The prevalence of type 2 diabetes mellitus and impaired fasting glucose in semi-urban population of Nepal.

The increase in life expectancy in developing countries and as a result of increasing obesity and other life style changes, the global incidence of type 2 diabetes mellitus (T2DM) is increasing. The purpose of this study was to investigate the prevalence of T2DM and impaired fasting glucose (IFG) in semi-urban population of Nepal and to compare the prevalence between men and women and among different age groups. A total 740 adults (286 men and 454 women) aged 21 to 94 years (men +/- SD; 45.6 +/- 15.6 years) were included. The prevalence of T2DM and IFG was 9.5% and 19.2% in the whole population. Prevalence of T2DM was higher in men (11.8%) then in women (7.9%), similarly IFG was noted higher in men (25%) then in women (15.4%0). The prevalence of T2DM and IFG was seen to be increased with age in the whole population. Among women, the prevalence of T2DM and IFG was 2.9% and 12.8% in 21 to 40 years age group, 9.7% and 13.8% in 41 to 60 years age group and 15.4% and 27.7% in > 60 years age group. Among men, it was 4.7% and 22.6% in 21 to 40 years age group, 13.3% and 30.5% in 41 to 60 years age group and 23% and 17.3% in > 60 years age group. To conclude, the overall prevalence of T2DM and IFG increases with age. Prevalence of IFG is highest among middle age men where as the prevalence of T2DM is highest among older men.

Soil transmitted helminthiasis in Kathmandu, Nepal.

A total of 200 soil samples taken from different sites and 1,504 stool samples collected from school children (n = 188) and patients (n = 1,316) visiting the health care centres in Kathmandu Valley were included in this study. Soil samples were investigated for the presence of parasitic eggs using sucrose flotation technique. Stool samples were examined by formal-ether concentration and direct smear techniques. The contamination rate of soil with parasitic eggs and larvae was found to be 28.5% (57/ 200). The overall parasitic infection rates in school children and patients were 42.5% and 2.8%, respectively. Four types of parasites were detected from soil samples, of which Ascaris was the most common. Trichuris was most common among school children whereas Ascaris in patients. Females in both study groups had higher prevalence compared with male counterparts with significantly low rate in health care centre visiting patients (p < 0.05).

Intestinal parasitosis among the elderly people in Kathmandu Valley.

Present study was carried out among the elderly people (60+ years of age) from August 2005 to July 2006 in Kathmandu Valley to assess the prevalence of intestinal parasitosis in them. Stool samples were collected from 235 elderly people (122 from government elderly home, 66 from private elderly home and 47 from the households in a rural community). The samples were examined by formal ether sedimentation and Sheather's sucrose floatation followed by Kinyoun's modified Ziehl-Neelsen staining. The overall prevalence of intestinal parasites was found to be 41.7%, out of which 30.6% had multiple parasitism. The government elderly home had significantly higher parasitic prevalence (50.8%) followed by the rural community (46.8%) and the private elderly homes (21.2%) (P<0.05). Males (43.8%) had slightly infection rate than females (40.4%) (P>0.05). There was equal infection rate with protozoa (25.8%) and helminths (27.0%). Trichuris trichiura (39.4%) and Entamoeba histolytica (19.7%) were the commonest helminth and protozoa, respectively.

Microbial study of hospital environment and carrier pattern study among staff in Nepal Medical College Teaching Hospital.

The present study was done to see the microbial flora in the environment (air and surface) of Nepal Medical College Teaching Hospital and the staffs working in the hospital. Altogether 160 environmental (air n = 43, surface n = 117) samples were collected and studied from different wards. Similarly 150 samples (48 nasal swabs, 48 throat swabs and 54 hand samples) from the staffs were collected and studied following the standard microbiological protocols. Gram +ve cocci were the most predominant ones among the bacterial isolates from the environment followed by gram +ve bacilli and gram -ve bacilli. Among fungal isolates, yeast were the most common isolates while Aspergillus spp. were the most frequently occurring mold. Out of 150 samples collected for the study of carrier pattern, 32 out of 54 samples collected were found to have Staphylococcus aureus in their hands, 1 had Escherichia coli. Other isolates were Bacillus spp., Micrococci and coagulase negative staphylococci. Similarly 21 (43.8%) out of 48 nasal samples were found to have S. aureus while none of the staffs were found to have beta-hemolytic streptococci in their throat. In the study, 1.6% environmental isolates and 5.7% carrier isolates of S. aureus were found to be Methicillin resistant.

