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Background The present Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum under Tribhuvan University - Institute of Medicine (TU-IOM) was last revised twelve-years back. Though the curriculum was built upon internationally approved recommendations on curriculum design, it is ineffectively practiced in most medical schools of Nepal with major focus on didactic teaching-learning. The curriculum, hence, needs effective implementation and revision. Objective To identify the strengths, weaknesses, and areas of improvement in the medical curriculum through student-based feedback and outline the possibility of incorporating newer evidence-based teaching-learning methodologies in Nepal. Method This is a descriptive and cross-sectional study. With appropriate ethical approval, a questionnaire was developed and disseminated virtually to all medical students of Nepal under TU from MBBS fourth year onwards. The questionnaire comprised of Likert and close-ended questions. The data analysis was followed after receiving the filled questionnaire through Google forms. Result A total of 337 respondents participated in the study. The most effectively implemented components out of the SPICES model were Integrated learning (I) and Community-based learning (C), with 73.89% and 68.84% responses. There were 94.7% (319) students who favored the incorporation of research in the core curriculum. Only 34.2% (115) students found PowerPoint lectures, the most utilized form of teaching-learning in Nepal, as engaging. The respondents (84.6%) showed a high degree of readiness to incorporate newer evidence-based teaching-learning tools such as flipped learning, blended learning, and peer-to-peer learning. Conclusion This study shows that effective interventions must be rethought on various aspects of the curriculum, taking students’ feedback on the table while considering curricular revision.

An experiment was conducted in the Kailali district to study the performance of wheat genotypes under different sowing from December, 2017 to April, 2018. The field experiment was conducted in Randomized Complete Block Design with a total of 18 treatments consisting of 2 dates of sowing (November 4 and November 20 ) and 9 wheat genotypes(WH1105, HD2733, HD2824, HD2967, Borlaug100, HD3086, PBW550, NL971 and PBW373). Grain yield (5.802 ton/ha),spike length(17.94 cm) and biomass yield(13.16 ton/ha) of NL 971 was highest. HD 2733 had highest number of effective tillers (519.1/ m2) while number of grains per spike(59.80) was highest in HD 2967. PBW 373 had lowest grain yield (4.551 ton/ha), Borlaug 100 was the variety with minimum number of tillers per m2 area (401.3), minimum spike length(15.14 cm) was observed in HD 2733 ,HD 3086 had lowest no. of grains per spike(42.12). Grain yield(5.328 ton/ha) , effective tillers per m2(475.5) , spike length(16.95 cm), number of grains per spike (53.12), biomass yield(11.45 ton/ha) was recorded maximum in wheat sown on 20th Nov. Grain yield (4.893 ton/ha),effective tillers(435.1), spike length(15.66 cm), grains per spike(49.59) and biomass yield(10.49 ton/ha) was recorded minimum in wheat sown on 4th Nov. Maximum test wt. (50.83 g ) was found in HD 2733 of 20th Nov. and the lowest test wt. (40.47 g) was found in PBW 550 of 20th Nov.

Among different factors, tillage and weed management are two important factors that influence remarkably the growth and yield of maize. The present review reveals that Echinochloa colona L. is the most dominant weed species with an importance value index (IVI) of 41 followed by Papaver rhoeas L. (32.6), Descurainia Sophia L. (22.27) and Polygonum aviculare L (16.16) in no-till maize. Wider spacing and initial slow growth of maize during the first 3-4 weeks provides enough opportunity for weeds to invade and offer severe competition, resulting in 60-81% in maize yield losses. The shift of the weed population towards perennial was observed under NT. Species like Xanthium strumarium, Solanum nigrum, Euphorbia helioscopia, Convolvulus arvensis, Sorghum halepense, Digitaria sanguinalis, Sonchus oleraceus and Euphorbia vermiculata were associated with no-till Zea mays. The highest weed seed density was found in conservation agriculture practices (no-tillage, no-fertilizer and no-herbicide use) with the highest seed distributed in 0-1 cm depth followed by 1-3 cm depth. Weed control efficiency of Nicosulfuron @0.90 kg/ha was found the highest (98.8%) followed by Atrazine + Tembotrione + Atrazine (@1 kg/ha + 120 g/ha + 0.5 kg/ha) (98.7%) and Tembotrione + atrazine (@ 120 g/ha + 0.5 kg/ha) (96.5%), therefore were very effective in controlling weed in no-till Zea mays.

