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Introduction: Recent trends in surgery for Hirschsprung's disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD. Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure. Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required. Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results. [ABSTRACT FROM AUTHOR]

17 α-Methyltestosterone (MT) is a commonly used synthetic androgen for the all male tilapia fry production. The probable residual effect of MT on human health and environment has been a concern. Two trials for two seasons were conducted to evaluate the effectiveness of carp testis (CT), as a source of natural androgen, on sex reversal of Nile tilapia (Oreochromis niloticus) and compare it with MT at Department of Aquaculture, Agriculture and Forestry University, Nepal, using completely randomised block deign (RCBD). Altogether 8 treatments with 4 for methyltestosterone (40 mg MT kg-1 of diet) and 4 for 75% rohu (Labeo rohita) testis. Both source of androgen were fed for 15, 18, 21 or 24 days. Treatments were replicated thrice. The result of methyltestosterone feeding for 24 days showed significantly (p<0.05) higher percentage of male (98.5±1.5) than 15 days (87.1±3.5) but was statistically similar with 18 (91.8±2.6) and 21(94.3±3.0) days feeding. Similarly percentage of male obtained with18 (84.8 ±2.1) and 21 (85.8 ±2.9) days of CT feeding were statistically similar(p>0.05) with 24 days and also with 15 days CT treatment but the result of 24 days CT feeding was significantly higher (91.4 ±1.2) than 15 days (82.5 ±2.7) of carp testis feeding. [ABSTRACT FROM AUTHOR]

An experiment was conducted in 12 earthen ponds of 200 m² at Kathar VDC, Chitwan, Nepal for 270 days to analyze the productivity and nutrient budget in some carp based polyculture systems. The experiment was conducted in a completely randomized design with four treatments in triplicate each: a) Carps only or control (7000 fish/ha) (T1); b) Carps (7000/ha) + tilapia (3000/ha) (T2); c) Carps (7000/ha) + tilapia (3000/ha) + sahar (500/ha) (T3); and d) Carps (7000/ha) + tilapia (3000/ha) + sahar (1000/ha) (T4). Silver carp (Hypophthalmichthys molitrix), bighead carp (Aristichthys nobilis), common carp (Cyprinus carpio), grass carp (Ctenopharyngodon idella), rohu (Labeo rohita) and mrigal (Cirrhinus mrigala) of mean stocking size 3.0, 4.2, 10.0, 18.8, 10.5, 2.2 g, respectively were stocked in all ponds at the ratio of 4:2:1:1:1:1. The mean stocking size of Nile tilapia (Oreochromis niloticus) and sahar (Tor putitora) were 9.7 and 3.4 g, respectively. The ponds were fertilized weekly with urea and di-ammonium phosphate @ 4 g N and 1 g P/m²/day. Fish were fed with locally made pellet feed (20% CP) once in an alternate day at @ 2% body weight. At harvest, the extrapolated fish yield ranged from 1.5 to 1.7 t/ha/year in different treatments, without significant differences among treatments (P>0.05). Inclusion of sahar in Nile tilapia ponds decreased recruits by 63 to 72%. There were no significant differences in water quality parameters among treatments, except dissolved oxygen concentration, which was significantly lower in T1 and T3 than T2 and T4 (p<0.05). Both nitrogen and phosphorous were gained from fish species and lost from soil and water. There were no significant differences in nitrogen and phosphorous contents of all inputs and outputs among treatments. The unaccounted nitrogen and phosphorous loss ranged from 9.8-17.1% and 51.2-64.4%, respectively. The nitrogen and phosphorous required for producing 1 kg fish ranged from 337.5-375.9 g and 130.3-150.9 g, without significant difference among treatments. The nitrogen and phosphorous discharged for producing 1 kg fish ranged from 1.59-4.35 g and 1.6-9.3 g, respectively. [ABSTRACT FROM AUTHOR]

