Influenza: An Emerging and Re-emerging Public Health Threat in Nepal

Influenza virus type A and B are responsible for seasonal epidemics as well as pandemics in human. Influenza A viruses are further divided into two major groups namely, low pathogenic seasonal influenza (A/H1N1, A/H1N1 pdm09, A/H3N2) and highly pathogenic influenza virus (H5N1, H5N6, H7N9) on the basis of two surface antigens: hemagglutinin (HA) and neuraminidase (NA). Mutations, including substitutions, deletions, and insertions, are one of the most important mechanisms for producing new variant of influenza viruses. During the last 30 years; more than 50 viral threat has been evolved in South-East Asian countriesof them influenza is one of the major emerging and re-emerging infectious diseases of global concern. Similar to tropical and sub-tropical countries of Southeast Asia; circulation of A/H1N1 pdm09, A/H3N2 and influenza B has been circulating throughout the year with the peak during July-November in Nepal. However; the rate of infection transmission reach peak during the post-rain and winter season of Nepal.

Catheter Associated Urinary Tract Infection: Prevalence, Microbiological Profile and Antibiogram at a Tertiary Care Hospital

Background: Catheter associated Urinary tract infections (CAUTI) are the most common nosocomial infection. Though urinary tract catheterization is an important aspect of medical care, its inappropriate use may lead to significant morbidity and mortality, increased hospitalization and financial burden. This study was carried out to identify the etiological agents of UTI and its antibiogram among inpatients with indwelling catheters.Methods: A total of 136 urine samples were collected over a period of 10 months. Microscopic and macroscopic examinations were performed. Isolation, identification and antimicrobial susceptibility testing was performed by standard microbiological methods. Statistical analysis of data was done by chi-square test.Results: Out of the 136 patients, 17 (12.5%) developed catheter-associated UTI. Development of significant bacteriuria was not affected by sex, age, urine pH or antibiotic intake however there was significant association be-tween significant pyuria and significant bacteriuria (p<0.001). E coli accounted for 35.3% followed by Klebsiella spp and Enterococcus spp. Cotrimoxazole was the most effective amongst antibiotics tested followed by Nitrofurantoin . Gram negative bacteria were least sensitive to Ampicillin.Conclusion: This study suggests urine culture and sensitivity should be done among the catheterized patients on regular basis. Unnecessary urethral catheterization should be avoided to reduce catheter-related complications.

Pattern of Antibody Titer Against Salmonella Enterica in Apparently Healthy Individuals

Background: Enteric fever is a serious health problem in developing countries including Nepal. Widal test is the routinely used for diagnosis of enteric fever. This study aimed to determine the baseline antibody titers for Salmonella typhi and paratyphi A, B in healthy individuals of Western Region of Nepal.Methods: A total 150 blood samples were collected from the healthy individuals and pattern of antibody titer was measured using standard quantitative tube method.Results: Among 150 blood samples, 103 had shown significant antibody titers (≥ 1:20). The significant proportion (10.7%) of the individuals had anti-O titer ≥ 1:80. Similarly, 86 had anti-H titers of ≥ 1:20 to S. enteric serotype typhi, 23 had a titer of ≥1:80 and 4 had a titer of ≥1:160 respectively. We found 10% and 1.3% for paratyphi A and B, anti-H titers of ≥ 1:20respectivelyConclusion: This study concludes that, there should be need to change in the cutoff levels for antibody titer against S. typhi to > 1:80 for both anti-O and anti-H titers for Western Development Region of Nepal.

Histopathological study of Uterine Leiomyoma in Hysterectomy Specimens

Background: Uterine leiomyoma is the most common benign neoplasm in women of reproductive age group. Hysterectomy is a mode of therapy in uterine Leiomyoma. The objective of this study was to evaluate the histopathological changes in hysterectomy specimens with uterine leiomyomas.METHODS: This is a retrospective study of one hundred sixty eight patients who underwent hysterectomy for uterine leiomyoma.Results: Uterine leiomyoma was most common in the age group of 41-50 years (54.76%). Most common location of leiomyoma was intramural (51.2%). Degenerative changes were seen in 10.72% cases. Hyaline degeneration was the most common type of degeneration (7.14%). Proliferative endometrium was the most common endometrial pattern (63.1%) in uterine leiomyoma. Associated malignant lesions were observed in 1.8 % cases of uterine leiomyoma.CONCLUSION: Uterine leiomyoma is associated with degenerative changes and coexistent benign and malignant patholologies. Histopathological examination of hysterectomy specimens should be done to confirm the diagnosis and rule out other pathologies, especially malignant lesions.

