Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.

Knowledge, Attitude and Practice Regarding Pharmacovigilance and Consumer Pharmacovigilance among Consumers at Lalitpur District, Nepal

BACKGROUND

Adverse drug reactions (ADRs) can be a big threat to the health of people in Nepal as a variety of medicines are consumed in the country. Involving consumers in pharmacovigilance can strengthen ADR reporting. The study aims to find out knowledge, attitude and practice regarding pharmacovigilance and consumer pharmacovigilance among consumers at Lalitpur district, Nepal Methods: It was carried out in outpatients visiting in KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Participant's knowledge, attitude and practice were measured by noting their agreement with a set of 21 statements along with multiple choice and open ended questions.

RESULTS

A total of 157 outpatients were surveyed. The knowledge scores for males (12) was better compared to the females (11), but the scores for attitude and practice were same for both groups. The maximum score for knowledge was 29, attitude was 6 and practice was 10. The overall KAP scores was 45. The total scores for knowledge, attitude and practice for males (24) were better compared to female (22) respondents. Seventy-one patients (68%) who participated in this study favoured establishing a consumer centre for obtaining information about ADRs.

CONCLUSIONS

Knowledge scores among consumers regarding pharmacovigilance is low and require advocacy and improvement.

Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal

Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.

Aetioepidemiological profile of spinal injury patients in Eastern Nepal

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal

BACKGROUND

Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal.

METHODS

The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal.

RESULTS

Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves.

CONCLUSIONS

Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.

Towards a Mg Lattice Clock: Observation of the ^{1}S_{0}-^{3}P_{0} Transition and Determination of the Magic Wavelength

We optically excite the electronic state 3s3p ^{3}P_{0} in ^{24}Mg   atoms, laser cooled and trapped in a magic-wavelength lattice. An applied magnetic field enhances the coupling of the light to the otherwise strictly forbidden transition. We determine the magic wavelength, the quadratic magnetic Zeeman shift, and the transition frequency to be 468.46(21) nm, -206.6(2.0)  MHz/T^{2}, and 655 058 646 691(101) kHz, respectively. These are compared with theoretical predictions and results from complementary experiments. We also develop a high-precision relativistic structure model for magnesium, give an improved theoretical value for the blackbody radiation shift, and discuss a clock based on bosonic magnesium.

Nutritional supplementation practices during pregnancy in Village Development Committees of Morang District, Nepal

BACKGROUND Pregnancy is a critical period for both woman and baby from a nutritional perspective. Poor nutrition, during pregnancy is associated with adverse maternal and fetal outcomes. However, due to various factors, pregnant women do not increase the quality or quantity of diet during pregnancy. OBJECTIVE To find out the prevalence of nutritional supplementations taken during pregnancy and to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. MATERIALS AND METHODS The cross-sectional study was conducted from 1st March to 14th March, 2014 among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semistructured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. RESULT The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy. CONCLUSION The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12948 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 10-17

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

Anemia in pregnancy and its associated factors: A study from Eastern Nepal

Background  Anemia in pregnancy is responsible for many adverse effects on maternal and fetal outcome. It is the commonest hematological disorder accompanying pregnancy. Prevalence of anemia among pregnant women is fairly high worldwide, especially in developing countries. A research finding published by World Health organization revels that the prevalence of anemia among pregnant women in developing countries averages 56% (ranging between 35 to 100%). Though Nepal has decreasing trend of prevalence of anemia, it is still high (42% in 2006). Identifying the associated factors which are responsible for the development of anemia during pregnancy would be of great help in mitigating the burden to some extent. Ojective of the study was to find out the pattern of anemia and associated risk factors for anemia during pregnancy. Materials and Methods A cross-sectional study was conducted in VDC named Hansposa.  Door to door survey was carried out to collect data using pre-designed questionnaires. Ante-natal check-ups were provided with analysis of hemoglobin levels, in every individual of study population, using conventional Shali's method. Chi-square test was applied, where applicable. Results Altogether 249 pregnant women were included in the study. The proportion of anemia was found to be 46.6%, the cases of mild anemia, and moderate anemia were 51.0% and 49.0% respectively. Risk factors includes: history of complications during previous pregnancy (P<0.001), education (P<0.05), age at marriage (P=0.028), low socio-economic status (P<0.001), gravidity and parity (P<0.01), poor knowledge about anemia (P<0.001), abnormal body mass index (P<0.001) and smoking (P=0.05). Conclusion This study indicates that the prevalence of anemia during pregnancy bears a resemblance to national value. Major associated risk factors include: history of complications during previous pregnancy, low knowledge about anemia in pregnant women, women with low body mass index, age at marriage, socio-economic status, gravidity and parity, and smoking. Most importantly, the lack of commitment in female education plays vital role in its existence.DOI: http://dx.doi.org/10.3126/nje.v4i4.11358 Nepal Journal of Epidemiology 2014; 4(4):386-92

