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Publication Publication Epilepsy in children: an epidemiological study at Kathmandu Medical College Teaching Hospital Kathmandu(2003) Shakya, KN; Shrestha, R; Baral, MRObjectives: To analyze the relative frequencies of various epileptic seizures and to study the age at onset of different seizure types in Nepalese children. Design: Prospective study. Setting: Hospital outpatient based in Kathmandu, Nepal, between November 2001 to October 2002. Participants: 50 children diagnosed as epilepsy excluding neonatal and febrile seizures. Main outcome measure: Diagnosis and classification of cases according to the International Classification of Epilepsy of the International League Against Epilepsy [ILAE] and number of patients in each category with various ages at first seizure. Result: Generalized seizures (78%) were 3.54 times commoner than partial seizures (22%). Most frequent seizure types were generalized tonic clonic (36%), tonic (16%), complex partial (14%), atonic (12%) and absence (10%). Generalized clonic, simple partial and partial with secondary generalization, each had less than 5% frequencies. In 40% cases the first seizure occurred when aged between 2-5 years. In partial seizures the peak age at onset was observed below 6 years while primary generalized seizure was more frequently seen in age group 2-10 years. Conclusion: More paediatric patients with primary generalized seizures (78%) were observed than with partial seizures (22%). In this age group, the most frequent seizure type was generalized tonic clonic (36%) with the peak frequency of age at onset of seizures in 2-5 years. Key words: Epilepsy, Frequency, Age at onset.Publication Publication Publication Publication Incidence of ophthalmoscopic fundus changes in hypertensive(Kathmandu University, 2003) KJD, KarkiA prospective, hospital based, clinical study was conducted in hypertensive patients referred to the eye OPD, KMCTH, Sinamangal during a period of three months to find out the incidence of fundus changes. A total of302 hypertensive patients were included in the study and their fundus changes were evaluated by direct ophthalmoscopy. The age of the patients ranged from 30-70 years and the duration of hypertension from 1-25years. The blood pressure was not controlled in 218 patients (72.18%). More female patients (56.22%) were hypertensive than male (43.78%). But the fundus changes were less in female patients. Caste-wise hypertension was more common in Brahmins (38.41%) and fundus changes were also comparatively more. The fundus changes were found in 192 patients (63.57%) and the most common findings were hypertensive retinopathy.GrI + GrII combined together (52.31%). The other common fundus finding was BRVO in 11 patients (3.64%).A routine ophthalmoscopic fundus examination to detect the retinal changes in hypertensive patients is recommended. Key words: Systemic hypertension, direct ophthalmoscopy, fundus changes.Publication Publication Occupational cancer in Nepal - an update(Kathmandu University, 2003) S K, JoshiThis article is a discussion of occupational cancer in Nepal. The knowledge of specific problems of occupational cancer in Nepal is very scarce. Few researches on occupational cancer have been done in Nepal. A case-control study done recently has revealed a high risk (OR 4.2 95% CI: 1.4, 12) for lung cancer among the workers, who have worked in the exposed occupations. The incidence of cancer is thought to be rising every year. In this article an attempt has been made to establish the probable occurrence of carcinogens in the middle and large scale manufacturing industries in Nepal and the approximate number of workers exposed to different hazardous substances at the work places. Keywords: Occupation, industries, carcinogens, exposure, occupational cancer, NepalPublication Hysterectomy: an analysis of perioperative and post operative complication(Kathmandu University, 2003) R, Saha.; M, Sharma; S, Padhye; U, Karki; S, Pandey; J, ThapaObjective : To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. Material and methods: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted-Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. Result: Total number of hysterectomy carried out was 50. 31(62%) were Total abdominal hysterectomy, and 19(38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12(24%), DUB 8 (16%), CIN 4(8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1(2%). Prophylactic for Ca breast 1(2%), Postmenopausal bleeding 1(2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1(2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laprotomy. There were three(6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.Publication Publication Publication Clinical Profile of Neonatal Sepsis(Kathmandu university, 2003) NK, Jain; VM,Jain; S, MaheshwariIntroduction: Neonatal Sepsis is a major cause of mortality and morbidity in newborns both in developed and developing countries. Objective: This study was to analyse the symptoms and sign of Neonatal Sepsis. Materials and Methods: Retrospective hospital based study the date was collected from patient record files of two years (Jan. 2001–Dec.2002). Result: 106 Neonates