Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal.

Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.

Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal.

Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.

Prevalence of Refractive Error and Ocular Pathologies among School Children: Finding from the School Eye Program of Dhulikhel Hospital.

Background Childhood blindness and visual impairments could lead to the onset of blindness among children and adolescents. New cases appear particularly between the ages of 6-15 years and if uncorrected, runs a risk of developing Amblyopia, strabismus. There exists a mounting need to strengthen and modify established school eye health programs in Nepal as per the local needs and conditions. Objective To determine the prevalence of refractive error and ocular pathologies among school children in rural Nepal. Method This cross-sectional study was conducted in nine schools of Kavrepalanchowk and Bhaktapur district with 953 students screened from December 2018 to February 2020. The team of optometrist, ophthalmic assistants and ophthalmologist applied a standard protocol for screening of refractive error as a part of the school eye program of Dhulikhel Hospital. Other standard eye examinations were performed to note the ocular pathologies. The association of socio-demographic factors of students having refractive errors with that in emmetropes was identified using logistic regression analysis. Result A total of 953 students were screened in nine study sites, age ranged from 5-19 years. There were 183 students (19.2%) with refractive errors. Blurred vision was the common complaint reported by 2.5% of students. Multivariate logistic regression analysis showed higher age group children (aOR=2.93; 95% CI: 1.62-5.29; P=0.01) and urban area children (aOR=4.37; 95% CI: 0.87-21.98; P=0.07) to have higher odds of refractive error. Conclusion Refractive error is the major eye problem among school children. Despite its high prevalence, there is still a major gap in timely diagnosis and treatment. Regular vision screening and timely treatment is required for better addressing refractive error among school-going children.

Expression of Echmr gene from Eichhornia offers multiple stress tolerance to Cd sensitive Escherichia coli Δgsh mutants.

The detoxification of heavy metals frequently involves conjugation to glutathione prior to compartmentalization and eflux in higher plants. We have expressed a heavy metal stress responsive (Echmr) gene from water hyacinth, which conferred tolerance to Cd sensitive Escherichia coli Δgsh mutants against heavy metals and abiotic stresses. The recombinant E. coli Δgsh mutant cells showed better growth recovery and survival than control cells under Cd (200 µM), Pb(200 µM), heat shock (50 °C), cold stress at 4 °C for 4 h, and UV-B (20 min) exposure. The enhanced expression of Echmr gene revealed by northern analysis during above stresses further advocates its role in multi-stress tolerance. Heterologous expression of EcHMR from Eichhornia rescued Cd(2+) sensitive E. coli mutants from Cd(2+) toxicity and induced better recovery post abiotic stresses. This may suggests a possible role of Echmr in Cd(II) and desiccation tolerance in plants for enhanced stress response.

Cardiovascular function in healthy Himalayan high-altitude dwellers.

BACKGROUND: Residents of the Himalayan valleys uniquely adapted to their hypoxic environment in terms of pulmonary vasculature, but their systemic vascular function is still largely unexplored. The aim of the study was to investigate vascular function and structure in rural Sherpa population, permanently living at high altitude in Nepal (HA), in comparison with control Caucasian subjects (C) living at sea level. METHODS AND RESULTS: 95 HA and 64 C were enrolled. Cardiac ultrasound, flow-mediated dilation (FMD) of the brachial artery, carotid geometry and stiffness, and aortic pulse wave velocity (PWV) were performed. The same protocol was repeated in 11 HA with reduced FMD, after 1-h 100% O2 administration. HA presented lower FMD (5.18 ± 3.10 vs. 6.44  ±  2.91%, p = 0.02) and hyperemic velocity than C (0.61 ± 0.24 vs. 0.75 ± 0.28 m/s, p = 0.008), while systolic pulmonary pressure was higher (29.4 ± 5.5 vs. 23.6 ± 4.8 mmHg, p < 0.0001). In multiple regression analysis performed in HA, hyperemic velocity remained an independent predictor of FMD, after adjustment for baseline brachial artery diameter, room temperature and pulse pressure, explaining 8.7% of its variance. On the contrary, in C brachial artery diameter remained the only independent predictor of FMD, after adjustment for confounders. HA presented also lower carotid IMT than C (0.509 ± 0.121 vs. 0.576 ± 0.122 mm, p < 0.0001), higher diameter (6.98 ± 1.07 vs. 6.81 ± 0.85 mm, p = 0.004 adjusted for body surface area) and circumferential wall stress (67.6 ± 13.1 vs. 56.4 ± 16.0 kPa, p < 0.0001), while PWV was similar. O2 administration did not modify vascular variables. CONCLUSIONS: HA exhibit reduced NO-mediated dilation in the brachial artery, which is associated to reduced hyperemic response, indicating microcirculatory dysfunction. A peculiar carotid phenotype, characterized by reduced IMT and enlarged diameter, was also found.