Short note

A field experiment was carried out at Rajapur, Bardiya Nepal to determine the effect of different biofertilizers on the yield of spring rice (Oryza sativa L.). Five different combinations of biofertilizers and chemical fertilizer viz. T1 (Azolla + N:P:K @50:15:15 kg ha-1), T2 (Azotobacter+ N:P:K @50:15:15 kg ha-1), T3 (Azotobacter +Mycorrhiza + N:P:K @50:15:15 kg ha-1), T4 (Azotobacter + Phosphorus Solubilizing Bacteria+ Potassium Mobilizing Bacteria+ N:P:K @50:15:15 kg ha-1) and T5 (Recommended chemical fertilizer i.e. N:P:K @100:30:30 kg ha-1) was used. The experiment was laid out in a simple RCBD design with four replications and 3mˣ2m individual plot size. The hardinath-1 variety was used for the experiment. Biometrical observations like plant height (99.92 cm), number of tillers (355.62 m-2) were found significantly highest in T1 (Azolla + NPK@50:15:15 kg ha-1). Similarly, yield attributing characters such as the number of effective tillers (340 m-2), number of filled grains per panicle (114.30), highest panicle length (28.42 cm) was found significantly the highest in T1 (Azolla + NPK@50:15:15 kg ha-1). The highest grain yield (8.46 ton ha-1), straw yield (12.6 ton ha-1), and harvest index (0.40) were also observed on T1 (Azolla + NPK@50:15:15 kg ha-1). Benefit cost ratio was also found highest on T1 (Azolla + NPK@50:15:15 kg ha-1) which was 2.05 incurring the cost of cultivation Rs 72035 per hectare returning the total revenue of Rs 148190 per hectare. The study shows that the application of T1 (Azolla + NPK@50:15:15 kg ha-1) was the best fertilizer combination for spring rice production as it was superior over other fertilizer combinations in terms of yield and yield attributing characters with the highest benefit cost ratio. SAARC J. Agric., 19(1): 57-69 (2021)

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Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension. Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Weed is one of the major constraints for success of dry direct seeded rice (DDSR) technology. The productivity, weed density and weed dry weight of DDSR is influenced by weed management practices. A field experiment was done to evaluate tillage methods and weed management practices on weed dynamics and yield of DDSR using split plot design; each treatment replicated thrice. The treatment consisted of two tillage methods in the main plots, and eight weed management practices in the sub-plots. Gorakhnath-509 was the variety of rice used. Weed flora observed in the experiment comprised of 25 weed species, belonging to 12 families. Among them 12 were broadleaf weed, belonging to 10 families; 8 were grasses, belonging to Poaceae family, and the rest 5 were sedges, belonging to Cyperaceae family. Tillage methods did not influence weed density and weed dry weight in DDSR, but weed management practices reduced weed density and dry weight at all dates of observation compared to weedy check. All the weed management practices significantly improved the grain yield of DDSR in both tillage methods. Treatments with higher grain yield of DDSR were, use of pendimethalin followed by hand weeding (3,742 kg ha-1); pendimethalin followed by bispyribac-Na (3,552 kg ha-1), and pendimethalin followed by tank mixture application of bispyribac-Na and ethoxysulfuron(3,638 kg ha-1), but were statistically similar (p>0.05). Results thus supports the fact that application of popular pre-emergence herbicide- pendimethalin followed by manual weeding, or post-emergence herbicide, such as Bispyribac-Na, or tank mixture of post emergence herbicides bispyribac-Na and Ethoxysulfuron could be the most effective weed management practices in both tillage method of rice cultivation.

Background: Gastrointestinal stromal tumors (GIST) are rare of all gastrointestinal neoplasms with histology and immunohistochemistry similar to gastrointestinal stromal tumors. They occur outside the gastrointestinal tract rarely and are, hence, called the extra gastrointestinal stromal tumors (EGIST). Herein, we report a rare case of malignant extra intestinal gastrointestinal tumor. Case report: A 39 yr old female presented to the surgical OPD with a lump in the abdomen since 4 months. We received a lobulated tumor which measured 40x25x20 cm3 and showed capsule. Cut surface was predominantly solid, grey white with areas of hemorrhage and necrosis along with cystic areas. Histopathology and immunohisto chemistry revealed it to be a malignant EGIST of mesentery because of no continuity of the tumor with the small intestine microscopically. Conclusion: EGIST is a rare no epithelial tumor of mesentery. Omentum histopathological examination is a standard technique to diagnose the tumor and to differentiate it immunohistochemically from other tumors having similar morphology. Correct diagnosis plays valuable role in the treatment.