with suspected sepsis were studied out of which 30 were culture positive. The most common organism was E. coli and the most common clinical presentation was the respiratory distress and letharginess. Conclusion: Infection in Neonate is an important cause of mortality & morbidity especially in low birth babies. Key Words: Neonate, Sepsis and Mortality.Publication Seroprevalence of antibodies to hepatitis C virus among injecting drug users from Kathmandu(Kathmandu University, 2003) I L, ShresthaObjective: To determine the seroprevalence of antibodies to hepatitis C virus among injecting drug users (IDU) from Kathmandu. Design: Retrospective cohort study from January 1997 to December 2002. Setting: Pathology Lab, Siddhi Polyclinic, Dillibazaar, Kathmandu. Materials and methods: Blood samples were collected from 400 injecting drug users and 400 healthy young adults. Serum samples were examined in duplicate along with negative and positive controls for the presence of antibodies to hepatitis C virus using third-generation enzyme-linked immunoassay (EIA 3.0) kit in fully automated, USA FDA approved, Bio-Rad EIA analyzer. Samples positive for anti HCV were re-examined for confirmation. Results: 342 out of 400 (85.5%) serum samples from IDU were found to be positive for anti HCV compared to 3 out of 400 (0.75%) serum samples from young adults without the history of IDU. Conclusions: 1. Injecting drug use is an important risk factor in the spread of hepatitis C virus. 2. Sharing of needles should be stopped. 3. Education and health counselling should be given to the people at risk to bring about behavioural change. Keywords: antibodies to Hepatitis C virus, seroprevalence study, EIA third generation, Injecting drug users.Publication Publication Measuring life skills of adolescents in a secondary school of Kathmandu: an experience(Kathmandu University, 2003) S, SharmaObjective: The objective of this study was to develop a scale to measure life skills and to assess the levels of life skills in adolescents of a secondary school at Kathmandu. Methodology: a descriptive, cross sectional survey of adolescents from class VIII, IX, and X of a public co-educational secondary school of Kathmandu was done with the help of self-administered questionnaires prepared in English and translated into Nepali. Focus Group Discussions consisting of boys only, girls only and a mixed group comprising of one student from each section of each class were conducted to confirm the results of the study. All the data obtained from the questionnaire survey were edited, coded and entered into EPI info Version 6. Results: A total of 347 adolescents participating in the study. 176 adolescents (51%) had life skill scores above the mean, and was termed as having “high level” of life skills and 171(49%) , had “low level” of life skills scores. Mother’s education was significantly associated with increased level of life skills in adolescents (P=.001). Conclusion: Most of the teachers were not aware of the concept of life skills. Maternal education was significantly associated with higher life skill levels in adolescents. Connectedness and family support were other important factors influencing the level of life skills in the adolescents. Keywords: Life skill, adolescence, scale measuring life skillPublication Publication Publication Environmental noise induced hearing loss in Nepal(Kathmandu University, 2003) SK, Joshi; S, Devkota; S, Chamling; S, ShresthaIntroduction: Noise pollution in urban cities is a serious problem and steadily increasing over the years. This has direct and indirect affect to the people that can lead to the health hazard. Objectives: To find out environmental noise induced health effect on people residing in an urban community and to predict the risk of the environmental noise induced hearing loss Material and methods: One hundred fifty questionnaires were filled up for the environmental noise pollution survey. For the case control study, 36 exposed and 25 non-exposed residents of Kupondole were included. Based on the place of residence (main road and 20 min. walking distance from the main road), subjects were divided into exposed and non-exposed group concerning environmental noise. Demographic data and information about health problems was obtained by a structured interview. Audiometric test was performed using manual audiometer. Odds ratios (OR) and their 95% confidence intervals (95% CI) for noise induced hearing loss were estimated using logistic regression. Adjustment for occupational noise was done Results: The major health effect induced by the environmental noise was observed as lack of concentration followed by irritation, fatigue and headache. The crude OR and 95% CI for the exposed subjects was 4.2 (1.4, 12). After adjustment for occupational noise, the OR (95% CI) was 4.0 (1.2, 13). Conclusion: This study shows that exposure to noise causes wide range of health effects. For the exposed subjects there was an increased risk of noise induced hearing loss. The risk was significantly increased also after adjusting for occupational noise. Keywords: Environmental Noise, Noise Induced Hearing Loss (NIHL), Audiometric Test, Noise Pollution Survey, NepalPublication Publication