Is routine hospital visit after day case inguinal hernia surgery in children necessary?

BACKGROUND: To observe the prospects of day case inguinal hernia surgery in children without routine postoperative hospital visits. The aim was to access the advantages, acceptability and safety of this change in practice in low resource country like Nepal. METHODS: This was a cross-sectional study in a tertiary care general teaching hospital. Thirty children aged 6 months to 14 years who had elective day case Inguinal Hernia surgery from May 2011 to Oct 2011 were prospectively observed. Children with obstructed hernia, un-descended testis were excluded. Parents were counseled for omission of routine hospital visit after surgery. Main outcome measures were to observe unplanned hospital visit, reasons for visit, post-operative pain, wound infection and overall satisfaction of parents interviewed by telephone. Study was approved by institutional review committee. RESULTS: There were 28 boys and two girls. Average age was five years. Right Inguinal Hernia patients were 19 in number while 11 patients had left sided hernia. None of the children visited health facility for pain or wound problem. Two children were brought to outpatient because they were mistakenly given appointment slip. Mother noticed recurrence and brought one child to surgical outpatient. All 30 parents responded to telephone enquiry and were satisfied. CONCLUSIONS: Routine follow up visit after day care Inguinal Hernia surgery in children is not necessary. This practice is safe, economic and well accepted by children and parents.

Ocular trauma in patients presenting to Dhulikhel Hospital.

BACKGROUND: Ocular trauma is an important cause of blindness and ocular morbidity throughout the world. Prevalence studies help to define the target group, plan strategies and thereby lessen trauma related blindness in the country. OBJECTIVE: To identify the risk factors for ocular trauma, those at risk, describe the visual acuity at time of clinical presentation, and assess the nature and severity of ocular trauma in patients presenting to Dhulikhel Hospital emergency department and eye OPD with ocular trauma. METHODS: It is a descriptive and prospective study of all the patients with ocular trauma presenting to Dhulikhel Hospital from December 2009 to December 2010. A complete history and detailed ophthalmologic evaluation was done and noted down. RESULTS: There were 112 subjects with ocular trauma. Mean age was 28.43+/-16.36 years with a range of one year to 74 years. Males predominated with 72.3% frequency (p less than 0.001). Incidence peaked in third decade of life (p less than 0.01). Ocular trauma peaked in months of September and October. Presenting visual acuity better than 6/12 was noted in 83.9% of cases whereas 2.7% of cases had visual acuity of less than 3/60. Household (56.3%, p less than 0.001) was the commonest place of injury with wooden objects (19.6%) being the commonest object of injury. Most of the injuries were mechanical (85.7%, p>0.001). CONCLUSION: Blunt injuries were more common in young males. Household and workplace were common location of ocular injuries. Public awareness and strict legislation to use personal protective devices can help to reduce the occurrence of ocular injury.

Bacterial conjunctivitis and of antibiotics in Dhulikhel Hospital-Kathmandu University Hospital.

