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Objective To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA. Design Cross-sectional study of screening programmes in five countries. Setting Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005–2008) Bangladesh and Georgia. Participants General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549). Primary and secondary outcome measures Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30–300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data. Results The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively. Conclusions Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease.

Infantile hypertrophic pyloric stenosis (IHPS) is a common acquired condition of infancy, characterized by pyloric muscle hypertrophy leading to complete or near-complete gastric outlet obstruction. A typical presentation includes projectile, non-bilious vomiting. While the palpable \"olive\" and visible peristaltic waves are classic signs, ultrasonography is the diagnostic modality of choice due to its high accuracy. Diagnosis relies on established sonographic thresholds for pyloric muscle thickness and canal length. Differential diagnoses include transient pylorospasm, which resolves on its own, and prostaglandin-induced mucosal hypertrophy, where only the muscular wall should be measured. Herein, we present the case of a four-week-old male infant with projectile non-bilious vomiting and failure to thrive. Ultrasonography confirmed the diagnosis, demonstrating the classic radiological signs. The patient was successfully managed with fluid resuscitation and a Ramstedt pyloromyotomy. This case highlights the pivotal role of ultrasonography in diagnosing IHPS, discusses relevant differential diagnoses, and underscores the importance of recognizing potential imaging pitfalls, such as a posteriorly displaced pylorus due to an overdistended stomach.

IntroductionRheumatic heart disease (RHD) remains a major contributor to morbidity and mortality in developing countries. The reported prevalence rates of RHD are highly variable and mainly attributable to differences in the sensitivity of either clinical screening to detect advanced heart disease or echocardiographic evaluation where disease is diagnosed earlier across a continuous spectrum. The clinical significance of diagnosis of subclinical RHD by echocardiographic screening and early implementation of secondary prevention has not been clearly established.Methods and analysisThe authors designed a cross-sectional survey to determine the prevalence of RHD in children from private and public schools between the age of 5 and 15 years in urban and rural areas of Eastern Nepal using both cardiac auscultation and echocardiographic evaluation. Children with RHD will be treated with secondary prevention and enrolled in a prospective cohort study. The authors will compare the prevalence rates by cardiac auscultation and echocardiography, determine risk factors associated with diagnosis and progression of RHD, investigate social and economic barriers for receiving adequate cardiac care and assess clinical outcomes with regular medical surveillance as a function of stage of disease at the time of diagnosis. Prospective clinical studies investigating the impact of secondary prevention for subclinical RHD on long-term clinical outcome will be of central relevance for future health resource utilisation in developing countries.Ethics and disseminationThe study was considered ethically uncritical and was given an exempt status by the ethics committee at University of Bern, Switzerland. The study has been submitted to the National Nepal Health Research Council and was registered with http://www.ClinicalTrials.gov (NCT01550068). The study findings will be reported in peer-reviewed publications.ClinicalTrials.gov IdentifierNCT01550068.

Objectives To evaluate a protocol for a population-based programme targeting the prevention of rheumatic heart disease (RHD) progression by early echocardiographic diagnosis of valvular lesions and timely implementation of secondary prevention. Design Observational survey with a subsequent prospective cohort study. Setting Private boarding school in the urban area of the Sunsari district situated on the foothills of the Lower Himalayan Range in Eastern Nepal. Participants Fifty-four unselected school-going children 5–15 years of age, 24 girls and 30 boys. Primary outcome measure Logistic feasibility of a large-scale population-based screening study using the echocardiographic criteria formulated by the World Heart Federation, with longitudinal follow-up of children with definite or borderline RHD in a prospective cohort study. Results Standardised interview, physical examination and screening echocardiography were performed in a three-staged process and took approximately 6 min per child. Socio-economic status was assessed using surrogate markers such as the occupation of the primary caregiver, numbers of rooms at home, car, television, cell phone and internet connection. Physical examination was focused on cardiac auscultation and signs of acute rheumatic fever and targeted echocardiography was performed by an independent examiner without knowledge of the clinical findings. Two children with evidence of borderline RHD were re-examined at B.P. Koirala Institute of Health Sciences and the indication for secondary antibiotic prevention was discussed with the parents and the children. At 6 months of follow-up, echocardiographic findings were stable in both children. Implementation of secondary antibiotic prevention was challenged by impaired awareness of subclinical RHD among parents and inadequate cooperation with family physicians. Conclusions This pilot study shows that the methods outlined in the protocol can be translated into a large-scale population-based study. We learned that education and collaboration with teachers, parents and family physicians/paediatricians will be of key importance in order to establish a sustainable programme.

Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal. It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal. Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30-43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002). Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.

PurposeTo compare the effectiveness and safety of shockpulse with pneumatic lithotripsy in percutaneous nephrolithotomy. MethodsA prospective randomized comparative study was performed in Department of Urology, Bir Hospital for 1-year duration with 61 patients in shockpulse (Group 1) and 58 patients in pneumatic lithoclast (Group 2) groups, respectively. Patient’s demographics, stone characteristics, hemoglobin drop, hospital stay, operative duration, stone fragmentation time and postoperative complications were compared.ResultsThe two groups did not differ significantly in terms of patient’s demographic and stone characteristics. The mean hemoglobin drop was 1.96 ± 1.48 g/dl in Group 1 and 2.32 ± 1.38 g/dl in Group 2 (p = 0.16) and hospital stay was 3.14 ± 1.42 days in Group 1 and 3.29 ± 1.82 days in Group 2 (p = 0.62). The number of cases that required multiple tracts were six (9.8%) in Group 1 and 12 (20.68%) in Group 2 (p = 0.12). The stone-free rates were 78.69% in Group 1 and 74.13% in Group 2 (p = 0.66). Mean total operation time was 43.23 ± 18.49 min in Group 1 as compared to 51.53 ± 19.48 min in Group 2 (p = 0.0188). Mean stone fragmentation time was 17.95 ± 15.25 min in Group 1 and 24.37 ± 11.12 min in Group 2 (p = 0.0096). Overall complications were not significant between the two Groups (p = 0.58). On sub-analysis of the patients with single tracts in both groups the results were comparable to patients with single and multiple tracts combined.ConclusionsDespite similar stone-free rates and complications between the two Groups, shockpulse has significantly lower stone fragmentation time and total operation time as compared to pneumatic lithotripsy.