Factors affecting Early Age Marriage in Dhankuta Municipality, Nepal

Background: Child marriage is a substantial barrier to social and economic development in Nepal, and a primary concern for women’s health. Little evidence from Nepal is available regarding the ways in which early marriage may compromise young women’s lives and their reproductive health and choices. The objectives of this study was to find out the factors associated with early age marriages in Dhankuta Municipality. Methods: The cross-sectional study was conducted among the residents of Dhankuta municipality, Nepal; where 246 households were taken as subjects. Pretested semi-structured questionnaire was administered to the study subjects and face to face interview was conducted. Chi-square test was applied to find out the association between factors and age of marriages. Results: Almost 53.3% of women were married before age 18 years. Education of wife and husband, and economic status are found to be the important variables in explaining early age marriage. Prevalence of child marriage was higher in Hindu than in Buddhist and Christian women but the difference was not significant. Age of marriage was not significantly associated with contraceptive use. Unwanted pregnancies were higher in early age marriage. It was also seen that unwanted pregnancies was higher (59.3%) than wanted pregnancies (48.6%). Conclusion: The findings of the study indicate that early age marriage was associated with low education and being poor. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 26-30 DOI: http://dx.doi.org/10.3126/njms.v3i1.10354

Social Marketing in Health: Developing Country’s Perspective

No abstract available.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 1-4 DOI: http://dx.doi.org/10.3126/njog.v8i2.9758  

Denitrification and N2O:N2 production in temperate grasslands: processes, measurements, modelling and mitigating negative impacts

In this review we explore the biotic transformations of nitrogenous compounds that occur during denitrification, and the factors that influence denitrifier populations and enzyme activities, and hence, affect the production of nitrous oxide (N2O) and dinitrogen (N2) in soils. Characteristics of the genes related to denitrification are also presented. Denitrification is discussed with particular emphasis on nitrogen (N) inputs and dynamics within grasslands, and their impacts on the key soil variables and processes regulating denitrification and related gaseous N2O and N2 emissions. Factors affecting denitrification include soil N, carbon (C), pH, temperature, oxygen supply and water content. We understand that the N2O:N2 production ratio responds to the changes in these factors. Increased soil N supply, decreased soil pH, C availability and water content generally increase N2O:N2 ratio. The review also covers approaches to identify and quantify denitrification, including acetylene inhibition, (15)N tracer and direct N2 quantification techniques. We also outline the importance of emerging molecular techniques to assess gene diversity and reveal enzymes that consume N2O during denitrification and the factors affecting their activities and consider a process-based approach that can be used to quantify the N2O:N2 product ratio and N2O emissions with known levels of uncertainty in soils. Finally, we explore strategies to reduce the N2O:N2 product ratio during denitrification to mitigate N2O emissions. Future research needs to focus on evaluating the N2O-reducing ability of the denitrifiers to accelerate the conversion of N2O to N2 and the reduction of N2O:N2 ratio during denitrification.

A study of prevalence of Taenia infestation and associated risk factors among the school children of Dharan

BACKGROUND

Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue.

OBJECTIVES

To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan.

METHODS

A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation.

RESULTS

Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than nonpork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present.

CONCLUSION

Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors.

