Tobacco smoking and hypertension.

Coronary artery diseases is rapidly increasing in our part of the world. The South Asian ethnic groups are especially vulnerable to coronary artery disease. The two most striking features of coronary artery disease in the South Asian population are extreme prematurity and severity of the disease, both resulting from the malignant atherosclerosis that begins at an earlier age than in other population. Triple vessel disease and complicated lesions are not common even in young people and follow a malignant course. The most important aspect of prevention is to identify individuals with high risk of coronary artery disease at an early age and aggressive modification of risk factors. Tobacco smoking and hypertension are the two most important risk factors for coronary heart disease and stroke. Both of these risk factors have very high prevalence in India, Nepal and other countries of this region. There is a synergistic interaction of tobacco smoking with hypertension and high blood cholesterol which greatly increase coronary heart disease risk as well as sudden death and stroke.

Prevalence of rheumatic fever and rheumatic heart disease in school children of Kathmandu city.

To find out the prevalence of rheumatic fever/rheumatic heart disease in an urban area, a survey of school children aged between 5 to 16 years studying in randomly selected government schools in Kathmandu city was done. Out of 4984 students enrolled in the study 4736 were examined, the percentage of absentees being five. Revised Jones Criteria (1992) was used for the diagnosis of rheumatic fever. Diagnosis of rheumatic heart disease was confirmed only after Doppler echocardiography in suspected cases. A total of six cases of definite rheumatic heart disease (out of 13 suspected cases) were identified giving overall prevalence rate of 1.2 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in most earlier studies from developing countries but it is similar to that reported from rural Kathmandu in 1991. It is concluded that there is some downward trend in rheumatic fever/rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented overdiagnosis in the present study. We feel that there is an urgent need to launch a National Programme for the control of rheumatic fever/rheumatic heart disease in Nepal with emphasis on primary and secondary prophylaxis of the disease.

Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal.

A survey of school children aged 5 to 16 years living in a rural community of the hill region of Nepal, situated about 15-22 km outside Kathmandu city, was conducted to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). Of the 4,816 eligible children enrolled in the selected schools, 4,452 (92.4%) were examined. WHO expert committee criteria (1966) was used for the diagnosis and classification of rheumatic fever. Chest x-ray, electro-cardiography, echocardiography and Doppler study were done in all suspected cases of rheumatic heart disease. Six cases of RHD (1 pure mitral stenosis, 3 mitral regurgitation and 2 combined mitral stenosis and regurgitation) were identified giving overall prevalence rate of 1.35 per thousand. No case with active rheumatic fever could be identified. This is the first study on prevalence of RF/RHD in Nepal. The prevalence rate is lower than that reported from neighbouring countries.