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting. Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center. Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery. Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension.Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%. Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

We present a case of 29 years lady with secondary infertility and amenorrhea. Her clinical findings were normal. Her hormone assays and ultrasonography was normal. She underwent hysteroscopy which showed atrophic endometrium and PCR for mycobacterium tuberculosis was sent which was reported positive for Mycobacterium tuberculosis. She was diagnosed as a case of Endometrial tuberculosis. Anti tuberculosis therapy was started for six months. After the completion of medical therapy she spontaneously conceived and delivered a healthy full term baby. Tuberculosis is a major public health problem among developing country like Nepal.

The status quo of the land management and information system in Nepal is a far cry from where the developed world stands. Paper-based system is still the spine of this system which is tedious, less accurate and difficult to store and update. So, there is a need for a digitized system providing country’s land authorities with a powerful tool that creates a unified platform for the creation of an accurate spatial database, timely maintenance and updating of the database in a dynamic web platform. The database including spatial data of land features can be utilized to create a web-based thin-client mapping application which meets the needs of all the stakeholders (government authorities from Survey Offices, Land Revenue Offices, Land Reform Offices, etc.). This paper shows the use of open-source software for the creation of a web mapping system including QGIS, PostGIS extension of PostgreSQL for spatial database, HTML for markup, CSS for styling, JavaScript, Leaflet, Open-Layers for client-side scripting and Geo-Django for backend designing. The developed methodology can be utilised for the preparation of an interactive thin-client web mapping server that enables general users to dynamically view data, zoom, pan and search from the database and obtain land information. The login system enables administrators with various access to upload, verify and edit data along with performing various spatial operations while the super admin is entitled to access to the PostgreSQL database. The major finding is that the use of a thin client application for a land information system is beneficial for all stakeholders. It is also a measure of the performance of land authorities allowing better planning, preparedness, and allocation of resources.

The strength and deformational behaviour of rocks under loading conditions are important in underground excavations, mining and every civil engineering constructions as it determines the stability of such structures. This study aims to augment the existing know-how on such behaviour through analysis of point load tests conducted on anisotropic rocks of metamorphic nature. Three types of anisotropic rocks named augen gneiss, granitic gneiss, psammitic schist, and greenschist from different formations of the Lesser and Higher Himalaya of Central Nepal have been investigated. It is observed that the point load index strength of the anisotropic rocks is related to their grain size and the loading angle with respect to the planes of anisotropy. The anisotropic index shows pronounced effects on the surface energy distribution of the samples on the application of stress.

Introduction: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. Palliative care must be a part of every medical personnel’s practice. But still medical education curriculums have not included palliative care in its syllabus, sufficiently due to which most of the health professional are not aware about this specialty. The purpose of this study is to find out the perception of the medical students in palliative care in a teaching hospital. Methods: A descriptive study was done among 270 undergraduate medical students studying in Institute of Medicine using a self structured pretested questionnaire. Data was entered in Microsoft Excel and analyzed by using SPSS 21. Results: Of the total 270 undergraduate medical students only 152 has heard the word “palliative care”. Only 84 students know, palliative care can be provided early in the life threatening illness. Total 80 students know it doesn’t intend to postpone and hasten death. Though only 49 students didn’t know PC is not included in our curriculum, 227 are interested to learn about it if given any opportunity. Conclusions: The perception of palliative care medicine is low in first couple of year of medical study. It is increased in clinically exposed students but is surprisingly more in fourth year than final year undergraduate medical students. However, it should be included in undergraduate medical study. Keywords: medical students; palliative care; perception.

