Background: An effective method for cataract surgery should be identified to combat cataract blindness. Aim: To study the surgical outcome of conventional extracapsular cataract extraction versus manual small-incision cataract surgery. Materials and methods: A randomized clinical trial was carried out including one hundred eyes (88 patients) which were divided into two groups using systematic randomization: groups of conventional extracapsular cataract extraction with posterior chamber intraocular lens (ECCE with PCIOL) implantation and manual small-incision cataract surgery (MSICS). The postoperative parameters/variables studied were the unaided and best-corrected visual acuity and astigmatism. Statistics: Epi info 2000 version statistical software was used for data analysis and calculation of relative risk, 95% CI and p value. The p value of less than 0.05 was considered as significant. Results: In the immediate postoperative period, unaided visual acuity of =/> 6/18 was achieved in 24 subjects in MSICS group versus 7 in ECCE with PCIOL group (RR=2.05, 95% CI=1.44 - 2.94, p = 0.0002), whereas the same at 6 - 8 weeks postoperatively was found in 28 and 22 subjects in those groups respectively (RR=1.27, 95% CI=0.86-1.89, p=0.23). The astigmatism of =/> 2 at 6 - 8 weeks was found in 35 and 17 subjects from the conventional and MSICS groups respectively ( R=2.28, 95% CI = 1.39-3.73, p=0.0002). Conclusion: Both MSICS and conventional ECCE with PCIOL are safe and effective techniques for treatment of cataract patients. A more rapid recovery of good vision can be achieved with MSICS than with conventional ECCE with PCIOL in the immediate postoperative period. Key words: ECCE; MSICS; visual acuity; astigmatism DOI: 10.3126/nepjoph.v1i1.3668 Nep J Oph 2009;1(1):13-19

Patients with nummular dermatitis are at significant risk of developing secondary allergic contact dermatitis, which contributes to the severity and chronicity of their dermatitis. Patch testing has the potential to improve the quality of life in these patients. Hence, patients with chronic recalcitrant nummular dermatitis must be patch tested.

Appalachian Kentucky (App KY) leads the nation in lung cancer incidence and mortality. Trace elements, such as As, have been associated with lung cancers in other regions of the country and we hypothesized that a population-based study would reveal higher trace element concentrations in App KY individuals with cancer compared to controls. Using toenail and drinking water trace element concentrations, this study investigated a possible association between lung cancer incidence and trace-element exposure in residents of this region. This population-based case-control study had 520 subjects, and 367 subjects provided toenail samples. Additionally, we explored the relationship between toenail and fingernail trace-element concentrations to determine if fingernails could be used as a surrogate for toenails when patients are unable to provide toenail samples. We found that, contrary to our initial hypothesis, trace element concentrations (Al, As, Cr, Mn, Co, Fe, Ni, Cu, Se, and Pb) were not higher in cancer cases than controls with the exception of Zn where concentrations were slightly higher in cases. In fact, univariate logistic regression models showed that individuals with lower concentrations of several elements (Al, Mn, Cr, and Se) were more likely to have lung cancer, although only Mn was significant in multivariate models which controlled for confounding factors. While drinking water concentrations of Al, Cr and Co were positively related to cancer incidence in univariate models, only Co remained significant in multivariate models. However, since the drinking water concentrations were extremely low and not reflected in the toenail concentrations, the significance of this finding is unclear. We also found that fingernail concentrations were not consistently predictive of toenail concentrations, indicating that fingernails should not be used as surrogates for toenails in future studies.

Intorduction: Vulval disorders can be of venereal and non-venereal etiology. Establishing non-venereal causation of vulval disorder helps in alleviating fears in patients with the condition. These patients are better dealt in a multidisciplinary clinic as patients with these disorders frequently visit dermatologists and gynecologists for the treatment. Objectives: To study the clinico-demographic profile of women with non-venereal vulval disorders and to determine their relative frequency. Materials and Methods: This is an observational, descriptive study done at the Departments of Dermatology and Venereology and Gynecology and Obstetrics, Nepal Medical College Teaching Hospital. All consenting female patients with problems pertaining to female external genitalia were recruited for the study after excluding venereal diseases. Details of the patients were obtained and entered in a predesigned proforma. Results: Seventy-five females were recruited during a period of 20 months with a mean age of 34.79±17.90 years. Majority were married, uneducated and homemakers. Duration of disease ranged from 3 days to 35 years. Itching was the commonest presenting complaint (82.67%) followed by redness (32.00%), burning sensation (26.67%), white lesions (24.00%) and pain (24.00%). Commonest diagnosis was lichen sclerosus (17.33%), followed by candidiasis (14.67%). Patients presenting with vulval symptoms without lesions were diagnosed with non-specific vulval pruritus (9.33%) and vulvodynia (2.67%). Conclusion: Itching is the most common presenting complaint and contrary to the popular belief, inflammatory disorders especially lichen sclerosus, rather than infections were common diagnoses in females with non-venereal vulval disorders.

Introduction: Skin tumors are on the rise in the Nepalese community. The different morphological pattern of skin tumors requires its meticulous categorization for understanding its effect on prognosis and treatment. Our study aimed at studying the prevalence of skin tumors among the skin biopsies performed in the dermatology outpatient department in a tertiary care hospital of Nepal. Methods: A descriptive cross-sectional study was done from skin biopsy samples from 1st January, 2017 to 31st December, 2019, at a tertiary care center. Ethical clearance was taken from the institutional review committee (IRC), Ref No: 056-077/078. Convenience sampling was done. A self-designed proforma containing questions on the patients' socio-demographic data and clinical details were used, and a biopsy of those clinically suspected to have skin tumors was done. Skin tumors were classified according to the World Health Organization 2018 classification of skin tumors. Data were analyzed using Statistical Package for the Social Sciences Version 16. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated. Results: A total of 671 skin biopsies were done during this study, out of which 125 (18.63%) at 95% Confidence Interval (15.68-21.57) were diagnosed with skin tumors. Among them, 77 (61.6%) were female, and 48 (38.4%) were male. Among the diagnosed cases, 105 (84%) were benign, and 20 (16%) were malignant. Conclusions: The findings from our study show the increasing prevalence of skin tumors, and the results were comparable to other similar studies conducted in various parts of Nepal.