Background: Drug‐resistant tuberculosis (DR‐TB) remains a significant global public health challenge, particularly in regions with a high burden of TB. Nepal, one such country, has been witnessing a rise in DR‐TB cases, posing serious challenges to TB control efforts. Despite this growing concern, there is a lack of localized data on the risk factors contributing to DR‐TB, especially in urban areas like Pokhara. This study aims to fill that gap by assessing the prevalence of DR‐TB and identifying associated demographic, behavioral, and clinical factors among TB patients in Pokhara Metropolitan City, Gandaki Province, Nepal. Methods: A retrospective cross‐sectional analysis was conducted using 617 TB patient records from the Pokhara Metropolitan Health Office for the fiscal year 2078/79 (July 2021 to July 2022). Data on demographic characteristics, clinical history, treatment regimens, and behavioral factors such as smoking and alcohol consumption were extracted. Descriptive statistics were used to determine the prevalence of DR‐TB, and bivariate logistic regression was applied to identify statistically significant risk factors associated with DR‐TB. Results: Among the 617 TB patients, the prevalence of DR‐TB was 2.6%. Most patients were male (57.4%) and within the 21–30 age group (26.9%). Pulmonary bacteriologically confirmed TB was the most common type (53.6%), predominantly affecting adults (98.1%). The primary treatment regimen administered was 2HRZE + 4HR (78.8%). TB‐HIV co‐infection was found in 1.9% of cases, with all co‐infected patients receiving antiretroviral therapy. In a bivariate analysis, individuals with current smoking status (UOR: 9.384; CI: 3.342–26.351), exposure to smoking (UOR: 8.550: CI: 2.916–25.064), and current alcohol consumption (UOR: 4.553, CI: 1.406–14.745) had a higher likelihood of DR‐TB. In a multivariate analysis, exposure to smoking (AOR: 5.317; CI: 1.394–20.274) and current alcohol consumption (AOR: 6.84; CI: 2.071–22.58) emerged as independent predictors associated with an increased risk of DR‐TB. Conclusion: The study revealed a relatively low prevalence of DR‐TB among TB patients in Pokhara, with strong associations between DR‐TB and lifestyle factors such as smoking and alcohol use. These findings underscore the need for targeted public health interventions addressing behavioral risk factors to reduce DR‐TB incidence. Enhanced surveillance, public awareness, and preventive strategies should be integrated into TB control programs to mitigate the spread of DR‐TB in this region. Moreover, targeted behavioral interventions may be crucial in curbing the emergence of DR‐TB, particularly in high‐burden urban centers.

Introduction. Potts disease is extrapulmonary skeletal tuberculosis mostly affecting the thoracolumbar spine. It destroys the disc space, adjacent vertebral bodies, and spinal elements, leading to cord compression and paraplegia. Methods. This is a case report study of a 29-month-old toddler who presented to our hospital with bilateral lower limb weakness. Results. On clinical, laboratory, and radiological examination, she was diagnosed with Pott’s spine, started on antitubercular therapy, and planned for surgery in her follow-up. Conclusion. Tuberculosis of the spine is still prevalent in developing countries, mainly in children. Complications of the disease can be devastating because of its ability to cause bone destruction, spinal deformity, and paraplegia. So, in a tuberculosis-endemic region, clinical suspicion should be there for Potts disease when a child presents with paraplegia of the lower limbs. Children can develop tuberculosis which can spread to the spine despite vaccination. The prognosis of spinal tuberculosis is improved by early diagnosis and rapid intervention.

Introduction. Potts disease is extrapulmonary skeletal tuberculosis mostly affecting the thoracolumbar spine. It destroys the disc space, adjacent vertebral bodies, and spinal elements, leading to cord compression and paraplegia. Methods. This is a case report study of a 29-month-old toddler who presented to our hospital with bilateral lower limb weakness. Results. On clinical, laboratory, and radiological examination, she was diagnosed with Pott's spine, started on antitubercular therapy, and planned for surgery in her follow-up. Conclusion. Tuberculosis of the spine is still prevalent in developing countries, mainly in children. Complications of the disease can be devastating because of its ability to cause bone destruction, spinal deformity, and paraplegia. So, in a tuberculosis-endemic region, clinical suspicion should be there for Potts disease when a child presents with paraplegia of the lower limbs. Children can develop tuberculosis which can spread to the spine despite vaccination. The prognosis of spinal tuberculosis is improved by early diagnosis and rapid intervention.

Background A significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients. Objective To compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization. Methods A prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up. Results The mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score. Conclusion Monopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.Background A significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients. Objective To compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization. Methods A prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up. Results The mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score. Conclusion Monopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.