Summaryobjective To document the frequency of Leishmania donovani infection at community level in a highly endemic region in southeastern Nepal, and to assess socioeconomic and environmental risk factors.methods A random cross-sectional population survey was held in two visceral leishmaniasis (VL) foci in Morang District in April to May 2003, enrolling individuals 2 years or older and residing in the endemic area for at least 12 months. Leishmania infection was defined as a direct agglutination test (DAT) titre equal to or higher than 1:3200. Risk factors were identified by logistic regression.results The direct agglutination test was positive in 7.5% (95% CI: 5.1-10.8) and the leishmanin skin test (LST) in 13.2% (95% CI: 9.9-17.2) of the 373 study participants. No case of current kala-azar was found, but 5.1 % (95% CI: 3.1-7.8) reported having suffered from VL. Independent risk factors for Leishmania infection were proximity of the house to ponds [odds ratio (OR) 3.7, 95% CI: 1.6-8.5], family size (OR 4.4, 95% CI: 1.6-12.6), age P15 years (OR 5.5, 95% CI: 1.2-25.0) and house constructed in mud (OR 3.0, 95% CI: 1.1-7.6). Bednets, not impregnated and in poor condition, were used by 95.2% (95% CI: 92.3-97.0) of the population, but did not show any protective effect.conclusion This study shows that there is a serious problem of transmission of VL in this area of Nepal. The risk factors identified are linked with the socioeconomic level and the environment. The population would benefit from a community intervention to improve the environmental and housing conditions in the villages.keywords visceral leishmaniasis, Leishmania donovani, leishmanin skin test, environmental risk factors, Nepal

Abstract. Clinical isolates of Leishmania, from visceral leishmaniasis (VL) cases in Nepal and from cutaneous leishmaniasis (CL) cases in Peru, were cultured using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to type species and strain. Promastigotes from 38 isolates, within eight passages from isolation, were used to infect mouse peritoneal macrophage cultures in vitro, and the amastigote sensitivity to miltefosine was determined. The concentration required to kill 50% of intracellular amastigotes from Nepalese VL isolates, all typed as Leishmania (L.) donovani (N ‫ס‬ 24) from both Sb v responders and nonresponders, ranged from 8.7 to 0.04 g/mL. In contrast, the concentration required to kill 50% intracellular amastigotes from isolates from Peru, typed as L. (V.) and L. (V.) lainsoni (N ‫ס‬ 4) was 3.4 to 1.9 g/mL. This demonstrates a notable difference in the intrinsic sensitivity of Leishmania species to miltefosine in vitro. If this model can be correlated to therapeutic outcome, it may have implications for the interpretation of clinical trials.

Sodium stibogluconate (SSG) is the first-line therapy for visceral leishmaniasis (VL) in south-eastern Nepal. Recent studies from the neighbouring state of Bihar, India, have shown a dramatic fall in cure rates with treatment failure occurring in up to 65% of VL patients treated with SSG. A prospective study was conducted at a tertiary-level hospital located in south-eastern Nepal from July 1999 to January 2001. Parasitologically proven kala-azar patients with no previous history of treatment for VL were treated with SSG 20 mg/kg/d for 30 d which was extended to 40 d in those with persistent positive parasitology. Of the 110 patients who completed SSG therapy and were assessed at 1 and 6 months, definite cure was achieved in 99 patients (90%) and SSG failure occurred in 11 patients (10%). Except for the presence of hepatomegaly and a lower platelet count there was no clinical or laboratory baseline characteristic associated with treatment failure. A significantly lower cure rate (76%, P= 0.03) was observed in patients from the district of Saptari, which borders the antimony-resistant VL areas of Bihar. The efficacy of SSG as a first-line treatment for VL in south-eastern Nepal was still satisfactory, except for the patients living closer to the antimony-resistant VL areas of India. These findings indicate that the spread of resistance to antimonials is already taking place in Nepal and that a policy to control further spread should be urgently implemented.

Background: Cutaneous and subcutaneous metastasis from an underlying primary, indicates a dismal outcome for patients. It is appropriate to use fine needle aspiration cytology as a minimally invasive method for diagnosis. This study emphasises the role of fine needle aspiration cytology in diagnosing metastatic skin nodules. Materials and methods:This was a retrospective study in which the record of all patients subjected to fine needle aspiration cytology from April 2008 -Nov 2010 in the Department of Pathology, Tribhuvan University Teaching Hospital, were reviewed. Of 5,927 patients, 19 cases diagnosed as metastatic skin lesions were included in the study. Results:Out of 19 patients with metastatic skin nodules, 9 patients had metastasis simultaneously with the primary and 8 cases were previously diagnosed. All metastases were from internal solid organ tumours with male to female ratio of 1.7:1. Lung carcinoma was the most common to metastasis in both sexes which included adenocarcinoma (5 cases) and squamous cell carcinoma (6 cases). Common sites for cutaneous/subcutaneous metastasis were the chest wall (9 cases) followed by abdomen (4 cases) and scalp (3 cases). Conclusion:Fine needle aspiration cytology can diagnose a variety of skin lesions which may be supportive in diagnosing a metastasis in cases with known primaries or it may offer a clue to underlying malignancy in unsuspected cases.

