Introduction: Age related macular degeneration is a disorder of the macula most often clinicallyapparent affecting central vision and is one of the leading causes of blindness in the populationabove 50 years. The aim of this study is to determine clinical profi le of AMD in Nepalese presentingto a Teaching Hospital in Kathmandu.Methods: It was a hospital-based cross-sectional study. The subjects included in the study were thosepresenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospitalfrom July 2007- Dec 2007.The total number of individuals included in the study were 402 and totalnumber of eyes were 804.Results: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group withprevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-groupindividuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjectsabove 71 years. This study revealed that the prevalence of AMD in females was higher with femalepreponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/24-6/60 vision and 15% had vision <3/60-PL. Our study revealed statistically signifi cant increased riskfor AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though theOdds ratio (OR) was statistically insignifi cant (p=>0.01).Conclusions: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College TeachingHospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically signifi cantincreased risk for AMD development in this study.Key Words: Age-related macular degeneration, blindness, Nepalese, prevalence

Background: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. Objective: To determine level of immunoglobulin E (IgE) in the tear ¿ lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Materials and methods: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro-capillary glass tube method and tear IgE levels were measured using an enzyme -linked immunosorbent assay (ELISA). Results: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically signi¿ cant (p=0.16). No statistically signi¿ cant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically signi¿ cant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any signi¿ cant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically signi¿ cant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically signi¿ cant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p= 0.72). Conclusion: There was high concentration of tear IgE level observed in VKC.Key words: Vernal keratoconjunctivitis, Tear¿ lm, IgE level, Type I hypersensitivity reaction, Type IV hupersensitivity reaction. T ype I hypersensitivity reaction which is IgEdependent and type IV hypersensitivity reaction have been implicated for the pathogenesis of Vernal Keratoconjunctivitis (VKC) 1,2,3 . However, IgEdependent hypersensitivity reaction has been observed as the important factor for the pathogenesis. IgE sensitizes cells like mast cells and basophils, resulting in degranulation and release of vasoactive amines which are responsible for clinical manifestations of VKC. In VKC, tear IgE level is signi¿ cantly high. In a study by Nomura K and Takamura E, tear IgE concentration was increased signi¿ cantly in the VKC (322.2 +/-45ng/ ml = 134.25 IU/ml), SAC (194.7+/-21.7 ng/ml) and PAC (134.8+/-23.1 ng/ml) than in controls (52.1+/-9.7 ng/ml=21.71 IU/ml) (p=0.1) 4 .In another study by Mathea R Allansmith, Hahn GS and Simon MA, the mean tear IgE concentration was high i...

Growth characteristics of Piriformospora indica an endophytic fungus with plant growth promoting rhizobacteria in an aspergillus medium were studied. P. indica showed promotional effects with species of Azotobacter chroococcum, Azospirillum brasilensis, Bradyrhizobium spp., and inhibitory effect with Pseudomonas fluorescens. The biochemical and molecular level of inhibitory factor produced by P. fluorescence suggests that the antifungal substance was thermolabile and the protease test showed it to be protease resistant in nature. Dialysis test indicated that this substance had a molecular weight of more than 12,000 kDa. The inhibitory substance turns out to be 'fungistatic' as well as 'fungicidal' in nature. Scanning electron microscopy (SEM) and Transmission electron microscopy (TEM) studies showed the cell wall in damaged form suggesting the high potency of this antifungal substance. The inhibitory compound produced by P. fluorescence was suspected to be pyoverdine, a kind of siderophore, an iron containing substance.

BackgroundLow-value use of laboratory tests is a global challenge. Our objective was to evaluate an intervention bundle to reduce repetitive use of routine laboratory testing in hospitalised patients.MethodsWe used a stepped-wedge design to implement an intervention bundle across eight medical units. Our intervention included educational tools and social comparison reports followed by peer-facilitated report discussion sessions. The study spanned October 2020–June 2021, divided into control, feasibility testing, intervention and a follow-up period. The primary outcomes were the number and costs of routine laboratory tests ordered per patient-day. We used generalised linear mixed models, and analyses were by intention to treat.ResultsWe included a total of 125 854 patient-days. Patient groups were similar in age, sex, Charlson Comorbidity Index and length of stay during the control, intervention and follow-up periods. From the control to the follow-up period, there was a 14% (incidence rate ratio (IRR)=0.86, 95% CI 0.79 to 0.92) overall reduction in ordering of routine tests with the intervention, along with a 14% (β coefficient=−0.14, 95% CI −0.07 to –0.21) reduction in costs of routine testing. This amounted to a total cost savings of $C1.15 per patient-day. There was also a 15% (IRR=0.85, 95% CI 0.79, 0.92) reduction in ordering of all common tests with the intervention and a 20% (IRR=1.20, 95% CI 1.10 to 1.30) increase in routine test-free patient-days. No worsening was noted in patient safety endpoints with the intervention.ConclusionsA multifaceted intervention bundle using education and facilitated multilevel social comparison was associated with a safe and effective reduction in use of routine daily laboratory testing in hospitals. Further research is needed to understand how system-level interventions may increase this effect and which intervention elements are necessary to sustain results.

Introduction: The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . Methods: It was cross-sectional case–control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). Results: Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. Conclusions: Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG. Keywords: diastolic blood pressure; diastolic perfusion pressure; POAG; systolic blood pressure; systolic perfusion pressure.