Summary Philadelphia chromosome/BCR‐ABL1 positive chronic myeloid leukaemia (CML) can be successfully treated with Glivec (Imatinib), which is available free of cost through the Glivec International Patient Assistance programme (GIPAP) to patients with proven CML without means to pay for the drug. We review the acquired mutations in the tyrosine kinase encoded by the BCR‐ABL1 gene underlying Glivec failure or resistance in a cohort of 388 imatinib‐treated CML patients (149 Female and 239 male) registered between February 2003 and June 2016 in Nepal. Forty‐five patients (11 female 34 male) were studied; 18 different BCR‐ABL1 mutations were seen in 33 patients. P‐loop mutation, Kinase domain and A‐loop mutations were seen in 9, 16 and 4 patients respectively. Other mutations were seen in five patients. A T315I mutation was the most common mutation, followed by F359V and M244V. Sixteen mutations showed intermediate activity to complete resistance to Glivec. Among the 45 patients evaluated for BCR‐ABL1 mutations, 4 were lost to follow‐up, 14 died and 27 are still alive. Among the surviving patients, 16 are receiving Nilotinib, 5 Dasatinib and 3 Ponatinib, while 3 patients were referred to India, one of who received allogenic bone marrow transplantation. Understanding the spectrum of further acquired mutations in BCR‐ABL1 may help to choose more specific targeted tyrosine kinase inhibitors that can be provided by GIPAP.

In times of disaster, hospital’s preparedness for disaster and response plan contributes significantly to better functioning of the hospital and reducing mortality and morbidity. Activating Hospital incident command system in a timely manner in Patan Hospital has showed how the hospital is better prepared to handle this epidemic outbreak.

BackgroundChronic Myeloid Leukemia (CML) is caused by the abnormal fusion protein BCR-ABL1, a constitutively active tyrosine kinase and product of the Philadelphia chromosome. Gleevec (Imatinib mesylate) is a selective inhibitor of this kinase. Treatment with this agent is known to result in hematologic, cytogenetic, and molecular responses. Patan hospital (Patan, Nepal) is one of the Gleevec International Patient Assistance Program (GIPAP) centers for patients with CML.MethodsA total of 106 Philadelphia positive CML patients were enrolled in our center between Feb 2003 and Jun 2008, and 103 of them were eligible for cytogenetic and/or hematologic response analyses.ResultsOut of 103 patients, 27% patients underwent cytogenetic analysis. Imatinib induced major cytogenetic responses in 89% and complete hematologic responses in almost 100% of the patients with confirmed CML. After a mean follow up of 27 months, an estimated 90% of the patients on imatinib remained in hematologic remission and more than 90% of the patients are still alive. About 30% of patients developed some form of manageable myelosuppression. A few patients developed non-hematologic toxic side effects such as edema and hepatotoxicity.ConclusionsOur study demonstrates that imatinib is safe to use in a developing country. Furthermore, we demonstrate that imatinib is very effective and induced long lasting responses in a high proportion of patients with Ph chromosome/BCR-ABL1 positive CML. Imatinib is well tolerated by our patients. The lack of cytogenetic analysis in the majority of our patients hindered our ability to detect inadequate responses to imatinib and adjust therapy appropriately.

Introduction: Patan Academy of Health Sciences (PAHS) was established in 2008 with a social accountability mandate and the mission to produce competent and committed health professionals to serve the rural and underserved population. Enrolment of undergraduate medical students started from 2010.  This article describes the context and process for the establishment of the Academy, the approaches taken and some of the early outputs. Method: The information was collected from the policy documents, PAHS website, meeting minutes/ discussions, feedbacks and medial school records. All the information were compiled and presented under different headings/subheadings in a phase wise manner. Result: PAHS has been actively engaged in a multitude of partnerships from local to global and has chosen the best and most applicable innovations from around the world. The integrated suite of innovations the Academy has developed includes its admission policy, teaching-learning methodologies, community-based learning, scholarship-schemes and service bonds. The PAHS School of Medicine has successfully enrolled undergraduate medical students from all over the country, representing ethnic diversity, remote/rural background, underprivileged communities and gender balance. More than 50% graduates from the first five-batches are successfully deployed into primary level peripheral health facilities of the government health system. Conclusion: The initial reports and observations confirm that the integrated measures taken by the Academy have been effective in enrolling the right students, educating them in an effective way and deploying them to address the country's need. A longer follow-up on rural retention and performance evaluation is needed to conclusively establish the outcome of the school.

Introductions: Hepatitis C virus (HCV) infection is common in the patients undergoing hemodialysis (HD). The quality of life and survival of patients with hepatitis C infected end-stage renal disease is less than that of the noninfected ones. This study aims to determine the prevalence of HCV in patients undergoing HD and the risk of transmission. Methods: This was a retrospective study of charts of the chronic kidney disease patients who underwent dialysis at Patan Hospital from March 2011 to July 2017. Those patients who were positive for HIV, HBsAg and HCV before the initiation of dialysis were excluded. Pearson Chi square test and Fisher’s Exact test were used to determine the significance of the results. Results: Out of 173 patients, 12 (6.9%) seroconverted to HCV: five (41.66%) in first year, four (33.33%) in second year, and three (25%) in third year (Fisher’s Exact test p=0.26). Out of 173 patients, 137 (79.2%) received blood transfusion, 27 (15.6%) received erythropoiesis stimulating agent (ESA), 9 (5.2%) received both blood transfusion and ESA. The HCV seropositivity were 9 (75%), 2 (16.66%), and 1 (8.33%) respectively in them, Fisher’s Exact test p value was 0.65. There was no significant association between the seroconversions in in-center versus multicenter HD and the number of dialyses per week. Conclusions: Hepatitis C infection was common (6.9%) in HD patients. There was no significant association of transmission in regards to duration of HD, transfusion or single vs multicentre HD.