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

An experiment was conducted for 190 days from September 15, 2005 to March 25, 2006 in 12 outdoor concrete tanks of 24 m² (4.9 m x 4.9 m) size and 1.25 m in water depth, at the Institute of Agriculture and Animal Science (IAAS), Rampur, Chitwan, Nepal to evaluate the growth performance and profitability of silver barb in mono and polyculture systems. The experiment was laid out in a completely randomized design (CRD) with four treatments having three replications each. There was one mono and three polyculture systems of silver barb with different fish species as treatments: (1) Silver barb at 1.5 fish/m² (control); (2) Silver barb at 1.5 fish/m² plus common carp at 0.2 fish/m²; (3) Silver barb at 1.5 fish/m² plus male Nile tilapia at 0.3 fish/m²; and (4) Silver barb at 1.5 fish/m² plus carps at 0.5 fish/m² (silver carp 40%, bighead carp 20%, and common carp 40%). Silver barb were fed with 23% CP feed @ 4% body weight daily. At harvest, the mean weight, daily weight gain, gross fish yield (GFY) and net fish yield (NFY) of silver barb in monoculture treatment were significantly greater than in polyculture with common carp (p < 0.05), whereas there were no differences with polyculture with Nile tilapia (p > 0.05). However, survival of silver barb was not significantly different among treatments (p > 0.05). The combined GFY in polyculture with Nile tilapia treatment was significantly greater than in polyculture with common carp and in polyculture with other carps (p < 0.05). The NFY was highest in polyculture with Nile tilapia (4.4 ton/ha/yr), intermediate in polyculture with other carps (3.5 ton/ha/yr) and lowest in polyculture with common carp (2.9 ton/ha/yr) and monoculture (2.5 ton/ha/yr). Water quality parameters were not much difference in different treatments; however, water temperature was a crucial as it was less than 20 °C for about 3 months (mid November to mid February). All the treatments produced positive net returns; however, the net returns were higher in polyculture with Nile tilapia than in other treatments. This study demonstrated that silver barb polyculture with male Nile tilapia is far better than other combinations. [ABSTRACT FROM AUTHOR]

Meckel's diverticulum is a congenital diverticulum. Mostly it is asymptomatic. In children the commonest complication is lower GI bleeding. High index of suspicion is required for its diagnosis. Technetium-99m pertechnetate scan is useful to detect ectopic gastric mucosa. Surgical treatment of symptomatic Meckel's diverticulum is diverticulectomy or ileal resection. [ABSTRACT FROM AUTHOR]

Visual axis opacification (VAO) occurs in up to 40% of pediatric patients after cataract surgery withintraocular lens implantation(IOL) even with a primary posterior capsulotomy (PPC). In both children and adult group, opacification does obscure the visual axis. However, in children after PPC, there is no capsule. Hence, the terminology VAO is used in children rather than posterior capsular opacification. This opacification is caused by a proliferation of epithelial cells on the posterior capsule or anterior vitreous face and can hinder the optical image quality needed for normal visual development. The rate of epithelial mitotic activity is higher in children compared to adult. It can be managed by Yag laser or surgical membranectomy, the latter is preferable. International and national published articles were systematically reviewed on aetio-pathogenesis, surgical techniques and equipment, type and material of IOL, and management of VAO in children operated for cataract. Author's experience was also included to write manuscript. VAO is frequent complication following cataract surgery in pediatric patients. Age of cataract patients, surgical technique and type and materials of IOL are most common influencing factor for VAO. Immediate management with advance equipment of VAO reduces the incidence for development of irreversible stimulation deprivation amblyopia.

Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. To evaluate the lung and mediastinal masses and to analyze and compare the results with cytological findings, 257 patients were retrospectively studied who underwent CT guided FNAC over a period of 2007 to 2013. The study was done in patients who presented with respiratory symptoms with a localized lung lesion which was confirmed radiologically. 252 cases of lung masses and 5 cases of mediastinal cases were included. Patients' age ranged from 24 to 84 year and the male to female ration was 1.2:1. Radiologically, out of 257 cases, 225 cases were given as malignant, 8 cases as benign and 24 cases as inflammatory lesions. Cytologically, 212 cases were malignant, 12 cases were benign and 21 cases were inflammatory. Most common lung malignancy was adenocarcinoma (87 cases) followed by squamous cell carcinoma (56 cases). 8 cases of lung metastasis were seen. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

An accessory lobe of liver is a rare congenital anomaly which can be detected incidentally or can even present as acute surgical emergency due to torsion. We report a case of accessory hepatic lobe in right lumbar region in a 21years old female who came for a ultrasound abdomen for lower abdominal pain. We report the importance of ultrasonography and Computed Tomogram (CT) scan for the diagnosis of accessory hepatic lobe.

Cryptorchidism is a known cause of testicular tumor. The incidence of testicular tumor is 11 times more in inguinal testes and 50 times more in intra-abdominal testes. The position of the undescended testis is related to the likelihood of carcinogenesis with the intra-abdominal location having the highest risk for malignancy. Bilateral testicular tumors are rare and 80% of bilateral tumors are metachronous. Synchronous bilateral testicular tumors are rare and bilateral synchronous testicular seminoma in a patient with bilateral cryptorchidism is very rare.

Objective: The concept of dividing extracranial head and neck into different spaces is a notion that dates back to the 1800s. Various studies have led to detailed description of the soft tissue spaces that are contained within the fascial layers. This study was carried out to determine the accuracy of computed tomogram (CT) in differentiating malignant from benign lesions in the neck, to study the spatial distribution of different types of histological groups in the neck and the prevalence of malignant versus benign diseases involving the neck., Methods: This was a hospital-based, prospective study conducted in the department of Radiodiagnosis, Kasturba Medical college, Mangalore, from 2005-2008. A hundred consecutive patients referred for CT scan examination presenting with complaints related to involvement of neck spaces or presence of palpable neck masses were enrolled in this study. The details of all the cases regarding their radiological findings and histopathology were reviewed., Results: Of the 100 patients studied, 53 % had malignant lesions, out of which 43 % were squamous cell carcinoma and 4 % were metastatic lymph nodal involvement. Twenty percent of the lesions were of an infective origin while 23 % were benign and congenital cystic lesions., Conclusion: CT scan as an imaging modality has the ability to evaluate the malignant and benign tumors of the neck. Considering histopathology as the gold standard, the sensitivity of CT in detecting malignant/benign lesions was 96.5 % with a specificity of 100 %. The positive predictive value was 100 % and the negative predictive value 95.2 %.

The aim of the study was to determine the average axial length reading of the bilateral pediatric cataract undergoing cataract surgery. Pre-operative axial length measurement was done in 80 children below 15 years who had bilateral pediatric cataract. Axial length measurement was done in 56 fellow eyes. The axial length was measured under general anesthesia with the Accutome A-scan. The mean age was 69.7 months (SD=52.6), range from one month to 168 months. The mean axial length reading was 21.3 mm in operated eyes and 21.1 mm in fellow eyes. The range of axial length reading was 16.2 -31.5 mm in operated eyes and it was 16.5 -31.5 mm in fellow eyes. This short observation found that in bilateral pediatric cataract, the axial length value is similar in both operated and fellow eyes. Based on the axial length value of the operated eye, the patients with bilateral congenital cataract can undergo surgery in those eye hospitals where facilities of measurement of axial length is not available.

Teratoma is a germ-cell tumor that commonly affects the gonads. Extragondal teratoma is a rare entity. Teratoma in the region of adrenal gland is a rare and uncommon retroperitoneal tumor; only few cases have been reported. This case report describes such a tumor in a 40-year-old-woman who presented with multiple vague complaints. Ultrasonography of the abdomen showed a mixed echogenic mass with areas of calcification in right suprarenal region and a lymph nodal mass in the right renal hilar region. Computed tomography showed a mass containing fat, calcification and soft tissue component in right supra-renal region indenting the superior pole of kidney. Intraoperatively a supra-renal tumor was found within in a pseudocapsule that covered most of the tumor with a part of duodenum fixed to the mass.

