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भक्तपुर तलेजुको मूलचोक - बिनोद राज शर्मा

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ज्योतिर्बिद गिरिन्द्र राजोपाध्याय जयन्ती

राजोपाध्याय का पुर्खा मानिएका हरीबंश का बारेमा थप केही कुरा

                                                      

Preliminary Study of Prevalence of Coronary Heart Disease amongst the Civil Servants, Employees of Corporation and Academic Institutions in Nepal

Dr. U.K. Shreshta*, Dr. T.N. Bhattarai*

Dr. A.B. Upadhyaya**, Amsuka Rajopadhyaya***
Srijana Rajopadhyaya****, Dr. M. R. Pandey*****

Introduction

While the coronary heart disease is declining in the developed countries, there is an increasing trend or 

this disease in developing countries. If this trend continues, coronary heart disease will be a major public 

health problem in the developing world by the turn of the century. So, if we are to achieve the goal of 

“Health for all by 2000” immediate steps should be taken to control this disease. 

There has been very few studies about the magnitude of CAD problem in Nepal. Analysis of 12, 215 

cases admitted in the medical ward of Bir Hospital from 1969 – 1975 showed that 14.5% of the cases 

were due to heart diseases and of this 8% were due to CAD. It has been the impression of many 

physicians in Nepal that this disease is rapidly increasing specially amongst the higher socio-economic 

group. But no definite study has yet been done to find out the prevalence of this disease in Nepal. 

Objectives 

Recently there has been many studies showing the efficacy of preventive measures using both the mass 

and the high risk strategy in controlling CAD and many countries have successfully launched National 

coronary prevention programme. For scientific planning of community control of CAD in Nepal, one 

should know the magnitude of the problem. So the present study has been designed with the following 

