Journal Issue: Volume: 22, No. 3 & 4 (2000)
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2000
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Role of palliative surgery in advanced gastric carcinoma
(Institute of Medicine, 2000) Singh, Yogendra; Vaidya, Pradeep; Singh, Keshaw P; Khakurel, Mahesh
Epidemiological Survey of the Snakebite Problem in Human in the Terai Region of Nepal, 1996/97
(Institute of Medicine, 2000) Joshi, DD; Chapman, David R; Joshi, Yuba Raj
Abstract
In this survey the team visited 13 zonal or district hospitals, veterinary hospitals, and municipalities across the Terai and gathered a variety of informations. Epidemiological data on snakebite incidence was collected for 1996 & 1997 from all these hospitals. Information on treatment protocols for snakebite by medical staff, availability and cost to the patient of ASV, and awareness of the rural populations about first aid treatment for snakebite was gathered. Age & sexwise venomous snakebite cases were recorded in Nepal for the year 1996/1997. The case fatility rate is higher in children: 8% in 1996 and 3% in 1997, than adults: male 3% & female 4%. The 1994 study demonstrated a total of 1917 bites by venomous snakes in the Terai area and a total of 151 deaths, the mortality rate being 8% over a period of 6 years. Morbidity was highest in Mechi, Koshi, Sagarmatha, Bharatpur and Lumbini hospitals respectively. The peak season for snakebite was from June to September, during and following the monsoon, when snakes are most abundant. It has been shown that a breakdown of snakebite morbidity by age and sex for 10 years (1985/86 - 1994/95) from Bharatpur hospital, Chitwan. The case fatality rate exceeded 20% in this district.
Mortality and injury to both humans and livestock due to the bites of venomous snakes is a serious public health problem in much of the developing world, and particularly in Southeast Asia where there are abundant venomous snakes (Navy, 1965a). It has been estimated that there are on average 3000 reported human deaths per year from snakebites (Sawai, 1993), and this figure is probably underestimated. Several prior epidemiological studies (Joshi 1982, 1983, 1994) have demonstrated that mortality and morbidity caused by snakebite is a significant problem in the Terai region of Nepal. Studies in neighbouring India have identified 4 species of snake responsible for the majority of fatal bites: the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Vipera russellii), and saw-scaled viper (Echis carinatus) (Gaitonde, 1979). The polyvalent anti-snake-venin (ASV) produced in India by the Haffkine Institute and Serum Institute of India, and currently purchased by His Majesty's Government for use in Nepal, is directed against the venom of these four snakes. Recent studies (Joshi et al., 1996) in Nepal suggest that the Indian cobra and common krait are the problem snakes in the Terai region, whilst Russell's viper and the green pit viper (Trimeresurus albolabris) constitute a threat in the hill and mountain forest areas of Nepal.
Fear and dislike of snakes often leads to indiscriminate killing of snakes on sight, even though the great majority of snakes are non-venomous. In addition to the ecological impact of decimating snake populations, there are economic impacts to farmers of such actions. It has been suggested that 20 - 50% of India's grain crop is destroyed by rodents (Whitaker, 1975), and snakes constitute one of the most effective natural controls over rodent populations, often multiplying in response to increasing rodent populations. Unfortunately, indiscriminate killing of snakes removes this natural control leading to expanding rodent populations and increased loss or grain and crops.
Keywords: Snakebite, Nepal
Is tracheomalacia a postoperative complication of Oesophageal Atresia with Tracheo-oesophageal Fistula ?
(Institute of Medicine, 2000) Pokharel, Rameshwar Prasad; Maeda, Kosaku; Lenaga, Tetsuya; Yamamoto, Tetsuo
Abstract
Postoperatively survived 24 oesophageal atresia (EA) with tracheo-oesophageal fistula (TEF) infants were studied. Development of postoperative tracheomalacia (TM) is whether due to anomaly of tracheal structure or by surgical manipulation is not yet known well. We analyzed these factors in our infants. The onset of TM and tracheal structural anomalies in relation with sex, types of EA, TEF communicating level and gap between two oesophageal ends were analyzed. Surgical procedures during primary radical operation were evaluated according to the division of azygos vein or without it. A total of 11 infants developed postoperative TM within 98 + 88 days; 38% postoperative EA with TEF infants developed TM; only 14% of them had severe symptoms and needed aortopexy. Post-aortopexy (83%) improved well and are comfortable, for more than 33.8 + 35.3 months. However, mild to moderate symptomatic infants, managed conservatively, also improved and are asymptomatic for 88 + 46 months in the recent follow-up.
Male predominance was observed significant (p = 0.004) for the development of postoperative TM. Those who developed postoperative TM had only Gross C type of EA. Statistically Gross C type of EA showed significant relation (p = 0.02) with postoperative TM, whereas other types of EA could not show significant relation between them. However, statistical relationship with postoperative TM between TEF communicating level, gap between two oesophageal ends and division of azygos vein or without it, could not show significant differences. These findings suggested that sex of infants and type of EA play a significant role, and surgical procedure has only relative association to develop postoperative TM in EA with TEF corrected infants.
Keywords: Oesophageal atresia, Tracheo-oesophageal fistula, Postoperative Tracheomalacia
Dietary and nutrient intakes of school girls in Kathmandu, Nepal
(Institute of Medicine, 2000) Tiwari, Kalpana; Seshadri, Subadra
Abstract
The present study was carried out on school girls aged 10-18 years of Kathmandu district with the objective to assess the dietary and nutrient intakes of these girls. Data of three days dietary and nutrient intakes were collected using 24 hr recall method. The major findings of the study have shown that the intake of fats and oils, sugars and roots and tubers exceeded 60% of the amounts recommended by the ICMR, whereas intake of protective foods such as pulses, green leafy vegetables and fruits were less than 50% of the suggested balanced diet. Mean intake of nutrients such as fat, niacin, ascorbic acid and phosphorus exceeded the recommended dietary intakes (RDIs), whereas intake of energy, protein, calcium, iron, vitamin A and folic acid were lower than RDIs. But intake of none of the nutrients was less than 50% of RDIs.
Keywords: Diet, nutrient, adolescent girls
Prevalence of Wuchereria bancrofti Infections in Tokha-Chandeshwori Village Development Committee, Kathmandu, Nepal
(Institute of Medicine, 2000) Bhusal, Krishna Prasad; Joshi, Anand B; Mishra, Purna Nath; Bhusal, Kalpana
Abstract
Bancroftian filariasis is endemic in many areas of Nepal. This study describes the infection and intensity of Wuchereria bancrofti in the Kathmandu valley. The real burden of Wuchereria bancrofti in most endemic areas remains unknown even through it is a major public health problem in many communities, particularly semi-urban areas of Nepal. This study describes the infection and intensity of Wuchereria bancrofti in Tokha-Chandeshwori VDC, the Kathmandu valley. The nocturnal periodicity of the parasite requires parasitological examinations to be done at night. The aim of this study was to develop and validate rapid epidemiological assessment tools for the community diagnosis of Wuchereria bancrofti that maybe used in the future to determine the distribution of the disease and identify high-risk communities in Nepal. A survey of 978 nocturnal blood film in this VDC indicated an overall prevalence of 5.8% for microfilaraemia. And crude disease rate of Wuchereria bancrofti was recorded to be 13.0% in the study area. The highest microfilaraemia infection rate was recorded as 11.8% among age group of 40-49. And the highest crude disease rate was recorded 36.4% in the age group of 70 and above.
Keywords: Filariasis, Wuchereria bancrofti, prevalence, Infection Tokha- Chandeshwori, Nepal