Amsler chart. Objectives: To compare the efficacy of measuring the central visual field using the Berkeley central field test (BCFT) and the Amsler grid test. Materials and methods: In a comparative and validity study, 30 subjects with maculopathy and 35 controls were recruited. The maculopathy subjects with the best corrected visual acuity of 20/200 or better and 2.5M for distant and near vision respectively, were included. All the subjects under went a complete eye examination where visual assessment was done using the distant and near vision Log MAR Chart. The subjects were assessed with the Amsler chart-II at a distance of 30 cm. The BCFT was used as a 50- point scoring system. The effectiveness of BCFT was compared with that of the Amsler grid regarding the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: Out of 65 subjects, 30 subjects had maculopathy and 35 were normal. The mean age of the 65 subjects was 49.8±9.1 years. Of the 30 subjects with maculopathy, the majority (54%) had age- related macular degeneration. The sensitivity, specificity, PPV and NPV of the Amsler grid test were found to be 80%, 100%, 100% and 87%, respectively, whereas those of the BCFT were 71%, 99%, 98% and 82% ( p=0.37 ). Conclusion: The BCFT test was as good as the Amsler grid test at detecting the presence of maculopathy. DOI: http://dx.doi.org/10.3126/nepjoph.v6i2.11701 Nepal J Ophthalmol 2014 ; 6 (12): 170-176

Introduction: In some instances, the understanding of the ocular manifestations in childhood leukemia is not only important to establish the diagnosis but also reflects the disease state and prognosis. Objective: To study the ocular manifestations of childhood acute leukemia among the children attending a tertiary-level hospital in Nepal. Materials and methods: A cross-sectional, descriptive study was undertaken at the B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) and Kanti Children Hospital (KCH), Kathmandu, over a period of one-and-a-half years. Children diagnosed with acute childhood leukemia referred to the BPKLCOS from the Oncology Unit of the KCH and the Emergency Department of the Tribhuvan University Teaching Hospital (TUTH) were included in the study, using a non-probability sampling method. Results: Of the 71 cases with childhood acute leukemia, 55 (77.5%; 95% CI = 66% - 85%) had acute lymphoblastic leukemia(ALL)whereas the other 16 (23%) had acute myeloblastic leukemia (AML). Ocular involvement were seen in 33 cases (46%) and were more frequent in cases of AML as compared to those with ALL (p=0.001, OR 5.0, 95% CI= 1.4 – 17.5). Direct ocular involvement and secondary ocular involvement were observed in 12 (16.9%) and 29 (40.8%) subjects, respectively. Ocular symptoms were present in only 11 cases (15.49%). Cerebro-spinal fluid (CSF) and bone marrow examination in cases with direct ocular involvement showed 10 cases (83.3%) positive for blast cells in the CSF and 6 cases (50%) positive for blast cells in bone marrow. The most common secondary manifestation was retinal haemorrhage, seen in 23 cases (32.4%). Conclusion: In view of the high asymptomatic ocular involvement and the significant visual morbidity, a routine ophthalmic examination is recommended as an integral part of the medical examination in all cases of childhood acute leukemia. DOI: http://dx.doi.org/10.3126/nepjoph.v6i2.11678 Nepal J Ophthalmol 2014; 6(12): pp. 197-204

Introduction: High altitude, often characterized by settings over 2400m, can be detrimental to the human body and pose a significant risk to ocular health. Reports concerning various ocular morbidities occurring as a consequence of high altitude are limited in the current literature. Objectives: This study was aimed at evaluating the ocular health of porters working at high altitudesof Himalayas in Nepal. Materials and methods: A mobile eye clinic was set up in Ghat and patient data were collected from its out- patient unit by a team of seven optometrists which was run for five days. Ghat is a small village in north-eastern Nepal, located at 2860 m altitude. Travellers walking through the trekking route were invited to get their eyes checked at the clinic. Comprehensive ocular examinations were performed, including visual acuities, objective and subjective refraction, anterior and posterior segment evaluations, and intraocular pressure measurements; blood pressure and blood glucose levels were also measured as required. Ocular therapeutics, prescription glasses, sunglasses and ocular health referrals were provided free of cost as necessary. A total of 1890 people visited the eye clinic, among which 57.4% (n=1084) were porters. Conclusions: Almost half of the porters had an ocular morbidity. Correctable refractive error was most prevalent, with other ocular health-related complications, including dry eye disease, infectious disorders, glaucoma and cataract. Proper provision of regular and effective eye care services should be made more available for those residing at these high altitudes in Nepal.

