Re-emergence of dengue virus serotype 2 strains in the 2013 outbreak in Nepal.

Background & objectives: Epidemiological interventions and mosquito control are the available measures for dengue control. The former approach uses serotype and genetic information on the circulating virus strains. Dengue has been frequently reported from Nepal, but this information is mostly lacking. The present study was done to generate a comprehensive clinical and virological picture of a dengue outbreak in Nepal during 2013. Methods: A hospital-based study involving patients from five districts of Nepal was carried out. Demographic information, clinical details and dengue serological status were obtained. Viral RNA was characterized at the molecular level by reverse-transcription polymerase chain reaction (RT-PCR), nucleotide sequencing and phylogenetic analysis. Results: From among the 2340 laboratory-confirmed dengue cases during the study period, 198 patients consented for the study. Clinically they had fever (100%), headache (59.1%), rashes (18.2%), retro-orbital pain (30.3%), vomiting (15.1%), joint pain (28.8%) and thrombocytopenia (74.3%). Fifteen (7.5%) of them had mucosal bleeding manifestations, and the rest were uncomplicated dengue fever. The patients were mostly adults with a mean age of 45.75 ± 38.61 yr. Of the 52 acute serum samples tested, 15 were positive in RT-PCR. The causative virus was identified as DENV serotype 2 belonging to the Cosmopolitan genotype. Interpretations & conclusions: We report here the involvement of DENV serotype 2 in an outbreak in Nepal in 2013. Earlier outbreaks in the region in 2010 were attributed to serotype 1 virus. As serotype shifts are frequently associated with secondary infections and severe disease, there is a need for enhancing surveillance especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in the region.

Nursing Personnel Planning for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs.

Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO—Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel.

The Epidemiology and Health Burden of Neurocysticercosis in Nepal.

Neurocysticercosis (NCC) is a public health burden in Nepal. In patients burdened by this disease epileptic seizures are common. Computerized tomography scan (CT-scan) and Magnetic resonance imaging (MRI) techniques are most commonly used investigative tools for the diagnosis of NCC. Radio imaging techniques combined with serological techniques such as Enzyme linked immunosorbent assay (ELISA) and/or Enzyme linked immunoelectrotransfer blot (EITB) are commonly used as confirmatory diagnostic tools for this disease. Poor sanitation and hygiene accompanied with free range system of keeping pigs, deliberate use of human feces as pig feeds and social economic status of the society were reviewed the main causes for the persistence of Neurocysticercosis in Nepal. It was found that NCC exists in various development stages in the human brain as vesicular, colloidal, granular nodular and calcified forms. Based on the developmental stage and location of the cyst, a patient may present a focal seizure (FS), focalised seizure secondary generalised (FSSG), generalised toniclonic seizure (GTCS) , intractable seizures, headache, vomiting, impaired vision and or cognitive dysfunctions. Radio-imaging (CT scan and MRI) techniques and immunodiagnostic kits (ELISA, EITB, Dot Blots, and Western Blots) were found to be the main tools for diagnosis of NCC/Cysticercosis in Nepal. The chemotherapeutic treatment for NCC associated epilepsy was found to be analgesics, corticosteroids, and/or a combination of both. Albendazole was found the most used and effective anthelminthic drug for the treatment of multiple lesion. NCC is an easily preventable disease of poor and the neglected people. In a resource limited setting like Nepal, effective diagnostic techniques and treatment routines in place is very difficult. It is recommended that provision of education to the public on the epidemiology of the disease, promotion of safe pork production practices, supply of tap water, improvement of personal hygiene and sanitation would play a bigger role in eradicating the disease.

Comparison of central corneal thickness of primary open angle glaucoma patients with normal controls in south India

Studies mainly in the western population have compared central corneal thickness in primary open angle glaucoma and normal individuals have found variable results. We did this study to compare the central corneal thickness of primary open angle glaucoma patients with normal controls in a south Indian population. This was a masked, cross-sectional study undertaken in a tertiary care center in South India. A total of 50 controls and 50 primary open angle glaucoma patients were studied. Central corneal thickness between the two groups was compared using Wilcoxon two sample test and the signed rank test. The mean central corneal thickness in the control group was 536 microm [462-608 microm] and in the primary open angle glaucoma group was 531 microm [476-609 microm]. There was no significant difference in the central corneal thickness between primary open angle glaucoma patients and the normal controls

Intracranial haematoma resulting from lightning stroke.

Intra-cerebral haemorrhage due to lightning stroke is extremely rare. We report a 45 year old woman who developed intracranial haemorrhage due to a direct lightning stroke. This was proved by CT scan. The haematoma was evacuated surgically, resulting in full neurological recovery of the patient.