Background: Substance use is very rampant in a developing country like Nepal. Unfortunately, medical field is not exempt from it either. Substance use among medical students and doctors not only reduces their efficiency at present but also increases their DALY on long term. The main objectives of the study were to assess the prevalence of substance use among medical student and to find out whether substance use started before or after joining the medical school., Methods: The study design employed for the research was descriptive cross sectional. A structured questionnaire about current use of tobacco, alcohol and marijuana was used to collect the data from third year students from eight medical and one dental college from across the country having 2006 batch., Results: The overall response rate was 74.12% (N=510). Among those who responded, prevalence of substance use was 49.6%, of which 38.2% were Nepalese nationals and 11.4% were foreign nationals and 39% were male and 10.6% female. Alcohol based product users were 52.3%, tobacco based product users were 55% and marijuana users were 65.7% and all started using them after joining the medical school., Conclusions: Almost half of the respondents were involved in some sort of substance use and more than half of those using started after joining medical school. Hence if proper measures are taken to address this then its prevalence can be significantly reduced if not eliminated completely.

Introduction: The study assesses the spectrum of ocular morbidity and predictors of morbidity in children living in orphanages in the Kathmandu Valley., Methods: A descriptive, cross-sectional survey was performed at 12 orphanages over a period of three months. The survey included a questionnaire and a complete eye examination, which included measurement of refraction, ocular deviation, and a fundus exam. Prevalence of ocular morbidity was calculated. Factors associated with ocular morbidity were examined using logistic regression., Results: A total of 660 children were included in the study (median age nine years [range 0.25-15]; 53% male). The prevalence of ocular morbidity was 17.9% (118). Of those with ocular morbidity, 88.1% (104) had similar ocular problems bilaterally. The most common type of morbidity was refractive error, found in 70.3% (83) of those with ocular morbidity (12.6% overall)., Conclusions: Refractive errors, which are largely correctable, are the greatest source of morbidity. In order to reduce childhood blindness, children living in orphanages are an appropriate group to target for future ocular screening in Nepal.

Pre-operative keratometry measurement of the subjects was done in 80 children with bilateral congenital cataract below 15 years who had undergone pediatric cataract surgery. The objective of the study was to evaluate the average keratometry reading in Nepalese children with bilateral cataract. The keratometry reading was taken under general anesthesia with the Nidek Auto Keratometer, model KM-500. The mean age was 69.7 months (SD = 52.6), range from one month to 168 months. The mean keratometry reading was 44.8 (SD = 2.7) in operated eyes and 44.7 (SD = 2.6) in fellow eyes. The minimum and the maximum values of keratometry reading in operated eyes were 39.4 and 51.5 respectively where as it was 40.3 and 51.5 in fellow eyes. We concluded that in bilateral pediatric cataract the keratometry value is similar in both operated and fellow eyes. Based on the keratometry value of the operated eye, the patients with bilateral congenital cataract can undergo surgery in those eye hospitals where facilities of the keratometry is not available under general anesthesia. We also recommended that additional study on axial length will be needed to calculate the Intra Ocular Lens power in fellow eye.

