Long-Term Consumption of 6 Different Beverages and Cardiovascular Disease-Related Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

The relationship between beverage consumption and risk of cardiovascular disease has been extensively examined in cross-sectional studies. However, limited studies have investigated beverage consumption as a longer-term habitual behavior, which is important owing to potential cumulative harmful or beneficial cardiovascular effects. We examined the association between the long-term consumption of 6 types of beverages (sugar-sweetened or artificially sweetened beverages, tea, coffee, fruit juice, energy drinks, and alcohol) and cardiovascular mortality, by considering sex differences. We conducted a systematic search of MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus databases from 2010 to December 2023. Of 8049 studies identified, 20 studies were included for meta-analysis. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the use of a random-effects model. We found that long-term coffee consumption was related to reduced cardiovascular disease-related mortality in males (pooled HR: 0.63; 95% CI: 0.46, 0.87; P = 0.005) but not in females (HR: 0.78; 95% CI: 0.60, 1.02; P = 0.07). Long-term higher intake of tea was associated with lower risk of cardiovascular disease-related mortality in all adults (pooled HR: 0.81; 95% CI: 0.72, 0.92; P ≤ 0.001). Higher alcohol intake was linked to higher stroke in both males (pooled HR: 1.44; 95% CI: 1.06, 1.94; P = 0.02) and females (pooled HR: 2.26; 95% CI: 1.34, 3.81; P = 0.002). Higher sugar-sweetened beverage intake was in relation to higher cardiovascular disease-related mortality (pooled HR: 1.31; 95% CI: 1.16, 1.46; P ≤ 0.0001). We concluded that long-term habitual coffee consumption is beneficial for males, and tea consumption is beneficial for all adults. Long-term high alcohol and sugar-sweetened beverage consumption increased risk of cardiovascular disease-related mortality for both males and females. However, we were unable to draw conclusions on the potential benefit or harm of the long-term consumption of fruit juice and energy drinks on cardiovascular disease-related mortality owing to the limited number of studies available. This review was registered at PROSPERO as CRD42020214679.

A systematic review of the evidence for effectiveness of interventions to address transport and other unintentional injuries among adolescents

INTRODUCTION

Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions.

METHODS

A systematic review of peer-reviewed original research published between 2010-2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10-24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status).

RESULTS

Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls).

DISCUSSION

Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified.

CONCLUSION

This review provides evidence to support investment in effective adolescent injury prevention interventions. Further evidence of effectiveness is needed, especially for low- and middle-income countries, populations at increased risk of injury who would benefit from greater consideration of equity and for high lethality injury mechanisms like drowning.

Acceptability of a mHealth strategy for hypertension management in a low-income and middle-income country setting: a formative qualitative study among patients and healthcare providers

BACKGROUND

Understanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.

OBJECTIVES

This formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.

DESIGN

A qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.

SETTING

The study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.

PARTICIPANTS

A total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30-70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.

RESULTS

The respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient's essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient's details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2-3 times/week) preferably in the morning or evening.

CONCLUSIONS

We found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.

Comparison of Radial and Femoral Percutaneous Coronary Intervention

BACKGROUND

The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention.

METHODS

This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding.

RESULTS

Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290).

CONCLUSIONS

Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal.

Theory-based mobile phone text messaging intervention for blood pressure control (TEXT4BP) among hypertensive patients in Nepal: study protocol for a feasibility randomised controlled trial

INTRODUCTION

Uncontrolled blood pressure is one of the main risk factors for cardiovascular disease and death in Low-income and middle-income countries. Improvements to medication adherence and lifestyle changes can be assisted by using mobile phone text messaging interventions. This study aims to test the feasibility and acceptability of a text messaging intervention for blood pressure control '(TEXT4BP)', developed based on behavioural change theory to improve treatment adherence and lifestyle change among hypertensive patients in Nepal.

METHODS AND ANALYSIS

The TEXT4BP intervention will be tested using a two-arm parallel-group, unblinded, individually randomised controlled trial. This feasibility study would recruit 200 clinically diagnosed hypertensive patients aged 18-69 years, currently receiving blood pressure-lowering medication for more than 3 months, visiting a tertiary healthcare facility in Kathmandu, Nepal. A nested qualitative study will assess the acceptability of the short message service intervention. The intervention group will receive text messages containing information on hypertension, diet, medication and physical activity three times a week for 3 months. The control group will receive standard care. At baseline and 3 months, measures of medication adherence, salt intake, physical activity and blood pressure will be collected. Feasibility measures, such as differential rates of recruitment and attrition rates, will be calculated. Acceptability of text message interventions will be studied using usability measures and in-depth interviews among intervention group participants. This pilot study is not funded.

ETHICS AND DISSEMINATION

This study has received ethics approval from the University of New South Wales Human Research Ethics Committee B (HC190357), Nepal Health Research Council (302/2019) and Institutional Review Committee of Kathmandu Medical College and Teaching Hospital Kathmandu, Nepal (030520192). The findings of the study will be disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12619001213134.