ObjectiveTo evaluate the demographic predictors of major depressive disorder (MDD) in hospitalized congestive heart failure (CHF) patients and measure the differences in hospital stay and cost per comorbidities and the associated risk of in-hospital mortality.MethodsThis retrospective cross-sectional study used nationwide inpatient data from the healthcare cost and utilization project (HCUP). We identified patients with CHF as the primary diagnosis and MDD as the secondary diagnosis using ICD-9-CM codes and compared with the CHF patient without MDD. The differences in comorbidities were quantified using chi-square tests and the logistic regression model was used to evaluate mortality risk among comorbidities using odds ratio (OR).ResultsElder CHF patients, 36–50-year-old (OR: 1.324) and whites (OR: 1.673), have a higher likelihood of a co-diagnosis of MDD. Females with heart failure have two-fold higher odds of MDD (OR: 2.332). Majority of the medical comorbidities were seen in a higher proportion of CHF patients without MDD. Hypothyroidism (10.2%) and drug abuse (15.2%) were seen more in depressed patients comparatively. Among substance use disorder, patients with drug abuse stayed longer and had a higher hospitalization total cost ($51,828). And, hypothyroidism was associated with longer inpatient stay (5.6 days) and cost ($64,726), and four-fold higher odds of in-hospital mortality (OR: 4.405). Though alcohol abuse was seen only in 7.4% of CHF patients with MDD, it was associated with the three-fold higher likelihood of deaths during hospitalization (OR: 3.195).ConclusionA middle-aged, white female with comorbid depression has a higher risk of hospitalization for heart failure. Depressed CHF patients with comorbid hypothyroidism were hospitalized for a longer duration with higher inpatient cost and four times higher risk of mortality during hospitalization stay. Further studies are required to evaluate the underlying cause of worse hospital outcomes in depressed CHF patients with alcohol abuse and hypothyroidism. An integrated healthcare model is required for early diagnosis and treatment of depression and associated comorbidities in CHF patients to reduce mortality and improve post-CHF outcomes.

The purpose of this study was to determine the incidence of wormian bones (WBs) in different head shapes of Nepalese skulls along with their distribution at various sites. This study was conducted on 70 Nepalese skulls obtained from the Department of Anatomy, Nepal Medical College, and the Institute of Medicine from September 2017 to January 2018. The skulls were examined for the presence and topographic distribution of WBs. The occurrence of WBs at various sites was correlated among different head shapes. The incidence of skulls showing WBs was 88.57%. The WBs were observed at the lambdoid (61.43%), parietomastoid (41.43%), occipitomastoid (27.14%), pterion (25.71%), asterion (24.29%), lambda (11.43%), sagittal (7.14%) and coronal sutures (4.28%). The dominant head type was dolichocephalic (44.29%) and the least dominant was brachycephalic (10%). The maximum number of WBs was shown on brachycephalic (mean 8.86 ± 7.13) then hyperdolichocephalic (mean 8.33 ± 9.15), mesaticephalic (mean 5.10 ± 4.45) and dolichocephalic heads (mean 4.16 ± 5.30). Brachycephalic heads frequently exhibited WBs at the pterion (57.14%) and at different sutures: lambdoid (71.42%), parietomastoid (57.14%), sagittal (28.57%) and squamous (14.28%). Hyperdolichocephalic heads displayed more lambda (33.33%) and coronal (8.33%) WBs. Similarly, dolichocephalic and mesaticephalic heads showed WBs at the occipitomastoid (35.48%) and asterion (30%), respectively. Inca bones were only identified in three dolichocephalic skulls. Neurosurgeons, radiologists and orthopedists should be careful when doing clinical and surgical procedures on different head shapes of the Nepalese population.

Background: Abnormalities of facial pigmentation, or facial melanoses, are a common presenting complaint in Nepal and are the result of a diverse range of conditions. Objectives: The objective of this study was to determine the frequency, underlying cause and impact on quality of life of facial pigmentary disorders among patients visiting the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital (NMCTH) over the course of one year. Methods: This was a cross-sectional study conducted at the Department of Dermatology and Venereology, NMCT H. We recruited patients with facial melanoses above 16 years of age who presented to the outpatient department. Clinical and demographic data were collected and all the enrolled participants completed the validated Nepali version of the Dermatology Life Quality Index (DLQI). Results: Between January 5, 2019 to January 4, 2020, a total of 485 patients were recruited in the study. The most common diagnoses were melasma (166 patients) and post acne hyperpigmentation (71 patients). Quality of life impairment was highest in patients having melasma with steroid induced rosacea-like dermatitis (DLQI = 13.54 ± 1.30), while it was lowest in participants with ephelides (2.45 ± 1.23). Conclusion: Facial melanoses are a common presenting complaint and lead to substantial impacts on quality of life. Accurate diagnosis and management can prevent or treat many facial melanoses, including those that lead to substantial loss of quality of life, such as melasma with steroid induced rosacea-like dermatitis. Health care systems in low and middle-income countries should dedicate resources to the identification, prevention and treatment of these conditions to improve quality of life.