Introduction: Cutaneous Leishmaniasis is a vector borne disease caused by the bite of an infected sandfly. The disease is rare in Nepal with only few cases reported till date. We report the largest collection of patients over six years.Objective: To describe the clinical, epidemiological and pathological aspect of Cutaneous Leishmaniasis in Midwestern region of Nepal Materials and Methods: Thirty-three patients referred to the department of Pathology for fine needle aspiration were diagnosed as Cutaneous leishmaniasis based on detection of Leishmania donovani in the fine needle aspiration smears. Demographic data and clinical details including site, size, and duration of disease onset were recorded on a printed proforma. Statistical analysis was done using SPSS version 16.0 for windows. Results:A total of 33 patients with age ranging from 11 years to 65 years were included in the study. Mean age was 26.5±11.5 years. Most patients were in the age group 21-40 years. Male: Female ratio was 1.7:1. Mean duration of disease was 5.3±4.4 months. Thirty patients had single lesion. Lesions were either of plaque type (84.9 %) or papulonodular type (15.1%). Conclusion:Cutaneous leishmaniasis is uncommon in Nepal. So, it is often neglected. It is in an increasing trend. Cutaneous leishmaniasis should be included in the differential diagnosis of a non-healing ulcer.
Introduction: Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods: We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results: Among hospital cases (n ¼ 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n ¼ 62). Aluminum phosphide (n ¼ 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n ¼ 1463/2535; 57.7%), phosphine gas (n ¼ 653/ 2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n ¼ 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n ¼ 273/ 450, 60.6%). Conclusion:The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.
Introduction: Since 2003, only few cases of sickle cell disease have officially been reported in Nepalese medical journals, and all reported patients belong to the Tharu ethnic group of Nepal. This is the first study that details sickle cell disease and carrier in 1250 individuals in western Nepal. Methods: This is a retrospective review of the patients and carriers of sickle cell disease diagnosed by either a positive haemoglobin electrophoresis report or a positive high performance liquid chromatography (HPLC) report. Analysis was done using SPSS 20. Results: Out of the 1250 individuals, 51.4% were females. 601 (48.08%) were patients with a form of sickle cell disease, the mean age was 24.5 12 yrs years. Most patients came from Bardiya district. Most common symptoms were related to joint pain. The patients and carriers of sickle cell disease were mostly from Tharu ethnic group (97.7%). Conclusion: These data suggest that sickle cell disease and other haemoglobinopathies are more prevalent than previously reported among members of the Tharu ethnic group and other residents of western Nepal. More research is imperative to assess the burden of the sickle cell disease and other haemoglobinopathies in Nepal.
The Bardet–Biedl syndrome (BBS) is a rare ciliopathic autosomal-recessive disorder, with multiple organ systems involvement. It is usually seen in family with consanguinous marriage. It is characterized by truncal obesity, polydactyly, retinal dystrophy, mental retardation, renal dysfunction and hypogonadism in males. It affects both males and females. Very few cases are reported in Nepal. Here we report a 30 year obese lady who presented to our center with history of excessive weight gain and blindness with polydactyly. She visited many local medical centers before landing to our hospital.
Background: Sickle-cell disease is characterized by a modification in the shape of the red blood cell from a smooth shape into a crescent shape. The misshapen cells lack plasticity and can block small blood vessels, impairing blood flow. The purpose of the study was to find out the quality of life of client living with sickle cell disease. Method: A descriptive cross sectional quantitative study design was used. Non probability convenient sampling technique was used for the selection of respondents after conforming hemoglobin electrophoresis report attending out-patient department of Bheri Hospital. Results: A total 143 participants were studied who were at age range of 19 to 40 years with mean age of 30.26±8.42. Almost 81.8% perceived their health was only fair in comparison to past year. In comparison to other people 60.1% participants believe they get sick little easier. The overall quality of life was good in 56% participants. The health related quality of life scores for eight domains are as follows-physical functioning (77.25±18.22), social functioning (58.39±16.77), role limitation due to emotional problem (57.23±33.99), pain (56.43±22.84), role limitation due to physical problem (49.56±29.76), emotional wellbeing (49.59±14.5), Vitality (36.62±16.85) and general health (36.78±19.99). Conclusion: Quality of life of adults with sickle cell disease is better in the domain of physical function in comparison to other domains. The aspect of energy scale indicates poor quality of life. Female and uneducated clients should be focused for improvement in all domains.
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