Introduction: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of renal replacement therapy.Methods:A community-based screening on, 3218 people ≥20 years were assessed by door-to-door survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney Disease was evaluated.Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusions: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. Findings indicate that activation a large prevention and intervention program to tackle Chronic Kidney Disease and Cardiovascular Disease in Nepal is needed.Keywords: chronic kidney disease; community-screening; diabetes; hypertension; intervention; Nepal.

Background and aims: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. Methods: One hundred and fifteen consecutive patients diagnosed as acute myocardial infarction and were below 45 years over the period of one year were enrolled in the study. Clinical parameters, risk factors, angiographic patterns were analysed. Patients were assessed daily during hospital stay to study in-hospital outcome and complications. Results: Out of total patients studied, 64.3% were smokers, 27.8% were hypertensive, 15.65% were diabetic and 9.6% had history of dyslipidemia. There was history of recreational drug abuse in 4.3% of patients. Most patients present as ST elevation myocardial infarction (87%). Majority of patients were in Killip class I (69.5%) at presentation in emergency. Single vessel disease (58.3%) was the most common finding in coronary angiography and 7.6% patients have normal or non obstructive coronary lesions. Complications include arrhythmia (6%), cardiogenic shock (5.2%) and mortality (1.7%). Conclusions: In young acute myocardial infarction patients, smoking is the single most important modifiable risk factor. Other conventional risk factors are less strongly associated than older patients. Young patients tend to have less extensive coronary artery lesions. In few patients, presence of normal or non obstructive coronary lesions would suggest possibility of different mechanism of myocardial necrosis. Overall, these patients had favourable outcome and better prognosis. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 12-16 DOI: http://dx.doi.org/10.3126/njh.v10i1.9740

Background: pleural effusion is the common fi ndings in patients presenting with cardiopulmonary symptoms but specifi c studies are lacking in Nepal. Objective: The main objective of this study is to fi nd out the various causes of pleural effusion, their mode of clinical presentation and laboratory analysis of blood and pleural fl uid to aid diagnosis of patients with pleural effusion. Materials and methods: Retrospective data from July 2009 to July 2007 from all the cases diagnosed with pleural effusion were taken. Altogether 100 cases diagnosed with pleural effusion by chest X-ray (Posterior-Anterior and Lateral view) and Ultrasonogram of the chest were studied. The following parameters were analysed: Patients demographic profi le, causes, location (Unilateral, Bilateral), Blood haemoglobin and count, sputum profi le, Monteux test, chest Xray and USG fi ndings and pleural fl uid analysis[Biochemical, Haematological, Microbiological(culture and stain) and cytological]. This study was analysed by using SPSS 16. Results: The mean age of the patient was 44.89 ± 21.59 and must patients with pleural effusion belong to age group 21-30. Most common cause of pleural effusion was found to be tubercular effusion followed by parapneumonic effusion. Right sided effusion was seen in most cases of tubercular parapneumonic and malignant effusion whereas bilateral effusion was seen in 87.5% of the patient (7 out of 8) having congestive heart failure and all cases of renal disease (4 out of 4). Shortness of breath (83%), cough (67%) and fever (66%) are the most common mode of clinical presentation. Conclusion: Our study concluded that the most common cause of unilateral pleural effusion is tuberculosis followed by parapneumonic effusion and most cases of those belong to younger age group (21 -30yrs) and most common cause of bilateral pleural effusion is congestive cardiac failure.

Introduction: A basic familiarity with orthopaedic disorders is important for all medical school graduates. The purpose of this study is to assess the adequacy of undergraduate orthopaedic knowledge among the first batch interns of our academy.Methods: The validated basic cognitive examination designed by Freedman and Bernstein, consisting of 25 short answer questions was administered to the first batch interns. Overall scores and responses to the individual questions were analyzed. The recommended passing score of 73.1 per cent as suggested by Freedman and Bernstein was considered. The overall unweighted and weighted scores were calculated. The questions were also separated into anatomy, general orthopedics and trauma groups. The Microsoft Office Excel 2007 was used for the statistical analysis.Results: Forty eight interns appeared the examination with the mean scores obtained was 58.79 per cent. Forty five interns (94 per cent) failed to demonstrate basic competency on the examination. The overall weighted score for all interns was 61 per cent. Forty two (88 per cent) of the 48 interns failed the examination even when the questions were weighted. The average scores in the general orthopedics, trauma and anatomy groups were 49, 76 and 54.6 per cents respectively.Conclusion: Majority (94 percent) of the first batch interns failed the validated basic musculoskeletal examination. Curriculum and teaching methods is inadequate or inappropriate and should be re-evaluated to address this problem.