SIGNIFICANCE: This study suggests that pre-term infants, even without retinopathy of prematurity, are at risk for abnormal refractive development and informs the need for close monitoring of refractive error in such infants, regardless of their retinopathy of prematurity status. PURPOSE: The present study aims to investigate the refractive error trend in Nepalese pre-term infants without retinopathy of prematurity (ROP) in the first 6 months of life and explore the association of refractive error with birth weight (BW) and gestational age (GA). METHODS: Thirty-six pre-term infants without ROP and 40 full-term infants underwent cycloplegic retinoscopy at birth, term (for pre-term only), 3 months, and 6 months chronologically. Refractive status was classified into emmetropia (mean spherical equivalent refraction [SER] 0 to +3.00D), myopia (SER < 0.00D), and significant hyperopia (SER > +3.00D). Refractive parameters at various age points were compared between the pre-term and full-term infants using general linear model repeated measures ANOVA. RESULTS: At birth, the SER in the pre-term infants was +0.84 ± 1.72D; however, there was a shift toward myopia at 6 months of age (SER = -0.33 ± 1.95D). There was a significant difference in SER, astigmatism, and anisometropia between pre-term and full-term infants by 6 months of age (P < .01). Astigmatism and anisometropia showed an increasing trend with age in pre-term infants (P < .05 at 6 months) in contrast to a decreasing trend in full-term infants (P < 0.05 at 3 and 6 months). In pre-term infants, there was a statistically significant positive relationship between GA and SER (β = 0.32, R = 17.6%, P < .05) but a negative relationship between BW and astigmatism (β = -1.25, R = 20.6%, P < .01). CONCLUSIONS: Pre-term infants who do not develop ROP show a trend toward increasing myopia and demonstrate greater astigmatism and anisometropia than full-term infants in their first 6 months of life.

Background: To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous Nepalese eyes using spectral domain optical coherence tomography (SD-OCT) and study its relationship with visual field sensitivity. Methods: A total of 120 eyes comprising primary open angle glaucoma (POAG), glaucoma suspects (GS), normal tension glaucoma (NTG) and healthy subjects (n = 30 cases in each group) underwent a complete ophthalmic examination, including optic nerve head (ONH) evaluation and standard automated perimetry (SAP). RNFL thickness measurements around the optic disk were taken with circular spectral domain optical coherence tomography (SD-OCT) scans. Analysis of variance (ANOVA) was used for comparison of RNFL parameters among various study groups. The relationship of RNFL parameters with visual field (VF) global indices was evaluated with regression analysis. Results: The mean pRNFL thickness was significantly less in the POAG (64.30 ± 14.45 μm, p

Prevalence of ocular morbidity among street children is largely unknown. The present study was carried out to determine the prevalence of ocular morbidity among street children in the Kathmandu Valley.A cross-sectional study consisting of an eye examination program among 569 street children aged younger than 18 years was conducted from March 2013 to February 2014. Children were included from 11 safe houses of 6 non-governmental organizations and an independent eye camp. Eye examination included visual acuity testing, anterior segment and posterior segment examination, retinoscopy and refraction, cover test, convergence, accommodation and color vision tests. Chi-square test was used to analyze the association of ocular morbidity with age, sex and living conditions.The majority of children (43.8%) were in the age group of 12-15 years, and the male to female ratio was 3.9:1. Uncorrected and best-corrected visual acuity ≥6/9 in at least one eye was found in 89.8% and 98.4% of children, respectively. Total ocular morbidity was observed at 31.6%. The most common types of ocular morbidity were conjunctivitis (11.0%) and refractive error (11.6%). Ocular morbidity was more common in children over 15 years of age (40.9%; p 0.01; odds ratio 1.8).Ocular infection and refractive error represent the most common ocular morbidities in street children in the Kathmandu Valley.