Alpha-1 antitrypsin (AAT) deficiency is a clinically under recognized inherited disorder. The main clinical manifestations relate to three separate organs: the lung, the liver, and the skin. In the lung, severe deficiency of AAT predisposes to chronic obstructive pulmonary disease. We present a case of 34 years male with a history of recurrent chest infections in past and treated in the line of bronchial asthma but not relieved. He was admitted on 22nd May 2011 at BPKIHS. He presented with type 2 respiratory failure and had features of severe pulmonary arterial hypertension and left lower lobe pneumonia. The patient got improved with the treatment and is doing well on follow up. The diagnosis should be strongly suspected in patients with history suggestive of bronchial asthma and with obstructive features.Journal of Advances in Internal Medicine 2014;3(2):65-67

Use of improved seeds has a vital role in enhancing agricultural production. Agriculture extension has implemented farmers’ managed seed multiplication program at the community level to ensure efficient supply of improved seeds. Several success and failure cases of seed multiplication through farmers' organizations were experienced. Therefore, a case study was conducted in the western terai region of Nepal to explore the factors responsible for success/failure of farmers' organizations involved in seed production. The results of the study found that internal factors of group, nature of extension support, quality control mechanism, and seed marketing approaches are the key elements, which affect the performance of farmers' organizations- seed groups and cooperatives. It was also observed that organizations developed in farmers' own initiatives performed better than those formed in external influence. The results of this research suggest that the autonomy of group actions has long term impact on ownership development. Business skills, technical skills and organizational management skills were equally important for the viability of farmers' organizations so far as seed business is concerned. Agronomy Journal of Nepal (Agron JN) Vol. 3. 2013, Page 156-167 DOI: http://dx.doi.org/10.3126/ajn.v3i0.9018

Background Hypertension is a major public health challenge in the world. Developing countries share the major burden of it. Unlike thought before, hypertension is increasing among poor, young and women. Methods It was a cross sectional study carried out in The Hypertension Screening and Awareness Program conducted in the shopping malls at the heart of Kathmandu on the occasion of World Hypertension Day 2012 by Shahid Gangalal National Heart Center, Kathmandu. The blood pressure was measured according to World Heart Organization’s guideline by registered nurses. There were total 486 participants with the mean age of 29.51±10.77years. Majority of the participants were male (67.1%). Most of the participants were less or equal to 40 years (84.6%). Mean systolic blood pressure was 112.3±14.69mmHg and mean diastolic blood pressure was 75.09±11.89 mmHg. Average mean blood pressure was 87.41±12.28mmHg in the study population. Results Despite majority of participants were at young age, prevalence of hypertension was 23.7%, pre-hypertension was 30% and 46.3% had ideal blood pressure according to JNC-7 Classification. Prevalence of hypertension was higher among male (30.39% vs. 10%). Almost two third of the hypertensive subjects were less or equal to 40 years (64.35%). Awareness, treatment and control of hypertension were 39.13%, 18.26% and 7.38% respectively. Conclusion In conclusion, Hypertension is an emerging public health challenge in urban areas of Nepal. Most importantly, it may be increasing among young population. Moreover, awareness, treatment and control rates are not satisfactory. DOI: http://dx.doi.org/10.3126/njh.v9i1.8346 Nepalese Heart Journal Vol.9(1) 2012 pp.33-36

INTRODUCTION: Refractive error is one of the causes of avoidable blindness. Myopia, hypermetropia and astigmatism are the common types of refractive error. Not many studies are done to detect pattern of refractive error in Western Nepal. So, the study will determine the prevalence and distribution of refractive errors. MATERIALS AND METHODS: A prospective study of all consecutive patients of age less than 40 years who visited eye department, Gandaki Medical College, between May 2010 and May 2011 was conducted. Visual acuity, naked eye and pin hole examination was done by ophthalmic assistant with cycloplegic refraction when needed. Those who did not turn up for refraction were excluded from the study. RESULTS: A total of 601 patients were seen within the study period. Mean age of male patients was 22.4 years }0.6 (95% CI, 21.2-23.6 years) and mean age of female patients was 24.2 years }0.5 (95% CI, 23.2-25.2 years). Majority of the patients were in age group 11-20 years (39.3%). Myopia was the most common refractive error (43.3%) followed by simple myopic astigmatism (23.8%). Refractive errors were more common in females. CONCLUSIONS: Myopia was the commonest refractive compared to hypermetropia. Refractive error was more common in females than in males. Such studies help to know the picture of refractive errors in community and such reports are helpful in planning programme to prevent avoidable blindness.DOI: http://dx.doi.org/10.3126/ijim.v2i2.8324 Int J Infect Microbiol 2013;2(2):59-63

