An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal.

BACKGROUND: Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal. METHODS: The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal. RESULTS: Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves. CONCLUSIONS: Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.

Serum uric acid level in normal pregnant and preeclamptic ladies: a comparative study.

Preeclampsia is a serious pregnancy complication characterized by hypertension, proteinuria with or without pathological edema. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not in preeclamptic patients. Pre-eclamptic patients admitted in Nepal Medical College Teaching Hospital from June 2012 to June 2013 were included in this study. Age matched normal healthy pregnant ladies served as control. The record of their blood pressure and serum uric acid level was evaluated. Results showed significantly high blood pressure [SBP 149.42±12.35 vs 109.00±7.93 mm Hg; DBP 96.85±8.32 vs 72.5±7.10 mm Hg], and serum uric acid level [6.27±1.37 vs 4.27±0.61 mg/dl] in pre-eclamptic patients compared to their healthy counterparts. Uric acid is a terminal metabolite of the degradation of nucleotides, which increases their blood levels in patients with preeclampsia increasing its synthesis by damage and death of trophoblastic cells and proliferation. Uricemia in preeclampsia likely results from reduced uric acid clearance from diminished glomerular filtration, increased tubular reabsorption and decreased secretion. Results of the present study indicated association of elevated serum uric acid level with preeclampsia which could be used as a biochemical indicator of preeclampsia in pregnant women.

Color vision deficiency among a group of students of health sciences.

Color vision deficiency, most of the time remains an unnoticed problem; even many doctors/health professionals do not know the severity of their color vision deficiency and their disability. Some common difficulties reported by medical practitioners and students of health sciences were in recognizing- widespread body color changes (pallor, cyanosis, icterus, rashes, erythema of skin), colorful charts, slides, test-strips of blood and urine, body products: blood or bile in urine, faeces, sputum, vomitus, microscopy, oral and throat lesions, titration end-points, tissue identification (surgery) etc. The present study was undertaken to evaluate the presence of congenital color vision deficiency among the students of health sciences. The study was carried out among the medical and dental male students of Nepal Medical College and Teaching Hospital (n = 215) from November 2, 2012 to December 4, 2012 with the help of Ishihara chart which was shown to all male participants and were asked to read the impressions in the color chart. The impressions perceived by a person with normal color vision were different from the impressions perceived by a person with color vision deficiency. After careful screening, it was noted that among the study population (n = 215), 12 were color deficient (5.58% of our study population). Among them, one could not appreciate color (total color blindness according to the chart used), protanomaly was detected in 1, deuteranomaly in 3 and deuteranopia in 7 volunteers. Students of health sciences must be made aware of their congenital color vision deficiency and its effects on their work. Screening enables the students and later the health professionals to become aware of limitations in their powers of observation and devise ways of overcoming them. The patient is protected from harm and legal action may be avoided when the health professional have adapted their practice to their deficiency. Medical/ dental students and health professionals must be screened for color vision deficiency and advised about it, so that they can take special care in clinical practice.

Lysosomal storage disease.

We report a case of lysosomal storage disease diagnosed by lysosomal enzyme assay in a two year old boy with a history of gradual onset of weakness of body, poor vision, flaccid neck and spasticity in all four limbs with hyper-reflexia. On fundus examination cherry red spots were noted at macula. On performing lysosomal enzyme assay, beta-galactosidase level was considerably low. This indicates that the child is affected by lysosomal storage disease most likely GM1 gangliosidosis. The diagnosis is important because the disease is rare and it may be missed as the symptoms are similar to other neurological conditions and the diagnosis can help with future conception.