Evaluation of the XpertMTB/RIF for the Diagnosis of Pulmonary Tuberculosis Among the Patients Attending DOTS Center Parsa District of Nepal

Tuberculosis diagnosis and monitoring rely in Sputum microscopy of National Tuberculosis Programme, Nepal because of its low cost and easier to perform. Direct sputum microscopy is popular worldwide. Currently, there are 533 microscopy centres catering for sputum microscopy examination throughout the country. Most of the microscopy centres are established within government jurisdiction and remaining are established as non-governmental organization as well as private sectors.A cross-sectional study was conducted from July 2013 to January 2015. A total of 2091 patients were enrolled in the study who were attending the DOTS Centre in Parsa District of Public Health Office, Nepal. Smears stained with ZN stain methods were examined microscopically followed by the GeneXpert MTB/RIF assay.Out of 2091 suspected pulmonary TB patients enrolled for sputum microscopy and GeneXpert MTB/RIF for the confirmation of TB, the 1301(62.21%) were male and 790 (37.78%) were female. The maximum TB cases were from Parsa district (555, 26.5%). The comparative study of different diagnostic tools reveals the sensitivity of MTB/RIF was 95.50% (91.87, 97.82) and significantly higher than smear microscopy performed on the same fluid, which had a sensitivity of 61.97% (55.41, 68.21). Five of 127 smear-negative cases had MTB/RIF-positive un-centrifuged sputum, resulting in a specificity of 81.23% (75.95, 85.78), which was similar to smear microscopy 98.29 % (97.34, 98.97; p=0.121). The positive predictive value (PPV) and negative predictive value (NPV) of MTB/RIF were 96.85% (93.61, 98.72) and 94.95 % (93.52, 96.14), respectively. HIV co-infection did not impact sensitivity, specificity or liquid culture time to positivity (TTP). When MTB/RIF accuracy was evaluated using composite reference standard culture positivity from sputum, the sensitivity and specificity were similar to those obtained in the primary analysis using either definite TB versus possible and non-TB combined; definite and possible TB combined versus non-TB

Pattern of Cancer in Nepal from 2003 to 2011

Correction: On 15th January 2017, the authors Sunil Kumar Sah and Naval Kishor Yadav were added to the author list.Cancer is global burden of disease in developed and developing countries. It is one of the main causes of death. The environmental factor and life styles are major causes of cancer.This hospital based retrospective study was carried out using data retrieved from the register maintained at seven cancer centers. The most common basis of diagnosis were microscopic (histopathological and cytopathological examination). The diagnosis was also based on clinical examination, radiological examination, endoscopy, biochemical and immunological tests.Most of the cancer cases were diagnosed at BPKMCH (23908) followed by BPKIHS (9668) and BH (5959) and few cases from KCH (518) in 2003 to 2011. The total number of cancer cases were increasing from 2003 to 2011 and it become double in 2011. Out of 75 district of Nepal, more number of cancer cases was found in Kathmandu, Sunsari, Morang, Chitwan, Lalitpur, Jhapa, Kaski, Nawalparasi, Rupendehi and Kavrepalchowk in 2010. Similarly, in 2011 more number of cancer cases was found in Kathmandu, Morang, Jhapa, Sunsari, Chitwan, Lalitpur, Rupendehi, Kaski, Saptari, Bhaktapur. Lung cancer was the common cancer and similarly, other prevalent cancers were cervical, breast, stomach, ovarian and colo-rectum cancer in 2003 to 2011. The common cancers were lung, cervical, breast, stomach, ovarian and colo-rectum. The number of patients is increasing, which may be due to change in life style and lack of education

Dengue periodic outbreaks and epidemiological trends in Nepal

Abstract Dengue is a global health problem and expansion of its endemics towards new territories in the hilly regions in Nepal is a serious concern. It appeared as a new disease in Nepal in 2004 from Japanese traveler with sporadic cases every year and massive outbreaks in 2010, 2013 and 2016. The serotype was responsible for outbreak in particular year was dengue virus serotype-1 (DENV-1) in 2010, 2016; and DENV-2 in 2013. Nepal lacks basic health related infrastructure in rural areas and does not have a stringent health care policy. With severances of epidemic like dengue, a new surveillance or an upgrading of existing one are direly needed to better challenge the possible outbreaks. This review paper aims to explain the dengue trend in last one decade in Nepal and warrants concerted and timely public health interventions to minimize the deleterious effects of the disease

First day serum bilirubin level, as predictor of significant hyperbilirubinemia in neonates

Background: Age-specific (24 ± 6 h) predictive value of total serum bilirubin (TSB) ≤6 mg/dl in developing significant hyperbilirubinemia in infants. Materials and Methods: A prospective observational study on 200 term neonates having birth weight ≥2500 g and gestational age ≥37 weeks. Blood was collected from the venous site. The blood sample of all infants was sent for grouping and TSB estimation. Babies were clinically examined every day for jaundice. Whenever jaundice was clinically noticed to be >10 mg/dl, bilirubin estimation was repeated immediately and then every day until 5 days of age, and the highest reading was recorded as the peak TSB. Results: Significant hyperbilirubinemia (>17 mg/dl) was present in 13% of cases. At 24 ± 6 h, TSB >6 mg/dl was present in 47 cases and 26 of these developed hyperbilirubinemia (≥17 mg/dl), and TSB ≤6 mg/dl was present in 153 cases and two of them developed significant hyperbilirubinemia. The incidence of hyperbilirubinemia in babies whose mothers received oxytocin and those whose mothers did not receive oxytocin was 19.6% and 8.2%, respectively. The difference was highly significant. The mean values of TSB at 24 ± 6 h in oxytocin used and oxytocin not used groups were 3.94 ± 2.15 mg/dl and 3.36 ± 1.91 mg/dl, respectively, the difference was statistically significant; however, the mean values of peak TSB in oxytocin used and not used groups were 12.78 ± 4.28 mg/dl and 12.03 ± 3.42 mg/dl, respectively, which were statistically not significant. Conclusion: The incidence of significant hyperbilirubinemia in healthy babies is 13%. The use of oxytocin increased its incidence. TSB at 24 ± 6 h ≤6 mg/dl has a high predictive value in identifying those infants who are unlikely to develop subsequent hyperbilirubinemia. This study, thus, will help to discharge healthy term infants with TSB on 2nd day ≤6 mg/dl

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