The offspring of unilaterally cauterized (CAUT) and non-cauterized control (CTRL) sows were used to study the effects of increased uterine space on postnatal average daily gain (ADG), backfat and loin depth, mortality, and adrenocorticotrophic hormone (ACTH) induced cortisol response. At gestation day (D) 35, the total number of embryos was significantly decreased in CAUT sows (CAUT=9.1±3.0, CTRL=15.3±4.3; P =0.001). At birth, piglet weight (WT D0 ), gender, and morphometrics were recorded. Offspring were weighed at D21 of age, weaning, week (W) 7, 12, 16, and 19 of age. Average daily gain (ADG) was calculated during the lactation (ADG LACT ; 0–21days), up to weaning (ADG WEAN , 1–3W), nursery (ADG NUR , 3–7W), finisher (ADG FIN , 7–19W), and birth to market (ADG LIFETIME , 0–19W) periods. P2 backfat (BF) and loin eye (LOIN) depth were measured ultrasonically at 70 and 110 kg live weight. Saliva samples were collected from offspring following 5 IU/kg ACTH challenge at W12 and W20 of age. Offspring from CAUT sows were heavier than CTRL at birth and D21 ( P P =0.06). ADG LACT and ADG WEAN were higher in CAUT pigs ( P LACT had higher ADG LIFETIME ( P D0 . WT D0 however, was the most consistent factor affecting ADG in all growth periods assessed. We conclude that the postnatal growth benefits of additional uterine space associated with a reduction in intrauterine crowding are primarily mediated through increased birth weight. Moreover, improving lactational growth rate can help offset the poor lifetime growth rates of low birth weight piglets.

The Himalayan rivers have an enormous hydropower potential that is still not exploited fully for the benefit of the region. Bhutan and Nepal together have an economically feasible potential of 60,000 MW of hydroelectric power generation capacity but are too weak financially to bear the risks associated with the development of their hydro resources alone. India is the only potential market for the electricity supplied from these sources. The power purchase agreement framework for the 336 MW Chukha Hydel Project in Bhutan could serve as a model for the transfer of risks, management of risks and sourcing of finance in exchange for sharing the economic rents associated with such projects. India undertook the costs and risks of constructing the hydroelectric dam and power plant in exchange for a reduced purchase price of electricity from the completed facility. This paper contains a financial and economic assessment of the Chukha Hydel Project. While India is in a position to exercise monopsonic power in this electricity market, this analysis shows that it is possible to have an agreement for sharing the risks and returns between India and the Himalayan countries that is highly beneficial to all the stakeholders.

Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the first-line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 months after completion of therapy and explored the potential role of drug compliance, parasite drug resistance, and reinfection. Results. The initial cure rate was 95.8% (95% confidence interval [CI], 92.2-99.4) and the relapse rate at 6 and 12 months was 10.8% (95% CI, 5.2-16.4) and 20.0% (95% CI, 12.8-27.2), respectively. No significant clinical risk factors of relapse apart from age

The pore water pressure head that builds in the soil during storms is a critical factor for the prediction of potential slope instability. We report findings from a 3-year study of pressure head in 83 piezometers distributed within a 13-ha forested catchment on the northern coast of California. The study's primary objective was to observe the seasonal and storm-based dynamics of pressure head at a catchment scale in relation to observed rainfall characteristics and in situ topography to better understand landscape patterns of pressure head. An additional goal was to determine the influence of the interaction between rainfall and forest canopy in altering delivery of water and pressure head during the large storms necessary to induce landsliding. We found that pressure head was highly variable in space and time at the catchment scale. Pore pressures peaked close to maximum rainfall intensity during the largest storms measured. The difference between rainfall and throughfall delivered through the canopy was negligible during the critical landslide-producing peak rainfall periods. Pore pressure was spatially variable within the catchment and did not strongly correlate with surficial topographic features. Only 23% of the piezometers located in a variety of slope positions were found to be highly responsive to rainfall. Topographic index statistically explained peak pressure head at responsive locations during common storms, but not during the larger storms with potential to produce landslides. Drainage efficiency throughout the catchment increased significantly in storms exceeding 2 to 7 months peak pressure head return period indicated by slowing or cessation of the rate of increase of pressure head with increasing storm magnitude. This asymptotic piezometric pattern persisted through the largest storm measured during the study. Faster soil drainage suppressed pressure head response in larger storms with important process implications for pore pressure development and landslide hazard modelling. Copyright © 2012 John Wiley & Sons, Ltd.

