We compared the validity of pancytopenia, the formol-gel test (FGT), the indirect fluorescence antibody test (IFAT), the direct agglutination test (DAT), and the rK39 dipstick test as diagnostic criteria for visceral leishmaniasis (VL) in Nepal. Between September 2000 and January 2002, 310 clinical suspects had a bone marrow aspirate, and if negative, a spleen aspirate smear examined for Leishmania donovani. Sensitivity and specificity of all tests were determined compared with parasitology and by latent class analysis (LCA). Compared with parasitology, the sensitivities of the other tests were as follows: pancytopenia = 16.3% (95% confidence interval [CI] = 11.3-22.5%), FGT = 39.9% (95% CI = 32.7-47.4%), IFAT = 28.4% (95% CI = 22.0-35.5%), DAT = 95.1% (95% CI = 90.8-97.7%), and the rK39 dipstick test = 87.4% (95% CI = 81.7-91.9%). Sensitivity estimates obtained by LCA were similar, but specificity estimates were substantially higher (DAT = 93.7% versus 77.8%; rK39 dipstick test = 93.1% versus 77.0%). The DAT or the rK39 dipstick test can replace parasitology as the basis of a decision to treat VL in Nepalese peripheral health services.

Summarybackground We evaluated the diagnostic accuracy as well as the reproducibility of the urine latex agglutination test 'KAtex' in the diagnosis of kala-azar in patients recruited at a tertiary care centre in Dharan, Nepal, between November 2000 and January 2002.methods All patients presenting with fever of 2 weeks or more and splenomegaly were consecutively enrolled. Bone marrow and -if negative -spleen aspirates were examined for Leishmania donovani. Serum and urine samples were taken in duplicate for the Direct Agglutination Test (DAT) and KAtex. The reference laboratory determined sensitivity and specificity of KAtex. Reproducibility between both laboratories was assessed.results KAtex was performed on urine from 155 parasitologically confirmed kala-azar and 77 non-kala-azar cases (parasitology and DAT-negative). KAtex showed a sensitivity of 47.7% (74/155, 95% CI: 39.7-55.9) and a specificity of 98.7% (76/77, 95% CI: 93.0-100.0). Reproducibility of KAtex showed a kappa of 0.684 (P < 0.001, n ¼ 232).conclusion KAtex evaluation showed high specificity, low sensitivity and moderate reproducibility. A urine test for kala-azar could become a real breakthrough in kala-azar management if its reproducibility and sensitivity could be further improved.keywords visceral leishmaniasis, sensitivity and specificity, diagnostic accuracy, urine antigen detection test, Nepal

Clinicians still lack an appreciation of the potential importance of Pseudomonas aeruginosa (PA) in the hospitals. So this study was done in order to isolate and assess the prevalence of multi-drug resistant P. aeruginosa (MDRPA) and pan-drug resistant P. aeruginosa (PDRPA) from the intensive care units (ICUs). A cross-sectional study was conducted for six months at the ICUs of Shahid Gangalal National Heart Centre, Kathmandu. A total of 1,060 samples were processed out of which 700 were clinical samples directly taken from the admitted patients while 360 were the surface swab samples. The isolates were identified using routine conventional methods based upon microscopic findings, colony morphology and biochemical properties. Antibiotic susceptibility testing (AST) was performed by Kirby Bauer disc diffusion technique. P. aeruginosa was isolated from 66 (9.43%) clinical samples while 60 (16.67%) were surface swab samples. Among clinical isolates, 56 (84.8%) were sensitive to cefoparazone+sublactam (CSL) followed by 42 (63.6%) to polymixin-B and 36 (54.5%) to piperacillin-tazobactam (PT), while among surface swab sample isolates more than 90% were sensitive to most of the common antibiotics used. About 59 (89.4%) MDRPA were isolated from clinical samples while it was only 7 (11.7%) from surface swab samples. Only isolates from clinical samples (6.1%) yielded PDRPA. Since P. aeruginosa has shown the reduced susceptibility towards single antibiotics such as carbapenems, fluoroquinolones, aminoglycosides and cephalosporins, combined antibiotics like CSL and PT remained choice of treatment. This can eliminate potential threat of MDRPA and PDRPA in the ICUs. Nepal Journal of Science and Technology Vol. 13, No. 2 (2012) 197-202 DOI: http://dx.doi.org/10.3126/njst.v13i2.7736

BackgroundSerum total cholesterol (TC) and LDL cholesterol (LDL-C) have been used as major laboratory measures in clinical practice to assess cardiovascular risk in the general population and disease management as well as prognosis in patients. However, some studies have also reported the use of non-HDL cholesterol (non-HDL-C). As non-HDL-C can be calculated by subtracting HDL-C from TC, both of which do not require fasting blood sample in contrast to LDL-C which requires fasting blood sample, we aimed to compare non-HDL-C with LDL-C as a predictor of myocardial infarction (MI).MethodsThis hospital based cross sectional study was undertaken among 51 cases of MI and equal number of controls. MI was diagnosed based on the clinical history, ECG changes and biochemical parameters. 5 mL of fasting blood sample was collected from each research participant for the analysis of lipid profile. Non-HDL-C was calculated by using the equation; Non-HDL-C = TC – HDL-C. Statistical analysis was performed using SPSS 14.0.Results42 MI cases were dyslipidemic in contrast to 20 dyslipidemic subjects under control group. The differences in the median values of each lipid parameter were statistically significant between MI cases and controls. The lipid risk factors most strongly associated with MI were HDL-C (OR 5.85, 95% CI 2.41-14.23, P value = 0.000) followed by non-HDL-C (OR 3.77, 95% CI 1.64-8.66, P value = 0.002), LDL-C/HDL-C (OR 3.38, 95% CI 1.44-7.89, P value = 0.005), TC/HDL-C (OR 2.93, 95% CI 1.36-7.56, P value = 0.026), LDL-C (OR 2.70, 95% CI 1.20-6.10, P value = 0.017), TC (OR 2.68, 95% CI 1.04-6.97, P value = 0.042) and Tg (OR 2.54, 95% CI 1.01-6.39, P value = 0.047). Area under the receiver operating curve was greater for non-HDL-C than for LDL-C. Non-HDL-C was also found to be more sensitive and specific than LDL-C for MI.ConclusionsHDL-C and non-HDL-C are better discriminating parameters than LDL-C for MI. Thus, we can simply perform test for HDL-C and non-HDL-C both of which do not require fasting blood sample rather than waiting for fasting blood sample to measure LDL-C.

Background and Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia. This study aims to evaluate its prevalence in patients attending emergency department of tertiary care cardiac centre.Methods: It was a prospective observational study of 1012 consecutive patients who attended emergency department of Shahid Gangalal National Heart Centre from September 2014 to November 2014. Electrocardiogram, demographic features, diagnosis and clinical presentations were reviewed.Results: Among the 1012 patients, 553 (54.6%) were male and 459(45.4%) were female. Mean age was 52.13} 17 years. A total of 140 patients (13.8%) patients had AF. The mean age of patients with AF was 55 years. The prevalence of AF was higher in female than male (19.2% Vs 9.4%). Among the Rheumatic heart disease patients, seventy percentages of them had AF. Dyspnea was the commonest symptom of patients with AF followed by palpitation.Conclusion: The prevalence of AF in our study is higher than in western world mainly because of endemic rheumatic heart disease.Nepalese Heart Journal 2016; 13(1): 1-4