Economic impact of pulmonary tuberculosis on patients and their families of Dharan municipality, Nepal

Tuberculosis (TB) affects mostly economically active population in underdeveloped and developing countries, therefore TB can have far reaching economic and social consequences among infected people and their household members. The objectives of this study were to estimate the household expenditure before and during the course of disease, to explore the direct and indirect cost burden of tuberculosis in terms of annual family income and to compare the total cost burden in a family of case treated with directly observed treatment shortcourse (DOTS) and without DOTS. A total of 160 treatment completed, pulmonary tuberculosis (PTB) cases fulfilling the inclusion criteria were interviewed. The median patients income before and during illness was US$1.95 and US$0.9 respectively. Similarly, household expenditure before illness was US$3.24 and during illness was US$4.28. Direct cost burden in terms of annual family income was higher (15.2%) than indirect cost burden (8.2%). But, free distribution of anti tuberculosis therapy (ATT) through DOTS reduced the total cost burden of patient by more than 8%. In conclusion, overall cost burden of pulmonary tuberculosis is high even though the treatment is free of cost.

Factors associated with patient delay in diagnosis of pulmonary tuberculosis in a district

BACKGROUND

Tuberculosis one of the major public health problems that is affecting large number of people each year including Nepal.

METHODS

A descriptive cross sectional study was conducted in Sunsari district of Nepal. The patients with pulmonary tuberculosis patients from 14 DOTS centers in the District were interviewed. Face to face interview by using structured questionnaire was used for data collection. Extra pulmonary tuberculosis and patients under Category II were excluded from the study.Data entry and analysis was carried out in SPSS version 16. Pearson Chi square test was used to test the association between outcome variable with different categorical independent variables.

RESULTS

Out of the total 215 patients, 91 (65.6%) were male, 109 (50.7%) were from rural residence, 69 (32.1%) were illiterate, 147 (68.4%) were married and 141 (66%) were sputum positive. The overall median patient delay was 42 days. About 145 (67.4%) of the patients had delayed their first consultation for more than 30 days. The patient delays were 56 out of 68 (82.4%) in age above 50 years patients, 121 out of 161 (75.2%) in married patients, 37 out of 45 (82.2%) in Kirats, 55 out of 69 (72.7%) in illiterates and 95 out of 124 (76.6%) in those who travel the distance of 2 or more km from the place of residence to health facility.

CONCLUSIONS

Since the time duration before the treatment and diagnosis in TB patients is long, this study emphasizes the need of awareness about symptoms of tuberculosis among general population.

Adverse drug reaction reporting in a pharmacovigilance centre of Nepal

BACKGROUND

Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored.

AIMS

To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal.

METHOD

A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability.

RESULTS

A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs.

CONCLUSION

Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.

Adverse drug reaction reporting in a pharmacovigilance centre of Nepal

BACKGROUND

Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored.

AIMS

To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal.

METHOD

A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability.

RESULTS

A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs.

CONCLUSION

Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.

The Burden of Injury in terms of Economic Loss and Disability Days: A Community Based Study from Eastern Nepal

Background Injuries are already a substantial public Health problem all over the world and are expected to increase in the 211st Century. They are major causes of deaths and disability in the population and also involve high societal costs. Objectives This study was designed to assess the economic loss due to the injury and the disability days due to different types of injuries. Methods A systematic random sampling technique was used to select 1388 households from 19 wards. A detailed questionnaire was used to collect information related to injuries to the persons suffered from injuries including treatment obtained, cost of treatment (direct/indirect cost) and length of disability. Results Among the minor injured persons, majority (93.2%) did not spend any indirect cost. 36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000 as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for major injury treatment. Maximum number (67.4%) of major injured persons had disability days of 31 to 90 days. Conclusion The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6283Kathmandu Univ Med J 2011;9(2):27-30

Health seeking behavior during pregnancy and child birth among Muslim women of Biratnagar, Nepal

Maternal mortality remains one of the biggest public health challenges in Nepal. This paper explores the health seeking behavior, during pregnancy and child birth in certain ethnic group. The poverty, illiteracy, women's low status in the society, lack of access and difficult geographical terrain are major reasons for poor maternal health status in Nepal. Cross-sectional study was conducted among 200 Muslim women of ward # 7 of Biratnagar municipality. They were interviewed to understand their health seeking behavior during pregnancy and childbirth, factors associated with use of health services and their role in the family. Information's on usages of health services, education level, family stricture, and occupational status, information were collected using a pretested and structured questionnaire. The overall institutional delivery in study population was found 24.5%. Low socio-economic status, Illiteracy and poverty in women are the major challenging features of pregnancy and child birth.