Intestinal parasitic infections among HIV seropositive and high risk group subjects for HIV infection in Nepal.

Present study was carried out to find out the prevalence of intestinal parasites in HIV seropositive (HIV+) subjects and high risk group (HRG) for HIV infection in Nepal. A total 196 (HIV+: n = 112; Age: 16-52 years and HRG: n = 84; Age: 16-39 years) individuals were included. Stool specimens were examined by direct smear, formal-ether sedimentation, Sheather's sucrose floatation and Kinoyun modified Ziehl-Neelsen methods. Overall prevalence of intestinal parasites was 35.7% (70/196) (26.7% in HIV+ subjects and 47.6% in HRG subjects). Trichuris trichiura was the commonest parasite in HIV+ subjects (50.0%), whereas hookworm was most common among HRG subjects (56.8%). There was an association of parasitic infections with the gastrointestinal tract symptoms in both the study subjects. Tibeto-Burmans study subjects had marginally higher prevalence than Indo-Aryans study subjects (P > 0.05). Multiparasitic infections were relatively more common among HIV+ subjects (7.2%) in comparison to HRG subjects (4.8%). Similarly the protozoan infections were relatively higher in HIV+ subjects (4.5%) compared with HRG subjects (1.2%). The opportunistic protozoa Cryptosporidium parvum was detected only in 5.2% HIV+ subjects.

Viral investigation of acute hemorrhagic conjunctivitis outbreak (2003) in Nepal using molecular methods.

A nationwide outbreak of acute hemorrhagic conjunctivitis (AHC) occurred in Nepal during August to September 2003, which affected nearly half of the population. Sixty conjunctival swabs from AHC patients were collected at Tilganga Eye Center in Kathmandu. For the first time in Nepal, we demonstrated the etiologic viral agents of AHC, namely, Coxsackievirus A24 variant (CA24v) by reverse transcription real time polymerase chain reaction (PCR). Of the 60 samples, 19 were positive for CA24v. No difference in the two genders was observed. Conversely, Adenovirus (AdV) was detected in 32 samples, which suggested that the epidemic was caused by mixed infection. AdV was detected also on 10 rupee notes. Findings indicated that inadequate personal hygiene was the main cause of the spread of these highly contagious viruses in the community environment in Nepal during the summer of 2003.

Helicobacter pylori associated gastroduodenal problem among the Nepalese.

Present study was undertaken during a period of eighteen months (April 2001 to October 2002) to see an association of Helicobacter pylori with the gastric problems among the Nepalese. This study comprised of 203 subjects (Males: 154 and Females: 49) aged 21 to 71 years with gastric problems. The biopsy samples taken from the stomach and duodenum using endoscope were tested for the presence of H. pylori by in-house rapid urease test (RUT) and culture. Representative samples were also tested by PCR. Of the total 203, 60 (29.5%) were RUT positive. Marginally high RUT positive rate was observed in males compared with females (P>0.95). Same was true with ethnic group with a marginally higher positive rate among Tibeto-Burmans compared with Indo-Aryans (P>0.05). Age-wise, higher incidence (34.4%) was observed in the age group of 36 to approximately 50 years followed by over 50 years (29.0%), and 21 to approximately 35 years (24.4%) (P>0.05). Both RUT and culture positive rate increased with the severity of the problem. RUT results were confirmed also by PCR. All RUT positive patients were given a full course of new triple therapy (combination of two antibiotics: Clarythromycin and Amoxycillin and a proton-pump inhibitor: Omeprazole) for two weeks followed by extended monotherapy with Omeprazole for up to six weeks. Of the total, 168 (82.7%) patients were available for follow-up and all of them showed an improved condition with negative RUT.

Study on cyclospora cayetanensis associated with diarrheal disease in Nepal and Loa PDR.

A study of diarrheal diseases associated with Cyclospora cayetanensis was conducted in Nepal and Lao PDR. A total of 2083 samples were included in this study. Samples in Nepal were collected from October 1999 to August 2002 whereas samples in Lao PDR were collected from February 2002 to June 2003. C. cayetanensis was detected by direct microscopy using ultraviolet and differential interference contrast microscopy. The overall positive rate in Nepal was 9.2% (128/ 1397). A higher positive rate was observed in children aged 10 years and under (11.1%) and was lowest in the age group of 51-60 years (3.1%). A significantly higher positive rate was observed in the summer (rainy season) (12.6%) with the lowest prevalence in the spring (dry season) (1.8%) (p < 0.05). The positive rate was closely associated with rainfall (ml/month). Interestingly, only one of the total 686 samples (0.1%) from Lao PDR was found to be positive for Cyclospora oocysts.