BACKGROUND: Acute Infective Conjunctivitis may be due to viral or bacterial infection; though it is usually self limiting, topical antibiotics are often prescribed for rapid recovery. OBJECTIVES: This study aims to find out prevalence of bacterial infection among cases of acute infective conjunctivitis and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents and to find out whether the rampant use of topical antibiotics are at all necessary or justified. METHODS: A prospective analytical study conducted over a period of two years on clinically diagnosed cases of Acute Infective Conjunctivitis. Isolation and identification of microorganisms by culture and antimicrobial susceptibility test were done on conjunctival swabs from 65 patients. RESULTS: A total of 65 patients were included where children (one month to 10 years old) accounted for the commonest age group (35.4%).On Gram Stain, 90.8% were negative for pus cells or micro organisms. Gram positive cocci were found in 6.2% of cases. On culture, bacterial growth was seen in 11 cases (18.9%) among which Streptococcus pneumonia was seen in seven cases (10.8%).The analysis on in-vitro susceptibility testing showed that Chloramphenicol and Gentamicin were the most sensitive (78.6% of samples) drugs for conjunctivitis. CONCLUSION: Ophthalmic antibiotics should be prescribed judiciously in acute infective conjunctivitis even for suspected bacterial cases; since it is found to resolve spontaneously without any serious complications. Chloramphenicol and Gentamicin are drugs of choice if at all required.

Refractive errors and visual anomalies in school children in the Kavrepalanchowk District.

BACKGROUND: Schoolchildren form an important target group for a nation, as any ocular morbidity in this age group has huge physical, psychological and socio-economical implications. Childhood eye disorders can contribute to the burden of blindness in any society. This study aims to highlight the prevalence of ocular morbidity in governmental schools in a sub-urbanised area of Nepal, in relation to ethnic variation. METHODS: A descriptive study, and the study population used were schoolchildren who were examined in their schools and afterwards referred to the hospital if required. Presenting and best corrected visual acuity, refraction, binocularity assessment, anterior and posterior segment evaluation was carried out. Data was analysed statistically using SPSS software, version 14. RESULTS: We examined 1,802 school children. The mean age was 10.78 ± 3.61 years. Ocular abnormality was detected in 11.7%. Low vision and blindness was rare (0.11% and 0.05%). Ocular morbidities were more common in Newar communities (3.71%) followed by Brahamans (3.38%). Lid abnormalities were the most common (3.55%), and morbidities in each ethnicity were followed by refractive errors (3%), conjunctival abnormalities (1.10%), strabismus (0.88%) and amblyopia (0.33%). Refractive errors were most common among Newar communities (1.16%) at almost twice as many Brahamans (0.61%) followed by Mongolians (0.49%). Convergence insufficiency was detected in 2.49% (p less than 0.01). CONCLUSIONS: Ocular morbidities are common in children in Kavhrepalanchowk District with lid abnormalities being the most common issue, probably due to a lack of hygienic practice. Ethnic variation of ocular morbidities is an important observation mostly for refractive error and strabismus.

Computed tomography guided percutaneous transthoracic fine needle aspiration cytology in chest masses.

A retrospective, hospital based descriptive study was done to know the pathological spectrum of thoracic lesions and to correlate the radiological findings with cytological findings obtained from computed tomography guided percutaneous transthoracic fine needle aspiration of chest mass. The clinical, radiological and cytological data of 100 patients were studied who underwent CT guided FNAC from May, 2004 to May, 2007. Diagnostic accuracy of FNAC is 82%. Cytological examination showed that 51 cases were malignant and 31 cases were benign. Provisional diagnosis based on radiological findings were 50 and 32 cases of malignant and benign lesions respectively. Sensitivity and specificity, positive and negative predictive value of radiological findings in this study was 88%, 84%, 90% and 81% respectively. Post procedure complication were (a) pneumothorax in two cases and both the cases had to be hospitalized for active management (b) minimal perilesional hemorrhage and hemoptysis in three cases and (c) chest pain in six cases. CT guided FNAC is a simple and safe procedure with high diagnostic accuracy in the evaluation of focal chest lesions. Pneumothorax, perilesional hemorrhage, hemoptysis and chest pain are the usually encountered complications. Very few cases of complication require active management.

Detection of Dientamoeba fragilis by culture.