Improving Safety Among Pregnant Women Reporting Domestic Violence in Nepal-A Pilot Study

Introduction: Domestic violence (DV) during pregnancy is associated with poor health outcomes for both the mother and newborn, and sometimes death. In a low-income country like Nepal, women have few options to leave abusive situations. Therefore, there is a need for interventions to improve their safety. The aim of our study was to explore the use of safety measures before and after an educational intervention among women who have reported DV during pregnancy. Materials and methods: Of 1010 pregnant women screened consecutively for DV using the Abuse Assessment Screen (AAS) during routine antenatal care, 181 women reported domestic violence. All 1010 participating pregnant women were taught 15 safety measures using a locally developed flipchart. We obtained contact with 80 of the 181 eligible women postpartum, of whom 62 completed the follow-up assessment. We explored and described the use of safety measures at baseline and follow-up, using a standardized instrument called the Safety Behavior Checklist. Results: At follow-up, less than half of the women (n = 30, or 48.3%) reported any form of DV. Of the women who reported DV at follow-up, significantly more reported the experience of both violence and fear at baseline (21.9%, p = 0.01) compared with the women who did not report DV at follow-up (3.3%, p = 0.01). Women reporting DV at baseline and follow-up used more safety measures at baseline (56) and follow-up (80) compared with women reporting DV at baseline only (36 and 46). Women reporting DV at baseline and follow-up used more safety measures for the first time at follow-up, 57 new measures compared with the 28 new measures used by women reporting DV at baseline only. Conclusions: The use of a flipchart teaching session on safety measures within antenatal care may increase the number of safety measures women use to protect themselves during pregnancy and decrease the risks of adverse health effects of DV.

First Measurement of the Total Neutron Cross Section on Argon between 100 and 800 MeV

We report the first measurement of the neutron cross section on argon in the energy range of 100-800 MeV. The measurement was obtained with a 4.3-h exposure of the Mini-CAPTAIN detector to the WNR/LANSCE beam at LANL. The total cross section is measured from the attenuation coefficient of the neutron flux as it traverses the liquid argon volume. A set of 2631 candidate interactions is divided in bins of the neutron kinetic energy calculated from time-of-flight measurements. These interactions are reconstructed with custom-made algorithms specifically designed for the data in a time projection chamber the size of the Mini-CAPTAIN detector. The energy averaged cross section is 0.91±0.10(stat)±0.09(syst)  b. A comparison of the measured cross section is made to the GEANT4 and FLUKA event generator packages, where the energy averaged cross sections in this range are 0.60 and 0.68 b, respectively.

Prevalence of White Coat Hypertension among the Patients Visiting in a Tertiary Care Center, Kathmandu, Nepal

Background Hypertension is a major cardiovascular risk factor. White coat hypertension refers to elevated office blood pressure but normal out of office blood pressure. White-coat hypertension has a risk of cardiovascular events more than normotensives. Objective To identify the prevalence of white coat hypertension among patients presented in the cardiology department. Method The descriptive cross-sectional study was conducted among 165 patients who visited the cardiology outpatient department of Kathmandu Medical College and Teaching Hospital from December 2017 to November 2018. Blood pressure was measured at the hospital, and ambulatory blood pressure device was used to monitor 24hrs pattern. Hypertension is classified as per recent guideline. Data were entered and analysed using Statistical Package for social sciences version 20. Result Out of 165 ambulatory blood pressure monitoring conducted patients, 140 participants were enrolled in the study based on inclusion criteria. Among them 55% (77) were male, and 45% (63) were female. Age ranged from 18-78 years with a mean of 43.82 ± 12.31 years. Overall among 140 participants 14.28% had white coat hypertension, however, after excluding twenty-two high normal group, among 118 participants who were hypertensive according to office BP, 16.9% (20) had white coat hypertension, and 33.57% of patients did not have nocturnal dipping of blood pressure. Conclusion The white coat hypertension is prevalent among around one-sixth of hypertensive patients visiting tertiary care centre, and one third have non-dipping which needs to be considered in the management of hypertension.