Factors associated with intestinal parasitic infection among school children in a rural area of Kathmandu Valley, Nepal.

We studied predisposing factors of enteric parasitic infections in school children [n=340 (Boys: 177 and Girls: 163)] in a rural area in Kathmandu Valley, Nepal. Fecal samples were examined by formal-ether concentration technique. A total of 71.2% children had parasite. Altogether nine types of parasites were recovered; Trichuris trichiura was the commonest one followed by hookworm and others. A structured questionnaire regarding various predisposing factors was used. No significant differences in the infection rate between the sexes, age groups (< or = 10 years, 11-14 years and > or = 15 years) and family sizes (< or = 5 and > or = 6) were observed (P>0.05). The positive rates were significantly low in children with the history of taking antihelminthic drugs in the past six months (P<0.05). A marginally higher positive rate was found among Dalits children compared to Tibeto-Burmans and Indo-Aryans (P>0.05) and children from farming family (P>0.05). No difference in the infection rate was found in children having different types of toilet facility: open-field defecation, pit latrine and modern toilet at their houses (P>0.05). Slightly higher positive rate was associated with drinking water from Kuwa (shallow well) compared to natural spout, piped water and Khola (river) (P>0.05). Children were infected despite of their awareness regarding the safe water and geophagy.

First case of Dengue virus infection in Nepal.

Dengue virus transmitted by Aedes mosquito is one of the important cause health problems in world. Dengue fever and more severe and often fatal forms namely dengue hemorrhagic fever and dengue shock syndrome are emerging health problems in many part of the globe. No cases of Dengue virus infection have been reported from Nepal till date and for the first time, we report a case of dengue fever from Nepal.

Evaluation of rapid diagnostic methods for pediatric viral diarrhea using samples collected in Nepal and Japan.

We evaluated real time PCR, ELISA and immunochromatography (ICG) test systems for detection of diarrheagenic viruses (Rotavirus, Adenovirus and Norovirus) in pediatric diarrheal fecal samples collected in Kathmandu, Nepal (n = 23) and in Kobe, Japan (n = 25) in summer of 2004. Of the 23 samples collected in Nepal, one (4.3%) was positive for Rotavirus and two (8.7%) for Adenovirus whereas six out of 25 samples (24.0%) collected in Japan were positive for Norovirus. Of the Japanese samples, 11 (44.0%) showed diarrheagenic bacteria (Campylobacter jejuni, Salmolella enteritidis) while six (26.1%) samples from Nepal showed parasites like Ascaris lumbricoides, Giardia intestinalis, Trichuris trchiura and Vampirolepis nana. Viral pathogens were not common during summer season in both Nepal and Japan. Real time RT-PCR was found to be relatively more sensitive compared with ELISA for Norovirus. However, immunological methods are simple and less time consuming (three hours for ELISA, 15 minutes for ICG) and appeared to be useful for rapid diagnosis of viral gastroenteritis especially in developing countries.

Prevalence of intestinal parasitic infestation in schoolchildren in the northeastern part of Kathmandu Valley, Nepal.

This paper presents the status of intestinal parasitosis in public schoolchildren (1 to 10 classes) in a rural area of the Kathmandu Valley, Nepal. A total of 533 schoolchildren (269 girls and 264 boys, aged 4 to 19 years) were included in this study. A questionnaire was filled out regarding hygienic and other habits, including factors predisposing to parasitic infections. Fecal samples from the children were examined by formol-ether concentration technique. The overall prevalence of parasitosis was 66.6% (395/533) with no significant difference between boys and girls (p> 0.05). Tibeto-Burman children had a non-significant higher prevalence, compared with Indo-Aryan and Dalit children (p>0.05). Half (53.8%; 191/355) of the children had multiple parasitic infections. Altogether, nine types of parasites were recovered. The recovery rate of helminths was higher (76.9%) than protozoa (23.1%). Trichuris trichiura was the most common helminth detected, followed by hookworm, Ascaris lumbricoides and others. Entamoeba coli was the most common protozoan parasite, followed by E. histolytica, Giardia lamblia and others.