Symptoms associated with Dientamoeba fragilis include diarrhoea, abdominal pain, nausea, vomiting, epigastric pain and weight loss. A possible link between D. fragilis and irritable bowel syndrome (IBS)-like symptoms has been reported, and therefore the presence of this parasite should be excluded before making a diagnosis of IBS. Over a six-month period, 976 faecal samples were submitted to NPHS Microbiology Aberystwyth for routine microbiological analysis. All samples were also cultured for parasites using Robinson's xenic medium. Trichrome staining was undertaken whenever practicable, but many stools had insufficient material. D. fragilis was isolated from 25 (2.6%) patients, whereas Cryptosporidium spp. was detected in 16 (1.6%) patients. D. fragilis was only detected in nine (1.3%) out of 685 specimens stained with trichrome, although four of the 25 culture-positive stools had insufficient sample for staining. Parasite culture proved to be less laborious than trichrome staining and dramatically increased D. fragilis detection rate.

Incidence of Blastocystis hominis in faecal samples submitted for routine microbiological analysis.

Over a one-year period, 1390 faecal samples were submitted to Aberystwyth Public Health Laboratory for routine microbiological examination. All were stained using a commercial trichrome method. Blastocystis hominis was detected in 96 (6.9%), making it the most common parasite found in the study. Of the B. hominis-positive specimens, 73% were missed on direct microscopy. Molecular typing of B. hominis has revealed extensive genetic diversity in morphologically identical strains and thus detection by microscopy alone may not be sufficient to confirm the role of this organism in human disease.

Changing approaches to mountain watersheds management in mainland South and Southeast Asia.

Mountain watersheds, comprising a substantial proportion of national territories of countries in mainland South and Southeast Asia, are biophysical and socioeconomic entities, regulating the hydrological cycle, sequestrating carbon dioxide, and providing natural resources for the benefit of people living in and outside the watersheds. A review of the literature reveals that watersheds are undergoing degradation at varying rates caused by a myriad of factors ranging from national policies to farmers' socioeconomic conditions. Many agencies--governmental and private--have tried to address the problem in selected watersheds. Against the backdrop of the many causes of degradation, this study examines the evolving approaches to watershed management and development. Until the early 1990s, watershed management planning and implementation followed a highly centralized approach focused on heavily subsidized structural measures of soil conservation, planned and implemented without any consultation with the mainstream development agencies and local people. Watershed management was either the sole responsibility of specially created line agencies or a project authority established by external donors. As a consequence, the initiatives could not be continued or contribute to effective conservation of watersheds. Cognizant of this, emphasis has been laid on integrated, participatory approaches since the early 1990s. Based on an evaluation of experiences in mainland South and Southeast Asia, this study finds not much change in the way that management plans are being prepared and executed. The emergence of a multitude of independent watershed management agencies, with their own organizational structures and objectives and planning and implementation systems has resulted in watershed management endeavors that have been in complete disarray. Consistent with the principle of sustainable development, a real integrated, participatory approach requires area-specific conservation programs that are well incorporated into integrated socioeconomic development plans prepared and implemented by local line agencies in cooperation with nongovernment organizations (NGOs) and concerned people.

Changing farmers' land management practices in the hills of Nepal.

This paper sheds light on changing farmers' land management practices in two mountain watersheds, with and without extemal assistance, in the western hills of Nepal. Information used in the analysis were obtained through a survey of 300 households, group discussion, key informant interviews, and field observation conducted during April-September 1999. Confronted with ever-decreasing landholding size due to a steadily growing population and scarcity of nonfarming employment opportunities, farmers in both watersheds have increasingly adopted assorted types of structural and biological measures to control soil erosion, landslides, gully expansion, and soil nutrient loss to maintain or even enhance land productivity. Adoption of guly control measures, construction of the retention walls, alley cropping, use of vegetative measures for landslide control, mulching, and use of green manure and chemical fertilizers are found significantly high in the project area due to the provision of technical and financial support, whereas composting is found significantly high in the nonproject area. Different from the traditionally held beliefs, population pressure on a finite land resource has brought positive change in land management. However, the experience from both watersheds indicates that there is limit to the extent that resource poor farmers can respond to land degradation without any extemal assistance. Required is the arrangement for appropriate polices and support services and facilities enabling farmers to adopt locationally suitable and economically attractive land management technologies.

Issues in natural resources management in developing countries.