Self-Perception of Halitosis among Undergraduate Students of Kathmandu University School of Medical Sciences - A Questionnaire Based Study

Background Halitosis is a frequently reported oral health problem worldwide with a prevalence rate of 10-30% in the general population. It is defined as the disagreeable or foul smelling breath originating consistently from a person's oral cavity. It not only effects the normal daily life activities of the patient but also bring humiliation, reduced self- esteem, ultimately resulting into decreased quality of life. Objective To determine the self-perception of halitosis among undergraduate students of different medical branches of Kathmandu University School of Medical Sciences (KUSMS); Kavre, Nepal. Method A descriptive cross-sectional epidemiological survey was conducted among undergraduate students of Physiotherapy, B.Sc Nursing, Bachelor of Nursing Sciences (BNS), MBBS and BDS program of Kathmandu University School of Medical Sciences, Dhulikhel. A self-administered questionnaire was developed and were distributed among 500 undergraduate students. Result Out of total 500 distributed questionnaires, 406 were completely filled and returned giving an overall response of 81.2%, in which 70 (89.7%) male and 280 (85.4%) female students from different medical branches were aware of the term halitosis. Among them 29 (7.14%) of students think that they suffer from halitosis. Similarly 178 (43.84%) students had severe impact of halitosis on their social life while 153 (37.68%) and 62 (15.27%) students had moderate and mild impact respectively. Conclusion Due to the multifactorial complexity of halitosis, further longitudinal studies including objective assessment of malodor are required to determine its prevalence and to further investigate the association of this problem with other etiological factors in the context of Nepal. Also, curriculum of different fields should be modified to include this simple but very necessary topic.

Utilization of Maternal and Child Health Care Services and Nutritional Status of Under Five Children in Bungmati Village Development Committee, Lalitpur, Nepal

IntroductionMaternal and child health care services is essential component to promote family health. Despite of being provided free of cost, adequate utilization on of services is still the issue affecting health of both mother and child in Nepal.Objective The objective of this study was to assess the utilization of Maternal and child health care services and nutritional status of under five children in Bungmati Village Development Committee Lalitpur, NepalMethodologyDescriptive cross sectional study was conducted in Bungmati VDC of Lalitpur district, Nepal among one hundred and fifty households having either under five children, postnatal mothers or pregnant women which was selected purposively based on the objectives of the study. Data was collected by using interview guidelines and anthropometric measurement of children under five was taken. Collected data were analyzed in SPSS.ResultsRegarding utilization  of maternal health care services, 90.9% had done their four-time antenatal checkup, 94.2% had delivered their baby at hospital and 65% married women of reproductive age were using one of the family planning methods. Likewise, immunization of under five children showed 100% BCG coverage, 88% pentavalent DPT and Polio, 77% Measles and low coverage of inject able Polio vaccine. About Nutritional status of under five children, more than half (57%) of the child were underweight, 41% were stunted and 20% of them were wasted.ConclusionUtilization of maternal health care services is good though Coverage of family planning needs to be improved and Immunization program should be strengthened. Awareness program for improvement of nutritional status of the under five children should be planned to address nutritional problem of children.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, page: 93-97

Income Inequality and Use of Dental Services in 66 Countries

This study explored the association between income inequality and use of dental services and the role that investment in health care plays in explaining that association. We pooled individual-level data from 223,299 adults, 18 years or older, in 66 countries, who participated in the World Health Organization (WHO) World Health Surveys with country-level data from different international sources. Income inequality was measured at the national level using the Gini coefficient, and use of dental services was defined as having received treatment to address problems with mouth and/or teeth in the past year. The association between the Gini coefficient and use of dental services was examined in multilevel models controlling for a standard set of individual- and country-level confounders. The individual and joint contributions of 4 indicators of investment in health care were evaluated in sequential modeling. The Gini coefficient and use of dental services were inversely associated after adjustment for confounders. Every 10% increase in the Gini coefficient corresponded with a 15% lower odds of using dental services (odds ratio: 0.85; 95% confidence interval: 0.70-0.99). The association between the Gini coefficient and use of dental services was attenuated and became nonsignificant after individual adjustment for total health expenditure, public expenditure on health, health system responsiveness, or type of dental health system. The 4 indicators together explained 80% of the association between the Gini coefficient and use of dental services. This study suggests that more equal countries have greater use of dental services. It also supports the mediating role of investment in health care in explaining that association.

Epidemiological and Outcome Analysis of Orthopedic Implants Removal in Kathmandu University Hospital

Background Orthopedic Implant removal is one of the commonly performed elective orthopedic surgeries. Implants are generally removed after the purpose of keeping implant is solved by healing of the fracture, but there is no consensus whether routine implant removal should be a policy for all fractures that were fixed. Objective This study aims to analyze the epidemiology and outcome of implant removal surgery carried out in the past three years in Kathmandu University Hospital. Methods Patients who underwent implant removal between 2010 January to 2012 December constituted the study cohort. Demographic data, indications, types of hardware and location of fractures were recorded. Similarly, duration of surgery, type of anesthesia and duration of hospital stay were recorded. All the patients who had undergone implant removal in this three years period were called for follow up examination but those who were not able to come were interviewed on telephone. Results There were 275 implant removals constituting 7.8% of total orthopedic operations and 26.3% of fracture fixations. Male to Female ratio was 189: 86. Pediatric age group (34.5%) had the highest incidence of implant removal. Moderate sized implants were the commonest hardwares removed (63.2%). Femur (27.3%) followed by radius (26.9%) were the commonest bone for implant removal. Average operative time was 47.3 minutes with average hospital inpatient stay of 2.6 days. Commonest indication for the implant removal procedure was pain (45%). Conclusion Implant removal procedures are one of the most commonly performed elective orthopedic surgeries. Though, after orthopedic implants removal, pain relief can be expected but it is not so predictive and hence patient should be well counseled before and the indications for implant removal has to be evaluated for better patient satisfaction and safety. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12489 Kathmandu University Medical Journal Vol.11(2) 2013: 139-143