Background: Antenatal care provides an entry point for pregnant women to the health care system. Proper utilization of available health services essential for successful implementation of health programmes. Objectives: This study investigates factors associated with the use of maternal health services in terms of number of antenatal care visits. Methods: For analyzing the use of antenatal care health services in Nepal, data was extracted from individual recodes of a data file of Nepal Demographic Health Survey 2006. The unit of analysis for this study was Ever Married Woman (who had at least one live birth in the five years preceding the survey). The sample of study consisted of 4182 Ever Married Woman. The response variable has numbers as its possible outcome therefore generalized Poisson regression model was selected for establishing linkage between number of antenatal care visits and several explanatory variables. Results: The result of this study shows that women with low education level, those residing in rural areas and those with low socio-economic status are less likely to attend antenatal care visits. Conclusion: This study confirms that antenatal care visit is indeed an effective entry point for delivery care. Programmes directed at improving and increasing the accessibility of antenatal care are important to improve maternal health, especially in developing countries like Nepal.DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10629Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, Page: 69-74

This study focused on the testing of a process-based, numerical model known as PESTFADE (PESTicide Fate And Dynamics in the Environment), in a sprinkler-irrigated soybean plot located at the Asian Institute of Technology experimental farm. Field soil water content (SWC) and metribuzin residue adsorbed at soil profile depths of 0–10, 10–20 and 30–40 cm over different time periods were intensively measured by the gravimetric method and by Liquid Chromatography Tandem Mass Spectrometry, respectively. The model performed relatively well for simulating SWC at 10–20 cm and metribuzin residue concentration at 0–10 and 10–20 cm soil profile depths with R2 values as high as 0.99 and relative error values as low as−0.22; the model performed relatively poorly at 30–40 cm soil profile depth. The results indicate that when properly calibrated, PESTFADE can be used to predict the movement of water and metribuzin through the soil profile for tropical zones.

Heteroplasmy due to length polymorphism with tandem repeats in mtDNAs within individual was hardly studied in domestic animals. In the present study, we identified intra-individual length variation in the control region of mtDNAs in Nepalese sheep by molecular cloning and sequencing techniques. We observed one to four tandem repeats of a 75-bp nucleotide sequences in the mtDNA control region in 45% of the total Nepalese sheep sampled in contrast to the Chinese sheep, indicating that the heteroplasmy is specific to Nepalese sheep. The high rate of heteroplasmy in Nepalese sheep could be a resultant of the mtDNA mutation and independent segregation at intra-individual level or a strand slippage and mispairing during the replication.

Background: Dry eye symptoms are more frequent in contact lens wearers than in non wearers. Dry eye is considered relatively common in contact lens wearers than non-wearers. However, there was no any report in our clinical setting that compared and addressed the issue related to dry eye and its symptom in contact lens wearers. The present study was conducted to compare pre-ocular tear lm in contact lens wearers (CLW) and contact lens non wearers (CLNW), and evaluate the relationship between clinical and subjective assessment of dry eye symptoms. Methods: It was a comparative study conducted among 131 subjects (262 eyes) attended in the contact lens clinic at BP Koirala Lions Center for the Ophthalmic Studies. Sixty five were daily soft contact lens wearers; sixty-six were non wearers. Tear function assessment included non- invasive tear break up time, invasive tear break up time, tear prism height and Schirmer II test. Subjective assessment of dry eye symptoms was carried out using McMonnies questionnaires. Results: Mean age of CLNW was 23.01± 5.53 and CLW was 23.6± 4.61. Female (89 subjects) visited more than male (42 subjects) in contact lens clinic. Mean symptom score in CLW was significantly higher than CLNW (p

PURPOSE To determine the prevalence of ocular morbidity and refractive error among the children of the squatter settlements in Kathmandu. METHODS A cross-sectional study was carried out at five squatter settlement areas at Kathmandu, including 366 children younger than 16 years. Detailed eye examination included the visual acuity testing, cycloplegic refraction, binocular vision assessment, anterior segment examination, and posterior segment examination. Variations in age, sex, and ethnic distribution of the study population were analyzed through analysis of variance. Pearson χ test with Yate correction was used to analyze different types of ocular morbidity. Pearson correlation coefficient test was performed to correlate refractive error in the right eye and the left eye. RESULTS Majority of children (28.9%) belonged to the age group 8 to 10 years, and most of them belonged to the Manohara settlement area (40.2%). Male-female ratio was 0.7. Uncorrected and best-corrected visual acuity of better than or equal to 6/9 in at least one eye was found in 87.9% and 99.0% children, respectively. Total ocular morbidity was observed in 33.7%. The common type of ocular morbidity was conjunctivitis (11.2%), refractive error (9.0%), and blepharitis (5.4%). Ocular morbidity was common in infants (57.9%; p = 0.043; odds ratio, 2.8) and 14- to 15-year-old children (52.8%; p = 0.002; odds ratio, 2.5). CONCLUSIONS Ocular infection and refractive error represent the common ocular morbidity in children living in squatter settlements.