Effect of Disease Modifying Agent on Oxidant and Antioxidant Status in Rheumatoid Arthritis

Background: Rheumatoid Arthritis is a chronic disease and a leading cause of disability in people with advancing age. Disease modifying antirheumatic drugs have become the mainstay of management in rheumatoid arthritis. Among these drugs, methotrexate the most frequently used agent has a proven anti-inflammatory action and is known to slow down the progression of the disease. Hence the present study is undertaken to evaluate the effect of methotrexate on the oxidant and antioxidant status in patients with rheumatoid arthritis on methotrexate.Methods: A total of 40 rheumatoid arthritis patients and 40 controls were enrolled for the study. The rheumatoid arthritis patients were further divided into patients on methotrexate (group I) and patients without methotrexate (group II). The lipid peroxidation index -Malondialdehyde and total antioxidant activity, superoxide dismutase and glutathione levels were analyzed in all the participants.Results: A significant increase in total antioxidant activity (p = 0.048) and decrease in lipid peroxidation (p = 0.04) was found in methotrexate treated arthritis patients compared to patients without methotrexate. A significant negative correlation (p=0.01) was found between MDA and total antioxidant activity in both groups of patients whereas, the antioxidant enzyme superoxide dismutase was positively correlated with lipid peroxide levels. Conclusion: In conclusion low dose methotrexate seems to act as an effective anti-inflammatory drug and may also play an important role in minimizing the oxidative stress in rheumatoid arthritis. Serum total antioxidant activity is significantly raised in subjects with altered liver function profile.

Are we appropriately testing for vitamin B12 and folate deficiency?

Background: The most common reason for assessing vitamin B12 and folate status is a clinical suspicion of deficiency along with the haematological abnormality of macrocytic anaemia.However, there is often a lack of a precise clinical or haematological picture to guide the appropriate investigation of these patients. Normal haemoglobin or mean cell volumes are often found, masking the need for appropriate investigation. When abnormal haematological parameters are found, it is often a sign of advanced deficiency. In this study we investigated whether patients with haematological findings of macrocytosis and/or anaemia are appropriately investigated for vitamin B12 and folate deficiencies and whether clinicians request metabolite screening to assist with the diagnosis.Methods: This was a retrospective audit of data obtained from the laboratory information system for a six month period at a tertiary academic hospital. Adult patients with macrocytosis, anaemia or both were selected and laboratory records reviewed to determine whether they were investigated for vitamin B12 and folate deficiency.Results: Only 16.2% of patients with macrocytic anaemia, 7.8% of patients with isolated macrocytosis and 6.5% of patients with normocytic anaemia were tested for vitamin B12 and/or folate deficiency. Metabolite assays such as homocysteine and methylmalonic acid were not requested as part of a vitamin status assessment. Conclusions: In our setting, vitamin B12 and folate assessment is a diagnostic dilemma, delaying identification of potentially debilitating disease. Clinicians need to be informed about earlier investigation and of the availability of metabolite screening and their use in establishing early deficiency.

Biomarkers of hepato-renal damage of fuel filling station attendants using or abstaining from use of protective gears

Different gears (e.g. overall, mask, gloves) are being used for protective purposes by fuel filling station attendants (FFSA) in Nigeria. Whether they can adequately protect susceptible organs like liver and kidney remains largely undetermined. The aim of the study is to compare the biochemical parameters of hepato-renal axis in FFSA that abstained from and that used protective gears in the course of daily duty. Materials and Methods: The study population was grouped into three; GROUP A was made up of ten adult male FFSA who have used the protective measures consistently in the course of dispensing petroleum products. GROUP B was composed of 40 FFSA who did not use protective gears. GROUP C was the control group made up of thirty male adults not exposed to petroleum products. The minimum period of exposure for FFSA recruited for the study was 5 years. Information on worker safety was obtained through administered questionnaire concerning the use of self-protective equipment as a routine safety protocol for personal protection. Serum was utilized to assess biochemical indices of hepato-renal functions. Statistical differences were determined using Student’s t test and analysis of variance. p< 0.05 was considered significant.Results: Both GROUP A and GROUP B showed activities or levels of ALP, AST, ALT, creatinine, urea, albumin, and total protein that were significantly different compared with control (GROUP C), suggestive of hepatic damage.Conclusion: Data obtained from this study suggest that the three available protective gears used by FFSA in GROUP B did not significantly reduce exposure.