Global burden of untreated caries: a systematic review and metaregression

We aimed to consolidate all epidemiologic data about untreated caries and subsequently generate internally consistent prevalence and incidence estimates for all countries, 20 age groups, and both sexes for 1990 and 2010. The systematic search of the literature yielded 18,311 unique citations. After screening titles and abstracts, we excluded 10,461 citations as clearly irrelevant to this systematic review, leaving 1,682 for full-text review. Furthermore, 1,373 publications were excluded following the validity assessment. Overall, 192 studies of 1,502,260 children aged 1 to 14 y in 74 countries and 186 studies of 3,265,546 individuals aged 5 y or older in 67 countries were included in separate metaregressions for untreated caries in deciduous and permanent teeth, respectively, using modeling resources from the Global Burden of Disease 2010 study. In 2010, untreated caries in permanent teeth was the most prevalent condition worldwide, affecting 2.4 billion people, and untreated caries in deciduous teeth was the 10th-most prevalent condition, affecting 621 million children worldwide. The global age-standardized prevalence and incidence of untreated caries remained static between 1990 and 2010. There is evidence that the burden of untreated caries is shifting from children to adults, with 3 peaks in prevalence at ages 6, 25, and 70 y. Also, there were considerable variations in prevalence and incidence between regions and countries. Policy makers need to be aware of a predictable increasing burden of untreated caries due to population growth and longevity and a significant decrease in the prevalence of total tooth loss throughout the world from 1990 to 2010.

Adherence to Antihypertensive Medications: Population Based Follow up in Eastern Nepal

BACKGROUND

Poor adherence toward antihypertensive drugs is a worldwide problem that results in poor health outcomes and increased health care costs. Community based study related to adherence to antihypertensive medication is limited in context of Nepal.

METHODS

This study was conducted to explore the extent of adherence towards prescribed antihypertensive treatment and to identify the factors of non adherence. Community based cross sectional study was conducted in Dharan Municipality of Eastern Region of Nepal from September 2009 to February 2010. Out of 975 hypertensive patients, 154 calculated samples were selected following simple random sampling method. Data was collected by interview method and adherence was measured by using four items Morisky Medicine adherence scale. Data was analyzed using SPSS by descriptive and inferential (Chi square and logistic regression analysis) Statistical method.

RESULTS

Among the 154 hypertensive patients, only 56.5% patients were adherent to antihypertensive medication. The important predictors of non adherence by logistic regression analysis at 95% Confidence Interval were illiteracy (OR 5.34, CI= 1.23 -23 , P=0.025), expensive price of medicine (OR 5.14, CI=1.1-23.9, P=0.037), missed medicine due to cost (OR 0.143,CI=0.02-0.78, P= 0.025), no family history of hypertension (OR 4.46,CI= 1.21-16.4, P=0.024), irregular follow up (OR 6.39,CI=1.22-33.3, P=0.028), more than one pills per day ( OR 5.33,CI=1.19-23.7, P= 0.028).

CONCLUSIONS

Around half of the population was non adherent towards antihypertensive medications so identified gap need to be addressed to increase adherence level.

Performance and economic analyses of year-round forage systems for forage-fed beef production in the Gulf Coast

On a global scale, most beef is produced from grazing pastures or rangelands. Certain limitations exist, however, such as not having adequate animal rates of gain for marbling and availability of adequate forage nutritional value and quantity for constant animal weight gains. In the last 20 yr, there has been an increased interest in forage-fed beef for multiple reasons (health related, environmental concerns, and welfare issues). Starting on June 5, 13, 14, and 8 in 4 consecutive yr, 54 steers (initial BW=259±5.6 kg; average of 9 mo of age) were randomly allotted to 3 yr-round forage systems. Each system occupied 6 ha/replicate and had the same stocking rate. System 1 had annual ryegrass (Lolium multiflorum) for winter grazing and bermudagrass (Cynodon dactylon) for summer grazing; while Systems 2 and 3 added rye and a clover mix to the ryegrass and diversified the use of pastures in the fall (dallisgrass [Paspalum dilatatum] and clovers [Trifolium spp.]). System 3 added the use of annual summer forages. During their respective growing season for each forage or forage mix, mass and height did not limit animal performance; however, there was a sampling date effect (P<0.05) for nutritive value variables since it decreased as forages became mature. The ADG observed (0.44 kg) for all systems (P=0.78) during summer was lower than expected and might have been limited by the observed temperature as well as forage nutritive value. Systems 1 and 2 had more grazing days (P=0.03) during summer (155 and 146 d, respectively) compared to System 3 (132 d) due to the greater pasture area of bermudagrass in those systems. Steers in System 3 were fed more hay for a longer period of time (P<0.05) than on the other 2 systems. System 1 and 2 produced more hay per hectare than System 3 (P<0.05). No differences (P>0.05) were detected between systems in ADG year round, during the winter season, or carcass characteristics. Return over total direct costs and total specified expenses were greater for Systems 1 and 2, while System 3 was the lowest. Hay making and bale sales played a major role in explaining the economic results of this study. Where possible, year-round forage systems are a viable alternative for forage-fed beef production; however, the low gains during summer and forage availability during the transition period when hay is necessary deserve further research to find alternatives to improve productivity during those times of the year.

Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression

We aimed to consolidate all epidemiologic data about severe periodontitis (SP) and, subsequently, to generate internally consistent prevalence and incidence estimates for all countries, 20 age groups, and both sexes for 1990 and 2010. The systematic search of the literature yielded 6,394 unique citations. After screening titles and abstracts, we excluded 5,881 citations as clearly not relevant to this systematic review, leaving 513 for full-text review. A further 441 publications were excluded following the validity assessment. A total of 72 studies, including 291,170 individuals aged 15 yr or older in 37 countries, were included in the metaregression based on modeling resources of the Global Burden of Disease 2010 Study. SP was the sixth-most prevalent condition in the world. Between 1990 and 2010, the global age-standardized prevalence of SP was static at 11.2% (95% uncertainty interval: 10.4%-11.9% in 1990 and 10.5%-12.0% in 2010). The age-standardized incidence of SP in 2010 was 701 cases per 100,000 person-years (95% uncertainty interval: 599-823), a nonsignificant increase from the 1990 incidence of SP. Prevalence increased gradually with age, showing a steep increase between the third and fourth decades of life that was driven by a peak in incidence at around 38 yr of age. There were considerable variations in prevalence and incidence between regions and countries. Policy makers need to be aware of a predictable increasing burden of SP due to the growing world population associated with an increasing life expectancy and a significant decrease in the prevalence of total tooth loss throughout the world from 1990 to 2010.

Global Burden of Severe Tooth Loss: A Systematic Review and Meta-analysis

The goal of the Global Burden of Disease 2010 Study has been to systematically produce comparable estimates of the burden of 291 diseases and injuries and their associated 1,160 sequelae from 1990 to 2010. We aimed to report here internally consistent prevalence and incidence estimates of severe tooth loss for all countries, 20 age groups, and both sexes for 1990 and 2010. The systematic search of the literature yielded 5,618 unique citations. After titles and abstracts were screened, 5,285 citations were excluded as clearly not relevant to this systematic review, leaving 333 for full-text review; 265 publications were further excluded following the validity assessment. A total of 68 studies-including 285,746 individuals aged 12 yr or older in 26 countries-were included in the meta-analysis using modeling resources of the Global Burden of Disease 2010 Study. Between 1990 and 2010, the global age-standardized prevalence of edentate people decreased from 4.4% (95% uncertainty interval: 4.1%, 4.8%) to 2.4% (95% UI: 2.2%, 2.7%), and incidence rate decreased from 374 cases per 100,000 person-years (95% UI: 347, 406) to 205 cases (95% UI: 187, 226). No differences were found by sex in 2010. Prevalence increased gradually with age, showing a steep increase around the seventh decade of life that was associated with a peak in incidence at 65 years. Geographic differences in prevalence, incidence, and rate of improvement from 1990 to 2010 were stark. Our review of available quality literature on the epidemiology of tooth loss shows a significant decline in the prevalence and incidence of severe tooth loss between 1990 and 2010 at the global, regional, and country levels.

Analysis of the Community Diagnosis Program Conducted by Department of Community Medicine of Nobel Medical College Biratnagar

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 6-10 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8798

Effect of Health Education Programme on the Knowledge regarding Hand Washing and Immunization in the Disadvantaged Community of Eastern Nepal

Journal of Nobel Medical College Vol. 2, No.2 Issue 4 May-October 2013 Page 18-23 DOI: http://dx.doi.org/10.3126/jonmc.v2i2.8800

Awareness of disease and self care among hypertensive patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Background: Hypertension (HTN) is a major risk factor for cardiovascular and renal diseases. The prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The levels of awareness, treatment, and control of HTN vary between different countries and population groups. Objectives: The objective of this study was to find out the awareness of hypertensive patients about their own disease and self care. Methodology: Descriptive cross sectional study was conducted among 50 hypertensive patients who were admitted to Tribhuvan University Teaching Hospital (TUTH) and attended to medical OPD. Data was collected by using interview schedule by face to face interview method. Results: Among 50 hypertensive patients, 56% were aware about meaning of hypertension, 68% symptoms, 34% cause, 62% prognosis, and 62% complication of HTN. Likewise regarding self care, 70% were doing regular follow up, 92% using regular medication, most of them (80%) were not smoker and 84% were non alcoholic, and 74% taking low fat and low salt diet. Conclusion: Study finding reflects many of them (56%) had more than 50% of knowledge about the hypertension and more than half (54%) were giving more than 50% emphasis about their own self care.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7296 Journal of Nobel Medical College (2012), Vol.1 No.2 p.29-35