Epidemiological survey of intestinal parasitic infections of diarrhoeal patients in Nepal and Lao PDR.

Intestinal parasitological survey was conducted to clarify the distribution of intestinal parasites in Nepal and Lao Peoples' Democratic Republic (Lao PDR) from 2001 to 2003. A total of 401 diarrheal fecal specimens were collected from patients aged one to 75 years (250 from Nepal and 151 from Lao PDR). The specimens were examined using the formalin-ether sedimentation (FES) and sucrose centrifugal flotation (SCF) techniques. Nine species (3 Nematoda, 1 Cestoda, and 5 Protozoa) of parasites were recovered from Nepal, whereas seven species (3 Nematoda, 1 Trematoda, and 3 Protozoa) from Lao PDR. Of the parasites detected, (14.4%) was the most common in Nepal, and was Opisthorchis viverrini (29.8%) in Lao PDR. Infection rates were markedly different among age groups in both countries; higher rates were observed in age groups of 10-29 years than in 0-9 years group. Scanning electron microscopic observation revealed that trematoda eggs recovered from Lao PDR were identified as O. viverrini, which could not be done by a light microscope.

Detection of diarrheagenic viruses from diarrheal fecal samples collected from children in Kathmandu, Nepal.

Diarrhea causing viruses (Rotavirus. Adenovirus and Norovirus) were investigated in diarrheal fecal samples collected from children in Kathmandu, Nepal in Janury 2004 using both real time PCR and immuno-chromatogaphic techniques. Of the total 12 diarrheal samples investigated, 8 (66.7%) were positive for Rotavirus, 1 (8.3%) was positive for Adenovirus and none was positive for Norovirus (Norwalk like virus). The Adenovirus positive sample was also positive for Rotavirus. Similar results were obtained by immuno-chromatographic technique. All of Rotavirus detected belonged to Group-A. Results indicated that immuno-chromatographic technique was equally good in the detection of diarrhea causing viruses in fecal samples. Furthermore, it was simple, cost-effective and less time consuming (15 minutes) compared with the PCR. Immuno-chromatographic technique, therefore, appeared to be useful for rapid diagnosis of viral gastroenteritis in developing countries like Nepal.

Study on enteric parasitosis and nutritional status of school children in remote hilly areas in Nepal.

We examined the effect of enteric parasitosis on nutritional status of school children in remote hilly areas in Nepal. A total of 325 school children aged 6 to 19 years (boys: 214; girls: 111) who provided both blood and stool samples were included. The height (Ht) (cm), weight (Wt) (kg), age, sex, ethnic of each child were recorded. Fecal samples were examined by direct smear method in duplicate. The blood hemoglobin (Hb) was estimated by Sahli's method in the field (Nepal) whereas the serum protein (Prot), albumin (Alb), Alb/globulin ratio (A/G), serum glutamate pyruvate transaminase (SGPT), cholesterol (Chol), triglycerides (Trig), and serum iron (SI) were measured in Japan. Of the total, 201 (61.8%) had enteric parasites, predominantly the soil transmitted helminths. Ascaris lumbricoides was the most common parasite detected (72.6%) followed by hookworm (16.2%) and others. Protozoan infections were very low (<6.0%). Of the total 201 parasite positive children, 15.4% had multiple infections. No significant differences in Ht and Wt in parasite positive and negative boys and girls of both age groups (< 11 and 11-19 years) were observed (P>0.05). Overall, no significant differences in levels of Hb, Prot, A/G, SGPT, Chol, Trig and SI in the parasite positive and negative children were observed (P>0. 05) but in Alb level (P<0.05). When, the levels of these parameters were compared in the age groups of <11 and 11-19 years, similar findings were observed in both the age groups. But, in the age group of 11-19 years, a significant difference was observed in Trig level (P<0.05). No differences were found in the levels of these parameters in the parasitic positive and negative children belonging to Dalits and different ethnic namely, Indo-Aryan and Tibeto-Burman, respectively.

Detection of Toxoplasma oocysts from soil by modified sucrose flotation and PCR methods.