Association between Alcohol Consumption and Smoking Habit in the General Population of Rural Nepalese Community

Background: Various studies have shown that alcohol consumption and smoking habits are complementary and associated behavior for each other, and these behaviours are influenced by socio-cultural and socio-demographic factors.Methods: A community based cross sectional study was conducted on 2013 among 648 general people of rural community of Ramechap district, Nepal. Questionnaires were used to collect information on age, gender, smoking habit, alcohol consumption habit and occupation. Frequency, percentage as well as mean and standard deviation (SD) were calculated as descriptive statistics. To measure the association between alcohol consumption and explanatory variables ( i.e. sex, smoking habit and occupation), we used univariate and multivariate logistic regression analysis to calculate unadjusted odds ratios (ORs) and adjusted odds ratios(aORs) with 95% confidence interval (95%CI).Results: Alcohol consumption was found to be associated with different explanatory variables as follows : smoking habit (Yes: aOR =3.90, 95%CI = 2.58, 5.92), sex (Male: aOR = 3.64, 95%CI = 2.27, 5.82), occupation (house wife: aOR = 0.79, 95%CI =0.44, 1.43; teacher: aOR = 1.88, 95%CI = 0.68, 5.24; government service: aOR = 1.99, 95%CI = 1.11, 3.59; and others: aOR = 0.61, 95%CI = 0.25, 1.47).Conclusions: Our findings showed an association between alcohol consumption and smoking habit among the population under study.

Boost Up Quality Assurance through Regular Evaluation of Proficiency Testing Performance

Background: Participation in External Quality Assessment (EQA) program with practice of Internal Quality Control (IQC) is the excellent indicator of good laboratory practice (GLP) to assure quality services. EQA is an essential component of Quality Assurance to assess the analytical performance compared within same methods of other laboratories. It is also important to detect equipments failure, identifying reagent problems, reviewing staff training as well as to initiate and evaluate corrective action timely.Methods: This is descriptive analysis of the feedback received from EQAS body for twenty routine biochemical parameters which are most commonly performed in the Clinical Biochemistry Laboratory of Dhulikhel Hospital. Variation Index Score (VIS), Overall Mean VIS (OMVIS) and Standard Deviation Index (SDI) of all parameters for the year 2014 and 2015 were analyzed statistically.Results: On the analysis of twenty routine biochemical parameters regularly participated in EQAS, over all mean variation index score (OMVIS) of individual tests found 55%, 30% and 15% under good, very good and satisfactory category respectively.Conclusion: Participation and periodic evaluation of EQAS indicators along with practice of internal quality control has been galvanizing good laboratory practice and scientifically it boost up quality service in clinical laboratories.

Report of Beta Thalassemia in Newar Ethinicity

Beta thalassemia trait is a heterogeneous autosomal recessive form of beta thalassemia. Individual with beta thalassemia are clinically asymptomatic. Here we have described a case that has been incidentally diagnosed as beta thalassemia trait. A 31 year old male form Newar Community came to hospital for routine health checkup was send for hematological investigation. On examination, his red cell morphology was found to be microcytic hypochromic and his hemoglobin concentration was mildly decrease. His other parameters was evaluated and requested for analysis of iron profile and hemoglobin electrophoresis. Iron profile test was normal. Hemoglobin electrophoresis showed prominent band in HbA2 region. Presence of HbA2 band was confirmed by hemoglobin variant HPLC analysis. A diagnosis of heterozygous beta thalassemia trait was made. Prevalence of beta thalassemia gene in Tharu population was reported but its presence in other communities is still unknown so it is recommended to study the prevalence of beta thalassemia gene in Newar community as well.