The study aimed at finding out the morphological and clinico-pathological correlation of Orbital and Ophthalmic lesions in various eye institutes of Nepal. The study also aimed at finding out the prevalence of Ophthalmic lesions needing histo­pathological examination. This cross sectional descriptive study was carried out in various tertiary eye hospitals of Nepal from 2008 – 2012. The department of pathology was also incorporated in giving the correct histopathological findings in time. All the relevant data were entered in a specifically designed proforma for the study and analyzed. One hundred Oph­thalmic and Orbital lesions were studied in various age groups. Ophthalmic and Orbital lesions were highest (18%) in 31-40 year age group patients. Eyelid (57%) was the most commonly involved site. Clinical diagnosis was consistent with histo­pathological diagnosis in more than 60% of the cases. Among eyelid lesions, incidence of dermoid cyst (21%) was highest. While in Conjunctival lesions, granuloma pyogenicum (22.5%) was highest followed by other lesions. A clinico-patho­logical diagnosis of malignant orbital tumors or ocular tumors was made in 30% of cases. While 70% cases of Ophthalmic or orbital lesions were benign in nature. All Ophthalmic lesions removed surgically should always (without exception) be subjected to histopathological examination to establish correct diagnosis for further management. However this study has shown that a good clinical examination and diagnosis before subjecting the patient for histopathological examination gives the patient and the treating surgeon a better outcome. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8442 Journal of Chitwan Medical College Vol.3(2) 2013 40-44

Purpose: The present study was conducted to find the preferred mode of learning among first-year preclinical students and compare the preferred mode of learning with sex, faculty of students, and academic performance of the students using the VARK questionnaire. Methods: A cross-sectional study was done among 142 first-year Bachelor of Medicine–Bachelor of Surgery and Bachelor of Dental Surgery students from February to May 2018. Demographic data and various academic performance marks were recorded for each individual. VARK (visual, aural, read/write and kinesthetic) questionnaire version 7.8 was administered to calculate the score of each component. Mean VARK scores were calculated and each student classified by their preferred mode of learning. The preferred mode of learning was compared with sex, nationality, faculty of students, and academic performance using χ 2 , unpaired t -tests, and the Mann–Whitney U test. P <0.05 was taken as statistically significant for comparison. Results: A majority of the students (53.52%) were multimodal. The most common multimodal mode of preference was bimodal (26.06%), while the most common unimodal preference was kinesthetic (29.06%). Total V score, K score, and VARK score were higher among males, while A and R scores were higher among females. The K score (7.96±2.35 in males and 6.96±2.43 in females) differed significantly ( P =0.019) between male and female subjects. More subjects with higher scores in the theory exam of anatomy were unimodal learners (53.8%) compared to multimodal learners (46.2%). Conclusion: From this study, it can be concluded that undergraduate students were diverse in their learning styles, but most were multimodal. Though learning styles were found to vary by sex, nationality, and academic performance, differences were not statistically significant.

We studied 604 suspected snakebite cases seen at the peripheral snakebite treatment centre, Damak, Eastern Nepal from January to December 2000 using pre-designed proforma. Seventy-five per cent of the patients were in the age group 11-40 years. The common victims were farmers (44.2%) and housewives (31.7%). The bite was commonly encountered during farming (29.4%), working in the field (16.2%), walking (13.7%) and feeding cattle (9.2%). Sixty-five per cent were bitten during outdoor and agriculture related activities. Bite during sleep was recorded in 7%: 62% had sustained bite in lower limb. Forty-two per cent of the victims arrived at the treatment centre within 2 hours of being bitten. Fourteen patients arrived 7 hours after being bitten and six were dead on arrival. A common local practice (seen in 56.7%) was to eat chillies to confirm envenomation. Application of a tourniquet, often multiple, was the common (90%) first aid measure. Neurotoxicity was present in 11% (n=66) of the victims. Five had local features of envenomation. No case of coagulopathy was recorded. Reaction to anti-snake venom was noticed in 28.16% (n=20). Two patients died during treatment. Mortality among patients with features of neurotoxicity was 3%.

Learning styles is a term used to refer to the methods of gathering, processing, interpreting, organizing and thinking about information. Students have different learning styles, which is the reason for the diversity seen in classrooms in regards to how students acquire information. Claxton and Murrell had divided the learning styles into the following four categories: personality models, information-processing models, social-interaction models, and instructional preferences models. VARK (an acronym for Visual, Aural, Read/write and Kinesthetic, different way of learning styles) is a learning inventory categorized into the 'instructional preference' modal. Many studies were done using the VARK inventory among the medical education but the preferred mode of learning was variable in different parts of the world. The relationship of age, gender and academic performance with the mode of learning was also not consistent. So this article tried to conclude the preferred mode of learning and relationship of mode of learning with gender and other factors by analyzing the previous studies done using VARK questionnaire among the medical students in daily teaching and learning environment. Pub Med and Google Scholar were used as a search engine to find the article. Altogether 20 full text research papers were retrieved and reviewed. In the most of part of the world the studies showed that multimodal learning style was the predominant one over unimodal. Further in multimodal quadmodal was the most preferred one followed by other presentation. In the unimodal presentation most preferred one is kinesthetic type of learning along with visual, aural and read write in less extent. Age factors had no lucid relationship with the learning style though some variations were observed with age.This review was expected to be useful as scientific evidence in the field of medical education and also as a reference for further research.