A detection method of Toxoplasma gondii oocysts from soil was evaluated using the sucrose flotation technique with modification involving addition of 0.1% gelatin into washing and floating solutions. PCR was performed on untreated samples and after treatment with polyvinylpyrrolidone (PVP), heating and cooling, and NaCl. The addition of gelatin in the sucrose solution yielded a higher number of oocysts. A very thin band was observed when DNA extract was diluted to 1:1024, indicating the presence of PCR inhibitor in the soil. PCR performed on untreated DNA, on PVP-treated, and on PVP-treated with heating and cooling without added bovine serum albumin (BSA) showed a band only at higher dilutions (1:1024 and 1:512) but at a much lower dilution (1:8) with BSA. In contrast, DNA treated with all three agents showed a band at a much lower dilution (1:64), even without added BSA, and no dilution was required when BSA was added. The PCR inhibitors present in the soil were removed by employing various treatment procedures during DNA extraction, and BSA in PCR. Furthermore, the detection limit with the method was 1 oocyst/g of soil, indicating that this method is useful in epidemiological studies.

Parasites detected from diarrheal stool samples collected in Nepal.

Intestinal parasites were investigated in 396 diarrheal stool samples collected from individuals aged 1 to 68 years (males: 239 and females: 157) in Nepal. Samples were collected at different medical centers located in Kathmandu and from two public schools in a village setting in Kathmandu Valley and outside, during October 1999 to January 2001. The stool samples were mixed with 2% dichromate solution and transported to Japan for investigations. Parasites were detected by employing the formal-ether sedimentation technique. Of a total of 396 fecal samples investigated, 193 (49%) were positive for some kind of parasite. Altogether, 15 species of parasites were detected. Giardia intestinalis topped the list of protozoa, whereas Trichuris trichiura was the most frequently detected among helminth parasites. Of the 193 positive samples, 109 (56%) had single parasite infections, whereas 84 (43%) had multiple infections with a maximum of five species. Of the total positive, 45 (23%) had both protozoa and helminths whereas 37 (19%) had only protozoa. Females (52%) and children (15 years and under) (52%) had a marginally higher prevalence compared with males (46%) and adults (45%), respectively (p > 0.05). Samples collected from two public schools in a village setting inside Kathmandu Valley and outside had a significantly higher positive rate compared with those observed in individuals visiting different medical centers in the city and suburban areas in Kathmandu (p < 0.05).

Toxoplasma infection in selected patients in Kathmandu, Nepal.

Seroprevalence of Toxoplasma infections in 272 patients with ocular diseases (uveitis, retinochoroiditis), malignancy (including leukemia), women with bad obstetric history (BOH) and others (patients with fever, lymphadenitis and encephalitis) have been was studied. Toxoplasma antibodies were detected by microlatex agglutination and IgM ELISA techniques. Overall, 50.7% (138/272) patients included in this study had Toxoplasma antibodies, out of which 5.7% (8/138) had IgM antibodies. Patients with malignancy had highest positive rate [68.7% (22/32)] followed by group of others. Of the different groups, women with BOH had highest Toxoplasma IgM positive rate [25.0%; (2/8)].

Acute hemorrhagic conjunctivitis epidemic--2003 in Nepal.

This rapid communication present the findings of nationwide outbreak of acute hemorrhagic conjunctivitis (AHC) epidemic occurred in Nepal during summer 2003. Only ten percent of samples showed bacterial and no fungus were grown. On the contrary, viruses were detected in 60.0% cases studied. Of the viruses detected, Adenovirus (ADV), Coxsackie virus (CA24v) and both accounted for 83.3% (30/36), 11.1% (4/36) and 5.5% (2/36), respectively. Interestingly, ADV was detected also from one of the ten a Rupees bill.

Small-scale study on intestinal parasitosis in a remote hilly village in Nepal.

A small-scale cross sectional study on intestinal parasitosis was conducted in a remote hilly village in western Nepal in January 2001. Stool samples collected from 115 inhabitants (M: 41 and F: 74; Aged: 1 to 89 years) were examined by direct smear method in duplicate. Overall positive rate was 27.0% with a marginally high positive rate in males (P>0.05). Dalits (the lower caste people) had highest prevalence (71.4%) than Tibeto-Burman and Indo-Arvan ethnic (P>0.05). Higher prevalence was observed in adults than in children. Eighty percent of subjects had single parasite infection. Altogether, six types of parasites were detected of which Ascaris lumbricoides was most common. People having toilet had marginally low positive rate. All subjects included in this study were drinking raw water. Occupation wise, farmers had marginally high prevalence.