Microalbuminaria in hypertension: a review

Microalbuminuria appears early in the natural history of kidney disease. Hypertension accelerates the progressive increase in albuminuria and decline in glomerular filtration rate, albuminuria is the most important risk for progressive kidney injury. Greater urinary albumin excretion is due to increased glomerular hydrostatic pressure and increased permselectivity of the glomerular basement membrane. Reduction in albuminuria is protective for the development of complication, Angiotensin converting enzyme inhibitor leads to larger decrease in albuminuria when compared to other antihypertensive drugs.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7292 Journal of Nobel Medical College (2012), Vol.1 No.2 p.1-10

A study on personal hygiene and sanitary practices in a rural village of Mornag District of Nepal

Background: Inadequate sanitation has direct effect on health of individual, family, communities and nation as a whole. Objective: To assess the personal hygiene and sanitary condition of the Katahari Village Development Committee (VDC). Methods: The cross sectional study was done in Katahari VDC of Morang district. A total of 80 households were randomly selected from two wards of VDC. The data were collected by interview method using interview schedule. Data were entered in Excel sheet and analyzed on SPSS program. Results: Many respondents (61%) were unable to read and write, 33% involved in private job in various factory. Knowledge of sanitation was high (90%) but only 65% of them were using soap water for hand washing. Sixty percent had no toilet facilities. There was significant association between education and toilet facilities among community people. Land holding and type of family had no significant association with toilet facilities. Conclusion: The knowledge regarding sanitation was high among community people but very poor in practice.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7298 Journal of Nobel Medical College (2012), Vol.1 No.2 p.39-44

Utilization of maternal health care services in Belbari VDC of Eastern Region of Nepal

Background: Appropriate utilization of maternal health care services is very important to reduce the maternal morbidity and mortality rate in the country and healthful practices while caring mother is needed to improve the health condition of both mother and child. Objectives: Main objectives of this study is to assess the utilization of Maternal health care services and know the cultural practices about care of mother and children of under one year of children. Methodology: Descriptive cross sectional study was conducted among 248 mothers of less than one year children on Belbari VDC of Morang district. Data was collected by using quantitative (house hold survey) and qualitative (focus group discussions and key informant interview) methods. Results: Among 248 mothers, 84% utilized the antenatal care services, 91% received TT vaccine during pregnancy. Most of them 80% had done delivery in health institutions. Conclusion: Based on proposed objectives of study, Utilization of maternal health care services should be encouraged in Belbari VDC of Morang District and healthful practices should be reinforced in areas where corrections are needed.DOI: http://dx.doi.org/10.3126/jonmc.v1i1.7288 Journal of Nobel Medical College Vol.1(1) 2011 53-58

Differential concentration and time dependent effects of progesterone on kinase activity, hyperactivation and acrosome reaction in human spermatozoa

Progesterone has been identified to be one of the physiological regulators of sperm hyperactivation and acrosome reaction. However, the high sensitivity of human spermatozoa to progesterone implies that many may undergo premature hyperactivation and acrosome reaction thereby compromising their ability to fertilize. We hypothesized that if a spermatozoon has to preclude the occurrence of these events prematurely, there should be differential dose- and time-dependent effects on motility and acrosome reaction. We observed that low concentrations of progesterone (10 and 100 nm) induce sperm motility and activate tyrosine kinase; higher concentrations (1-10 μm) are required to induce extracellular signal regulated kinases 1/2 (Erk1/2), p90 ribosomal S6 kinase (p90RSK), p38 mitogen-activated protein kinase (p38MAPK), c-Jun N-terminal kinase (JNK1) and AKT phosphorylation, hyperactivation and acrosome reaction. The induction of acrosome reaction and tyrosine phosphorylation in response to higher concentration of progesterone is not absolutely dependent on activation of T-type voltage-gated Ca(2+) channel or CatSper as Mibefradil did not completely abrogate progesterone-mediated effects. These results imply that although the spermatozoa are sensitive to low concentrations of progesterone, they only activate motility and tyrosine kinase activation; higher concentrations are required to induce hyperactivation and acrosome reaction probably by activating multiple kinase pathways including the MAPK and AKT.

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.