objectives:
1. To find out the prevalence of CAD amongst the civil servants, employees of corporations and
academic institutions in Nepal.
2. To find out if there is any difference in the prevalence amongst the gazatted officers or
equivalent and non-gazetted employees.
3. To assess the role of the risk factors like tobacco smoking, high blood pressure, diabetes and
lipid abnormalities.
___________________________________________________________________________________
* Registrar, Cardiology Unit, Dept. of Medicine, Bir Hospital
** Consultant Cardiologist, Bir Hospital
*** Senior Cardiac Technician & Member, Mrigendra Samjhana Medical Trust (MSMT)
**** ECG Technician& Member,  MSMT
***** Head, Cardiology Unit and Dept.  of Medicine, Bir Hospital & Founder MSMT – Corresponding
author; Email – pandeymr@gmail.com, msmtrust11@gmail.com  Methods:
Our study population consisted of 321 employees working in different institutions e.g. Agriculture
Development Bank, Royal Nepal Academy of Science and Technology (RONAST), and Public Service
Commission. They were subjected to an interview with a questionnaire developed by London School of
Hygiene for detection of CAD (Annex I). History of smoking, alcohol intake, dietary habits, family history
of CAD and associated diseases were also taken.
Physical examination was done with special attention to the recording of Blood Pressure which was
done according to the WHO standardized methods. The presence of any cardiac abnormalities,
Xanthelasma, Xanthomata and arcus senilis were noted. All the employees had undergone blood sugar
and serum cholesterol  estimations.
ECG was also done of all the employees.
Results:
Total of 321 employees of 30 years and above were examined, of them 300 were male and 21 were
female, gazetted officers were 179 (55.76%) and 142 (44.23%) were of non-gazetted rank. Our study
covered 85% of the target population of employees in the above mentioned institutions.
Risk factor analysis showed the following:
• Smokers were 148 (46.1%) of them officers were 65, and non officers were 78. We found no
female smokers in our smokers group.
• Khaini consumption was found in 42 (13.08%), there were no female khaini users.
• Alcohol consumption was seen in total of 170 (52.9%) among them 2 were female.
• Among our study group 7 employees were found to be diabetic (4 officers and 3 non-officers
rank).
In our study angina suggestive from the questionnaires was found in 11 (3.42%) employees, of them 7
were of non officer rank and 4 of officer rank.
• Angina with resting ECG changes was found in 1 male officer of 49-59 age group.
• History of previous MI was noted in 3 cases, which was confirmed by ECG an discharge
summary. All 3 were male officers (1 in 40-49 age group and 2 in 50-59 age group).
• Altogether in our study 15 cases were found to have coronary artery disease which makes the
prevalence rate of 4.67% among which officers were 10 (5.58%) and non officers were 5
(3.52%). Discussion:
As evident from our small study, prevalence of coronary artery disease (CAD) is about 4.67% which is
rather a high figure and is comparable with the figure from India. Studies done in India had showed
prevalence rate of CAD ranging from 2.1% to 1.5%. Sapru who reviewed all available date from India
suggested that an average figure of 2.5% for  CAD in the entire Indian population aged 40 years or above
would appear to be a reasonable estimate. Our study also showed the pattern of risk factors for CAD
e.g. smoking (46.10%), cholesterol value above 250 mg/dl (26.47%) and hypertension (10.9%). Smoking
rate among the non-gazetted employees were higher than in the officer rank employees. It has been
repeatedly shown in studies of smoking pattern in our country and abroad that smoking rate differs
among urban and rural dwellers and also among those with education and without education. This is
specially marked in case of female smokers. Also worth mentioning in our study was the prevalence of
hypertension which is 10.9% and more among employees of officer rank. Other community based
studies of hypertension has yielded figures ranging from 7 to 11%.
Prevalence of CAD which is at 4.47% in our study is higher than that of some communicable diseases like
tuberculosis for which there is already a separate national programme, national and regional centers. It
has already been proved by the experience of some developed countries that the prevalence of CAD can
be reduced by concerted effort targeted on risk factors reduction and education. So in our country also
there should be no delay in recognizing CAD as a common problem and implementing proper measure
for its control and treatment.
Limitations of the study:
Resource constraint was the main limitation. Without the availability of adequate resources, we could
not perform proper lipid profile for all our study population. For the same reason we had to restrict
ourselves to the relatively small sample size. Another restricting factor was the start of the very
