Journal Issue: Volume: 23, No. 1 & 2 (2001)
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Epidemiological status of taenia/cysticercosis in pigs and human in Nepal
(Institute of Medicine, 2001) Joshi, DD; Jimba, M; Neave, Lucy; Poudyal, Purna Maya; Mishra, PN; Mishra, M
Abstract
Two hundred and fifty slaughtered pigs for meat purpose, in various localities of Kathmandu Metropolitan City and Dharan Municipality were examined for Taenia cysts
during January 1997 to April 1998. A surveillance study was also carried out with butchers, meat sellers, farmers and pork consumers to study the awareness of taeniasis cysticercosis. Data was collected from the hospitals to determine the status of taeniasis/cysticercosis infection in humans. Out of 250 slaughtered pigs examined, thirty-four (13.6%) were found positive for cysticercosis. The sex wise prevalence rate of infection was 8.77% in male pigs and 24.05% in female pigs. The result reveals that females are infected more than the males. Out of 196 slaughtered pigs examined in Kathmandu, 28 (14.28%) were found positive, whereas in Dharan, out of 54, 6 (11.11%) were found positive. The result further reveals that the number of infected pigs is higher in Kathmandu than Dharan. It is due to the importation of infected pigs to Kathmandu both from rural areas of Nepal and India. The results show that pork consumption is risky from a public health point of view. In environments where animal cysticercosis is prevalent, human taeniasis/cysticercosis is likely to be present. Prevalence of Taenia solium infection in pigs was therefore observed and recorded for the first time in Dharan Municipality and Kathmandu Metropolitan Municipality in Nepal. Human cysticercosis cases were also studied. Out of 23,402 human biopsy cases recorded from Patan Hospital alone during July 1993 - Feb 1998, sixty-two patients were confirmed to have cysticercosis infection. Out of 62 taeniasis/cysticercosis patients, 40 cases were from Kathmandu and 22 were from outside Kathmandu. Among the 62 infected patients, 38 were females while 24 were males. The result reveals that the infection rate is higher in Kathmandu than outside Kathmandu. Sexwise data again reveal that females are infected more frequently than males. The surveillance study findings reveal that taeniasis and cysticercosis are prevalent in Kathmandu and Dharan due to various factors, viz, uncontrolled slaughtering, lack of a meat inspection program, lack of awareness about meat borne diseases, unhygienic conditions of slaughtering places due to lack of slaughter houses, environmental pollution etc. The incidence of human taeniasis/cysticercosis could be controlled by raising pigs under hygienic condition and improving the environmental quality in the pig slaughtering abattoirs under the supervision of medical and veterinary technicians. An effective veterinary public health activities should immediately be established in all 56 municipalities of the country for meat inspection and construction of slaughter houses.
Keywords: taeniasis/cysticercosis, biopsy, scanning
Maternal cardiac diseases complicating pregnancy: a review of 105 cases
(Institute of Medicine, 2001) Rana, A; Singh, M; Manandhar, B; Pradhan, N; Gurung, G; Dali, B; Koirala, B; Koirala, RR
Abstract
The outcome of pregnancies in 105 patients with heart diseases in TUTH, Kathmandu, Nepal between April 1995 and May 2001 was reviewed. The incidence of heart disease was 0.55% of the total 19038 deliveries. Rheumatic (79), congenital (17) and miscellaneous groups (9) complicated the pregnancy. Significant number (53) had their diagnosis made at the index pregnancy. Patients who developed cardiac failure (17) mostly did during antenatal period (20-42 weeks); the majority had cardiac failure (14) at third trimester. Two of the cases that had cardiac failure at 33 weeks ultimately had stillbirths later at term. Induction of labour for such cases, which was discouraged earlier, should be considered. In our hospital labour analgesia with epidural anaesthesia, pethidine or morphine is not a routine practice. Injection Methergin is also generally withheld. Save one or two, most Cesaerean sections had obstetrical indication. Prophylactic forceps or ventouse were barely used.