Leptospirosis and Weil's disease in eastern India

Leptospirosis is characterised by a broad spectrum of clinical manifestations varying from inapparent infection to fulminant fatal disease. Severe leptospirosis characterised by profound jaundice is referred to as Weil's disease. In the present study 20 patients of leptospirosis, of which 7 belonged to Weil's disease, were diagnosed based on the demonstration of IgM antileptospira antibody and supported by clinical correlation and appropriate biochemical markers. Overall, the male and female ratio was 17:3 and the same ratio for the Weil's disease was 6:1. The most common presentation involved fever, malaise and myalgia. Conjunctival congestion was found in 75% of the cases and jaundice was encountered in 90% of the cases. The prognosis of all these patients, including that of Weil's disease was excellent. Early recognition and initiation of antibiotic therapy were found to be important.

Angiotensin II activates Akt/protein kinase B by an arachidonic acid/redox-dependent pathway and independent of phosphoinositide 3-kinase

Angiotensin II (Ang II) exerts contractile and trophic effects in glomerular mesangial cells (MCs). One potential downstream target of Ang II is the protein kinase Akt/protein kinase B (PKB). We investigated the effect of Ang II on Akt/PKB activity in MCs. Ang II causes rapid activation of Akt/PKB (5-10 min) but delayed activation of phosphoinositide 3-kinase (PI3-K) (30 min). Activation of Akt/PKB by Ang II was not abrogated by the PI3-K inhibitors or by the introduction of a dominant negative PI3-K, indicating that in MCs, PI3-K is not an upstream mediator of Akt/PKB activation by Ang II. Incubation of MCs with phospholipase A2 inhibitors also blocked Akt/PKB activation by Ang II. AA mimicked the effect of Ang II. Inhibitors of cyclooxygenase-, lipoxyogenase-, and cytochrome P450-dependent metabolism did not influence AA-induced Akt/PKB activation. However, the antioxidants N-acetylcysteine and diphenylene iodonium inhibited both AA- and Ang II-induced Akt/PKB activation. Dominant negative mutant of Akt/PKB or antioxidants, but not the dominant negative form of PI3-K, inhibited Ang II-induced protein synthesis and cell hypertrophy. These data provide the first evidence that Ang II induces protein synthesis and hypertrophy in MCs through AA/redox-dependent pathway and Akt/PKB activation independent of PI3-K.

Kawasaki disease--Indian perspective

Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is a leading cause of acquired heart disease in many developed countries. Incidence of this disease in India is extremely low as evidenced by the meagre case reports. Complications due to this disease in Indian patients are still rarer. Here we report two cases of Kawasaki disease both of whom had a benign course. A comparison of this disease in Indian and Western literature shows that the incidence of cardiac complications in the Indian patients is about 10% while in the west it is reported at around 30%. This paucity of complications in the Indian patients may be the reason of poor reporting of this disease in our country.

Identification of promoter activity and differential expression of transcripts encoding the murine stromelysin-1 gene in renal cells

Stromelysin-1, matrix metalloproteinase-3 (MMP-3), is an important endopeptidase selectively expressed by somatic cells in organ tissues. The renal tubulointerstitium, for example, comprises tubular epithelium and interstitial fibroblasts forming the principal mass of the kidney. We observed that mRNA encoding stromelysin-1 is detectable in murine renal fibroblasts, but not in proximal tubular epithelium. Transcripts measured by RNase protection assay in renal fibroblasts increase following exposure to phorbol ester, and thereafter, activated stromelysin-1 protein can be detected in culture media by Western blotting. A 6.4 Kb genomic clone containing the putative stromelysin-1 promoter was isolated and a relevant 2.1 Kb PstI restriction fragment including 2.1 Kb of the immediate 5'-flanking region was sequenced on both strands. Two transcriptional start sites were identified by primer extension; the major start site corresponded to a previously established position in the rat promoter, and a second undescribed minor transcriptional start site was located 16 bp upstream of the primary site. A HiNF-A chromatin-activating element at -106 bp was found in the early promoter region of pR336 and an active AP-1 site at -72 bp with an Ets/PEA-3 motif at -203 bp was suggested by transient transfection of luciferase minigenes into renal fibroblasts responsive to phorbol ester. This Ets element was identical to a site in the early promoter of the fibroblast-specific gene FSP1. A baseline enhancement in activity of pR336 in fibroblasts was further observed with the addition of 5' flanking sequence out to -1980 bp. This additional region of flanking sequence contains two modular regions: one of multiple PEA-3 elements between -684 bp and -1955 bp and a second region between -1929 bp and -1980 bps containing a second AP-1 site at -1929 bp, a MBF-1/ MEP-1 metal binding site, and a PPAR peroxisome proliferator element at -1950 bp. Our findings implicate a gene structure with expected activity in a mesenchymal phenotype. The PKC-dependent regulation of the stromelysin-1 gene supports the notion that it may be modulated during inflammation or tissue remodeling.