welcome movement for democracy and subsequent events e.g. civil servants strike in our country. It
caused disruption in our study routine and inevitable delay in its completion. Last but not the least was
the manpower constraint. Investigators had hard time in organizing this study and fulfilling routine
duties at the hospital.
With all the limitations, it is hoped that this study will provide some of the much sought after
information and insight into the magnitude of CAD in our country. References:
1. Pandey, M.R. and Ghimire, M. Prevelance of various types of hearty diseases in Kathmandu,
Jour. Nepl. Med. Assoc., 1975, Vol 13:33.
2. Pandey, M.R. Myocardial infarction in Nepal. Indian Heart Jour. April 1970, 22 (21): 73-82.
3. Padmavati S. Epidemiology of cardiovascular disease in India. Circulation 25, 711. 1962.
4. Gopinath N. and Associates; Community based survey of coronary heart disease in urban Delhi,
1989 (Personal Communication).
5. Sapru R.P., A lowest estimate of prevalence of cardiovascular diseases in India. J. Assoc. Phys.
India, 32, 251, 1984.
  Annex 1
Name ………………………………..........................................  Age ……………  Sex …………
Date of Birth …………………………………………………………….. Height ……………… Weight …………..
Institutions ………………………………………………………………. Position ………………………………..
Salary ………………………………………………..
Have you ever smoked ? Duration
No  ………………………… Yes …………………….
Type: Cigarettes  …………………………
 Bidi  …………………………
 Hookah  …………………………
Daily  …………………………  No ………………….. / day
Occasionally ……………………….  No ………………….. /week
Stopped
 No …………….
 Yes  ……………. Weeks/months/years
Have you ever consumed khaini/jarda?
 No ……………… Yes …………….. ……………………. Standard pegs/week
 Ex ………………
London School of hygiene Cardiovascular
Questionnaire (Rose)
(For Administration by an Interviewer)
Section A: Chest Pain on Effort
1.Have you ever had any pain or discomfort in your chest ?
Yes ………….  No …………
If “Yes” ask next question (If during the remainder of section A an answer is recoded in a box
marked, proceed to section B).
2.Do you get it when you walk uphill or hurry ?
Yes ……………… No …………………
Never hurries or walks uphill ………………
3.Do you get it when you walk at an ordinary pace on the level ?
Yes …………….. No ……………….
4.What do you do if you get it while you are walking ?
Stop or slow down ……………………….. Carry on ……………………….
(Record ‘Stop or slow down’ if subject carries on after taking nitroglycerine.
5.If you stand still, what happen to it ?
Relieved ………………… Not relieved …………….
6.How soon ?
10 minutes or less …………………………     More than 10 minutes ………………………………….
7.Will you show me where it was ?
Sternum (upper or middle) …………………………………
Sternum (lower) ………………………………………………….
Left anterior chest …………………………………………….
Left arm ……………………………………         Other ……………………………………………………………. 8.Do you feel it anywhere else ?
Yes ………………………………………………………………….
No ………………………………………………………………….
(if ‘yes’, record additional information above)
Section B: Possible Infarction
9.Have you ever had a severe pain across the front of your chest …………….. for half an hour or more?
Yes …………………………………………………………………………..
No …………………………………………………………………………..
Present History:
Past History:
Family History:
Sudden death ……………………………
IHD ……………………………………………
Hypertension …………………………..
Diabetes ……………………………………
Gout …………………………………………
General Examination:
Pallor …………….. Cyanosic ………………. Clubbing …………… Arcus …………
High arch palate ……………… Xanthema ………….. Xanthelesma …………………
Cardiovascular Examination:
Pulse ………………………/min Peripheral pulses ………………………..
BP ………………….. /    /    /mm of Hg Supine
      Standing
Carotids …………………….
Lower limbs ………………….
Heart sounds ………………………
Pericardial rub ……………………
Other positive findings:
Investigation:
Blood:   Hb………….. Sugar……………. gm/dl
Cholesterol
Triglycerides
HDL Cholesterol
Uric acid
X-ray  chest  PA View Annex I (continued)
The diagnosis of coronary heart disease will be made according to the following criteria:
I. Pain of angina:
a) Question 1 yes
Question 2 or 3 yes
Question 4 stop or slow down
Question 5 received
Question 6 10 minutes or less
Question 7 (i) sternum (upper or middle or lower) or (ii) left interior chest and left arm
or (iii) pain of possible infarction
b) Question 9 yes
II.Definite ECG evidence of myocardial infarction
III. Positive exercise ECG test as shown by horizontal or down slopping ST segment depression
of 1.5 mm or more.
Table 1
Smoking Pattern:
30 – 39 yrs 40 – 49 yrs 50 – 59 yrs Above 60
Officer Nonofficer
Officer Nonofficer
Officer Nonofficer
Officer Nonofficer
27 17 40 35 11 17 1
Total = 148 (46.1%)
Table 2
Alcohol Consumption Pattern:
30 – 39 yrs 40 – 49 yrs 50 – 59 yrs Above 60
Officer
Non-officer
21
26
79
23
18
2
--
1
Table 3
Cholesterol Values:
Mg/dl 30 – 39 yrs 40 – 49  yrs 50 – 59 yrs Above 60
Less than 200
200 – 249
250 and above
40
38
16
53
69
47
18
19
20
1
--
--
Smoking pattern in Neg. Cases
Smoke 30 – 39 yrs 40 – 49  yrs 50 – 59 yrs Above 60
41 72 25 1
Total = 139 (33.33)

