Use of Validated Severity Scales for Measurement of Lepra Reactions

The need of a validated scale or tool to measure a disease condition, particularity its severity, cannot be over emphasized in clinical research. A validated scale can be used to compare a condition across cultures. Reactions in leprosy continue to be important causes of morbidity both systematic as well as local in the form of pain and disabilities. Measurement of their severity may be helpful in rationalizing their proper management. In this article, the salient features of validated tools to measure type 1 and 2 reactions in leprosy developed during last 7-12 years have been reviewed. The processes of validations are described too. Experience so far with the use of these severity scales to classify and monitor the anti-reaction treatment is limited. There is need to gain more experience in different endemic countries/regions so that duration and doses of anti-reaction agents could be better rationalized. Depending upon the field experience, these severity grading systems may be evolved further.

Pseudoexfoliation syndrome in various ethnic population of Nepal.

Pseudoexfoliation syndrome is an ocular condition characterized by a distinctive deposition of fibrillar material in the anterior segment of the eye. Pseudoexfoliation syndrome is frequently associated with glaucoma. Though it is seen in all the population, prevalence varies considerably in different races. A hospital based study done in Nepal by our group showed that Gurung population is frequently affected by this disease than any others. To determine the fact a larger population based study was necessary. Thus a research was designed to survey the various populations in the community. Different population from Kathmandu valley, Kavrepalanchowk, Pokhara, and Ghandruk were evaluated in two different phases to include major ethnic population living in Nepal. Household surveys done to bring all the targeted population to base hospital and detail examination including anterior segment evaluation after dilatation of pupil, optic disc evaluation, intraocular pressure measurement, gonioscopy, visual field recording and photographic documentation was done. Total of4430 population surveyed while only 2135 fulfilled the criteria for inclusion. Gurungs irrespective of their place of residence showed higher prevalence of Pseudoexfoliation syndrome accounting for 7.8% in Kathmandu valley while 12.0% in Ghandruk. Tamangs were affected very rarely by this disease accounting only for 0.3%. Gurungs are at higher risk of developing Pseudoexfoliation syndrome than any others in Nepal.

Barriers to up take cataract surgery in Gandaki Zone, Nepal.

OBJECTIVE: Cataract though avoidable remains as leading cause of blindness in Nepal. Though, Himalaya Eye Hospital rendering high quality surgical service through its base hospital and out reach service in Gandaki Zone having cataract surgical rate is below 1500 per million. Therefore, it is mater of interest to investigate the reason and the finding would be helpful to plan the future cataract programme to CSR to desirable level, if we know the reason(s) that forced them living as blind in community and not seeking available surgical services. METHOD: All person with cataract affecting their visual acuity to <6/60 (corrected) in either eye found in stratified cluster design sampling were enrolled in the study. They were interviewed with structured questionnaire investigating their knowledge and attitude of their visual impairment and barriers for not seeking cataract surgical service to date. RESULTS: A total of 303 eligible subjects were enrolled in the study. Out of them 57.8% of people knew about the cataract and they also think their vision impairment is due to cataract. But 56.11% of people were not aware their vision will improve. Surgical camp attendant or operated patients were found to be effective media to spread the message that the cataract is curable. Among the barriers: fear for surgery 31.1%, lack of attendant and geographical distance 32.8%, financial 24.1% and other clinical reason were found to be 12% as a reason for not seeking available surgical service. CONCLUSION: The cataract service marketing, eye health education disseminating the information on cataract and its curability is not found to be adequate. Therefore, the future cataract programme should give more concentration on creating awareness on cataract and subsidizing the available surgical service and service need to be brought to more proximity for the needy poor people.

Serum level of low-density lipoprotein cholesterol in hypertensive retinopathy.

Increased serum level of low-density lipoprotein is associated with coronary artery disease. There are, however, no reports on whether the same is true in hypertensive retinopathy. A cross-sectional comparative study was carried out to evaluate the serum level status of low-density lipoprotein in hypertensive retinopathy, including 30 randomly selected subjects with hypertensive retinopathy; age and gender matched 26 hypertensives without fundus changes. Serum low-density lipoprotein cholesterol (LDL-C) levels were assessed in all subjects. Results showed statistically significant (p < 0.0196) higher serum levels of LDL-C in hypertensive patients with retinopathy (mean +/- SD = 2.45 +/- 1.76 mmol/l, SE = 0.33 and 95% CI = 1.79-3.11 vs mean +/- SD = 1.6 +/- 0.4 mmol/l, SE = 0.08 and 95% CI = 1.44-1.76). An increased serum level of LDL-C is associated with hypertensive retinopathy.