Cyclic AMP regulates basement membrane heparan sulfate proteoglycan, perlecan, metabolism in rat glomerular epithelial cells

Perlecan, the basement membrane heparan sulfate proteoglycan (HSPG), has been fully cloned from mouse and human tissues. When a cRNA probe of murine perlecan cDNA was employed in RNase protection assay to test whether rat glomerular epithelial cells (GEC) constitutively express perlecan, several bands of hybridization were seen, suggesting that sequences between rat and murine perlecan may not be identical. Using primers based on published cDNA sequences of murine and human perlecan and poly A+ RNA of rat GEC, we synthesized a 497 bp product (RPD-I) by RT-PCR. The deduced aminoacid sequence showed an 85% and 88% homology with domain I of murine and human perlecan, respectively. The three putative sites containing the consensus sequence SGD for attachment of heparan sulfate chains were fully conserved in the rat perlecan as was a site (NFT) for attachment of N-linked oligosaccharide. RPD-I detected a > 9.5 kb transcript of perlecan in RNA of GEC, similar in size to that present in rat glomeruli. Employing a riboprobe synthesized from RPD-I in RNase protection assay we examined whether dbcAMP regulated perlecan expression in the GEC. At 1, 6, 24 and 48 h of incubation, 1 mM dbcAMP caused 43%, 32%, 47% and 40% reduction in mRNA abundance of perlecan, respectively. Immunoprecipitation showed a corresponding reduction of 61%, 70% and 65% in the synthesis of 35SO4 labeled basement membrane HSPG by the GEC following 12, 24 and 48 h of incubation with dbcAMP. Following incubation for 1 and 24 h prostaglandins, PGE1 and PGE2 (1 uM), known activators of glomerular adenylate cyclase, reduced perlecan mRNA abundance to a similar extent as dbcAMP on northern analysis. Our results show that glomerular basement membrane HSPG synthesized by the GEC belongs to the perlecan family. Decrease of GEC perlecan gene expression and synthesis by cAMP and prostaglandins may be of relevance to proteinuric states characterized by activation of these mediators.

A nuclear protein in mesangial cells that binds to the promoter region of the platelet-derived growth factor-A chain gene. Induction by phorbol ester

Mesangial cells predominantly express platelet-derived growth factor (PDGF)-A chain mRNA and release PDGF. Mesangial cell PDGF-A chain mRNA abundance is regulated by several agents including phorbol esters. We have recently demonstrated that induction of PDGF-A chain mRNA abundance in response to phorbol 12-myristate 13-acetate is primarily due to gene transcription. We have now analyzed the 5'-flanking region of the PDGF-A chain promoter to identify DNA binding protein(s) which have the potential to regulate PDGF-A chain gene transcription in human mesangial cells. DNase I footprint analysis of the 5'-flanking region of the PDGF-A chain promoter identifies a DNase I protected region at the location -82 to -102 corresponding to the sequence 5'-GGCCCGGAATCCGGGGGAGGC-3'. Therefore, nuclear extracts from human mesangial cells contain a protein, PDGF-A-BP-1, that binds to a DNA sequence (-82 to -102) in the promoter region of the PDGF-A chain gene. Gel mobility shift analysis using labeled oligomer corresponding to the binding site for PDGF-A-BP-1 indicates that PDGF-A-BP-1 is induced by phorbol ester in mesangial cells as well as fat-storing cells (> 20 fold). Egr-1 protein does not bind to labeled PDGF-A-BP-1 oligomer and does not compete with the binding of PDGF-A-BP-1. In addition, SP-1 binding sequence does not compete with the binding sequence of the mesangial cell protein. PDGF-A-BP-1 appears to represent a novel protein which is induced by phorbol ester and thus has the potential for an important role in the transcriptional regulation of the PDGF-A chain gene in mesangial cells and other vascular pericytes.

Platelet-derived growth factor B-chain gene expression in mesangial cells: effect of phorbol ester on gene transcription and mRNA stability

We have investigated the effect of phorbol 12-myristate 13-acetate (PMA) on platelet-derived growth factor (PDGF) B-chain gene transcription as well as on mRNA stability in cultured human mesangial cells. Addition of actinomycin to cells stimulated with PMA decreases steady state levels of PDGF-B chain mRNA analysed by solution hybridization assay. PDGF-B chain gene transcription was also assayed directly by measuring elongation of transcripts in isolated nuclei followed by hybridization of labeled RNA transcripts to a cDNA encoding for PDGF-B chain. Our data show that PMA induces PDGF-B chain gene transcription by approximately 2-fold. alpha-Amanitin, an RNA polymerase II inhibitor, blocked transcription by more than 70%. In addition, we determined the effect of PMA on the halflife of PDGF-B chain mRNA directly by pulse chase method. In human mesangial cells, the PDGF-B chain mRNA exhibited halflife of approximately 105 min. In the presence of PMA, the halflife of PDGF-B chain mRNA was reduced to approximately 72 min. These studies indicate that regulation of PDGF-B chain gene by PMA in human mesangial cells involves a coordinate effort at the level of transcription and mRNA stability.