There were two maternal deaths. One of them had pregnancy complication as eclampsia and presented with SVT and MI at 34 weeks. The other case died within 48
hours of Caesarean delivery for critical mitral stenosis with pulmonary hypertension. The perinatal losses were 7. This article strongly emphasizes the need for routine cardiac evaluation of patients at their very first antenatal check up so that patie nts with cardiac disease can benefit from shared co-operation between cardiologist, cardiothoracic surgeon, anaesthelogist and obstetrician.
Keywords: Heart disease, pregnancy, cardiac failure, obstretic analgesia, induction of labour
The Ineffective Use of Inhalers in Chronic Obstructive Pulmonary Disease
(Institute of Medicine, 2001) Graham, LE
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is the most common adult respiratory disease in Nepal. It is disabling condition and requires the use of inhaled and/or oral medications for stabilisation. Inhaled medications are preferable to oral medications because of their superior effect and lack of side effects. Spacer device are also available; these reduce the need for inhaler co-ordination. The aims of this study were to determine a) the percentage of patients with COPD attending the medical clinic who use inhaled medication. b) the skill level of patients regarding inha ler technique. c) the benefit of inhaler technique counselling for improving patient skill level. In this prospective randomised study we interviewed 95 patients with COPD over a 4-month period. Thirty-three patients were regularly using inhalers, but 100% had an unsatisfactory inhaler technique. Only one patient used a spacer device. Thirty percent of patients claimed that they had never been shown how to use the inhaler. Subsequent demonstration of inhaler technique by a doctor improved skill level in 85% of patients but resulted in a satisfactory inhaler technique score for only one patient. Although this is a small study, it is probably representative of the patient population with COPD who attend our clinics. Patients, especially the elderly, have considerable difficulty activating and using MDI – despite demonstration. Doctors infrequently prescribe spacers and the cost of these excludes many patients from using them.
Keywords: chronic obstructive pulmonary disease, metered dose inhalers, inhaler technique, spacers
Sero-diagnosis of Japanese encephalitis and Dengue virus infection from clinically suspected patients of Nepal
(Institute of Medicine, 2001) Sherchand, Jeevan B; Pandey, Basu Dev; Haruki, Kosuke; Jimba, Masamine
Abstract
Japanese encephalitis (JE) and other viral encephalitis are usually not confirmed in the laboratory in Nepal. However, every year during rainy and post -rainy season in Southern Nepal, from east to west, JE and other viral disease suspected patients become prevalent. The currently available methods for the laboratory diagnosis of JE
and dengue virus infections (DVI) (e.g., serology, and virus isolation) are difficult and often tedious to carry out as well as time consuming. So, there is a need for serodiagnosis of viral infections to identify the type of infection (JE, DVI or other viral diseases). The use of conventional methods, however, causes confusion due to the cross-reactions between JE and DVI. In our study, the detection of virus-specific IgM has been proved to be useful for early diagnosis of JE and DVI even with the use of a single specimen. We applied ELISA to differentiate JE from DVI by detecting IgM specific to JEV antigen and IgM specific to dengue antigen. From the 279 patients, 244 serum and 35 cerebrospinal fluid (CSF) samples were collected and examined with ELISA using two different antigens for JE and DVI. The results showed that 28.7% were positive for JE- IgM antibodies and 10.4% positive for DVI-IgM antibodies. In addition, JEV-specific IgM antibody detection by Indirect IgM-ELISA and IgMcapture ELISA was also compared in the study.
Keywords: Sero-diagnosis, Japanese encephalitis, Dengue virus infection, Nepal
Anxiety in medical students: relationship with examination
(Institute of Medicine, 2001) Gajurel, Bikram P; Pokharel, Anupam; Ojha, Saroj P; Koirala, Nabaraj
Abstract
High level of anxiety has been reported to impair academic performance of the students. Present study aims at measuring the level of anxiety in medical students before and after their annual examinations. Students of a single batch of MBBS programme were included in the study. Anxiety scores were rated using Zung Anxiety Rating Scale. Mean pre-examination anxiety score was 32.16±8.12, whereas postexamination scores was 27.00±6.64. The difference was statistically significant (t=2.424,
p<0.05). The effects of high level of anxiety in the level of performance need to be
studied.
Keywords: Anxiety score, Zung rating, MBBS, Academic performance