Summaryobjective To document the frequency of Leishmania donovani infection at community level in a highly endemic region in southeastern Nepal, and to assess socioeconomic and environmental risk factors.methods A random cross-sectional population survey was held in two visceral leishmaniasis (VL) foci in Morang District in April to May 2003, enrolling individuals 2 years or older and residing in the endemic area for at least 12 months. Leishmania infection was defined as a direct agglutination test (DAT) titre equal to or higher than 1:3200. Risk factors were identified by logistic regression.results The direct agglutination test was positive in 7.5% (95% CI: 5.1-10.8) and the leishmanin skin test (LST) in 13.2% (95% CI: 9.9-17.2) of the 373 study participants. No case of current kala-azar was found, but 5.1 % (95% CI: 3.1-7.8) reported having suffered from VL. Independent risk factors for Leishmania infection were proximity of the house to ponds [odds ratio (OR) 3.7, 95% CI: 1.6-8.5], family size (OR 4.4, 95% CI: 1.6-12.6), age P15 years (OR 5.5, 95% CI: 1.2-25.0) and house constructed in mud (OR 3.0, 95% CI: 1.1-7.6). Bednets, not impregnated and in poor condition, were used by 95.2% (95% CI: 92.3-97.0) of the population, but did not show any protective effect.conclusion This study shows that there is a serious problem of transmission of VL in this area of Nepal. The risk factors identified are linked with the socioeconomic level and the environment. The population would benefit from a community intervention to improve the environmental and housing conditions in the villages.keywords visceral leishmaniasis, Leishmania donovani, leishmanin skin test, environmental risk factors, Nepal

Abstract. Clinical isolates of Leishmania, from visceral leishmaniasis (VL) cases in Nepal and from cutaneous leishmaniasis (CL) cases in Peru, were cultured using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to type species and strain. Promastigotes from 38 isolates, within eight passages from isolation, were used to infect mouse peritoneal macrophage cultures in vitro, and the amastigote sensitivity to miltefosine was determined. The concentration required to kill 50% of intracellular amastigotes from Nepalese VL isolates, all typed as Leishmania (L.) donovani (N ‫ס‬ 24) from both Sb v responders and nonresponders, ranged from 8.7 to 0.04 g/mL. In contrast, the concentration required to kill 50% intracellular amastigotes from isolates from Peru, typed as L. (V.) and L. (V.) lainsoni (N ‫ס‬ 4) was 3.4 to 1.9 g/mL. This demonstrates a notable difference in the intrinsic sensitivity of Leishmania species to miltefosine in vitro. If this model can be correlated to therapeutic outcome, it may have implications for the interpretation of clinical trials.

Sodium stibogluconate (SSG) is the first-line therapy for visceral leishmaniasis (VL) in south-eastern Nepal. Recent studies from the neighbouring state of Bihar, India, have shown a dramatic fall in cure rates with treatment failure occurring in up to 65% of VL patients treated with SSG. A prospective study was conducted at a tertiary-level hospital located in south-eastern Nepal from July 1999 to January 2001. Parasitologically proven kala-azar patients with no previous history of treatment for VL were treated with SSG 20 mg/kg/d for 30 d which was extended to 40 d in those with persistent positive parasitology. Of the 110 patients who completed SSG therapy and were assessed at 1 and 6 months, definite cure was achieved in 99 patients (90%) and SSG failure occurred in 11 patients (10%). Except for the presence of hepatomegaly and a lower platelet count there was no clinical or laboratory baseline characteristic associated with treatment failure. A significantly lower cure rate (76%, P= 0.03) was observed in patients from the district of Saptari, which borders the antimony-resistant VL areas of Bihar. The efficacy of SSG as a first-line treatment for VL in south-eastern Nepal was still satisfactory, except for the patients living closer to the antimony-resistant VL areas of India. These findings indicate that the spread of resistance to antimonials is already taking place in Nepal and that a policy to control further spread should be urgently implemented.

Background: Cutaneous and subcutaneous metastasis from an underlying primary, indicates a dismal outcome for patients. It is appropriate to use fine needle aspiration cytology as a minimally invasive method for diagnosis. This study emphasises the role of fine needle aspiration cytology in diagnosing metastatic skin nodules. Materials and methods:This was a retrospective study in which the record of all patients subjected to fine needle aspiration cytology from April 2008 -Nov 2010 in the Department of Pathology, Tribhuvan University Teaching Hospital, were reviewed. Of 5,927 patients, 19 cases diagnosed as metastatic skin lesions were included in the study. Results:Out of 19 patients with metastatic skin nodules, 9 patients had metastasis simultaneously with the primary and 8 cases were previously diagnosed. All metastases were from internal solid organ tumours with male to female ratio of 1.7:1. Lung carcinoma was the most common to metastasis in both sexes which included adenocarcinoma (5 cases) and squamous cell carcinoma (6 cases). Common sites for cutaneous/subcutaneous metastasis were the chest wall (9 cases) followed by abdomen (4 cases) and scalp (3 cases). Conclusion:Fine needle aspiration cytology can diagnose a variety of skin lesions which may be supportive in diagnosing a metastasis in cases with known primaries or it may offer a clue to underlying malignancy in unsuspected cases.

The study aimed at finding out the morphological and clinico-pathological correlation of Orbital and Ophthalmic lesions in various eye institutes of Nepal. The study also aimed at finding out the prevalence of Ophthalmic lesions needing histo­pathological examination. This cross sectional descriptive study was carried out in various tertiary eye hospitals of Nepal from 2008 – 2012. The department of pathology was also incorporated in giving the correct histopathological findings in time. All the relevant data were entered in a specifically designed proforma for the study and analyzed. One hundred Oph­thalmic and Orbital lesions were studied in various age groups. Ophthalmic and Orbital lesions were highest (18%) in 31-40 year age group patients. Eyelid (57%) was the most commonly involved site. Clinical diagnosis was consistent with histo­pathological diagnosis in more than 60% of the cases. Among eyelid lesions, incidence of dermoid cyst (21%) was highest. While in Conjunctival lesions, granuloma pyogenicum (22.5%) was highest followed by other lesions. A clinico-patho­logical diagnosis of malignant orbital tumors or ocular tumors was made in 30% of cases. While 70% cases of Ophthalmic or orbital lesions were benign in nature. All Ophthalmic lesions removed surgically should always (without exception) be subjected to histopathological examination to establish correct diagnosis for further management. However this study has shown that a good clinical examination and diagnosis before subjecting the patient for histopathological examination gives the patient and the treating surgeon a better outcome. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8442 Journal of Chitwan Medical College Vol.3(2) 2013 40-44