INTRODUCTION: Very few reports exist regarding the causes of ocular morbidity in Western Nepal. The study is performed to identify the causes of ocular morbidity in a clinic at Waling in Western Nepal. MATERIALS AND METHODS: A retrospective study was done by reviewing the case records of all patients attending the eye clinic at Waling from August 2010 to August 2011. RESULTS: The study included 915 patients, 617 were females (67.5%), and 298 were males (32.5%). Refractive error was the most common ocular morbidity accounting 26.8% followed by conjunctivitis 20.6%, cataract 11.8%, pterygium 6%, chalazion/stye 4%, ectropion/entropion 3.9%, keratitis 3.8%, dry eyes 2.8%, and corneal opacities 2.3%. CONCLUSIONS: The study gives a picture and patterns of ocular disease in Western Nepal which will be helpful in planning & management of ocular health programmes in Nepal. DOI: http://dx.doi.org/10.3126/ijim.v1i1.6941Int J Infect Microbiol 2012;1(1):34-37

It is difficult to obtain phenotypic data on disease susceptibility directly from swine in an industry setting. The magnitude of the proliferative response of peripheral blood mononuclear cells (PBMC) to the T cell mitogen concanavalin A (Con A) has long been used as an indirect measure of the responsiveness of the immune system to antigenic stimulation. This trait is known to exhibit moderate heritability in swine, but little is known about the identity of the genes that control the response. In this study, we carried out a time-course microarray experiment to measure gene expression at 3 different stages (3, 20, and 68 h) poststimulation of PBMC with Con A. A total of 46, 452, and 418 differentially expressed (DifEx) genes were identified at each time point, respectively. Expression changes for a subset of these genes were subsequently confirmed by real-time PCR. Functional annotation analyses of the microarray results successfully identified sets of genes involved in processes associated with multiple aspects of cell division, such as DNA and protein synthesis, and control of mitosis. However, the discovery of genes that controlled the response of PBMC to mitogen was limited with this approach, because the drastic changes in the transcriptional program necessitated by cells undergoing division masked changes in smaller immune response gene sets. Pathway and network analyses that focused on immune cells proved to be a more effective strategy for the identification of genes that coordinate aspects of the mitogenic response that are specific to PBMC. The cytokine gene IL15 was shown to be central to the highest scoring network at 20 h and affect the expression of 16 other DifEx genes, including some genes known to regulate T cell activation, such as IL7R, JUN, TNFRSF9, and ZAP70. The IL15 gene maps to a previously identified QTL interval for immune responsiveness to Con A on SSC 8, which also contains the related IL2 gene. At 68 h, a distinct downregulation of major histocompatibility complex class II antigen presentation genes was observed. Overall, the gene expression profile of the Con A-stimulated porcine PBMC points to a Th(1) bias in immune activation. Further work is required to determine whether polymorphisms linked to genes identified in this study affect this immune response trait in pig populations and whether the trait itself correlates with decreased susceptibility to intracellular pathogens in swine.

Objectives To determine whether the measured change in score of a validated clinical severity scale reflected physician assessed improvement in individuals who had received corticosteroid therapy for leprosy associated nerve damage. Design Patients with nerve function impairment who participated in a randomised controlled trial of corticosteroids were classified into two groups using a retrospectively determined physician assessment of improvement. One group consisted of patients who had recovered or improved the other of patients who were unchanged or had deteriorated. The change in the clinical severity scale scores of these two groups was compared. Results The change in the clinical severity scale scores of the 34 eligible individuals in the two groups were significantly different (P = 0.003). Individuals in the group who recovered or improved had a greater change in severity score than those whose nerve function was unchanged or deteriorated. Conclusion The scale for measuring the severity of leprosy Type 1 reactions (T1Rs) and/or nerve function impairment reflects the clinical improvement of individuals with leprosy associated nerve damage.

BACKGROUND: Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions. OBJECTIVES: To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy. METHODS: Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured. RESULTS: We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment. CONCLUSIONS: This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.

Introduction: Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal. Methods: This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection. Results: A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed. Conclusions: There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect. Keywords: lateral epicondylitis; NSAIDs; physiotherapy; steroid; tennis elbow.