BackgroundRabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal.MethodsWe performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal.FindingsSo far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle.InterpretationBetter data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.
We present 5 cases of urethral diverticulum in male subjects, of which 2 were congenital and 3 were acquired. Of these diverticula 4 were in the anterior urethra, while 1 was in the posterior urethra. One congenital diverticulum contained multiple calculi.
IntroductionConsiderable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps.Materials and methodsA landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks.ResultsOnly a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes.DiscussionOverall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies.
We concluded that it's not only the overweight or obese patients who develop symptomatic cholelithiasis but also the individuals with normal BMI. The risk of symptomatic cholelithiasis increases with every increase in BMI. Risk of symptomatic cholelithiasis also increases in women and as the age advances.
One hundred and twenty-three women underwent microwave endometrial ablation (MEA) for the treatment of dysfunctional uterine bleeding (DUB). The mean age at treatment was 40.2 years and the average treatment time was 2 minutes 50 seconds. All patients stayed as day cases, except for two who stayed overnight, one due to pain and the other due to urinary retention. The follow-up was carried out at 6 months, 1 and 2 years, respectively. The success rate was 80%, 76% and 70% at 6 months and 1-year and 2-year follow-up. The patient satisfaction rate was 80%, 75% and 68% at 6 months, 1 year and 2 years, respectively. However, in women 45 years old and over the success rate was more than 90%, suggesting that MEA could be a preferred procedure for treatment of DUB in this age group compared to younger women, especially in those who do not benefit from the mirena intrauterine system or decline it. Approximately 70% of patients, who underwent hysterectomy due to the failure of treatment, had uterine/pelvic pathology in the form of adenomyosis, fibroid uterus or endometriosis; therefore prior to MEA, proper patient selection is vital. There were a few minor complications but no uterine perforation or emergency hysterectomies in the group studied.
Japanese encephalitis (JE) is a major public health problem in Nepal. For the effective management and surveillance of JE, a clear understanding of its epidemiology is essential. Therefore, we conducted descriptive and spatial analyses to understand the spatio-temporal distribution of JE in human in Nepal. From 2007 to 2015, 1,823 JE cases were reported with a cumulative mean incidence of 0.735/100,000 population and a case fatality rate of 6.6%. The death rate in the up-to-24 years of age group was 74%. The JE cases were most commonly reported in the age group of 1–14 years. There is a strong seasonal pattern of JE occurrence in Nepal which peaked in August and declined by October each year, which corresponds to the monsoon season. The JE cases were reported in 63 of 75 districts (84%), expanding in the mountain and hill regions. There was a strong clustering of JE incidence in the south-western and south-eastern Terai region, which is endemic for JE. Therefore, the JE surveillance system should be improved to better understand the drivers of disease expansion in Nepal for instituting a control program.
Introduction: Splenomegaly is an enlargement of the spleen which is a quite common problem in any part of the world. Spleen is enlarged in various clinical disorders e.g. infections, metabolism or storage disorders and hematological abnormalities. Splenomegaly is an indicator of pathologic process that may be of primary splenic origin but also may be a reflection of disease in virtually any other organ system. Thus, it is important to estimate the splenic size in vivo in the diagnosis, treatment and prognosis of a variety of disorders.Objective: The objective of this study was to determine the normal dimension of the spleen in the adult Nepalese people.Methods: This is a prospective study in which 320 adults subjects were scanned by using 3.5 MHz curvilinear probe. We used ultrasonography to examine 160 males and 160 females, not to have any condition likely to be associated with splenic enlargement. The measurement for the length and thickness of spleen were obtained in right lateral position.Results: This study revealed the splenic dimensions for males were greater than in females. The men spleen length were (10.07 ±0.7 cm, 10.1 ±0.54 cm, 9.5 ±0.7 cm and 9.0 ±0.43 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively). The females spleen length were (9.83 ±0.53 cm, 9.58 ±0.58cm, 9.2 ±0.64 cm and 8.8 ±0.36 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively). The men spleen thickness were more (4.1 ±0.5 cm, 4.05 ±0.58 cm, 3.43 ±0.38 cm and 3.0 ±0.36 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively). The females splenic thickness were 4.06 ±0.47 cm, 3.78 ±0.48 cm, 3.38 ±0.35 cm and 2.29 ±0.23 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively. Thus significant differences between male and female splenic dimensions were found for each age group chosen (P <0.05).Conclusions: The results show that the splenic length and thickness decreased with increase in age in both males and females and all the dimensions were greater in males than in females. This study established normogram that can be more reliably used as both a complementary modality to clinical evaluation and as a more sensitive means of evaluating and screening patients for splenic disorders for any pathological enlargement or reduction of size in clinical practice in a Nepalese populations.Journal of Gandaki Medical College Vol. 10, No. 1, 2017, page: 11-16
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