Upaku: Exploring the old Kathmandu during Indra Jatra

	-ASMITA MANANDHAR Source:http://theweek.myrepublica.com/details.php?news_id=42600 Amidst the crowded street, an idol of Lord Indra is placed on a high platform before the Aakash Bhairav, also known as “Aaju Dya” in Newar, the elder god symbolizing the protector or the king of the city at Indra Chowk of Kathmandu. The sight of the King of Heaven, as Indra is known, confronting yet another god, following the famous legend of Lord Indra’s theft of the flower Parijat, at the beginning of the autumn every year marks the preparation for the beginning of Indra Jatra, or the Procession of Indra, the biggest religious street festival of Kathmandu City. Yenya is the preferred name for the same festival by the local Newar community. Professor Baldev Juju, a senior culture expert, says that the festival Yenya originated much before Indra Jatra. Assuming the etymology of Yenya to be derived from two Newar words, “Ye” meaning Kathmandu, and “ya” meaning festival, Professor Juju regards it as the festival of the city. “It may be the anniversary celebration of the beginning of civilization in Kathmandu,” he says. People taking a specific route, lighting at all the shrines and temples on the way, which is named as Upaku, according to Professor Juju, might be the rituals established during the ancient times for celebrating the anniversary festival. He backs his argument with the trend of the Upaku route, which is considered to be the actual boundary of the medieval Kathmandu. Upaku follows an elaborate trail through the narrow alleys and lanes. The route represents the boundary of Kathmandu or Ye from the time when it was a separate country before the existence of unified Nepal. Upaku is a great opportunity to revisit the traditional Newar settlements established during ancient times. Supporting the argument that Upaku route during Yenya has a long history, Maheshwor Juju Rajopadhyaya, Vice-Chairman of Vedic Pratisthan, assumes that since the settlement was initially surrounded by forests, the citizens of Kathmandu might have used fire and drums to scare away wild animals, while circumambulating the border of their settlement. “It might’ve originated as a survival instinct which took the form of tradition as the society evolved with time,” he says. These days, bereaved families take to the Upaku route on the evening of the first day of Indra Jatra, which lasts for eight days. Family members offer lights to different religious shrines in the name of their deceased member/s. According to experts, the tribute to the deceased members of the family during Upaku in the present day has no definite meaning but it is possibly the result of general processes during Newar festivities to acknowledge the divine, the living, and the departed. Cultural expert Indra Mali says that apart from members of the procession lighting the lamps at temples and shrines in the name of their dead, they also exchange lights with fellow members who take the route. “There can be two explanations for this ritual; either, they are offered the lights to guide them through the night, or it is an honor not only to gods and the dead but also to the living ones,” he says. The varieties of rituals during the Upaku procession hold different meanings. The procession is led by Majipa Lakhe, a special Lakhe or a demon in Newar folklore who dances only during the Yenya. Depicted with a ferocious face, the dance of Lakhe is characterized by wild movements. The Lakhe are not trained dancers but they synchronize their beats with the music from the Newar orchestra which follows the Lakhe throughout the festival. The orchestra consists basically of percussions and wind instruments, which they play continuously while traveling through the city, producing loud thumping music. On the other hand, some of the families participating in the procession are also accompanied by a group of people singing hymns. Though people have started to sing different hymns en route the Upaku, according to Mali, it is the “Dharani Paath” that is basically sung during the occasion. “Dharani Paath is a Buddhist hymn which is somewhat like Mritunjaya Mantra, that is the death-conquering mantra,” he says. The communities that lie on the Upaku route, on their part, decorate huge piles of “Samay Baji,” a set of different Newar dishes which is considered to be representing Pancha Tatwa, the five elements referred to as sky, air, water, light, and earth, at different junctions along the way. A heap of beaten rice is covered with fried black soybean, fresh ginger rhizomes, marinated broiled meat, dried fish fried in oil, boiled-fried eggs, fresh and dried fruits in vertical lines along the beaten rice mound. Lentil patties are then placed at the top with several varieties of Newar breads on the sides of the stack. Though Samay Baji is a regular dish for Newars during festivities, it is the special dish during Yenya, says Rajopadhyaya. The decoration of Samay Baji is regarded as an offering to the gods before it is distributed among the community. Some of the communities also accompany the Samay Baji decoration with Newar orchestra. The highlight of the evening is also the display of masks of Bhairab at different parts of the city, most of which are only put for view to public once a year on the very day. It is a rare opportunity to witness the unveiling of the masks which are otherwise kept for safekeeping by the respective Guthis (guilds). During the Indra Jatra, Newari liquors are poured from the mouth of the mask of the Sweta (white) Bhairav as “prasad,” or the deity’s blessing. This occurs only once in a year and the consumption of the liquor is said to bring good health to the person throughout the year. According to Rajophayaya, the communities put on a miniature version of Lord Indra tied before Aaju Dya; therefore, the masks of Bhairab are also brought in display to signify the representative of the elder god. “It represents protection for the people; it shows that even the King of Heaven cannot interfere in these matters,” he says. Like many of the festivities that are related to agricultural changes or significances, Indra Jatra signifies the end of the agricultural season. One legend of Lord Indra says that when he was released by the King of Kathmandu following the request from Indra’s mother, deity Dangi, to forgive Indra for stealing the rare Parijat flower, she presented him with fog and dew. On the third day of Indra Jatra, a person impersonating Dangi walks around the city with people clad in white clothes following her. It is believed that Dangi had come to Kathmandu in search of his son, Indra. The citizens, having recognized her, followed her in the hope of discovering the road to heaven. The same night, a group of people also roam around the city impersonating a white elephant, called Pulu Kisi. The elephant is believed to be Indra’s vehicle, which rampantly searches for his master after Lord Indra disappears. The legend of the deity Dangi’s deal for the release of his son explains the change in the weather of the capital and the subsequent break taken by the Valley’s denizens from agricultural tasks. The weeklong festival marks the beginning of the celebrations, followed by Dashain and Tihar in a month’s time. The festival of Yenya is entirely based on myths, with different interpretations from many historians. With none of written scriptures to define the beginning of the Upaku, experts assume that its history dates back to the time of the origin of Kathmandu. A wooden totem pole, called Indra Dhwaj, erected in front of Hanuman Dhoka in the early hours of the initial day of the festival, marks the beginning of Indra Jatra. But the festival mood is set only in the evening when people tour the old city circuit through the Upaku route. Although, bereaved families from certain Newari communities are compulsorily required to participate in the Upaku, it is free for all the people who wish to take the walk. On the route that follows the shrines and temples, most of which are of Tantric significance, people can experience and have insights about the primeval religion and culture of Kathmandu. The area dazzles with lights offered by people walking the route. Local communities regulate the lights to guide the walkers through the lanes and alleys for many hours in the evening. The walk through the Upaku may have a certain tradition in the present context, but it is agreed by most that the route defines the boundary of the old Kathmandu. The festival might have changed its meaning over time but a stroll through the borders that represents the glory of origin of the capital city gives people a chance to mingle with the rich Newar culture of the core that is Old Kathmandu.
Published on 2012-09-28 12:52:14