Background: Rhegmatogenous retinal detachment is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple and minimally invasive procedure for retinal reattachment., Aim: This study aimed to assess the outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment at our facility., Study Design: This was a retrospective- prospective, interventional case series., Materials and Methods: All subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy at Tilganga Eye Centre of Nepal from January 2002 to June 2007 were included in this study., Results: A total of 32 cases were included in the study. The mean age of patients was 55.2 year (SD=11.0). The majority of cases (62.5%) presented within two weeks of symptoms with blurring of vision in 90% of cases. Pre-operatively, 56.3% (18) patients had a best corrected distance visual acuity of <6/60. Retinal detachment involving less than two quadrants consisted of 37.5% (12). A single retinal break was present in 78.1% (25) of cases and 87.5% (28) of the retinal breaks were located in the superotemporal quadrant. The macula was attached in 37.5% (12) of the cases. Sulfurhexafluoride and Perfluoropropane were used in 68.8% (22) and 31.3% (10) respectively. The average follow up period was 1.02 years (range one month to four years). The retina was completely attached in 81.3% (26) of cases at the last follow up. The best corrected distance visual acuity of 6/18-6/60 was found in 40.6% (13) of subjects in the last follow up. There was a transient rise in intraocular pressure in 6.3% (2) of subjects after the procedure., Conclusion: The anatomical success rate following pneumatic retinopexy is quite high (81.3%) with good visual recovery and less morbidity translating to higher productivity for the patient. This procedure, being quicker than the alternatives, will also save surgeon's time making PR a good choice for managing primary rhegmatogenous retinal detachment in countries like Nepal where resources are scarce.

Diabetic retinopathy is a public health challenge in developing countries including Nepal and is not like other preventable or treatable causes of blindness. The aim of study was to estimate the prevalence of diabetic retinopathy following a community screening for diabetes. A community-based, cross sectional study was designed to screen for diabetes in people age > or =40 years in a semi-urban community of Kathmandu, Nepal. In those individuals with detected diabetes, a comprehensive eye examination was performed by an ophthalmologist and diabetic retinopathy was graded using a standard protocol. 1475 persons were screened for diabetes with a mean age of 54.7 +/- 12 years with sex ratio of 0.69 male per female. Thirty-four subjects were found to have impaired fasting glucose and sixty subjects had diabetes. The prevalence of diabetes mellitus was 4.1% (60) but 6.4% (94) had an abnormal blood sugar level. Fifty-seven diabetic patients visited at-Tilganga Eye Centre for ocular examination. Among examined patients, the prevalence of diabetic retinopathy was 19.3% (11). Only one person had clinically significant macular edema requiring laser therapy. The prevalence of hypertension and cataracts were the same among patients with and without diabetic retinopathy. The prevalence of diabetic retinopathy was low but one of sixteen newly diagnosed diabetics did have evidence of diabetic retinopathy. Eighty-four percent of known diabetics had never had their eyes examined for ocular complications. Community awareness and physician coordination should be emphasized to increase the eye examination rate.

Diabetic retinopathy is the one of the leading cause of visual impairment in world including Nepal. The objective of the study is to estimate the prevalence of and factors associated with Diabetic Retinopathy among diabetics in a Tertiary Eye Care Centre, Nepal. A hospital-based, cross sectional study, was conducted at Tilganga Eye Centre, Nepal. 371 consecutive subjects were recruited during a period of study. Ophthalmologist performed comprehensive eye examinations, which were reconfirmed by senior ophthalmologist. Diabetic Retinopathy was graded using the Early Treatment Diabetic Retinopathy Study. Total 371 consecutive diabetics were examined, mean of 57.4 years (SD 12.0) having the sex ratio of 0.72 male per female. The prevalence of Diabetic Retinopathy was 44.7% (166) with non-proliferative Diabetic Retinopathy presented 85.5% (142) and 14.5% (24) were proliferative Diabetic Retinopathy. Clinically significant macular edema was found in 19.2% (32). The age at onset of diabetes, duration of diabetes and hypertension were significantly associated with Diabetic Retinopathy (p = < 0.05) whereas ethnicity, sex and cataract surgery were not associated with it (p = > 0.05). The prevalence of Diabetic Retinopathy was within the range of previous studies with a high rate of proliferative diabetic retinopathy. Factors associated with diabetic retinopathy were similar to other developed countries. To prevent this condition of Diabetic Retinopathy, the coordination between physician and ophthalmologist needs to be strengthened.