Background Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV) infected patients. Objective The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods The present study was conducted in Dirgh-Jeevan Health Care Research Center and Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal between June 2010 and May 2011 involving 146 Human Immunodeficiency virus (HIV) positive patients. Serostatus from these patients were detected by Enzyme Linked Immunosorbent assay. CD4+ T cell counts were done by flow cytometry. Stool was examined for enteric parasites by microscopy with special staining methods. Results A total of 146 HIV sero-positive patients with and without diarrhea age between 20 to 45 years were included in the study. Of the 146 patients, the protozoan parasitic infection was found in 30.13% (44/146). Out of 146 patients, 78 had diarrhea in which parasitic infection was 39 (50%) and 7.35% (5/68) protozoal parasites positive cases did not have diarrhea. A significant difference (p<0.05) was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Out of 43 patients whose CD4+ T cells were <200/?l, 29 (67.4%) had opportunistic parasitic infection whereas out of 103 patients whose CD4+ T cells were ?200/?l, only 15 (14.56%) had opportunistic parasitic infection (P < 0.05). Conclusion Enteric opportunistic parasitic infections were detected in 30.1% among HIV-seropositive patients and low CD4+ T count indicated high enteric opportunistic infection. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 14-17 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7336

Introduction: Rotavirus is one of the most common causes of acute gastroenteritis among infants and young children. The spread of rotavirus infection in pediatric wards can cause acute diarrhoea during hospitalization, and in turn, prolong hospitalization or need, rehospitalization. The aim of the study was to determine the prevalence of nosocomial infection due to rotavirus and other causal organisms among children less than 5 years of age. Methodology: A cross-sectional study between November 2009 and May 2010 was conducted among 96 pediatric patients in children hospital, Nepal. Stool samples were collected during hospitalization and up to 3 days after discharge from the hospital. Rotavirus antigens were detected by EIA and standard microbiological procedure were applied for other enteric pathogens. Results: The prevalence of nosocomial infection due to rotavirus was 30.2% (29/96). Of them, 16 (55.17%) of the 29 children with nosocomial infection during hospitalization and/or up to 72 hours after discharge developed diarrhoea. The prevalence of symptomatic cases of nosocomial infection was 55.17% (16/29), which involved 16.7% (16/96) of the study subjects, showing a prevalence of 44.82% (13/29) for asymptomatic nosocomial infection consisted of 13.54% (13/96) of the total subjects. Eleven of the 16 symptomatic subjects of nosocomial infection were affected by diarrhoea during hospitalization and five subjects after discharge. Bacteria (8.3%) and protozoa (5.2%) agents were also causing nosocomial infection in children. Conclusions: Children attending hospital may asymptomatically carry enteric pathogens and potentially act as source of nosocomial infection. Due to the relatively high frequency of nosocomial infection in the Children Hospital of Nepal, it is necessary to follow strictly hygienic rules such as isolation of patients with diarrhoea and hand-washing before and after the examination of each patient and cleaning the examination instruments after use in each patient.

INTRODUCTION:Viral infections during pregnancy carry a risk for intrauterine transmission which may result in fetal damage. Bad obstetric history implies for previous unfavorable foetal outcome in terms of two or more consecutive spontaneous abortions, history of intrauterine foetal death, intrauterine growth retardation, still birth, early neonatal death and congenital anomalies. Cytomegalovirus, a ubiquitous virus belonging to the herpes family, is known to cause abnormal fetal outcome. We aim to determine the possible involvement of CMV infection among pregnant women with bad obstetric history MATERIALS AND METHODS: A cross sectional study was carried out among 136 women with bad obstetric outcome attending Dhulikhel HospitalKathmandu University Hospital. The cytomegalovirus specific IgG and IgM antibodies were determined by ELISA test. Data were analyzed using SPSS, version 17.0 and interpreted according to frequency distribution and percentage. The data was considered significant if the p-value was <0.05. RESULTS:The results revealed that 87 (63.9%) out of 136 patients were positive for CMV IgG antibodies and only one (0.007%) patient was positive for CMV IgM. The majority of the patients were of the age between 20 and 29 years (99/136) and it was observed that most of the positive CMV IgG were participants of the same age group (63/ 99). There was no significant association of CMV seropositivity with the age of participants (p value 0.9).CONCLUSION: CMV infection could be the risk factor for BOH and may play a vital role in determining the foetal outcome. Thus we recommend routine serological testing to all pregnant women with or without BOH attending the antenatal clinics for both CMV specific IgG and IgM.

Oral keratotic white lesions are a common problem that is encountered on routine clinical examination. Clinical appearance of the lesion may belie the true nature of the lesion. So a biopsy followed by histopathological diagnosis is the gold standard in evaluating these lesions for malignant potential or dysplasias. Objective: The aim of the present study is to evaluate the clinicopathologic findings of oral keratotic lesions. Materials and Methods: Oral biopsies of 61 cases of oral keratotic white lesions during the period from January 2006 to July 2009 were studied retrospectively at the Department of Pathology, Kasturba Medical College, Manipal by microscopy. Clinical details and records were obtained from the medical records department. Results: In 61 cases of oral keratotic white lesions the age distribution ranged from 29 to 86 years. 66% were males while 34% were females and most lesions occurred between 31 and 70 years. The buccal mucosa was the most common site of lesion in 35% patients. Only 15 cases had some personal habits and 8/15 cases (53%) showed dysplasia. 12/ 54 cases (22%) of homogenous leukoplakia displayed dysplasia, of which 11 cases (92%) showed mild dysplasia and 1 case (8%) showed moderate dysplasia. Of the 4 cases of speckled leukoplakia, 75% showed dysplasia- mild, moderate and severe. 2/3 cases (66%) of verrucous leukoplakia displayed dysplasia- moderate and severe. There were 41 cases consistent with leukoplakia (67%), of which 22% showed epithelial hyperplasia and hyperkeratosis, 12 cases showed mild dysplasia, 3 cases moderate dysplasia and 2 cases showed severe dysplasia. Benign keratosis formed the largest group (35%) among the 61 cases. Of the 61 cases 17 (27%) showed dysplasia of which 19% was mild dysplasia, 5% was moderate dysplasia and 3% was severe dysplasia. Most frequent histomorphological feature seen in this study was nuclear pleomorphism in 21/ 27 cases (78%). There were 12 cases (71%) of dysplasia in males and 5 cases (28%) of dysplasia in females. There was 1 case of Progressive verrucous leukoplakia   in an 86 year old female patient. There were 3 cases (5%) each of oral lichen planus, lichenoid dysplasia and lichenoid keratosis in the present study. 6 cases (9%) of candidiasis was seen among the 61 biopsies. In the study there was 1 case (2%) each of verrucous  carcinoma, squamous cell carcinoma and micro-invasive squamous cell carcinoma. Conclusions: Oral keratotic white lesions demonstrate a wide spectrum of histopathological features from benign lesions to dysplastic lesions to carcinoma in situ to invasive ones. Scientific World, Vol. 10, No. 10, July 2012 p70-76 DOI: http://dx.doi.org/10.3126/sw.v10i10.6866