आदिबासी जनजाति र राजोपाध्याय

पशुपतिस्थित जयसिंहराम बर्ध्दनको अभिलेखमा "राजोपाध्याय "

यो सामग्री भक्तपुरका श्री अन्जन  राज शर्मा ज्यू  ले  उपलब्ध गराउनु भएको हो,  यसका  लागी   rajopadhyaya.blogspot.com  आभार प्रकट गर्दछ  । 

स्मरणरहोस श्री रामसिंह बर्धन्को मृत्यू बि. स. १४५७ मा भएको तथ्य यहि पुस्तकमा उल्लेख गरिएको छ l यस आधारमा भन्ने हो भने पनि "राजोपाध्याय" बि. स. १४५७अधि देखिनै अस्तित्वमा रहेको अनुमान गर्न सकिन्छ l

भक्तपुरको तलेजु मूलचोक - बिनोदराज शर्मा

हामीले कलाकार अरनिकोको बारेमा धेर  थोर सुनेका छौं  अथवा जानकारी पाएका छौं l   

अरनिकोले   नेपाली वास्तुकला  र   धातुकला लाई चीन र तिब्बतमा प्रसार गर्ने काम गरेका थिए।

के तपाई हामीलाई एक  राजोपाध्यायले तिब्बतमा तलेजु भवानीको स्थानान्तरण गर्नु भएको बिषयमा जानकारी छ ? छैन भने यो लेख पढने कि ....

वाने लायेकूको छोटो चर्चा - बिनोदराज शर्मा

कर्मकाण्ड तालिम

भद्रपुर। नेवार जातिको लोप हुन लागेको जन्मेदेखि मृत्युसम्मका मौलिक रीतिरिवाज तथा कर्मकाण्डलाई पुनर्जागरण गराउने उद्देश्यले नेवाः देय् दबू झापाले तीनदिने कर्मकाण्ड तालिम बिर्तामोडमा सुरु गरेको छ ।
तालिममा झापाका ३० गाविसबाट आएका ४० प्रशिक्षार्थीलाई प्रशिक्षकद्वय सञ्जय राजोपाध्याय र विजय राजोपाध्यायले प्रशिक्षण दिनुहुनेछ । नेवाः देय् दबू झापाका अध्यक्ष कृष्ण उदासको अध्यक्षतामा उक्त तालिम प्रशिक्षण भएको हो ।यसअघि झापाका काँकडभिट्टा र बिर्तामोडमा नेवार जातिका महिलालाई तीनघन्टे पूजा विधि प्रशिक्षण दिइएको थियो । रासस

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बिश्वनाथ उपाध्याय र जावालाखेल चिड़ियाघर स्थित पोखरी

आज मेरो बिदाको दिन घरमा थिए l   मेरी जीबन संगिनी दिपना ले ललितपुरवाट प्रकाशित हुने बर्ष ४ अंक ३  मिति २०६९ भाद्र ४ गतेको साप्ताहिक  अनलाइन पत्रिका मेरो हातमा दिदै  भनिन "यसमा राजोपाध्याय  ब्लगको लागी उपयुक्त  सामग्री छ लौ आफै पत्ता लगाउनु l "  पत्रिकामा प्रकाशित समाचारहरुको हेडिंग वाट  पत्ता  लगाउने  प्रयाश गरे तर मेरो अनुमान भन्दा बिपरीत पहिलो  पृष्ठमा प्रकाशित  भ्रस्टाचारको  समाचार होला   भनेको  समाचारनै  यस ब्लगको लागी उपयुक्त  रहेछ l  यस समाचारमा राजोपाध्यायको पुर्खा तथा मल्ला राजा सिद्दिनरसिंह मल्लका गुरु बिश्वनाथ उपाध्याय र जावालाखेल  चिड़ियाघर स्थित पोखरीको बारेमा उल्लेख गरिएको छ l  तपाई पनि पढने की .......

http://onlinepatrika.com/paper/3088/%E0%A5%A8%E0%A5%A6%E0%A5%AC%E0%A5%AF-%E0%A4%AD%E0%A4%BE%E0%A4%A6%E0%A5%8D%E0%A4%B0-%E0%A5%AA