PIP: The use and management of public and private natural resources is greatly affected by institutional, politicoeconomic, and socioeconomic factors. These factors operate in tandem at the household, regional, national, and international levels in affecting resource management. Any policy that focuses only on one dimension of the problem, such as population growth, and ignores such issues as poverty, environmentally unsuitable cropping systems, and the unavailability of nonfarm employment opportunities will be inadequate. National policies must consider structural factors: resource use, property rights regimes, poverty, unemployment, illiteracy, and population growth. A comprehensive strategy should account for these structural features, be tailored to regional circumstances, and have the input of local governments. Local governments and communities must be in a position to implement and monitor resource management. Hardin identified common property as a major contributor to land degradation and declining forest resources in developing countries. Only with a common agreement by the community to invest in planting trees and managing pastures can communal lands benefit multiple users in the long and short run. Social forestry projects have failed due to poor community participation, fragmented communities, poor social organization, and disputes over the distribution of profits. Traditional communal hunting and gathering activities adhered to institutional regulation; with the inception of urbanization, industrialization, and monetization of agriculture, the destruction of forests and pasture began. There was an increased need for food for the urban population; a small and powerful group of politicians, social leaders, and administrators retained access to public or "crown" lands and disenfranchised small and marginal farmers and the landless poor from previously accessible lands. Land redistribution schemes have not effectively distributed land resources. Commercial business and forestry managers are all responsible for deforestation. Land management is affected by personal, perceptual, attitudinal, social, economic, and institutional factors.^ieng

Impacts of emigration on mountain watersheds: the upper Pokhara Valley, Nepal.

"Confronted with adverse physical conditions, marginal landholdings and scarce non-farming employment opportunities, farmers in the Upper Pokhara Valley had opted for temporary emigration as an alternative strategy for fulfilling their subsistence requirements. This had caused somewhat malign effects on watershed due to dwindling farm management practices and increasing dependency on common resources.... Findings of this study are envisaged to be conducive to the formulation of a comprehensive watershed management strategy, including population planning....[It is suggested] that both overpopulation and depopulation could be instrumental in watershed degradation, especially in mountainous areas where labor is a critical factor in the use and management of farmlands."

Population and environment in the hills of Nepal.

PIP: This article examines how the people in the hills of Nepal, in spite of their physical and economic isolation from the national mainstream, could manage their economic activities for such a long time without any heavy environmental stress. The major proportion of Nepal's population lives in the hills. In the early 1900s, the population in the hills was small in absolute numbers. The population grew during the 1900s, despite continuous out-migration. Under present circumstances, the hills of Nepal do not allow any further intensification of cropping because of the zone's high elevation, steep slopes, poor soils, and high level of precipitation. The hills were mostly bypassed in terms of policy and planning until the beginning of the 5th Five Year Plan period (1976-1980), when development plans were drawn up and budget allocations were made on a regional basis. Because of concentration on agriculture in the plains, nonfarm employment opportunities barely exist there. Strategies the hill people have used to cope with the limited carrying capacity of land resources and few alternative employment opportunities include 1) expansion of agricultural lands into marginally suited areas, 2) enlarging the size of their livestock herds, 3) out-migration, and 4) collection of fuel wood. These practices have led to the deterioration of the ecological balance. The hill people are reluctant to adopt family planning because a small family size puts heavier pressure on the household economy and its available labor force. To stabilize the economic and environmental systems and to control accelerated population growth in the hills, a comprehensive development program must be worked out, focusing on alleviating pressure on the fragile resource system. The strategy would include 1) agricultural development, 2) implementation of an integrated agrarian and land reform program, 3) promotion of non-farm employment opportunities, 4) population control, and 5) people's participation in decision-making and planning. Watersheds are the appropriate spatial planning units for regional development planning processes.^ieng

Resettlement experiences and alternatives in Thailand.

Problems concerning the resettlement of those made homeless by the construction of dams to create reservoirs in Thailand are considered. The authors attempt "firstly, to examine the rationale for spontaneous and planned resettlement in Thailand. Secondly, the determinants of the success or failure of resettlers are explored with reference to selected planned resettlement projects. Finally, resettlement alternatives for prospective reservoir evacuees are proposed."